By Steven E. Hodes, M.D.
Physician to Meta-Physician
Through the fog of distant memory I recall my first clinical exposure to the concept of the placebo.
From the Latin I shall please , it was introduced during my medical school rotation in internal medicine. A ‘sugar pill’ which was labeled Obecalp [placebo spelled backward] was offered to patients in an attempt to demonstrate how often they fantasized or fabricated their symptoms.
When a patient ‘responded’ to a placebo pill, or an injection of saline, as opposed to an opiate for pain, the immediate assumption from the medical staff was ‘that the patient wasn’t really sick, or in pain, or just wanted to ‘get high.’
There was a definte consensus opinion among the medical establishment that ‘real’ pain or ‘real’ symptoms would only respond to an active chemical agent. Subsequently, it has become clear that this assessment was incorrect.
The emerging realityof the mind-body relationship has led many medical professionals to recognize that all symptoms as well as all physiological responses are the result of this totally integrated, sublimely complex matrix. Associated with this is how we perceive what is occurring to our bodies and how we react to those internal machinations.
Candace Pert and other researchers have demonstrated that nearly all human cells contain receptor sites for peptides released by our neuro-endocrine organs, endorphins which are natural pain killers and mood elevators. Our immune response cells, as well, can be activated or inhibited by our emotional state of being as well as our attitudes and beliefs about what is occurring to us. The expectation that a substance will relieve a symptom or complaint leads to improvement in those symptoms.
This result has been demonstrated to be so powerful that the FDA insists that drug companies demonstrate that their products are more efficacious than placebo before they will receive their approval. It may be surprising to the public that in a variety of ‘double-blind’ randomized studies [in which neither the patient or the people conducting the experiement know which is the placebo and which the active drug] the placebo produces from 35 to 45% improvemnt in the patient’s symptoms. The actual drug tested, which may have been the result of years of expensive research and development may offer only marginal improvement over these ‘sugar pills’.
These are not merely relegated to the relief of pain, which is itself impressive, but improvements in bowel function, heartburn, chest pain, joint discomfort, headaches and a whole host of symptoms are reported. What is also quite fascinating are the negative symptoms that patients in studies report as being secondary to placebos. Such a response is described as a nocebo result.
When issues of ‘cost-effectiveness’ are considered, it may very well be that the placebo, or obecalp would be hailed as the greatest breakthrough in medical science. Again, they demonstrate that a great deal of our body’s functional abilitity to maintain or establish a state of health or the process of healing may be influenced by our mind’s expectation or anticipation.
Physicians have long observed a vast range of ‘pain’ or symptom tolerance. There are patients of mine who have complained, for example, of severe heartburn symptoms. Upon observing their esophageal linings during endoscopy, however, I may find very little evidence of damage. On the other hand, I have scoped others whose complaints are barely discernible yet whose esophageal mucosa is horrendously ulcerated and inflamed.
My patients with ulcerative colitis or Crohn’s disease can nearly always associate an exacerbation of their symptoms with stress in their lives. The irritable bowel symdrome is a completely subjective account of abdominal pain, bloating and altered bowel function. One of the documented features of this syndrome is known as ‘visceral hypersensitivity’. These patients literally ‘feel’ physiological alterations that may remain below the level of awareness of a ‘normal’ patient.
More fascinating are the subconscious stresses which lurk below the level of awareness, yet still can ravage the neural complexes which line the gut. It is clear to me that the patient’s response to my recommendations also strongly depend upon how I approach their complaints, how carefully I pay attention to what these symptoms are revealing about their psycho-social and emotional lives and how positive I am about their eventual improvement.
The role of the physician or any other health care provider becomes a crucial component in the healing paradigm. The placebo reponse, rather than a sign of a patient’s misrepresenting or exaggerating their complaints provides support the contention that medicine is far from an exact science and that the mind-body relationsip is more potent than any of us can imagine.
© Steven E. Hodes, MD., 2006
Steven E. Hodes, M.D. is a board certified gastroenterologist with over 25 years private practice based in Edison and Old Bridge New Jersey. He also has a degree in Religious Studies and teaches Contemporary Metaphysics at Brookdale College as well as lecturing and writing on Kabbalah and Healing, the Jewish View of Afterlife and on Near-Death Experience. Visit him at his Blog, Physician to Meta-Physician at www.meta-md.com