Stress Illness and Placebos

In the next edition of The Economist magazine is an article about Edzard Ernst, professor of complementary medicine at Peninsula College of Medicine in Exeter, in southwestern UK.  He is retiring after 18 years of studying “alternative” medical remedies which includes acupuncture, chiropractic medicine, Reiki, herbal remedies, Ayurvedic medicine, homeopathy, reflexology and many others.  During this time he and his group published over 160 analyses of the research in these fields.

His conclusion is that these methods, on which billions of dollars are spent annually, offer placebo benefit but no more in 95% of cases.  A placebo is a medical treatment with no physiologic benefit such as a sugar pill, an injection of colored saline solution or a pretend/sham surgery.  Because treatment approaches used in contemporary western medicine must generally show benefit greater than placebo before they are approved for use, there is a tendency to assume that placebo benefit is minimal to nonexistent.  This is not the case, however.

Placebo tablets have been shown to reduce pain in people who are told the tablets are pain medication.  Fake knee surgery for arthritis provides benefit comparable to the real thing.  Placebos are particularly effective for conditions that are psychological and/or subjective such as Stress Illness (Psychophysiologic Disorder) and Depresssion.  They have been shown to stimulate production of natural painkillers in the brain.  Their effectiveness is enhanced when the prescriber believes in them.  This is why many alternative medicine practitioners tend to take considerable time with their patients and to believe passionately in their discipline.  Placebos can even have side effects.

Most of my patients with Stress Illness have tried numerous treatments (sometimes including surgery) with no more than temporary relief.  Therefore when they have sustained improvement after the discussions we have and the treatments I recommend, it is logical to assume I am achieving more than a placebo benefit.

However, I have not conducted a randomized trial comparing a placebo discussion to my approach of uncovering hidden life stresses and connecting mental health disorders like Depression, Anxiety or Post-Traumatic Stress to physical illness.  Clinicians who wish to take a scientific approach to their work with Stress Illness patients should bear in mind that some fraction of the results they observe, which likely varies for each individual, can be attributed to the placebo effect.  Placebo-controlled research underway in Michigan of a Stress Illness approach to fibromyalgia patients should help clarify the size of this fraction.

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