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K. Smythe's picture

Placebos

            I think the part of the discussion I found most interesting this week was regarding placebos.  We define placebos as substances that are pharmacologically inert but have an effect based on “suggestion” or mental expectation of results.  It is interesting then that we consider talk therapy as a legitimate treatment and that in no class or discussion I have had has it ever been compared to or brought up in association with placebos.  These types of therapy by definition put no substance (inert or otherwise) into the body, and yet we expect them (and pay lots of money for them) to affect our physical symptoms.  If there is an affect on symptoms is it unreasonable to pay for placebos as well?  We accept CBT therapies as treatment and yet when the idea of disorders being treated with placebos was brought up there was a lot of outrage at the idea.  I suppose the tricky part is that placebos can only work if you believe they will and the word placebo implies “medically inert substance”.  The idea that Professor Grobstein brought up was interesting, but seemed to be met with much criticism.  I’m not sure I understand why we can’t treat people with placebos and simply tell them that the drug they are taking has been shown to be whatever percent affective for people with their disorder.  If a placebo, though pharmacologically inert, creates a physical change in the body for whatever reason, is it actually as placebo?  At the point where it creates a physical change in the body, it is playing some part (albeit much may be the mental effect of the person, but the actual physical placebo is a necessary part) in treatment and seems to be to be by definition not an “inert” substance.

            It is also interesting to relate the idea of placebos to the notion that many of the drugs that we dispense today for so many maladies work through pathways we do know understand or even know sometimes.  We often encourage patients to (as was said during our discussion of psychotherapy) “use what they have themselves” before using drugs to fix a problem; couldn’t placebos be just that, the first attempt at fixing a problem?  If we tried a placebo and it wasn’t having an affect, then the patient (as with any drug treatment) would simply be switched to a different drug therapy (read not a placebo).  I do believe that this could only be appropriate for some symptoms/diseases (if any), and understand that some conditions need treatment immediately, but it is still an interesting idea to throw around, even if I’m not entirely sure that I agree with it.  The mind is a very powerful thing, and even if it means in a sense “tricking” our minds/bodies, it does on some level appeal to me to use the mind first for treatment before pumping our bodies full of chemicals we don’t really understand.

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