Holy mackerel, last week was a whirlwind! I usually like to spend a week gathering resources, writing, re-writing, and polishing up a post. It being the week before Halloween, the costumes needed to be completed, and the van needed wheel bearings replaced in which one day in the mechanic’s shop wasn’t long enough to finish the job. On top of that, I’ve been sick with a nasty cough that was making my daughter nervous all because she’s reading a book in which the main character’s mother died. The poor dear. It’s just a cold! But I did manage to hire her for $5 to feed her younger brothers breakfast and keep them all entertained for the morning so I could stay in bed and rest. So I apologize for the delay in part deux on placebos.
Placebos, Nocebos, Do-Si-Do!
A placebo is defined as a medically inert substance or technique, which is administered like a drug. As the staple negative control in clinical trials, placebos play a critical role in modern medicine. The placebo effect refers to the well-documented phenomenon in which patients feel better after receiving a placebo. In other words, the mere thought that a treatment has been received causes a beneficial physical response. (1)
To test a new medicine or treatment, it is generally pitted up against a placebo in a clinical trial and must be able to perform better than a placebo group. This placebo may be a sugar pill, a cream with inactive ingredients, or even just smelly shampoo. (2)
I thought it would be interesting to read the research study I participated in but was unsuccessful in finding it. It could still be finishing up as research studies do take years to complete. As for what group I was in… [drum roll please] … the placebo group. My slow and steady improvements could be attributed more to therapy sessions, but the side affects I thought might be from the medication were my own.
Fascinating how placebos can have effects even when they might just be an inert pill, huh? Our own expectations can influence how a medication works, as seen in this study – Pricier Meds Mean Worse Side Effects, Thanks to ‘Nocebo’ Effect – where those using what looked to be more expensive placebo cream reported more negative side effects than the other cheaper looking placebo group. Both anti-itch were placebos!
What’s the Harm?
So then, what’s the harm in taking a medicine that ends up being no better than a placebo if it appears to be providing some positive effects? Here’s one comic example:
In some cases, a placebo for pain management may be somewhat efficacious without contributing more side effects like an addiction to narcotic pain killers. In other cases, the delaying of or use of a less than effective treatment could have negative effects, especially when suggested by non-certified persons in place of properly trained medical practitioners.
Placebos cannot cure cancer or mend broken bones, but so long as they are of an inert substance (sugar, saline, etc) that cannot interfere with necessary treatment methods (ex. insulin for diabetes management, chemotherapy, antibiotics, etc.), the ethics of a placebo is an interesting topic to explore further. These are suggested guidelines for practitioners when choosing to administer a placebo:
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The intentions of the physician must be benevolent: her only concern the well-being of the patient. No economical, professional, or emotional interest should interfere with her decision.
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The placebo, when offered, must be given in the spirit of assuaging the patient’s suffering, and not merely mollifying him, silencing him, or otherwise failing to address his distress.
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When proven ineffective the placebo should be immediately withdrawn. In these circumstances, not only is the placebo useless, but it also undermines the subsequent effectiveness of medication by undoing the patient’s conditioned response and expectation of being helped.
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The placebo cannot be given in place of another medication that the physician reasonably expects to be more effective. Administration of placebo should be considered when a patient is refractory to standard treatment, suffers from its side effects, or is in a situation where standard treatment does not exist.
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The physician should not hesitate to respond honestly when asked about the nature and anticipated effects of the placebo treatment he is offering.
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If the patient is helped by the placebo, discontinuing the placebo, in absence of a more effective treatment, would be unethical. (5)
Improvement with just the right attention
One hypothesis hubby and I have discussed, is the clinician’s usage of time with patients. It seems like common sense that doesn’t need much research but sadly some doctors still scoff. As was noted in an editorial on aromatherapy, “Some have speculated that it is not the therapy itself but merely the increased time with a caring person that leads to improved outcomes.” (2) If one major goal is to improve patient outcomes, spending just the right amount of time as well as using the right words can have just as beneficial effects. Perhaps this is one reason some patients may choose practitioners of alternative medicine? But let’s leave discussions of that for another time.
In conclusion
After my participation in the study, I still felt the need for an added boost therefore, in addition to continuing therapy sessions, added an anti-depressant to my treatment plan so I could further regain control of myself and be a better mother.
Not all will choose medication for depression and that is okay. Therapy is also a great tool in the treatment box. It’s important that mothers realize that and not feel ashamed to seek help when those feelings of sadness, anger, and/or anxiety become unnaturally overwhelming and burdensome. Be it therapy, medication, or both, don’t ignore the demons of postpartum depression. You don’t have to fight them alone.
Bonus reading materials:
(1) More Than Just a Sugar Pill: Why the Placebo Effect is Real
(3) Pricier Meds … ‘Nocebo’ Effect
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