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The word
placebo which means I shall please, I shall be useful explains
a lot of things connected with healing and the so called - healing touch.
It also tells us how some quack therapies seem to work.
It has
been well known that the very act of taking medicine or initiating therapy
has an effect on the mind of the patient. The tribal healer, the modern
proponent of secret therapies and methodologies - in short the smooth
talking quack has a good knowledge of this and use it to show the effectiveness
of their treatment. So, in scientific studies this effect is always
evaluated by a group which is given treatment which closely approximates
preparation of the active ingredient to be tested in appearance, taste
and other properties but does not contain that. The person giving the
treatment does not know which patient is getting what. The therapy is
done through coded preparations which cannot be distinguished from each
other. So, neither the patient nor the doctor knows who is getting what.
The evaluation is done after the whole cycle of treatment is over and
the results are then interpreted. For example if a new drug for headache
is to be tested, it shall be done on different groups of patients some
of whom will be getting the known drugs, placebo and new drug to be
tested. The drug will be administered as a pill or a liquid which will
be of the same taste, colour, appearance and dosage. The number of patients
getting the relief from each group will be counted and statistically
analysed to check the effectiveness of the new drug. In cases where
a placebo could lead to deterioration of the patient’s condition,
therapies available to date will be used.
So, this
would give the researcher a good idea of the effectiveness of the new
drug under trial. However, this cannot be done in therapies which do
not have any scientific background. In those which involve incantations,
applications of instruments or devices, which are claimed to be specially
selected for each individual it is not possible to have such a group.
It is the practitioners of such systems of healing who claim that their
therapy works though there is no evidence for the same. Homeopathy is
one such in which no scientific study to date has demonstrated its effectiveness
beyond the placebo group. However, it is recognized as a system of medicine
in many countries including India. A number of well documented studies
have shown that the treatment by homeopathy has the same rate of cure
as the placebo group. In fact some of these studies were criticized
as those in which one placebo has been tested against the other. In
the absence of any logical explanations for their therapy, homeopaths
have taken recourse to various long winded discourses like mind over
matter, nano technology etc. The very same explanation holds good for
a number of such which involve physical interventions and very visible
methods of the treatment like color therapy, gem therapy, acupressure,
pranik healing etc., etc.
Many physicians,
including some practicing scientific systems of medicine do take recourse
to placebos for patients who have no organic disease yet show vague
symptoms. Here the placebos may be an injection of distilled water or
some such harmless solution or vitamin tablet or sugar syrup. However
one has to understand clearly that a placebo can only help the feeling
of the patient to the disease process and not the disease process itself.
For example a cancer patient given a placebo may get a feeling of well
being for some time but the disease may be merrily eating away at the
organs. So, it is extremely important that the disease be proved to
be a psychosomatic one or a functional disorder for the placebo effect
to be used. One cannot try such in patients with organic disease. That
is one reason why unproved methods of treatment should not be taken
before disease is properly diagnosed. Those who practice such therapies
have not proper knowledge of the disease process or have diagnostic
procedures available to them and that is one good reason why patients
should be careful when they opt for such systems.
A recent
trial has thrown light on how placebos do work. One thing is to be understood
clearly that they work at the level of the central nervous system and
only on the intact suggestible subject - that is it will not work on
experimental animals and those who have no understanding of what the
therapy is supposed to do like the infant or the unconscious patient.
It is suggested that endorphins and opioids released in the brain have
some effect in decreasing the perception of pain. It is well known that
the most of the effect of pain is by the perception of the source itself
for example if you watch the needle going into your body it will pain
more than when you do not see it! That is one reason why injections
are administered in those parts of the body which are not visible to
the patient!
This research
study of Dr.Fabrizo Beneditti demonstrates the placebo effect very conclusively.
He took four batches of volunteers- A,B,C,D and subjected them to four
sessions of painful exercise- three of them being practice sessions
and the last one being the competition. Some of them were injected with
morphine which dulls the pain and prolongs the time duration for which
the exercise could be done. Group A was the control which was not given
any type of treatment. Group B was injected with saline and were told
that they had been given morphine. Group C was given morphine during
a practice session but on the actual day of competition were injected
with saline, but were told that it was morphine. Group D which was treated
like group C all the time was injected with saline and a drug naloxone
which nullifies the effect of morphine, on the day of the competition.
On the day of competition they were all asked to do exercise which would
cause pain as in the practice sessions. The time duration for which
they performed was noted. Group A had the shortest time 14 seconds as
expected. Group B stayed on for a slightly longer time of 17 seconds.
Group C who had previously experienced the performance enhancing effect
of morphine but were actually injected with saline stayed on for the
usual 21-22 seconds. The D group which had been injected saline with
naloxone -which nullifies the effect of morphine showed the timing of
15 seconds only, which was the same as group A-the control.
This experiment
proves that the placebo effect is due to substances which are similar
to opioids as naloxone had blocked their effect. It also proved that
the effect of the placebo was because of previous experience since group
C showed the maximum tolerance to pain. This experiment is a significant
one in the sense that it proves that the placebo effect is not mind
over matter, but a perfectly explainable physiological effect due to
the secretion of some biochemicals like endorphins in the central nervous
system and naloxone blocks their effect. The same can also explain how
some can perform seemingly superhuman tolerance to pain and subject
themselves to painful processes like hanging from hooks through the
skin of the back, pass skewers through tongue, cheek etc.
The placebo
effect makes us tolerate the pain of some treatments and their ill effects in
the expectation that they would be for the ultimate good. But, one thing is to
be remembered is that this effect does change our attitude towards pain or
increases the tolerance to it. It does not affect the actual course of the
disease. The cancer patient who undergoes the pain of the treatment and the side
effects of chemotherapy does so as the brain does help by secreting endorphins
which increase the tolerance to pain. The curative effect is because the agents
which cause the pain and not those which help the body to bear it.
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