Sunday, October 26, 2008

Placebo or not?

Ora from New York City sent me an interesting article on the use of placebo by doctors: see here. The article explains that many doctors are using placebo (pills without any effect on the condition) to improve patients' well being by exploiting the placebo effect. The placebo effect is quite powerful. For example, let us take 900 patients with chronic headaches and divide them in three groups and give them either: nothing, a pill that does not contain an active compound, or Aspirin / Paracetamol. The winner is Aspirin / Paracetamol, but the second place is not shared but won by the placebo pill even though it contains no active compound. How is this possible? Here are possible explanations: you convince yourself that you feel better and override your body's feedback (it is a bit like putting your headphones on mute for 20 seconds when your girlfriend or parent launches into a tirade! :-), you feel better and more confident and your brain might release pain-killing neurotransmitters (putting yourself on drugs or natural painkillers), and so on. Placebo works better for some conditions than others.

An interesting challenge is the following: so if placebo works well, should doctors not use placebo, i.e. tell their patients that a pill works and then it works! Most alternative medicine is probably due to the placebo effect: you go to the practitioner, s/he talks to you, makes you feel better, and then gives you a placebo which he and you of course genuinely believe is working. And in the end it really helps. That's the paradox.

How about stuttering? There is a clear effect in the drug trials. I am convinced it plays a role in altered auditory feedback devices and conventional speech therapy. So does this mean that we should not use them? Someone could argue: Well they give more fluency, so who cares that it is placebo! My answer would be: yes short-term fluency gains but not long-term. And that's the key issue: placebo works well in the short-term.

5 comments:

Olivier said...

The placebo effect has already been measured by IRM...Of course, it's a short-term 'treatment'

Anonymous said...

IRM?
Lynne

Olivier said...

Sorry. MRI. I'm French

Anonymous said...

Placebo is the most powerful medicine ever invented, says my friend the psychologist . I think it could work in the long term, too. When a stuttering person experiences fluency and experiences the skills to speak and communicate easily, these skills will not vanish. Even the fluency mustn't vanish.
jm2C K.

ig88sir said...

hello jim2c k,
for a great percentage of us the fluency does vanish. I'm proof right here! I can be perceptibly fluent for 10 minutes and then have a moderate stutter for the next 10. Without warning. It's actually very exciting!