The Placebo Effects And Its Implications

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Mr ABC feels that for every sore throat and flu that he suffers from, he feels relief by consulting a local healer who practices in their residential block. And at the same time, he is adamant that he does not feel satisfied when has visited the GP in their locality. From a third person’s view, Mr ABC probably takes the same time to heal and recuperate after suffering from an ailment ( or maybe tilting a little in favour of the traditional healer). But the overwhelming sense of satisfaction he gets by consulting the healer has made him put his trust in his skills and competence. He may be prescribing just a herb here and a seed there and sometimes nothing at all as compared to allopathic medication advised by the GP. Turns out that Mr ABC feels that the local GP hardly has time to address his health concerns on every visit and seems to be in a hurry. And for the bitter icing on the cake, he has acted rude during the little duration of interaction they have had in the past.

The same case scenario exists in the case of Mr DEF who feels comfortable consulting one Doctor while not being satisfied with another. Even with the latter being more qualified, competent and popular than the former. Goes without saying that the same illness with same confounders ( for example an acute self-limiting upper respiratory illness ) will respond differently in the hands of different Health Care Providers in different settings ( provided the variables are adjusted ). What is this ‘X-Factor’ which contributes to the routine medical treatment provided to patients. This is the Placebo Effect!!

Placebo Effect In Medical Research:

To further elaborate on this, I will shed light on the Elephant in the room which we all are well aware of and as Health Care Providers come across day in and out. Our Medical Research is incomplete without it. Whenever new drugs are approved for use, there is a process of them undergoing rigorous trials called Randomized Controlled Trials. Good Quality ones are Double-blind. Where the Physician and the Volunteer or Patient, both do not know which is being prescribed, the ‘Actual’ drug or a ‘Placebo ( dummy drug). The volunteers are divided into 2 groups, the ‘Control’ which receives a Placebo( which looks and feels like the drug in the treatment group, it may be a pill, capsule, powder or injection) and the ‘Treatment’ group which receives the ‘Actual’ drug.

Now, after completion of a certain period of intervention in both groups the outcomes of the ‘Actual’ drug and ‘Placebo’ on their respective groups are measured to see whether the drug or placebo had any effect in the improvement of outcomes of disease. Then you hear about the ‘Absolute’ and ‘Relative’ risks. To avoid indigestible details in this regard, these risks are the differences in outcomes between both groups which when are ‘ Statistically Significant’, we can say that the ‘ Actual Drug’ is effective.

But hold on a minute, if you closely look at the effects of the ‘Placebo’ in the ‘Control’ group you will see that even the dummy has effects in different parameters in the analysis. Sometimes, the effects are at par with the ‘Drug’ so much so that the improvement shown by the ‘Drug’ becomes statistically significant when compared with the ‘Placebo’. Now isn’t it strange and eyebrow-raising how a dummy drug( patient assumes it to be the actual drug since there is blinding ) produces the same effect as a drug with a molecule with years of research behind it. This is the ‘Placebo’ Effect.

Probable Explanation For The Effect:

What supposedly happens is when you are firm and fixed in your mind over a fact, your whole body responds in a harmonious manner in sync with what the brain is actually feeling. This throws into effect cascades of events like a decrease in inflammation and other positive effects on processes such as digestion, sleep and appetite. From what we know from Human Physiology & Anatomy, the Mind and Body are a single unit and respond in sync to positive or negative stimuli. One affects the other and they are connected to each other through a vast meshwork of nerves in form of the Central and Peripheral Nervous Systems. We cannot treat one part of this ‘Unit’ without treating the other. Which is why It is now coming to light through research that chronic depressive illness and low mood can precipitate a host of acute and chronic diseases along with lowering our immunity.

Putting this into context we understand why a person assuming a ‘Dummy’ drug to be the ‘Actual’ drug can have the same effect as the ‘Actual’ drug is producing in the treatment group.

Implications Of The Placebo Effect:

The Practical Implications of this effect are all around us in our lives. I will stick to Health Care. When we put our health issues into the hands of a ‘Qualified’ Health care Provider, we should be at peace Mentally and trust the concerned individual that he or so will suggest and do what is best for us. The feelings of Trust and Positivity have profound effects on our relationship with the Health Care Provider. Our bodies and its processes respond better to intervention then.

As Health Care providers it is our obligation to be comforting to the patients and establish a Rapport. It obviously takes time but once set into motion yields tangible health benefits for the patients. When patients come to us afloat on a cloud of positivity and surety they walk away ‘knowing’ that they are in safe hands. This state of mind improves our bodily functioning in subtle yet significant ways. For example, our immune system and metabolic processes ( blood sugars, lipid levels, inflammation ) improve with a positive frame of mind. Our stress hormones drop and our anxiety is alleviated.

In A Nutshell:

Doctors should be empathic and compassionate with their patients to ensure a bond which ensures better health outcomes. Trust and Rapport have profound effects on the way our patients respond to what we advise them, the way we advise them. Even a simple multivitamin pill turns out to be a game-changer when prescribed to patients with psychological distress. While on the other hand, patients should try to trust their Health Care Providers since this is the foundation of a good Doctor/Patient relationship. Having said all this, it cannot be overemphasized that the ‘Placebo’ effect which is in the best interest of the patient is something which should go hand in hand with Genuine Health Care provided by “Qualified’ people. This effect is widely abused by quacks so be sure that you get your Health Services from the right place and right. This subtle yet meaningful effect cannot be ignored.

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Dr. Syed Hunain Riaz
He is a Specialist Physician by qualification with expertise, interest and experience in Endocrinology/Metabolism and infectious diseases. He has extensive experience in delivering talks to audiences regarding topics relating to Endocrinology/Metabolism and HIV & AIDS( on platforms of various international organizations). Has a few research articles under his belt. He likes to convey his thoughts through articles for the masses. Besides medicine has interests in astronomy/cosmology, traveling, photography and philosophy.

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