Strength of Belief

I was thinking about the placebo effect the other day, and it reminded me of this excellent article on the matter at Wired Magazine. The article points out that:

“It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.”

And that seems to be true across the board. It is not that people seem to believe in the healing power of pills so much that they get better, regardless. It is that they believe in modern medicine in general.

And that belief is getting stronger. It is simply amazing how many patients walk out of my consulting room feeling immediately better, simply because they have “seen the doctor” and are clutching a script. Some feel so good, they don’t even collect the script! Least you think I am bragging, this is true for any doctor who instills confidence in his patient. And this placebo effect appears to work well on children as well, even small children and babies who have no understanding of medicine (in their case, I assume they are just collecting the good feelings from their parents and feel comforted).

Admittedly, when I am talking about placebo effect in this context, I am talking about a feeling of well-being, rather than the alleviation of a specific symptoms. But both types of placebo effect seem to rely on that same unwavering belief in the efficacy of medicine.

It is all a little humbling.

It is for this reason that I tend to have a relaxed attitude to the large number of people who come through my consulting room every day who have little or nothing wrong with them. Chances are that I will do them good, even if I provide them with a bit of symptomatic relief. And as long as I can still get to the people who really need to see me, I don’t have much of a problem with this.

You might consider it a waste of money, but these people have as much right as anyone else to feel well – and medicine is really about making people well, rather than simply curing disease.

It is also for this reason that I have a fairly relaxed attitude towards my patients accessing alternative medical therapies. If it makes them feel better, then I consider it a good expenditure of time and money, regardless of what our evidence based world-view says. My only problem with alternative medicine is that it sometimes attempts to use its placebo influence on a truly serious medical disease that needs proper conventional treatment. At that point complementary alternative medicine (CAM) and I part company. It does not impress me to watch a diabetic patient destroy his kidney function because some charlatan thinks that waving a few crystals over him will cure him of his diabetes. When CAM does no harm, then they and I are just fellow snake-oil salesmen, doing a bit of placebo placating. When CAM gets in the way of  the need for real treatment, then they break the first rule of healing – the rule that has lasted nearly 2,500 years – “First do no harm”.

That’s the trouble with belief. It is a powerful force when focused on something that is true, but a dangerous one when focused on falsehood. The placebo effect can be a powerful tool for healing when harnessed. But it is still doing nothing.

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