For people dealing with medicine, the word placebo may mean many things. I remember what F. K. Yap told me. He brought some rodent tuber plants to show a patient in a hospital in Kuala Lumpur. A young doctor rebuked him. “The efficacy of the plant had not been proven”. However, for Yap, this tuber was the very plant that had saved his life and made him cancer-free! (Note: a classical case of theory vs. practical wisdom). The doctor said: “For all that you know,it was just a placebo.” This remark means that the curative effects of the tuber are not real and are just a matter of suggestion to the emotional mind. When said in the context of traditional medicine, the remark may also imply “fraud, bluff, imagination or even an attempt to cheat or take you for a ride.”
Placebo means “to please” in Latin. When patients come to see their doctors, chances are that they will respond to the doctors’ treatment, as long as they believe in the doctors and their drugs. The drugs could only be sugar pills or mere plain water. They still work! That is the placebo effect. For example, when you see a doctor for influenza, you are prescribed antibiotics and advised to go home and rest. Within a week, the flu is gone and you are well. Do you think it is the antibiotic that heals you? Probably NOT. Why? Antibiotics do not kill viruses! It is actually your confidence and belief in the doctor’s abilities and not the drugs prescribed that helped heal you after seven days! That is the placebo effect. The giving of antibiotics is just to delude your mind into thinking that you will be healed. When you have influenza, it is your body that does the healing, given the proper rest, nourishment and mental condition (in this case, a belief that you will be healed). You do not need to take the antibiotics or even see a doctor for such a problem! Your body heals itself within a week (against seven days with antibiotics?).
People dealing with medical drugs love and hate the placebo effect! They love it because this allows them to sell a sugar pill as medicine and make money! One classical case of a great money-spinner is the pill for depression widely used in the US. Research has shown that the drug’s effectiveness is more likely due to the placebo effect and not the active ingredient. People who take it feel good because their doctors prescribe the drug and they fully believe that it is good for them.
Drug companies know the powerful effects of using placebos, and they too, play the game. Hence, before launching a new product, a massive publicity campaign is carried out to inform the public of this new drug’s effectiveness and benefit. Subsequently, news reports play to the tune, and hype the benefits of the ‘breakthrough’. Doctors and patients are led to expect and believe what the reports say. In actual fact these could be the work of those in the marketing department! Everyone is primed for the new drug and bravo — a miracle occurs for patients worldwide!
Research has shown that after a while, the novelty of the new drug wears out. When this happens, more and more people begin to suffer from its side effects, and eventually, doctors and patients begin to lose confidence in that miracle drug. When people lose confidence, that same drug does NOT remain effective anymore.
The next time you get to see your doctor, “sinseh” (Chinese physician) or “bomoh” (sharman), pay attention to those many certificates on the wall in his office: frames and frames of certificates on the wall; his very proper attire, neck tie or long beard; his astounding knowledge — seen in the use of his language of healing or in his scientific gadgetry; etc. All these are important paraphernalia to boost your confidence in him and elicit that placebo effect. Remember that the key to all healing is confidence and belief in your healer and what he does.
Why do some people hate placebos? Common sense tells us that you do not need to see a doctor for influenza. Just stay home and rest. Your body heals itself without the aid of any drug. Taking drugs is just a placebo, i.e., you want to feel safe, protected or cared for by someone. Since a placebo cannot be packed into a capsule and sold in the stores, no one can make much money from it. My doctors are rather honest with me, they asked, albeit reluctantly, if I need antibiotics or not. Most of the time, I ended up not taking any at all. Instead, they emphasise the use of warm salt water for gargling! That is one standard advice my doctor gives me every time I turn up with influenza. Now, I have stopped seeing him when I am down with flu. I take my flu herbs instead.
A placebo can be a powerful medicine, but unfortunately, not much is written or said about it. Neither is there any extensive research carried out on it. Nobody is going to make any money from such knowledge. Vested interest groups would be contented to exploit the advantages and benefits of the placebo effect while at the same time publicly denouncing its role, especially when it involves alternative medicines. Either way, the placebo effect serves their agenda.
In the process of evaluating the effectiveness of a drug, the effect of placebos can be a nuisance. To get around this problem, drug-researchers carry out double-blind experiments. This involves testing a drug with a dummy version; a drug containing no active ingredient. That is one-blind. The second-blind is that neither the doctors nor the patients know who are taking the real pills and who take dummy ones. In this way the placebo effect or the power of suggestion is eliminated in any drug study.
So, let us go back to the case of the rodent tuber plants taken by Yap. His statement that the plants helped and cured him, is in fact a powerful suggestion. Even if there is nothing much in the rodent tuber, it may still help the patient if he believes in what Yap says. But the learned doctor was upset and said it was simply a placebo. But a more enlightened mind may wish to ponder much harder and deeper — what is so wrong with a placebo effect? If it helped Yap with his cancer and if it can help others as well, let placebo be the medicine. Indeed, medical literature recognises this placebo effect and encourages it.
Many people like to point out that taking herbs is taking a placebo — a figment of the imagination. I am saying to all sceptics that taking herbs is NOT a placebo. The effect is real. If the herbs have a placebo effect, then all the better. Effectiveness and the placebo effect combined make an effective brew and can give a miraculous result. A herbalist or healer who is knowledgeable would treat a placebo as a friend and take advantage of its benefits.
Nocebo – the Power of Suggestion for Evil
While the word placebo is known to many people, the word nocebo is rarely heard of. The nocebo effect is the negative counterpart of the placebo. This word is derived from Latin meaning inflicting damage. As explained earlier, mere thoughts and emotions can generate very real physical reactions which can bring about positive (placebo) or negative (nocebo) effects. Indeed, these two are the same phenomena but have opposite results. The same requirement of belief is required to bring out their effects.
