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| This is going to cure you |
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| Features |
| Written by Yasen Pekunov (Kapital), translated by Donika Valeva |
| Sunday, 25 October 2009 20:02 |
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If you take a group of patients who just underwent surgery, and you secretly pour a painkiller in them, the effect of it will be half as weaker as in the case when these patients are informed about the medicine against their pain. This observations sounds weird, to say the least, but it has its explanation. The abovementioned observation (Pain 2001;90:205) was done by the team of Dr. Fabrizio Benedetti from the Torino University, who is one of the leading scientists in the placebo effect sphere. What does this effect truly represent? Just a lie We call placebo a harmless substance, a false procedure or any other effect on a sick person, which aims at fooling that person that he or she is being treated. In about 30 to 60 percent of the cases, according to the nature of the disease and many other factors, the placebo has a therapeutic effect. This is known as the placebo effect and is in fact a paradox. If something does not have healing properties, it should not be healing, right? Undoubtedly. But as early as 1799 it was proven that the placebo effect exists. Furthermore, 57 percent of the general practitioners in the United States regularly subscribe inefficient substances, according to a research presented in the British Medical Journal (2008;337:a1938). Let us not be surprised by this. The placebo effect is indispensable to good therapy. According to three of the leading specialists in the field, who have recently published a marvelous resume on the subject matter (Annu Rev Psychol 2008;59:565), at the basis of the therapeutic effect of the placebo lies the desire of the individual to receive relief from pain. This has been proven by a number of rather diversified researches during the recent years. A few examples. The power of the placebo effect depends for instance on the size and the color of the candy pill. Big and shiny pills have a greater effect. In a similar way the pain-relieving effect of a false pomade is as great as the doctor's superlatives about its unique properties are. It is proven that fake "very expensive" and "revolutionary methods of curing" have a greater effect than the placebo that does not receive as many compliments. The phenomenon described at the beginning of this article is part of the whole picture. The effect of a painkiller is about two times greater when the patients have been explicitly told that at that given moment they will be given something for the pain. Meanwhile, it is documented that the effect of a saline mixture can have the effect of six to eight milligrams of morphine. Every miracle has its explanation There are no miracles. There is only one or another level of knowledge. This maxim is perfectly illustrated during the recent years by medics who research in the field of "the magical effect." With the development of the methods of scientific observation, the effect reaches its explanation. The placebo effect is observed in some diseases and in some people. As a rule, those who want to get cured and have more faith in medicine are more likely to respond to a treatment with candy or any similar method. Among the conditions, which are most strongly affected by the fake methods of treatment are depression and pain. Most of the researches, looking for psycho-biological effects of the "lie" focus on pain. To some extent the reason for this is also the fact that the experiment can be easily put in place in such a case, without harming the health and life of the patients. In order to explain the placebo effect, scientists divide it in three stages. The first one is related to the consciousness, the second to the activity of the brain and the third to the body. The first stage is to fool the consciousness. Doctors literally say that here everything lays in the faith of the patient that he or she will receive relief. This observation has its meaning for real medicine as well. For instance, if somebody believes that they will receive a placebo, but they receive morphine, this person will experience much less relief than if they knew the truth. The consciousness can be fooled through Pavlov's method as well. If every time before having a needle stuck in them, a patient is treated with a painkiller in the form of a cream that smells like strawberries, then in a matter of time, only the smell will be enough. The answer to why this is so is in the brain. The fooled psyche causes changes in the activity of the brain. In the case of pain, scientists observe a lowering of the levels of activity of those parts of the brain which respond to the feeling of anxiety and pain. In essence this means that the brain is fooled and notices less pain than the body is in fact experiencing. Differences in brain activity are also observed in patients susceptible to placebo treatment, in patients with depression, or Parkinson's disease. The third stage of the effect of the placebo is noticed on the body level. A very recent research, published in Science Magazine (2009;326:404), showed that the painkiller effect of the placebo in some cases is caused by changes in the activity of the spinal chord. In other words, Dr Falk Eippert from the University of Hamburg observes with the help of nuclear magnetic resonance what is happening in the spinal cord of 15 volunteers, while he puts a needle through their right hand. The place where the needle goes in all of the patients is treated with a fake painkiller. Half of the participants have been told that this might be a placebo. The other half are fooled that this is a new medication. As it can be expected, those who await a placebo have more pain in general. Those who are well-fooled, on the other hand, report 25 percent less ouch's. Dr Eippert says that the reason for this is in the activity of the central nervous system and more specifically in suppressing pain processing on a nervous level. Figuratively speaking, the brain that has been fooled orders the spinal nerve cells to close the door to pain. The observed phenomenon is most probably caused by the increase of secretion of endorphins and dopamine in the central nervous system. In a similar way the placebo causes secretion of serotonin during depression, which improves the mood. The case with pain caused by a needle is a single case of an already sort of clear mechanism of the placebo effect. Those who suffer from unexplained fibromyalgia, for instance, are also susceptible to placebo, but in their case the painkiller effect is not connected to changes in the central nervous system. One thing is clear. The placebo effect exists, and it has its own scientific explanation. We already understand why doctors use it and why the good doctor explains and convinces. And maybe also lies a bit, but let that remain his or her own secret. Lack of knowledge is therapeutic. Click here to go to the original article.
(c) Economedia, published with permission |
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