Treating the parts that real medicines cannot treat – a place for placebos

As a skeptic I have a shameful confession to make: I once had an imaginary condition miraculously cured by a placebo treatment.

Some conditions have symptons but not signs. Symptoms are felt and reported by patients, signs can be detected using some form of test. Headache and nausea are symptoms of migraine, vomiting and pallor are signs.

About 10 years ago I went through some high-stakes changes and made a career-move which required full-on keyboard use.  But I developed Repetitive Strain Injury which affected my hands to the extent that I experienced pain up to my shoulders.  Lawyers have a field day with RSI, because some repetitive strain injuries such as Carpel Tunnel Syndrome have signs, but others are just painful with no measurable physical changes. The long and the short of my story is that I bought a wrist magnet and strapped it on my right arm. Within half an hour my right arm was considerably less painful than my left and over the next few days the pains disappeared completely. I was able to take up my new job with no problem at all.  A miracle cure! For a condition my doctor had been powerless to treat! Woo hoo!

Doctors are often exasperated by patients who turn up with functional conditions (ie ones which have symptoms but not signs) because there is nothing concrete to treat and no objective way to measure outcomes. In the worst case, they consider the patient to be a malingerer and even in good cases trust between paient and doctor break down and create a space for kindly Alternative Medical practitioners to step into. Functional conditions are for Alt Med of course because the intervention needed isn’t medical. It’s in the realm that Terry Pratchett’s Granny Weatherwax calls “headology”. The wrist magnet really did cure my RSI.  It worked, not because it improved the flow of fluids in my body, but because I thought it improved the flow of fluids in my body.

Placebos are a side-effect free way to treat conditions which can’t be treated using evidence-based medicine. Let’s be clear here: these conditions are honestly experienced by people of integrity. Just because their minds and bodies are lying to them, doesn’t mean they are lying to the doctors. But there are no symptoms that can be measured and treated so the medical model and the patients’ experience simply don’t overlap. This creates a gap in the market which alt med happily and sometimes effectively fills. But not all alt med is innocent and all of it is expensive and based on false models and premises. We need medical science to admit there is something going on here that needs treating, rather than dismissing functional conditions as hysterical, imaginary or psychosomatic.

Unfortunately, medics who accept that placebos may indeed be appropriate for these conditions cannot bridge gap by prescribing them, even if they will work where “real” treatments fail. Doctors consider it unethical to lie to patients, and I think most patients would agree with them. So at the moment there is indeed a place for alt med in providing these interventions.  Alt Med has no place in treating pathological conditions of course (ie “real” ones): flower drops and sugar pills cannot treat cancer, and magnetic bracelets can’t cure Carpel Tunnel Syndrome.

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8 responses to “Treating the parts that real medicines cannot treat – a place for placebos

  1. Although a doc would see it as unethical (quite rightly) to give a placebo, could they not prescribe a basic pain killer that would allow the placebo to kick in as well thereby getting around the ethical dilemma? The concern is that by saying “at the moment there is indeed a place for alt med” it is getting onto the slippery slope. Is it too much of a stretch that if a patient has a psychosematic condition and an Alt Med treats it, is there not a danger that when they actually have something seriously wrong they will go to the same alt med instead of a real doctor?

    It’s a little harsh to say that even at this basic level it is wrong, but I would be interested to know how many people now use alt med regularly after initially using it for a psychosematic of self limiting condition? Personally I think it’s too much of a risk and if it’s done properly there is no reason a real doctor can’t allow the placebo to kick in- my inhaler has an effect and helps my asthma, but I am also aware that many times people think they need an inhaler at a specific moent they are using it simply as a placebo, I would not be surprised if most of my need for my inhaler is placebo based, but as it does have an actual physical effect it isn’t unethical in the way an outright placebo is.

    The other option is to be a little cruel and say “It’s all in your head now go in the corner and play with the safety scissors and PVA glue”.

  2. Ooooh interesting post.

    I blogged about this fairly recently as well – there are lots of reasons why it’s actually harmful to prescribe a placebo.

    Firstly it lets the patient think that there has been a pathological diagnosis when in fact that there has not. To prescribe a placebo treatment there has to be a placebo diagnosis. This means that they don’t get the chance to actually get a second opinion if they aren’t happy with your diagnosis of ‘not much really’.

    It encourages the patient to think that there is an illness and continue the sick role, for instance to continue to rest the arm whilst waiting for the placebo to work. Most placebo’s don’t work this fast. It also means that you are denying them the chance to really address the lifestyle factors that may be the cause. RSI is actually a really really complex situation and mass use of placebos isn’t really going to help a great deal.

    A lot can be achieved with the assurance that nothing serious is wrong and that it will get better! That way you set expectations and honestly. Some of my most satisfying, and most successful consultations have been assuring people that nothing is wrong!

    There’s nothing wrong with making use of the placebo, and explaining how people will feel better after giving a drug that will make them feel better. I have been known to say ‘I am injecting some very strong painkiller and very soon you will feel an awful lot better,’ as I am injecting an effective drug. I know some people who have said this whilst injecting saline – with a really good effect .(Saline is a inert substance because water is really painful to inject).

    I do know some very good doctors who have gone over to the dark side and starting using alt med, I’m sure that a large part of it is because it’s the only way to prescribe a placebo and not be struck off.

    Here the link to my blog: http://www.refertomedics.co.uk/?p=44

  3. The trouble is recognising when you need a placebo and when you need medicine. I think as a general rule alternative medicine practitioners should be consulted after the other sort! My brother as a baby was treated for a long time for a ‘cosmic disturbance’ it was only later that a real doctor diagnosed spina bifda that progress was actually made with his condition. I think encouraging a ‘dual fuel’ approach were alt medicine and conventional medicine are administered in the same centre would help to make alt medicine less dangerous but I’m not sure about the NHS funding expensive placebos when cheaper ones work just as well…after all if its just a placebo you shouldn’t have to gather the kangeroos eyelashes at midnight….Also a lot of what alt medicine does offer is counselling without having to see a councillor it’s easier to believe it’s the pill rather than the hour long consultation that did the trick….

  4. Don’t have anything much to add to the debate but blog post reminded me of this old “Smack the Pony” sketch.

  5. Pingback: Tweets that mention Treating the parts that real medicines cannot treat – a place for placebos « Thinking about it… -- Topsy.com

  6. This is a great post. I also had experience with Placebo but it was not administered to me but to one of the patients in the hospital. The patient wanted more pain killers which are not the required dose so the nurse administered pacebo and assured the patient that the pain will go away. And it did according to the patient report.

    I am just amazed by how powerful our minds are. The saying “Mind over Matter” is indeed true.

  7. So I conducted a double blind trial to see if there was any therapeutic benefit to Spanish opera singers.

    Half the people in the trial got a real Spanish opera singer…

    … oh, fill in the punchline yourselves.

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