In an interesting about face, researchers increasingly turn their attention to the placebo effect. Nor do they approach the subject as science-based myth-busters seeking to prove such responses reside all in the patient’s head. Or rather, they do hope to prove this by proving that placebos can and do cause beneficial changes in the brain and, by extension, in the body. The difference now is that instead of associating those brain changes with easily duped feeble minds, they see these effects as a way to decrease and in some cases eliminate the need for more physiologically and financially costly conventional treatments.
Although I never felt comfortable admitting this in the past, I’ve always linked the human-animal bond and the placebo effect. I didn’t feel uncomfortable because I viewed any perceived bond effects as evidence of sloppy science or a phenomenon limited to the weak-minded. Quite the contrary, I saw both as long ignored concepts that play a critical role (for good or ill) in human and animal health and behavior. Currently human medical research focuses on positive placebo effects with the goal of lowering spiraling healthcare costs that take many conventional approaches beyond the income of the bulk of the world’s population. Given that the bulk of the world’s animal population also lacks access to conventional veterinary therapy, exploring the value of placebos in animal physical and mental health has merit too.
So what are the current placebo studies revealing? Perhaps the one that got the most attention initially was Harvard psychologist Irving Kirsch’s meta-analysis of 47 trials of 6 of the most commonly prescribed antidepressants described in his book The Emperor’s New Drugs: Exploding the Antidepressant Myth. In that study Kirsch and his colleagues discovered that placebos could duplicate 82% of the benefits attributed to antidepressant drugs. When mental and medical healthcare providers prescribing these drugs considered the drugs’ cost and the number of people taking them, they quickly realized what a potentially huge savings in the cost of healthcare a better understanding of the placebo effect could mean. And naturally, that makes me think about the increasing population of animals on those drugs too.
The difficulty with studying the placebo effect arises from the fact that, unlike testing the efficacy of a drug or surgery in which researchers design studies to glean specific results from a specific population under specific conditions, placebo responses aren’t predictable. This makes sense because our subjective or emotional contributions to the existence of certain illness or injury as well as our after-the-fact emotional response to any treatment may vary considerably.
Consider the human conditions that respond best to placebo treatment: pain, insomnia, fatigue, nausea, bowel disturbances, problems related to urinary or sexual function. All of these possess a strong emotional component because of the social or personal connotations such ailments may carry. On the other hand, placebo treatments aren’t effective with broken bones because such injuries typically don’t carry a comparable emotional charge. For example, a broken limb wouldn’t cause us to fear the mortification many of us would feel if we vomited or lost bowel or bladder control in public, or if we were unable to respond sexually to another.
Then there’s the fact that placebo treatments may produce negative side-effects, called the nocebo effect, similar to that of the “real” drug. A review of clinical trials by researcher Winfried H?user of the Technical University of Munich concluded that 50% of those receiving placebos in clinical trials experienced such problematic effects. (See “Beware the Nocebo Effect”) This research further reinforces just how powerful mind-body interactions can be.
Additionally the nocebo research reinforces two other interesting twists revealed by placebo research. The first is that the researchers themselves can alter the results based on how they define treatment success. Researchers who define the success of a placebo in terms of what they consider concrete evidence—for example some technological measurement such blood pressure or heart rate—would rate placebos as failures that other researchers who use the subject’s report of his or her own state of well-being as the criterion of success. The same problem arises when the placebo by proxy effect (called the caregiver placebo effect by some veterinary researchers) occurs in kids and animals.
This raises a fascinating but most complex question: Who should we trust more when it comes to evaluating how we or our animals feel and act? Ourselves or some point-in-time test result? While some of us may consider the answer to that question a no-brainer, we also may not agree on what that no-brainer answer is. For some of us, how we or our animals feel and act ranks as the obvious criterion whereas for others some test result is the gold standard. And not surprisingly, those within the medical professions must ask themselves a comparable question: Which do they trust more—what their patients (and any patient caregivers in the case of children and animals) tell them or their test results?
Just the thought of what the legal profession might say about this makes my brain ache! Sadly, I suspect that profession will raise the specter of sufficiently dire consequences of including the placebo effect into the medical process to block any kind of meaningful change in the medical professions in the near future. My intuitive feeling is that, lacking knowledge about the subjectivity and variability inherent in various medical tests currently in use, those in the legal community will continue to perceive these as something Dr. God sent down from the mountain and periodically updates. Something concrete and “real,” albeit totally man-made, that an attorney can use to dazzle a jury if necessary.
Other research into the placebo effect also addresses a difficult problem raised by placebos in the past. Traditionally clinicians didn’t disclose to patients that the treatment they prescribed was a placebo. This understandably raised legitimate ethical and legal concerns because, even if the clinician prescribed the placebo for what he or she considered the patient’s best interests, doing so still amounted to lying to the patient. But at the same time, this dilemma also suggested to some that the caregiver’s ability to communicate with the patient or, in the case of pediatric and veterinary medicine, the patient and the patient’s primary caregiver(s) might play an important role in the healing process.
