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Mawrtyr2008's picture

Placebo Reevaluation

This was such a great topic. If anything, it continually boggles my mind to realize just how much of brain function is devoted to things we aren’t even aware of most of the time. It’s incredible to me the vast amount of resources our body allocates to things like…. checking to make sure a limb is still attached… taking in as much information as possible through our senses… and constantly filtering it through to our consciousness.

I’d like to begin by addressing Emily and Felicia’s question about whether all pharmacotherapy is “merely” attributed to the placebo effect. While I disagree that all drug action across the board can be attributed to the placebo effect, I think there is a lot of merit in continuing the discussion about whether much of drug action is. I don’t think that “merely” is a useful way to characterize this process, because if so much of drug action and symptom alleviation can be attributed to this effect, it seems more “powerful” and less “mere” to me. It seems to me that for the placebo effect to be normalized enough to be an acceptable, prescribable medical tool, there really needs to be a word change or a drastic reevaluation of the connotations we place with the word “placebo”. There seems to be little controversy when one scientist comments on how little we actually know about mechanisms of action. Why, then, do we get defensive and threatened by the word placebo that concisely summarizes that lack of knowledge? I think a more useful question to ask here would be something like, “Though most people in the scientific community readily acknowledge that we have so much to learn, though many people support the idea of homeopathic healing practices, why is it so hard for us to discuss the placebo effect not just as a phenomenon, but as a tool that can be used effectively in medical practices?” A distilled version of that would be…. “What’s so scary about the placebo effect after all?”.

To comment now on why this is an important subject that merits thoughtful discussion, we need to consider the beneficial uses (which we discussed in class) and also the misuses (which we did not discuss in class) of the placebo effect. The NY Times articles gave a great explanation for the current antibiotic resistance crisis in terms of the placebo effect. The article stated that antibiotics have been used as placebos for patients with viral infections for decades. Clearly, the antibiotic won't cure the viral infection, and so in that respect, it's chemically inert and therefore acting as a placebo. However, the rammifications of physicians prescribing antibiotics for years had dangerous consequences as bacteria became resistent to the drugs. I'm convinced that placebos can have beneficial effects, but even if you're on the fence about that, isn't it enough to consider the consequences of improper use of placebos? No matter how skeptical you are, this example should motivate a discussion.

On another line of thought… I really appreciated insight regarding Body Dysmorphic Disorder as it relates to other human conditions, specifically the trans experience (body modification to align one’s perceived gender with one’s outward appearance), and even perhaps the feminist critique of the female experience (body modification to meet perceived cultural norms). Though that insight opened up a new way of perceiving culture as it relates to medicine, I think we need to be cautioned about overly pathologizing the human experience.

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