Monday, August 8, 2011

The placebo effect.

It's an interesting thing the placebo effect. Ben Goldacre of Bad Science, provided a nice little summary a few years ago at Nerdstock. Basically, it's an incredibly powerful thing, to the point where it works even if you tell people what it is. In certain cases it can even overcome medications with known physiological effects (some stimulants and relaxants). He sums it up as, roughly speaking, if I recall correctly, "several million fucktons more interesting that the fairy tales involved in homoeopathy (where the only effect is the placebo effect). And it is, a thoroughly interesting topic though. Worth reading, is a post at Science Based Medicine, which covers some recent work on the placebo effect. While the placebo effect is a powerful artefact, it appears to operate primarily at the subjective level. While a patient may feel better, at the physiological level, it has no effect. Which in certain circumstances, could be quite dangerous - think asthma where the patient feels better or just slightly short of breath, when in actual fact they're on the verge of total lung failure.
While I acknowledge that it's a very definitely an effect of sometime, it's not something I'd like to see added to the physicians general tool box. If a patient knows what a placebo is and that they are getting one, then there would be, I think, a certain amount trust lost in the physician - patient might feel better, but are they really going to have that much faith in a physician who is giving them inert medication. If the patient doesn't know, then it involves the physician lying to the patient, again, not something I'm comfortable with. Which is not to say that physicians should be ladling out drugs to those who don't need them, we should be aiming for a healthcare system where physicians have time to talk to patients, find out what's going on and be able to explain why patients need/don't need drugs. And a population that  listens.

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