Unit 8Section 3 Exercise 11Alternative Medicine The Placebo Effect

Clinical correlate #6 Spirituality

The following excerpt from Dr. Spiro's book, The Power of Hope, talks aboout the physician as placebo. Needless to say, the placebo is a recognized force in medical response to treatment. In this segment, Dr. Spiro discusses the role of the physician him or herself in achieving a 'placebo effect.'

From Howard Spiro MD, The Power of Hope, Yale University Press, 1996.

Modern physicians, imbued with notions of patient physician equality, have little faith in themselves as therapeutic agents and run the risk of antagonizing their patients by a take-it-or-leave-it attitude. (p. 25)

[A] National Institutes of Health study reaffirmed the importance of the doctor in enhancing the effectiveness of placebos. When clinicians expected their patients to improve more with one placebo than with another, the patients taking the preferred drug reported more pain relief than those taking another. When most medicines are prescribed, the scientific rationale, physicians rely much less on themselves as therapeutic agents than on their prescriptions and procedures. They are too embarrassed to try to be a healer…yet the success of alternative medical practices in making patients feel better may be changing this mindset.(pp. 28-29)

One recurrent, if paradoxical theme is that the more medical science does for disease, the less physicians do for patients. When hospitals became corporate enterprises with battalions of staff wielding high-technology devices against disease, individual physicians began to count for less and less. Even in their offices, physicians have come to rely increasingly on diagnostic and therapeutic technology, far more than on the comfort of their personal skills could assure. (p. 29)

In an era when physicians were more certain of themselves, a doctor could say, “The giving of a pill by the physician to the patient is the symbol for the statement, “I will take care of you.” Doctors who prescribe placebos take on the obligation of loyalty. Loyal physicians can give placebos as gifts, maybe even without any more explanation than “I think this will help you,” if they keep the interest of the patient uppermost in their mind. Paternalistic? Maybe, but no more so than the plumber who tells me to buy a new sink. Giving placebos does not automatically produce loyalty or include it in the gift. There is no transubstantiation. Giving a placebo without much thought and dedication will only glorify the physician’s image as a magic healer, able to cure without effort. That is not what placebos are all about. (p. 226)

The placebo has been my lens to look at science that measures and intuition that comes unbidden, at mainstream medical practice and alternative ways. Mystery can deepen understanding, and magic can spur the search for answers to forbidden questions. While science explores the universe of the cell, we may learn much about ourselves if we yield to the wonders of intuition….The scientific method can be used to improve this very material world, an nowhere in these chapters should anyone find even a hint that I have turned antiscientific. Yet there remains so much that science has not conquered. Depression is cured by chemicals, but sorrow does not yield to antidepressants, nor love to antioxidants. Practitioners and patients can build the bridge between the two cultures of science and art, between perception and intuition, by looking at what alternative and holistic practitioners do and how they answer the needs of their patients. Placebos relieve pain and heal some patients. Behavioral or mental mechanisms invoke physiological responses of endorphins, neural circuits and immunoneurology, so the neurobiological network may bring relief. The neural cleft, that hiding place of pain-relieving agents, may provide a final common pathway by which symbols excite behavioral mechanisms—different for different people in different places and different eras. The body cannot escape the mind...Symbols are stimuli, each with its own message that varies over the generations. Acquired traits do no pass on through genes, but habits and reactions do pass from parent to child. Our emotional response to stimuli, whether an injection from the pediatrician or the patterns of a flag, travel through the generations. Placebos tell patients that they have a doctor who cares, and remind the doctors of the people in those bodies that they repair.

Study Questions

1. What model of medicine guides Spiro’s ‘defense’ of the use of placebos?

2. What has happened to physicians and the health care system that has had an impact on the belief in placebos? What issues might arise in the use of placebos? See: http://www.aafp.org/afp/20080501/curbside.html (requires membership)

3. Is the placebo a thing or a person?