Wednesday, January 7, 2015

How Important is the "Placebo Effect" in Health Care? Proposing Questions for a Paradigm Change.

Technical Definition: 
pla·ce·bo ef·fect
noun: placebo effect; plural noun: placebo effects
  1. a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment.

    Why is the "Placebo Effect" important in Healthcare? It has to do with a very seemingly difficult part of healthcare that is largely left out of patient care, yet has provable tremendous effects on the outcome of care!  That is.........the patient's "belief" about a treatment or proposed outcome. Placebo effect is known to have around a 30% effect, give or take. What this means is that roughly 1 in 3 patients (or 30 % of the time.....or more) will respond to a treatment by simply "believing" it will work even when given a fake/ sham treatment. For Example: Drug companies will test "pill X" against a "fake or Placebo - sugar pill" and what is found is that even if a patient is given the sugar pill and not the real medication (say for High Blood Pressure) that somehow roughly 30% + of patients will respond favorably as though given the actual medication. The effect of Placebo is beginning to take a real foothold in some schools of thought in healthcare, both positive and negative as its effects are undeniable. Medical Schools such as Harvard Medical School are in the forefront of these types of studies. Individual MD's, such as Bernie Siegel, MD (ref) are also taking the positive effects of Placebo into effect in active practice. Dr. Siegel's book "Love, Medicine, and Miracles" (1986) is a very well-known text on this topic and compassion and miracles in the healthcare of his patients.

    If the concept of Placebo has been so vigorously tested that we know the belief of an individual has a 30% or better effect on the outcome of their care, then doesn't the Placebo effect in and of itself prove as strong influence on the effectiveness of care in general? If we trust enough in the Placebo Effect and we actively test against this effect on patients, then why do we not actively "use" it in helping patients get better with any care rendered? The Placebo effect is proof that we are not just machines like cars where parts can be removed and replaced without any attention to the thoughts, and emotions. To the contrary, it would seem that Placebo may be as high as 30% +/- of effective patient care in a more well-rounded Health care model. Unfortunately it is all too often taboo to address "belief systems" as a part of patient care. This leaves a major part of healthcare unaddressed all-together. Each patient comes to us with "hope, " therefore why do we not better use this hope in an effective manner to help the healing process? We would like to believe that the medication or treatment either works or doesn't in an effective and predictable manner and that the patient's thoughts, feelings, or emotions has nothing to do with it.........many patients actually hear a version of this from many of their healthcare providers even today. The fact is that patients are still too often treated like unfeeling machines when we know better scientifically. Even in fields such as Conceptual Physics, Quantum Mechanics, etc, we have a testable, yet little understood, knowing that Consciousness itself is one of our largest frontiers in all fields of science. For the most part, the only field of Healthcare that seems to attempt to regularly address this component of the individual is psychology and psychiatry. If an individual's consciousness has such a powerful effect on their entire being, much less how well they do or do not heal, then how do we focus that consciousness on the in-born power and ability for the patient to be the primary component of healing themselves. How do we make this a more effective part of effective patient care in our current healthcare system? Or do we continue to leave it out as a mere benchmark indicator for testing purposes alone?

    It is my opinion that every health care practitioner in some way encounters the Placebo effect in each of their patients whether the know it or not and whether they address it or not. What I mean here is that every patient has both an emotional involvement as well as expectations and hope regarding any procedure or treatment they may be undertaking due to some condition they "have." In this sense it becomes obvious that I believe "Placebo" exists in each treatment at some level regardless, and this is due to the fact that we are ALWAYS encountering a Patients "belief system" regarding any treatment that might be administered. 

     The question then becomes "How do we work positively with a patients expectations and hope to more effectively attain the desired outcome of improved patient health?" The first step would likely begin with simply asking what the patient's "expectations" are of any treatment. The most difficult part might then be the second part of actively using the hope and determination of each patient to structure or optimize the desired outcome. Again, Dr Siegel has an interesting approach of effectively using forms of "visualization" to actively aid in the "benefit" of therapies such as Chemo-therapy. Third, is how do we effectively create a "system" of the expectation/ hope dynamic for "different" patients? Forth, how do we then implement what will likely be a varied "system" based upon different fields of healthcare? 

    To begin with, many patients are not "neutral" to a particular treatment and have a particular and deeply help "belief" about  treatment X, Y, or Z. Therefore, if we have a way of determining those patients with certain beliefs Pro or Con ( As both can be powerful aids or detractors from the intended outcome of health), perhaps certain treatments can be "paired" with patients seeing / believing more strongly in the benefits of these treatments. Perhaps we can begin with "pairing" patients with treatments they believe in more powerfully. What then is also the potential for influencing a patients "perception" of a treatment to maximize the benefit? 

    In the end it would seem that as health care providers we are actively interacting with a patients "choice" regarding any treatment. We acknowledge this more and more across all the forms of healing. Will we be able to more specifically "structure" programs in order to more positively impact patient choices for the best possible outcome and more proactively utilize the "placebo effect?"

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