Research into the role the physician-patient relationship plays in the placebo effect currently explores this aspect of the phenomenon too. In one study conducted by Ted Kapchuck and his colleagues at Beth Israel Deaconess Medical Center in Boston, patients with irritable bowel syndrome were divided into 3 groups: those put on a waiting list for treatment and those receiving placebo acupuncture. The team further divided those in the placebo acupuncture group into those who received the bare-bones doctor-patient ritual, and those with whom the clinician interacted in a meaningful and empathetic manner.
In this era of rising healthcare costs, the results of Kapchuck’s study suggest that even though time may equal money in conventional medicine, it may not equal quality affordable healthcare for the patient. Of those put on the waiting list for the known placebo treatment, 28% reported that their bowel symptoms improved; 44% of those who received the standard bare-bones response from the clinician improved; and 62% of those who received more, quality attention said they felt better.
Not only did the quality attention given by those in the study communicate the caregiver’s confidence and trust in him/herself as well as the patient, it also communicated empathy. And relative to the role of quality attention and communication in the healing process, once again those of us treating our own or others’ animals must go the extra mile. Communicating empathy to an animal means we must at least possess a grasp of how that animal perceives his/her world and the behaviors the animal normally uses to survive and thrive in that environment on a daily basis.
Granted when our animals succumb to problems, our automatic first response will be, “What does this mean to me?” And certainly communicating via our presence that we possess the wherewithal to successfully provide whatever support our animals need plays a valuable role at that time. But beyond that, the kind of communication that triggers the powerful healing effects of the mind-body also includes answering the question, “What does this mean to the patient?” The ability to perceive at least on some level what this physical and/or behavioral pain means to this particular animal (as opposed to how we’d feel as humans in those same circumstances) provides the empathy necessary for a maximum placebo effect.
In one of his many excellent essays, researcher/physician/scientist/philosopher Lewis Thomas wrote that he believed the medical profession took a giant step backward when the stethoscope replaced the physician placing his head on the patient’s chest to hear the heartbeat. That seemingly simple act erected the first of a series of technological barriers with their associated reduction in quality communication and empathy that now threatens to become a wall between the practitioner and the patient. The veterinary profession made a similar error when it chose to pattern itself after human medicine many years later. In both cases, the increased research in the placebo effect allows all of us to regain some of what we lost as we gain new appreciation of just how complex yet elegant the healing process really is.
If you have any comments regarding subject matter, favorite links, or anything you’d like to see discussed on or added to this site, please let me know at mm@mmilani.com.
In an interesting about face, researchers increasingly turn their attention to the placebo effect. Nor do they approach the subject as science-based myth-busters seeking to prove such responses reside all in the patient’s head. Or rather, they do hope to prove this by proving that placebos can and do cause beneficial changes in the brain and, by extension, in the body. The difference now is that instead of associating those brain changes with easily duped feeble minds, they see these effects as a way to decrease and in some cases eliminate the need for more physiologically and financially costly conventional treatments.
Although I never felt comfortable admitting this in the past, I’ve always linked the human-animal bond and the placebo effect. I didn’t feel uncomfortable because I viewed any perceived bond effects as evidence of sloppy science or a phenomenon limited to the weak-minded. Quite the contrary, I saw both as long ignored concepts that play a critical role (for good or ill) in human and animal health and behavior. Currently human medical research focuses on positive placebo effects with the goal of lowering spiraling healthcare costs that take many conventional approaches beyond the income of the bulk of the world’s population. Given that the bulk of the world’s animal population also lacks access to conventional veterinary therapy, exploring the value of placebos in animal physical and mental health has merit too.
So what are the current placebo studies revealing? Perhaps the one that got the most attention initially was Harvard psychologist Irving Kirsch’s meta-analysis of 47 trials of 6 of the most commonly prescribed antidepressants described in his book The Emperor’s New Drugs: Exploding the Antidepressant Myth. In that study Kirsch and his colleagues discovered that placebos could duplicate 82% of the benefits attributed to antidepressant drugs. When mental and medical healthcare providers prescribing these drugs considered the drugs’ cost and the number of people taking them, they quickly realized what a potentially huge savings in the cost of healthcare a better understanding of the placebo effect could mean. And naturally, that makes me think about the increasing population of animals on those drugs too.
The difficulty with studying the placebo effect arises from the fact that, unlike testing the efficacy of a drug or surgery in which researchers design studies to glean specific results from a specific population under specific conditions, placebo responses aren’t predictable. This makes sense because our subjective or emotional contributions to the existence of certain illness or injury as well as our after-the-fact emotional response to any treatment may vary considerably.
Consider the human conditions that respond best to placebo treatment: pain, insomnia, fatigue, nausea, bowel disturbances, problems related to urinary or sexual function. All of these possess a strong emotional component because of the social or personal connotations such ailments may carry. On the other hand, placebo treatments aren’t effective with broken bones because such injuries typically don’t carry a comparable emotional charge. For example, a broken limb wouldn’t cause us to fear the mortification many of us would feel if we vomited or lost bowel or bladder control in public, or if we were unable to respond sexually to another.
