Placebo

An Osho story tells about a doctor who went to a village in Bastar district. A patient approached him. The doctor scratched name of drug on a piece of earthenware as there was nothing to write on. He said ‘levigate this drug in milk and take it for a month’. The patient returned back after one month. Doctor asked, ‘how are you now?’ He replied, ' Fine. Please give me another piece with name of the drug written on it’. The doctor was surprised and asked ‘what do you mean?’ Patient said ‘that piece of earthenware is worn out now. It was a very nice medicine.’

This is an excellent example of healing a disease without drug. In Ayurveda, Charakacharya says,' There is nothing like a non-drug in this world – everything can work like a drug'. If a patient forgets his ailment on hearing a song then that song is his drug. Though not a simple concept, these examples certainly prove importance of placebo.

Placebo means a drug that appears similar to the original drug but does not have any pharmacologic action. Getting admitted in a hospital for weakness and infusing intravenous ‘saline’ is also a type of treating with placebo.

Placebo can be useful in a few situations. Pain relief due to placebo is known to be related to opioid chemicals in brain. Placebo effect is, therefore, considered as physical rather than purely psychological. It appears that efficacy of placebo depends on several factors such as patient's personality and expectations, behavior and personality of doctor, doctor-patient communication, nature of the disease, and the cost and form of placebo. Pain of arthritis is a subjective perception that cannot be measured properly. The disease too keeps on varying in the severity. Placebo thus appears to be effective in 20-25% patients of arthritis.

Patients have their own ideas and expectations about their disease. Some patients feel better just by visiting their doctor. One school teacher came all the way from Latur city to see me for neck sprain. He started feeling better in the clinic reception itself! Any drug prescribed by a trusted doctor is good for that particular patient. Thus doctor- patient communication is extremely important. Having faith in the drug is also essential. Importance of this faith is rightly stated in the ancient Hindu religious text Vishnushodashnam “Aushadhe Chintayet Vishnum” (invoke Lord Vishnu while taking medicine). Some doctors have placebo personality. Their personality, their demeanor is such that patient feels better on getting any drug from him. Such doctors with their speech and behavior can increase efficacy of the drug. A placebo given by a loving, sympathetic and prompt doctor is more effective. A study was conducted at an electric company in Hawthorn (Australia) since 1924. This study showed that production increases if the employees are motivated properly. This is called Hawthorn effect. Earlier recovery is possible if the doctor communicates well with the patient, if all doubts of patient are cleared, if patient is reassured and made well-aware about the disease. Doctor's attire, behavior, voice, wording, body language and atmosphere of the clinic can also have such effect.

A study concluded that homoeopathic drugs are effective due to the communication skills of the doctor and not due to direct effect of the drugs. The form of drug is also important in this respect. A placebo injection is more effective than a placebo tablet. Some patients get pain relief for 2 days though half life of the tablet administered may be just 8-12 hours.

Intravenous injection is more efficacious than intramuscular one and a surgery is much more effective than any injection. Headache is sometimes relieved by an expensive investigation such as MRI. The chest pain of angina can stop after opening chest in an operation theater without correcting the blocked vessel. Piercing needles as in acupuncture or vomiting, enema or application of leeches as in Ayurveda panchakarma are useful in some cases. One may postulate that very nature of these treatments leads to placebo effects.

A Cochrane review concluded that placebo treatments produced no major health benefits, although on average they had a modest effect on outcomes reported by patients, such as pain. However, the effect on pain varied from large to non-existent, even in well-conducted clinical trials. Variations in the effect of placebo were partly explained by variations in how trials were conducted, the type of placebo used, and whether patients were informed that the trial involved placebo.

Over 50% physicians in US prescribe placebo treatments in various forms though international guidelines do not allow doctors to prescribe placebo. Placebo medicine is allowed only in clinical drug trials after obtaining necessary approvals from government agencies and institutional review boards.

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