Having a doctor in the family is a benefit for all the extended family members, not only to seek untimely opinion on any health-related issue but also to usurp some of the sample drugs and complimentary things offered by pharmaceutical representatives. This particular incident happened 15 years ago when I was working in Chandigarh as a doctor.
While talking over the phone, my mother spoke about her heel pain and I promised to send her the medications to Madurai. I packed all the goodies which included several boxes of medicines, fancy pens and notepads and other stuff gifted by the medical companies and couriered them. A few days later only did I realise that I had missed the box of pills specific for her heel pain in that package.
Since I was planning to travel soon to Madurai, I thought I would hand over the medications in person. When I reached home, she was all smiles and praised lavishly the pain-relieving gel that she found in the package which I had sent earlier. I was nonplussed since I had not sent one. She showed me the tube, which immediately brought a sheepish smile on my face. It was actually a marker pen designed in the shape of a pain-relieving gel tube, and she has been rubbing only the ink over her foot, but which remarkably had relieved her pain like a magic. If one wonders how would a non-medicated ink relieve someone’s pain, we call it the placebo effect.
Placebo is a drug or an intervention, which is inert and does not intend to have any therapeutic effect. Typically, placebos are used in clinical studies to study the effect of a real drug by giving the drug to one set of people, and placebo to another set of people. But interestingly, placebos have been noted to work really well as much as a scientifically formulated drug would do in many instances. Though scientifically, they do not alter the pathogenic basis of the disease, for many illnesses such as chronic pain, psychotic illness and bowel diseases, they seem to work effectively. Often, what the doctors prescribe you as multi-vitamins, food supplements, nutritional agents are all types of placebos, and they work well.
The term placebo is derived from Latin which means that “I shall be pleasing”. So, if inert and not altering the disease process, how do they make the patients feel better? Several theories have been proposed but the most accepted is the influence of the mind over the physical body. When the patient feels that he has received the right treatment, the brain releases certain hormones called endorphins into the circulation, which gives a feel-good effect for the physical body. The content and secure feeling that we get after consulting a well-qualified, empathetic doctor is a placebo effect initiated by the emotional centres of the brain. A high-end scan performed, a sense of genuineness and sophistication in the ambience, a friendly sympathetic approach by the physician add positive impacts in the brain and consequently the physical symptoms are subdued largely, often immediately.
There have been lots of debates in the medical field about the ethics of prescribing a placebo. If aware, would a patient agree to take a placebo which is not going to affect his disease? How well should the patient be informed about the purpose and effects of all the prescribed medications? Should the doctor be treating only the disease, or the patient as a sentient human being? If patient is aware that he or she has been prescribed only a placebo, will it be affecting the doctor-patient relationship? These questions have been discussed for many years but since placebos have been successful, no one has stopped prescribing them. In several studies, at least 40% of physicians have accepted the inclusion of placebos in their prescriptions. Researchers believe that the success of alternative treatments in many chronic diseases could partly be attributed to the placebo effect. It is also common to notice the opposite effect called the nocebo effect in some patients. If a patient has
negative thoughts or fear about a particular treatment, the patient may endure physical sufferings unrelated to the treatment.
In our daily life too, we are dependent on placebos to boost our morale. The everyday morning motivational messages that we receive in social media, a warm hug from a beloved person, a word of comfort from an elderly person in times of distress, spiritual beliefs, rigorous rituals and so on, are the placebos that keep us mirthful and hopeful in life. These simple gestures are not physically quantifiable but the positivity that sprouts in the mind helps us face the challenges of everyday life and tide over them. We need placebos in life and health!
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