Then there’s the fact that placebo treatments may produce negative side-effects, called the nocebo effect, similar to that of the “real” drug. A review of clinical trials by researcher Winfried H?user of the Technical University of Munich concluded that 50% of those receiving placebos in clinical trials experienced such problematic effects. (See “Beware the Nocebo Effect”) This research further reinforces just how powerful mind-body interactions can be.
Additionally the nocebo research reinforces two other interesting twists revealed by placebo research. The first is that the researchers themselves can alter the results based on how they define treatment success. Researchers who define the success of a placebo in terms of what they consider concrete evidence—for example some technological measurement such blood pressure or heart rate—would rate placebos as failures that other researchers who use the subject’s report of his or her own state of well-being as the criterion of success. The same problem arises when the placebo by proxy effect (called the caregiver placebo effect by some veterinary researchers) occurs in kids and animals.
This raises a fascinating but most complex question: Who should we trust more when it comes to evaluating how we or our animals feel and act? Ourselves or some point-in-time test result? While some of us may consider the answer to that question a no-brainer, we also may not agree on what that no-brainer answer is. For some of us, how we or our animals feel and act ranks as the obvious criterion whereas for others some test result is the gold standard. And not surprisingly, those within the medical professions must ask themselves a comparable question: Which do they trust more—what their patients (and any patient caregivers in the case of children and animals) tell them or their test results?
Just the thought of what the legal profession might say about this makes my brain ache! Sadly, I suspect that profession will raise the specter of sufficiently dire consequences of including the placebo effect into the medical process to block any kind of meaningful change in the medical professions in the near future. My intuitive feeling is that, lacking knowledge about the subjectivity and variability inherent in various medical tests currently in use, those in the legal community will continue to perceive these as something Dr. God sent down from the mountain and periodically updates. Something concrete and “real,” albeit totally man-made, that an attorney can use to dazzle a jury if necessary.
Other research into the placebo effect also addresses a difficult problem raised by placebos in the past. Traditionally clinicians didn’t disclose to patients that the treatment they prescribed was a placebo. This understandably raised legitimate ethical and legal concerns because, even if the clinician prescribed the placebo for what he or she considered the patient’s best interests, doing so still amounted to lying to the patient. But at the same time, this dilemma also suggested to some that the caregiver’s ability to communicate with the patient or, in the case of pediatric and veterinary medicine, the patient and the patient’s primary caregiver(s) might play an important role in the healing process.
Research into the role the physician-patient relationship plays in the placebo effect currently explores this aspect of the phenomenon too. In one study conducted by Ted Kapchuck and his colleagues at Beth Israel Deaconess Medical Center in Boston, patients with irritable bowel syndrome were divided into 3 groups: those put on a waiting list for treatment and those receiving placebo acupuncture. The team further divided those in the placebo acupuncture group into those who received the bare-bones doctor-patient ritual, and those with whom the clinician interacted in a meaningful and empathetic manner.
In this era of rising healthcare costs, the results of Kapchuck’s study suggest that even though time may equal money in conventional medicine, it may not equal quality affordable healthcare for the patient. Of those put on the waiting list for the known placebo treatment, 28% reported that their bowel symptoms improved; 44% of those who received the standard bare-bones response from the clinician improved; and 62% of those who received more, quality attention said they felt better.
Not only did the quality attention given by those in the study communicate the caregiver’s confidence and trust in him/herself as well as the patient, it also communicated empathy. And relative to the role of quality attention and communication in the healing process, once again those of us treating our own or others’ animals must go the extra mile. Communicating empathy to an animal means we must at least possess a grasp of how that animal perceives his/her world and the behaviors the animal normally uses to survive and thrive in that environment on a daily basis.
Granted when our animals succumb to problems, our automatic first response will be, “What does this mean to me?” And certainly communicating via our presence that we possess the wherewithal to successfully provide whatever support our animals need plays a valuable role at that time. But beyond that, the kind of communication that triggers the powerful healing effects of the mind-body also includes answering the question, “What does this mean to the patient?” The ability to perceive at least on some level what this physical and/or behavioral pain means to this particular animal (as opposed to how we’d feel as humans in those same circumstances) provides the empathy necessary for a maximum placebo effect.
In one of his many excellent essays, researcher/physician/scientist/philosopher Lewis Thomas wrote that he believed the medical profession took a giant step backward when the stethoscope replaced the physician placing his head on the patient’s chest to hear the heartbeat. That seemingly simple act erected the first of a series of technological barriers with their associated reduction in quality communication and empathy that now threatens to become a wall between the practitioner and the patient. The veterinary profession made a similar error when it chose to pattern itself after human medicine many years later. In both cases, the increased research in the placebo effect allows all of us to regain some of what we lost as we gain new appreciation of just how complex yet elegant the healing process really is.
If you have any comments regarding subject matter, favorite links, or anything you’d like to see discussed on or added to this site, please let me know at mm@mmilani.com.