The Placebo Effect

So here’s a hypothetical situation.  You’re sick and you go to the doctor who examines you and tells you what he thinks is wrong.  He writes a prescription for some medicine which you take to the pharmacy.  You take your medicine home and take it faithfully as directed.  You get better and go on with your life.

Would it later upset you to know your prescription told the pharmacist to give you sugar pills?

It was fairly common practice in the past for doctors, when faced with an illness for which there was no treatment, to prescribe what is called a placebo.  A placebo is a treatment with no active ingredients.  Sugar pills, flavored syrup, salt solution that stings when you inject it, there are a lot of ways to make patients THINK you’re giving them medication when you’re actually not.

Guess what.  A lot of the time, the placebo works.  It works, and the patient gets better.

Sometimes it’s because the illness itself was self-limited and was destined to resolve on its own.  Often, though, it’s because the human mind is VERY powerful.  If the mind creates the right environment for healing (i.e. if you KNOW you’re getting better) often the body goes along with the program.

This placebo effect is so powerful that scientific studies of medications are nearly always “placebo controlled,” meaning the treatment being tested is compared against a placebo.  Even acupuncture trials are placebo controlled, meaning treatment is compared to “sham needling” where the acupuncturist places needles in spots that are not acupuncture points.

In medicine we often skip straight to the therapeutic effect, meaning we ask how much better than placebo is the new medication or treatment.  What we miss, though, is how shockingly large the placebo effect can be!

Here is an example:  A study published in 2015 compared a nutritional supplement to placebo in decreasing migraine frequency and severity.  There was improvement in both arms of the study!  They gave migraine sufferers (getting an average of 6+ migraines per month, yikes!) a sugar pill and their migraines improved.  Not a lot, but they improved.  As a migraine sufferer myself, this is amazing!

As amazing as the placebo effect is, I want to add a word of caution.  Like many other powerful things (think sunlight and caffeine, LOL!) the power of the mind can be used for good or evil.  The placebo effect refers to the power of the mind to achieve health and healing.

The NOCEBO effect is defined as the power of the mind to hurt you.  The mind is able to create illness and misery.

Here is a good example.  I prescribe statin drugs for treatment of cholesterol and prevention of heart attacks.  Everybody is concerned about the possibility of muscle pain and weakness with the statin drugs.  For many of my patients it’s a hard sell getting them to consider taking these drugs that will significantly decrease their risk of having a heart attack or stroke.

I looked up the research on just how often patients in the early days of statin use experienced muscle pain with the drugs.  (If you want to read the gobbledygook, LOL, you’re welcome to check this link.)  In the initial trials of this medication when Merck (the company that developed the drug Zocor or simvastatin) was asking for approval of their new drug, the risk of muscle pain for patients treated with the highest dose of simvastatin was 0.61%.  That means 6 in 1000 patients developed muscle pain with the highest dose of the statin most likely to cause muscle pain.

I do not need to poll my medical colleagues to know that the percent of patients that experience muscle pain with statin use is MUCH higher than 0.6%.  In fact, I tell my patients that in my experience about 1 in 10 patients will develop muscle pain, meaning 9 in 10 will do just fine.  I haven’t done research about that, that’s just my quick-and-dirty sense of how my patients do with these drugs.  That’s ten times the rate researchers saw when nobody knew anything about statin drugs.

My sense of the reason behind the difference is that it’s the nocebo effect.  People are aware of statins and the risk of side effects.  A long list of possible side effects is printed on your drug information that you get with your prescription at the pharmacy.  Heck, you can’t watch TV in the evening without being bombarded with a gazillion potential side effects (including death!) with every pharmaceutical commercial.

Please be aware of the power of your mind.  Your expectations and your perspective determine your reality.  If you KNOW your doctor’s treatment will help you, you are probably right.  If you KNOW the treatment will hurt you, you’re probably right about that too.

If your doctor wants you to take medication or undergo a treatment, please make sure you know exactly why that treatment is expected to help you, how likely there are to be side effects and which side effects you could reasonably expect.  Also, find out what your doctor wants you to do if you DO develop a side effect or problem with the treatment.  Be an active partner in your treatment which will reduce the risk of problems.

Your mind is very powerful.  As Uncle Ben advised Peter Parker in the movie Spider-Man, “With great power comes great responsibility.”  Make sure you are using your power for good!

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