The Effect of the Placebo

By Shawn Vuong

I find it extremely interesting that Dr. Holm would bring up the power of faith and hope in the relief of pain and suffering, so closely to the article the British Medical Journal recently published about placebos.  

The study found that nearly half of the physicians that responded claimed that they regularly prescribed "placebos" to their patients.  So any reasonable person should be asking themselves, 'Hey what's going on here?  These doctors sound like their engaging in some pretty shady behavior that could be effecting my health!'  

The New York Times also got wind of this journal article, and they question the ethical findings of the study's results.  A solo-family practice doctor thinks this maybe the media's "Gotcha Style" journalism at work.  The doctor points out that the survey in the BMJ study didn't use the word placebo even once.  

Kevin MD also stated that the effect of placebos can be very powerful, "however ethically incorporating the power of the placebo effect in everyday medical practice remains a challenge."

I believe that the faith that the patient has in his/her provider is just as important as the actual treatment.  While placebos have shown that they can have strong effects on many illnesses, this makes me question the real value of some medications.  Also, this brings up some questions about treatments.  Can some illnesses be cured through a mind over matter technique?  If so, do alternative medical therapies take advantage of this idea?  How does the traditional practitioner take advantage of this mindset?  Hopefully, it is not only through prescribing placebos.  

An Autumnal Festival of Faith and Hope

By Richard P. Holm MD

There is a very old Greek, then Roman, then Christian story of three pre-teen girls: Faith, Hope, and their younger sister Charity. They were tortured and killed with their mother while traveling along an early Roman highway. This apparently became the reason for an ancient yearly autumn festival to celebrate faith and hope in the face of suffering. 

The relief of suffering certainly was about the most important job of those first Greek physicians, and it remains so for physicians today. What's more, we are still using some of the same medicines they used back then, with opium-based narcotics to dull the pain of illness and injury.

We now know more about these important morphine-like pain relievers. Scientists have discovered that narcotics work by attaching to special pain relieving receptors in the brain, and we know that our brain makes its own pain relievers, called endorphins, when the occasion calls for it. 

We have even discovered an antidote to narcotic overdose called naloxone (Narcan), which works by displacing or pushing narcotics off from opiod receptors in the brain. I remember a big burly fellow, in a city hospital emergency room years ago, who was almost not breathing from what we presumed was heroin overdose. Right after I injected the naloxone, he came up almost off the table to try to choke me. I think he was angry for losing his "high".

One study about pain relievers has always intrigued me. In analyzing medicines for the relief of pain following childbirth, they found codeine gave about 80% relief, aspirin 70%, and placebo (a sugar pill) 60%. The amazing finding came when they gave naloxone to the patients receiving pain relief provided by a sugar pill (placebo) and it brought back the pain. 

How about that! Not just morphine, but also faith and hope work by providing pain relief through turning on the endorphin system, which we can measure and even reverse.& So when they say, "it's all in your head" you know that's the truth. 

Thus, in understanding narcotics and something more about Faith and Hope, we are better equipped to relieve suffering.

Take home message:
1. An autumnal festival of faith and hope came from an ancient story of suffering;
2. Narcotics have relieved suffering for thousands of years;
3. All kinds of narcotics and even the pain relieving effects of a placebo sugar-pill are reversible with a narcotic antidote or antagonist named naloxone;
4. Having faith and hope that a medicine will work is an important part of providing pain relief.