Voodoo or Bone-pointing
One good example of a nocebo is voodoo, a ritual practised by the aboriginal tribes of Africa, South America, the Pacific Islands, Australia, New Zealand, etc. A witch doctor can put a curse on a person in the community by chanting and pointing a bone at him. Dr. Herbert Basedow (Voodoo Death, American Anthropologist 44: 169-181. 1942) wrote that the man “being boned is indeed a pitiable sight. He stands aghast, with his eyes staring at the treacherous pointer … his hands lifted as though to ward off the lethal medium … his eyes become glassy, the expression of his face becomes horribly distorted … he attempts to shriek but the sound chokes in his throat … (there is) froth at his mouth. His body begins to tremble and the muscles twist involuntarily. He sways backwards and falls to the ground … he writhes as if in mortal agony, covering his face with his hands, begins to moan.” Death is expected to come in no time.
Voodoo death has been a subject of study since the 16th century. For a voodoo curse to become a reality, the following must happen:
1) The victim must believe that the witch doctor who is pointing the bone at him has that magical power to harm him.
2) The victim must feel that he is totally powerless to do anything to save himself from this curse. This attitude of helplessness is essential.
3) The members of the tribe to which he belongs, e.g., the family, friends, etc. need to exert social pressure and reinforce his belief that he is helpless and going to die because of the curse. He becomes a social outcast and is abandoned by both friends and family. They treat him as if he is already dead. He feels obliged to die.
Voodoo death is psychogenic death. Psychogenic means brought about by the mind. Take note that it is not caused by the mind. Cause and brought about are not the same. An occurrence that is brought about by the mind is based on emotional logic and works on the emotional mind. It does not follow rational thinking at all.
Voodoo death is brought about by the power of suggestion based on a wrong belief system. In actuality, it is self-induced. Is there any scientific basis for such a death? Yes, indeed. W. S. Kroger (in Clinical and Experimental Hypnosis) wrote: “If a suggestion becomes a conviction, it has the power to produce an appropriate response in the body… it is known that thoughts based on conviction can heal or kill.” Dr. George Engel, professor of psychiatry at the University of Rochester Medical Centre (in Annals of Internal Medicine 74: 771-782) found out that “extreme feelings of hopelessness and helplessness produced sudden death.” What is the expression “he dies from a broken heart” supposed to mean?
The following are some examples of research to illustrate how placebo or nocebo effects are elicited.
1) Imagine that you go to a doctor for a chronic problem. You are prescribed some drugs and are told that they may or may not work. From that short encounter with the doctor you sensed that he is not sure of what he is doing. What do you think would be the outcome of your treatment? On the other hand, you go to another doctor and are told that the drug he is giving you is the best and most effective in the market. He is sure that it is going to be effective and you believe that he knows what he is doing and saying. The visit to this second doctor would probably bring about an effective outcome even if both doctors prescribed the same drug.
2) A study was made in England in 1987 with patients visiting a clinic because they were suffering from a wide range of illnesses. The patients were randomly assigned to two groups. In the first group, the patients were given positive conditioning. They were confident in the diagnosis and positive in the prognosis. In the second group the doctor was unsure and pessimistic. The study showed that 64% of patients in the first group became better within two weeks, while only 39% of those in the second group were better for the same period.
3) A study was done at the Massachusetts General Hospital, USA, to show how a doctor’s caring attitude could alter the expectation of a treatment and recovery rate from surgery. In this case, a placebo or nocebo effect could have resulted. The patients were divided into two groups. Since this was a double-blind experiment, no one, i.e., doctor, hospital staff or patient knew which group each patient has been assigned to. Before the operation, an anesthesiologist talked to each person in the first group on the normal perfunctory basis. The anesthesiologist, however, devoted a few extra minutes and was extra nice to those in the second group. He tried to establish a personal bond and listened to the patients’ worries, answered their questions and gave them assurance and encouragement.
After the surgery, the results showed that:
1) Patients in the second group asked for half as much of pain killer medication as those in the first group.
2) Patients in the second group recovered from the operation sooner than those in the first group.
3) Patients in the second group were discharged from the hospital on the average 2.7 days earlier than those in the first group.
The above illustrate that the placebo or nocebo effect can affect the body’s physical conditions in a very powerful and real way. What the mind perceives may be translated as reality. The placebo or nocebo effect works. This effect is not a deception. If at all it is a deception, it is a deception in our head!
The placebo effect begets hope while the nocebo effect begets hopelessness, fear and anxiety. A sense of negativity increases susceptibility to illness and reduces the healing ability of the body. Physicians have known this since ancient times. However, with the mind being relegated to non-existence, modern physicians tend to treat their patients as if they are robots.
Sadly, many do not see the importance or consider as part of their noble duty, the act of uplifting the patients’ spirit to elicit the effects of a placebo.
It is in the treatment of cancer that such a flaw in thinking rears its ugly head and is at its worst. Very often, patients go home disappointed and devastated after being told that they have only two weeks or two months to live. The patients visit their doctors in the hope of obtaining some help, relief or cure. Some have to spend their life’s savings to treat their cancer. Fortunately or unfortunately, physicians are people in society who possess great power to elicit a placebo effect or inflict a nocebo counter-effect on the sick. Some of them even put voodoo curses on their patients. And they are paid for that!
Chris Teo, Ph.D.
For more visit: cacare.com cacare.com, CancerCare.com.my CancerCare.com.my
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