Dear Dr. Roach: I happened to come across your recent article on the placebo effect.
As a professor of physiology, I understand perfectly your advice.
And I sort of feel that the placebo effect can be a good one. If someone feels 鈥渞elief鈥� from taking a harmless substance, what鈥檚 the matter with that? I鈥檓 talking here about non-life-threatening conditions, of course.
Indeed, it is because this effect exists that one needs randomized, controlled clinical studies in order to establish a real therapeutic effect for a pharmacological agent. In other words, don鈥檛 knock it!
But what鈥檚 your take on the following: I would imagine that the placebo effect can work only if the subject is not informed that its effectiveness hasn鈥檛 been established.
If you tell the patient that the treatment has not been 鈥減roven,鈥� wouldn鈥檛 that blunt the effect? Isn鈥檛 this why in a controlled trial, the patients aren鈥檛 informed of which treatment they鈥檙e receiving?
Why not tell the patient something vague, like: 鈥淲ell, some people do feel better taking this supplement, so there is no harm in you trying it.鈥�
I have been told that it is 鈥渦nethical鈥� to promote a placebo, and certainly there would be many situations where that would be so.
But, for example, a patient approaches the physician with a condition for which there is no real 鈥渃ure鈥� (like the common cold) and wonders whether supplement X would be beneficial. Why would giving a vague response, as illustrated above, be 鈥渦nethical?鈥�
Professor Emeritus W. Reuben Kaufman,
University of Alberta.
I appreciate professor Kaufman鈥檚 thoughtful comments.
I tend to agree with gently promoting the use of possibly helpful supplements (in what professor Kaufman calls the 鈥渧ague response鈥�) 鈥� assuming, of course, that the supplement is not harmful.
Although it seems counterintuitive, telling people that a placebo is a placebo does not seem to stop its being effective.
I once had an initial visit with a patient and saw 鈥測ellow placebo No. 1鈥� on his medication list, and when asked, he told me he knew it was a placebo but it was the only one of the pills that worked for him.
Researchers at Harvard are using a placebo, but are telling the participants that the pill they are getting contains no active ingredient.
Initial trials with this approach showed a very significant reduction in symptoms.
An 鈥渉onest鈥� or open-label placebo may be as effective as many medications, with less risk of side effects and at much lower cost.
Deception is not necessary for a placebo to work, and in my opinion, is ultimately harmful to the patient-physician relationship.
Dear Dr. Roach: Most often, when I brush my teeth, my bladder muscles start to contract and I must urinate immediately. Does this condition have a name, and are there others who have this problem?
J.
I hadn鈥檛 heard of this before, but a quick search showed that this is not at all uncommon.
The best answer that I can give is that it is most likely due to conditioning: You have gotten so used to urinating about the time you brush your teeth that the two are connected at a deep level in your brain.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
