You're Better? Are Ya SURE?
(November 24, 2020)
Umm, hi! I missed you. I've been off being a poll official during early voting and Election Day, and then recuperating from the semi-terminal exhaustion that brought on by binge-watching "American Horror Story". So, greetings! I'm glad to be back in what we jocularly call the "normal world".
So there is this thing that everyone has heard of and, consequently, think that they know what it is. Often, however, they are quite wrong. I am speaking here of the "placebo effect".
A placebo can be strictly defined as "a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder". (The pharmaceutical companies actually manufacture pills with inert ingredients for doctors to prescribe for this purpose. Here's a link to one:
That link will show you "Cebocap Blue". There's also Cebocap Green and Cebocap Orange -- I guess if your patient insists that s/he isn't better with the blue pill, the doctor can try a different color ("let's try a stronger dose") in the hopes that that one will be more persuasive. Oh, what a tangled web we weave... .)
If a doctor doesn't have the brass b*lls that it takes to prescribe a patient something completely fake, they will often prescribe vitamins or a mild painkiller or tranquilizer instead. But it doesn't matter. Because basically a placebo is a treatment that doesn't work (and isn't meant to), and the placebo effect is -- the phenomenon of someone deriving benefit from it anyway.
Seriously? How gullible can someone be to think that they've gotten better from something that not only doesn't work, but isn't meant to work and has been administered just to put one over on them? Not all that gullible, as it turns out. Because lots of the time people DO get better from placebos. Depending on the medical condition and the type of "treatment" given them, 15% to 72% of patients administered a placebo will tell you that they were helped. So a placebo may not be real, but the placebo EFFECT is a real thing.
And by saying the placebo effect is a real thing, I mean not just that people THINK they feel better. They DO feel better. And not just feel better, but often ARE better. Changes in blood pressure, shrinking of tumors, warts drying up and falling off, constricted airways dilating, inflammation measurably decreasing, and all kinds of hormonal and neurotransmitter changes have been documented to result from placebos. How about THAT!
The placebo effect is so powerful that doctors have finally learned to bow down before it. By that I don't mean just handing out sugar pills. I mean that if a patient is insistent enough on receiving a particular medication or some other treatment, most doctors these days will let them have it, even if the doctor thinks -- nay, KNOWS -- that it won't work. Because it still might. (Your insurance company going along with this is another story, of course.)
Weird, huh? Here's something even weirder. People can derive NO benefit from a treatment that DOES work, especially if they are anxious about it or distrust it for some reason. Or they can experience side effects that could not possibly come from what they took. THAT is called the "nocebo effect", and it is just as real as the other.
Symptoms that have been documented as a result of the nocebo effect include nausea, stomach pain, itching, bloating, depression, sleep problems, loss of appetite, sexual dysfunction and severe low blood pressure. This even extends to the mandatory warning patients get about side effects of drugs; having that information can contribute to experiencing those effects.
You know all that really annoying, New Agey, airy-fairy stuff you've heard your entire life about positive and negative attitudes? Turns out that there's an awful lot of truth in it. Also a lot of hoohah, of course, but still it's not to be dismissed out of hand. What's happening is that your mind, through the medium of your brain, can produce physiological changes.
The brain directly controls an enormous number of functions and indirectly influences all of them. Therefore how we think about something has everything to do with how that thing affects us. Hence the whole field of study called "mind-body medicine". We haven't heard much about that lately, because there are other current health topics that sort of suck all the air out of the room, but that doesn't mean it's not a thing anymore.
I'm not even talking about behavior here. How you behave when you think you CAN control something versus how you act when you think you CAN'T -- I'm not even getting into that. But if you add changes in behavior to to direct physiological alterations, you've got a pretty powerful combination of factors that every person brings to every treatment they ever receive.
There are quite a few conclusions that you can take away from all this. But here is the one that I would jump at first. Any time you have a physical problem you want to solve, research the heck out of it until you've decided what's most likely to be effective for you. Then do it. If you're still nervous about it, research it some more until you understand it backwards and forwards. Knowledge is power, after all.
I wrote on this subject before, in more technical depth and with an eye toward treatments that conventional medicine is too apt to dismiss (the stuff I do -- chiropractic and acupuncture), so if you want to revisit that it's still at http://www.drdianeholmes.com/placebo-effect-the.html
Expectations are a huge part of -- well, everything. Not just what you want but what you think you can achieve determine your goals. They're also a huge part (if not all) of your satisfaction with family and work. But that's kind of obvious in those arenas. Expectations aren't so obvious in medical and health care, and they have everything to do with what people get out of those. So do take control of yours if and when the time comes.
--dr. diane holmes
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