In other words, billions were spent on a
surgical procedure that hadn't undergone a decent
controlled study against placebo -- the same criticism
often leveled by CAM skeptics. At least glucosamine
doesn't have the known serious side effects associated
with unnecessary surgery.
The placebo effect has maddened the
medical world for generations. But recent advances in
brain imaging emphasize for me that “placebo” should not
be regarded a dirty word. In fact, it is time to give
placebo a new image and update its beneficial role in
our modern medical armamentarium.
Folk psychology tells us that the
placebo effect is, in large part, a function of patient
suggestibility and that some of us are clearly more
suggestible than others. For centuries, physicians have
handed out inert colored water and sugar pills with the
full knowledge that approximately a third of their
patients will report feeling better. We assume that the
degree of response is somehow a reflection of the
psychological state of the patient -- the greater the
degree of gullibility, the more likely he or she is to
believe that a sugar pill will relieve aches and pains.
But there's an unanticipated side effect of this
assumption.
Attributing the placebo effect to
gullibility is a subtle accusation of a patient's
weakness and lack of sophistication. I suspect that many
of us consciously or unconsciously look down upon those
who are good placebo responders, as though you have to
be a real dummy to believe everything the doctor tells
or gives you.
But placebo serves a very real
evolutionary function. At a time when there were no
medicines, the placebo effect was all that stood between
primitive humans and the agonies of injuries and
illnesses. A look at the functional imaging scans shows
how truly robust are the involved brain systems. These
systems are here to stay. Even given our advanced state
of medical knowledge, much of routine medical care --
from treating backaches to the common cold -- relies
primarily upon reassurance and hope, not
disease-specific treatments.
Given the choice, we'd all prefer to
be placebo responders, though none of us want to be
categorized as rubes. We complain about not getting
enough quality time with our doctors, yet would never
dream of directly asking for a prescription for a
placebo. Instead, if we believe in conventional
(allopathic) medicine, we might ask for an antibiotic
for the common cold, with the rationale that, yes, it's
only a virus, but perhaps the antibiotic will help. If
we are inclined toward alternative medical treatments,
we will plunk down a few bucks for a bottle of echinacea
or a pack of zinc lozenges. To the extent that we feel
better, we have invoked the placebo effect.
