Medical
Mystery of the Placebo
By
NORMAN COUSINS with SUSAN SCHIEFELBEN
Not long ago, two patients on anti-depressant drugs
were each given the same pill, described to them as a new promising
preparation. The first patient was told
that the pill would sharply reduce her bleak feeling and help her general
physical condition. The second patient
was told that the pill was still experimental, would probably have some adverse
side effects, but was worth taking nonetheless.
Each patient reacted in line with the predicted
expectations. How could the same pill
produce such different effects? The
pill wasn’t a drug at all, but a placebo—an innocent milk sugar capsule.
The study of this strange-sounding agent [pronounced
plahase-bo, from the Latin verb “to please”] is opening vast areas of knowledge
about the way in human body heals itself and about the mysterious ability of the
brain to order biochemical changes that are essential for combating
disease. In the classical sense, a
placebo is an imitation medicine—generally a nocuous milk-sugar tablet dressed
up likes an authentic pill. Today, it
is used most often in the testing of new drugs. Effects achieved by the preparation being tested are measured
against those that follow the administration of a “dummy drug,” or placebo.
But today the once lowly placebo is receiving
serious attention from medical scholars.
Investigators have found substantial evidence showing that the placebo
can actually act like an authentic therapeutic agent. While the way it works inside the body is still not completely
understood, some researchers theorize that placebos activate the cerebral cortex,
which in turn may switch on the endocrine system. Whatever the precise pathways through the mind and body, enough
evidence already exists to indicate that placebos can be as potent as—and
sometimes more potent than—the active drugs they replace.
It is obviously absurd to say that doctors should
never prescribe pharmacologically active drugs. There are times when such medications are absolutely
essential. But the good doctor is
always mindful of their power. There is
almost no drug that does not have some side effects. And the more vaunted the prescription—antibiotics, cortisone,
tranquilizers, anti-hypertensive compounds, anti-inflammatory agents, muscle
relaxers—the greater the problem of adverse side effects.
Moreover, studies show that most patients who reach
out for medical help are suffering from disorders well within the range of the
body’s own healing powers. The good
physician tries to distinguish effectively between the large number of patients
who can get well without heroic intervention and the much smaller number who
can’t. Such a physician loses no time
in mobilizing all the scientific resources available when they are necessary,
but he is careful not to slow up the natural recovery process of those who need
his reassurance more than his drugs. He
may, for such people, prescribe a placebo—both because the patient feels more
comfortable with a prescription in his hand and because the doctor knows that
the placebo can actually serve a therapeutic purpose.
The placebo, then, is not so much a pill as a
process. The process works not because
of any magic in the tablet but because the most successful prescriptions are
those filled by the human body itself.
The placebo is powerful not because it “fools” the body but because it
translates the will to live into a physical reality by triggering specific
biochemical changes in the body. Thus
the placebo is proof that there is no real separation between mind and
body. Illness is always an interaction
between both. Attempts to treat most
mental diseases as through they were completely free of physical causes and
attempts to treat most bodily diseases as though the mind were in no way
involved must be considered archaic in the light of new evidence about the way
the human body functions.
Placebos will not work under all circumstances. The chances of successful use are believed
to be directly proportionate to the quality of a patient’s relationship with a
doctor. The doctor’s attitude toward
the patient and his ability to convince the patient that he is not being taken
lightly are vital factors in the treatment of illness in general. In the absence of a strong relationship
between doctor and patient, the use of placebos may have little point or
prospect. In this sense, the doctor
himself is the most powerful placebo of all.
How much scientific laboratory data have been
accumulated on placebo efficacy? The
medical literature in the past quarter century contains numerous impressive
studies, including these three:
·
An anestheologist
at Haward is considered the results of 15 students involving 1082
patients. He discovered that 35 percent
of the patients consistently experienced “satisfactory relief” when placebos
were used instead of regular medication for a wide range of medical problems,
including severe post-operative wound pain, seasickness, headaches, coughs and
anxiety.
·
During a large
study of mild mental depression, patients who bad been treated with
anti-depressants were taken off the drugs and put on placebos. The patients showed exactly the same
improvement as they had gained from the drugs.
·
Eighty-eight
arthritic patients were given placebos instead of aspirin or cortisone. The number of patients who benefited from
the placebos was approximately the same as the number of benefiting from the conventional
anti-arthritic drugs
Inevitability, the use of the placebo involves built-in
contradictions. A good patient-doctor
relationship is essential to the process.
But what happens to that relationship when one of the partners conceals
important information from the other?
Is it ethical—or wise—for the doctor to nourish the patient’s mystical
belief in medication? An increasing
number of doctors believe they should not encourage their patients to expect
prescriptions, for they know how easy it is to deepen the patient’s
physiological and phychological dependence on drugs—or even on placebos, for
that matter. If enough doctors break
this habit, there is hope that the patient himself will come to regard the prescription
slip in a new light.
In the end, the
greatest value of the placebo is what it can tell us about life. For what we understand ultimately is that
the placebo is only a tangible object made essential in an age that feels
uncomfortable with intangibles. If we
can liberate our selves from tangibles, we can directly connect hope and the
will to live to the ability of the body to meet threats and challenges. Then the mind can carry out its difficult
and wondrous missions unprompted by little pills.
