OF PLACEBOS

9.4.99

    I recently read an article in the Oregonian, the statewide newspaper, about placebos and their place in medical research. Some researchers call placebos the most studied pharmaceutical in medical history. A placebo is basically the control element in medical studies. The researchers will, if studying the effects of Aspirin on patients administer a controlled amount to one group, perhaps a random amount to another group, none to a third group and a pill that looks like Aspirin but is actually made of sugar or some other eneffective ingredient to a forth group.

    Typically, those receiving either the placebo or the drug will not know what it is that they are receiving. This tests, supposedly, whether the drug has an effect or whether the effect is achieved naturally regardless of the drug. What the Oregonian article was suggesting is that a huge part of healing and treating illness is all in our minds.

    This isn't a huge concept to most people. I think its pretty obvious that if you can keep your hopes up and have a positive outlook that you will better overcome things like surgery or illness. And, of course, if you die anyway then at least you weren't an ass about it. But, what if you didn't know that you were going to die? What if the doctors had given up hope and began administering a placebo? What if they let you think it was a new drug? What if you got well and walked away from a death sentence?

    It's the not-knowing in these cases that is causing people to overcome obstacles larger than themselves. Patients aware that they were receiving a placebo sometimes got worse. Part of the article was a discussion of what, if anything, the medical community can do about placebos. The fact that placebos ever work at all sort of undermines everything. Plus, can you imagine if a doctor prescribed a placebo and the patient died? If that story ever came out the doctor would lose everything, risk jail time and probably bring down the hospital or his practice with him.

    So, that article got me thinking. I tried finding a copy of it online but no luck. I did find three others at the New York Times which I'll link to below.

    I'm about halfway through reading The Serpent and the Rainbow. It's the true story of a botanist (actually his study is much more narrow than that but let's just say botanist) who travels to Haiti in search of the origins and the make-up of the zombie poisen. He delves into the Voodoo, or Voudoun, culture and becomes something of a believer. There was a movie a couple years ago starring Bill Pullman which adapted this novel. The movie was pretty damn scary but didn't go into all the detail that the book does.

    One of the more interesting assertions in the book is that it's not just a poisen (which is real) but a culture that creates the zombie. It's the whole belief in voodoo which ensure that a person who is given the poisen will act in a zombified manner. If you were raised to believe in zombies and everyone around you believed in zombies and then you were buried alive and resurrected from the dead, whether or not you could act normal doesn't matter. Friends and relatives will shriek upon seeing you, you will be banished from their villages and your fate as slave labor will be sealed.

    The author goes into much detail about the history of the undead and the hysteria in Victorian Europe over the fear of being buried alive. He also draws a cultural parallel with the fainting spells of women at the time. Some say that it was the tight corsets of the era that caused women to faint. However, he points out that fainting was a socially acceptable way for women to deal with uncomfortable and/or frightening situations. As a woman, you were expected to faint. It was ladylike.

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    These are some things rattling around in my brain lately. Now, I'm off to buy sneakers and head out to a baseball game, Portland Rockies vs. Oregon Timberjacks. (Watch out Timberjacks!) The question is, are my sneakers really worn out or do I just think they are because I know how long I've had them.

Three articles from the New York Times, choose the title to view it here or the NY to view it on their site:

  • Sham Surgery Returns as a Research Tool (NY)
    "...The National Institutes of Health paid a young cardiologist in Seattle, Dr. Leonard A. Cobb, to conduct a novel test of the Fieschi technique. Cobb operated on 17 patients. Eight had their arteries tied; the other nine got incisions, nothing more. In 1959, the New England Journal of Medicine published his findings: The phony operations worked just as well as the real thing."
  • Placebos Prove So Powerful Even Experts Are Surprised (NY)
    "...Scientists, as they learn that the placebo effect is even more powerful than anyone had been able to demonstrate, are also beginning to discover the biological mechanisms that cause it to achieve results that border on the miraculous. Using new techniques of brain imagery, they are uncovering a host of biological mechanisms that can turn a thought, belief or desire into an agent of change in cells, tissues and organs. They are learning that much of human perception is based not on information flowing into the brain from the outside world but what the brain, based on previous experience, expects to happen next."
  • Enthusiasm of Doctor Can Give Pill Extra Kick
    "Physicians can even fool themselves. Years ago, researchers carried out controlled studies of a drug for angina or heart pain and found it was no better than a placebo, Molerman said. Once doctors knew that, its effectiveness fell."

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