The Placebo Effect

Have you ever heard of the placebo effect? Most people have, but if you haven't, I'll give you a quick rundown. The word placebo literally means (in Latin) "I shall please," and has come to describe a treatment that causes a patient to feel better because the patient believes it will work. There was a time when a physician could write a prescription for a placebo pill, but due to lots of ethical brouhaha, that is now considered a breach of doctor-patient trust. Interestingly, most physicians have given their patients placebos, although they come in the form of dietary supplements, unique vitamins and the traditional "You'll be better in a few days," instead of the old-time sugar pills.

We live in a society that has created an "all or nothing" form of healthcare. If someone goes to their doctor complaining of a sore throat, runny nose and a "fever" of 99.2, they better receive some sort of medication. In most cases, and especially in situations where a previous doctor/patient relationship doesn't exist (i.e., urgent care clinics), the above patient would want some sort of antibiotic, and maybe even a pain killer for their throat. It doesn't matter that the patient probably has a viral infection, and therefore would receive no benefit from the antibiotic, or that a gargle of warm salt water would help their throat as much as a Lortab, they "want it all," and would be very angry if the physician simply said, "you'll be better soon, just rest and let yourself heal." My only patient this AM at the county clinic was one such individual.

He was in his mid 20's, and when I entered into the exam room, two things struck me as odd. Number one, he was wearing a tank top tucked into his jeans. Never mind that it was in the 30's this morning, this guy worked out and wanted everybody to know. Number two, the woman that was with him, who I assume was his girlfriend, was about 6'2". He was approximately 5'6". I guess there really is someone for everyone. Anyway, after introducing myself and asking what brought him to the clinic, he told me, in a very quiet whisper, that he had been sick for two weeks. He stated, however, that he was feeling better now, although he still had a cough that "occasionally makes me have to turn my head to cough stuff up," in addition to "annoying laryngitis." He went on to let me know that he was never sick more than one day, and that the guys at work were worried because his voice was gone. I asked him if he had taken any OTC medication, to which he responded that his friend had lent him some antibiotics a day ago, and although he couldn't remember the name of the drug, he knew that the pills were green. Obviously I knew the medication based on the pill color...oh wait. He then proceeded to show me that he could still yell by giving an example of what he yelled at work - "Hey you motha' f*ckers, you f*ckin' need to get back to work before I f*cking feed your balls to your mom." I told him that yelling could prolong his vocal healing time, and that that alone could explain the reason for his laryngitis. He then asked me, "So if I don't yell, how am I supposed to give people directions?" I told him maybe he should buy a bullhorn, or write his instructions on picket signs. He said that that wouldn't help, and then stated, "I guess I'll just use my eyes," after which he proceeded to squint "menacingly." At this point, I performed my physical exam, which was normal, and told him that he appeared to be getting over a cold, and that things would heal on their own without any help from me.  Of course he was not happy with this, and said, "But I never get sick, what if I have pneumonia or something." I responded by saying his lungs were clear, and that the green pills had probably helped out, and since he was out of them, he probably didn't need any more. In addition, I told him that hot tea with honey could help his voice. He was adamant in wanting some medication, however, so I wrote him a prescription for an over-the-counter cough syrup. The change in his mood was almost magical, and he walked out of the clinic with a smile on his face. In an instant I had gone from being a bad doctor to a good one by simply writing the word "Robitussin" on a script pad.

This is one instance where being able to write a prescription for a placebo pill would have been extremely useful.  The patient obviously wanted some sort of medication, and while I didn't think he actually needed something, the change in his attitude was apparent after I wrote him a script.  I know that the placebo issue causes lots of debates about trust and medical misdirection.  Opponents of placebos state that prescribing them violates the Hippocratic Oath - the oft quoted "First do no harm."  What many physicians forget is that the Hippocratic Oath goes far behind this, and states "As to diseases, make a habit of two things.  To help, or at least, to do no harm," and can we not say that giving patients placebo pills is helping them?  It's amazing to me that you can say, "you'll be fine," or "your symptoms are normal," until you're blue in the face, but if you hand someone a 3x5 piece of paper with some scribble on it, you instantly transform into some sort of medical superhero. We tend to forget that we haven't always had antibiotics, and amazingly enough, the species didn't die off. The body has an innate capability to heal itself, and while medication or surgery can amplify that ability, so can physical contact, a good diet, or something as simple as the right word.

And now, the disability quote(s) of the day,

"I can't work because I get fired. No one will hire me, not even Wal-Mart."

You'll be fine,

-DD