Placebo Effect’s Dark Side

On the Sunny Side of the Street

We’ve all heard the story of the kindly doctor who gives a patient the sugar pill for an ailment.   The patient never knows and gets better.  At the very least, pain is reduced for a while.

The placebo effect, of course.

What is the placebo effect?

Wikipedia says it is

“a sham medical intervention intended to lead the recipient to believe that the intervention may improve his/her condition. In one common placebo treatment, a patient is given an inert “sugar pill” and told that the pill may improve his/her condition. The fact that the pill is inert is withheld from the patient. The intervention may cause the patient to believe that the treatment will change his/her condition; this belief sometimes causes the patient’s condition to change, a phenomenon known as the placebo effect.”

Placebo’s Latin origin for “I shall please” reminds us of the physician who feels the pressure to give a patient something to soothe them.  Some studies have found quantifiable brain changes based on placebo.  There is something at work here.

Placebo is a sham? Maybe so, maybe not. It’s certainly not understood.

Scientific American reports of the case of Mr. Wright, a patient with cancerous tumors -

A man whom his doctors referred to as “Mr. Wright” was dying from cancer of the lymph nodes. Orange-size tumors had invaded his neck, groin, chest and abdomen, and his doctors had exhausted all available treatments. Nevertheless, Mr. Wright was confident that a new anticancer drug called Krebiozen would cure him …

Mr. Wright was bedridden and fighting for each breath when he received his first injection. But three days later he was cheerfully ambling around the unit, joking with the nurses. Mr. Wright’s tumors had shrunk by half, and after 10 more days of treatment he was discharged from the hospital. And yet the other patients in the hospital who had received Krebiozen showed no improvement.

Over the next two months, however, Mr. Wright became troubled by press reports questioning the efficacy of Krebiozen and suffered a relapse. His doctors decided to lie to him: an improved, doubly effective version of the drug was due to arrive the next day, they told him. Mr. Wright was ecstatic. The doctors then gave him an injection that contained not one molecule of the drug—and he improved even more than he had the last time. Soon he walked out of the hospital symptom-free. He remained healthy until two months later, when, after reading reports that exposed Krebiozen as worthless, he died within days.

Yes, there is a dark side

If it is the case that people get better because of an effect based on the story a person believes, could they also get worse?

Take Sam Shoeman, who was diagnosed with end-stage liver cancer in the 1970s and given just months to live. Shoeman duly died in the allotted time frame – yet the autopsy revealed that his doctors had got it wrong. The tumour was tiny and had not spread. “He didn’t die from cancer, but from believing he was dying of cancer,” says Meador. “If everyone treats you as if you are dying, you buy into it. Everything in your whole being becomes about dying.” via  New Scientist.

A number of blogs and articles over the last few months have referred to overstated studies in neuroscience calling it voodoo science.

This is the flip side of that — the science of voodoo.

Both the placebo effect and the nocebo (I shall harm) effect have shown brain scan changes in subjects.  The changes have been in levels of dopamine and endorphins.  There is a real brain effect.

It isn’t just hearning that something works that sets these enigmatic processes in motion.  Some conditions that precede these happening are -

• The news (or the curse) comes from a trusted person, one with certain air of authority.
• The context is important — a medical facility, a shaman’s tent.  Some of the effect may come from the theater.
• There is ceremony involved. The sugar pill or an injection of an innocuous substance; the evel eye or the statement of the hex.
• The subject believes in the possibility of the change.
• Sometimes a chant, or an affirmation (as in psychotherapy?)
• The receiver leans toward either pessimism or optimism.

These are not to say that anyone could not experience either.  Often folks in double blind studies feel side effects from experimental drugs when they are receiving the dummy drug.

My wonderings lean toward this being a real phenomenon, some power that lies inert in all of our brains. If so, how could it be harnessed?

Mike.

Photo via Pixel Addict’s photostream