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October 4, 2014
I've been nagged recently by a true believer about the existence of the placebo effect. Apparently there is research to show that there is no such thing and it was something invented by Big Pharma to explain why things that don't really work, like almost all of alternative "medicine", sometimes look like they do something. The logic seems to be that if there is no placebo effect then homeopathy must work. This bizarre form of non-logic totally ignores what placebo response really is. When a trial is done comparing a medication to placebo the intention is to separate the placebo response from the medication response, because theoretically there will be the same placebo response to the real medication as there is to the dummy pills.
I spent a lot of years studying psychology so I have some idea of the power of the mind to influence perception. Let me tell you about two times that I have experienced placebo response, knowing full well what was happening. That is, the effects of some medical condition were apparently minimised when no actual intervention had happened and I was fully aware of both the response and the fact that nothing had been done.
I suffer from migraines. Usually I get signs beforehand, such as visual effects, heightened sensitivity to sound and loud noises, and other heightened senses. One sign I get is very difficult to describe to people who have not experienced it — I can feel my hair from inside my body. It's as if a gentle wind is blowing across my hair and moving it slightly. On one occasion I had a sudden migraine attack with no warning. I had been at a meeting in the Sydney CBD and my car was parked almost outside the building. I chatted on the footpath with some of the other members of the committee before I got my car and set off to drive home. As I came off the northern end of the Harbour Bridge I had a sudden and very violent pain in the left-hand side of my head, coupled with visual aura. This came on, as I said, with no warning at all. As I was only a short distance from Royal North Shore Hospital I decided I should try to get myself there, I rang my family from my mobile phone and told them what I was going to do. I told them if they arrived at the hospital and I wasn't there to notify the ambulance to go and find me because I would be parked somewhere on the side of the freeway. I managed to make it to the hospital (when I came back out I found my car parked diagonally across four parking spots with the driver's door open, so I must have left it in a rush). I presented to the triage nurse in an obvious state of anxiety, and I was immediately rushed to the front of the queue because the symptoms of migraine, particularly a sudden onset, can look a lot like stroke. It was quickly determined that I had not had a stroke and I was given a mild painkiller and put to bed to wait for my family to arrive. By the time they got there, which would have taken about 45 minutes, the pain had subsided and the anxiety attack had gone away. I had received no medical treatment other than a mild analgesic, and I knew this, but the fact that I felt safe had almost cured me. Placebo effect in action.
Recently I had a fall and whacked my head pretty severely on some concrete steps in a car park. When I got up I was confused, concerned about concussion, feeling a lot of pain in my wrists, hands, and face. My condition was not helped by finding an empty spot where I thought my car was supposed to be. As it happened I had gone up the wrong flight of stairs so I soon found where my car really was. It hadn't actually been stolen. I had no intention of trying to drive anywhere so as soon as I located the car I rang 000 to get an ambulance. The placebo effect kicked in immediately, because the 000 operator kept me on the line and continually reported the progress of the ambulance that was coming to attend to me. Again, because I felt safe, my body responded accordingly and the pain of my injuries seemed to diminish. Again, I knew exactly what was happening and I knew that I was experiencing a placebo response.
I have seen amazement expressed at the way some people experience a change in medical condition even when advised that the pills they are taking have no active ingredients. This is no surprise to me. Yes, homeopathy works by placebo effect, but that is not a legitimate reason to prescribe it to treat any medical condition. When I think realistically, I know that the migraine medication I take works a lot better than just being told "you haven't had a stroke", and the x-rays and iris response tests I had done in the ED after the fall were actually a lot more reassuring than just talking to someone on the telephone.
Placebo only works on conditions which have a large psychological or subjective component, like anxiety or pain. The damage to my face, teeth and hands from the fall took the normally expected time to get better, although I'm sure the antiseptics and bandages helped.