A little cough or a slight stomach upset, and Neharika Kapoor rushes to the doctor immediately. Blame her uncanny habit to ?fix things? and trust her to follow the doctor?s prescription to the T. The moment she pops in the medicine, she feels relieved. Just thinking that the medicine will make her feel better actually works for her. That?s something the doctor knows well enough to pamper her with. And, that supposed magic ?medicine? is actually just a placebo.
?When the mind feels positive, it has biochemical as well as psychological implications. A lot of our problems are due to psychological reasons and the placebo treats the stress factor or the psychological preoccupation,? says Dr Samir Parikh, psychiatrist with Max Healthcare.
Dr T Shringari, orthopedic with Paras hospitals, Delhi agrees: ?Even a suggestion of relief can have a significant analgesic effect.? A significant research in the domain, published in the journal Science, attempted to explore the mystery: The mere expectation of relief activated a part of the brain, indirectly reducing activity in the part of the brain that sensed pain. Sounds logical, does it not?
Researchers from Michigan and Princeton Universities conducted an equally interesting study ? they put volunteers inside MRI machines and subjected them either to electric shocks or heat. Pain, they found, activated the expected neural pathways. In the second stage of the study the volunteers were asked to apply a cream that blocks pain. Interestingly, the volunteers when subjected to shock and heat again, reported lesser pain than the previous instance. Oh! Except that the cream was nothing more than a body lotion of sorts.
?Cough syrups are a case in point. Most countries have banned it. In the US, the FDA has issued a warning that they should be discontinued. You would hardly find them in most European countries,? says Dr Raghuram Malliah, senior neonatologist at Fortis La Femme, Delhi. Malliah, as a matter of principle, refrains from prescribing cough syrup. ?Cough and cold are viral diseases and will continue for a week irrespective of any medication. Nothing can work like magic,? he explains.
?My child doesn?t eat too well? is another complaint he often gets to hear. So, does he recommend the trusted Liv 52? ?That?s 100% placebo. As an alternative, I counsel the parents to change the lifestyle of their kids. Encourage them to play, run and jog instead of watching TV and playing videogames. The appetite of the child would naturally increase,? he says.
One would question if placebos can really work for a child, who is not mature enough either to understand the disease or the medication being provided for it. However, there?s an explanation for that too. ?Most of the time we are treating the child as well as the parents. The child cannot express himself. All the communication therefore takes place through the parents. Trust me, 99 out of 100 times what they consider to be a problem is medically insignificant,? reasons Malliah.
However, placebos will not work in all cases. ?We can never treat a patient completely with placebos. Vitamins and micronutrients may act as placebos to help increase your appetite but in case of, say pain, we?ll have to administer painkillers to treat it locally. Additional placebos may enhance the potency of these drugs, but they can?t be relied upon for the entire treatment,? says Shringari.
Cardiologist at Lilavati Hospital in Mumbai, Dr Nitin Gokhale, too agrees. ?It?s fine as long as it psychologically helps the patients. Nearly 50% of the people expect the doctor to prescribe some medicine or the other ? that?s their idea of a good doctor. The other 50% are happier if they aren?t given any medicines at all. Personally, I see no point in over-medication.?
Wondering if the beneficial effects of homeopathy work in the same way? ?Placebos definitely work, and they work in all systems of medicine ? allopathy, homeopathy, ayurvedic …? says Dr Akshay Batra, deputy MD, Dr Batras Positive Health Clinic. In fact, it also depends on the comfort level a patient shares with his doctor or the trust he places in him,? he adds.
The mind-body phenomenon can definitely not be overlooked here. Ever noticed a doctor writing a prescription? If you have, you?d remember the doctor telling the patient in, well, detail, the benefits of each drug. The oratory exercise, rather, is part of the medication. One, it evokes trust in the doctor and two, helps the patient believe that the medicines really work. And creating that positive perspective, right at the beginning, goes a long way in the treatment.
According to a recent study, the more expensive a placebo, the more relief it can bring. The study, now published in the journal of American Medical Association, was conducted on 82 men and women. They were asked to rate the pain caused by electric shocks applied to their wrist, before and after taking a pill, described to them as a pain reliever. Half of them had read that the pill was regularly priced at $2.50 per dose. The rest read that it had been discounted to 10 cents. Care to know if the dummy pills helped? Well, both groups reported a strong placebo effect. 85% of those using the expensive pills reported significant pain relief, compared with 61% on the cheaper pills. The finding, authors believe, helps to explain why despite identical active ingredients, patients find generic drugs to be less effective than branded ones. So, next time instead of insisting (forcing) that your doctor should prescribe you a pill, try some mind power.
