placebo

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Improving Placebo Effectiveness at Kaiser

August 16, 2011 in Medical Studies | 1 comment

I went to my first physician appointment as a member of Kaiser.  I received a primary care visit and got lab work done within 30 minutes.  The whole process was incredibly efficient.  I notice the Kaiser docs and nurses followed best practices.  Further, the check-in process was very organized and my doctor could access my medical record electronically.  Further, the next day I could access my lab results online.  Overall, it was a very efficient experience.

The process as completely different from the alternative medicine described in a recent Atlantic article, ‘The Triumph of New Age Medicine‘.  Consider the case of a 60-year-old retired firefighter who had come in for an acupuncture treatment.

“His wife, a nurse, urged him to try acupuncture, and in February, with the blessing of his doctor, he finally met with Lao, who had trained in his native China as an acupuncturist. Their first visit had lasted well over an hour, Corasaniti says, time mostly spent discussing every aspect of his injuries and what seemed to ease or exacerbate them, and also other aspects of his health—he had been gaining weight, he was constipated, he was developing urinary problems. They talked at length about his diet, his physical activity, his responsibilities and how they weighed on him. Lao focused in on stress—what was causing it in Corasaniti’s life, and how did it aggravate the pain?—and they discussed the importance of finding ways to relax in everyday life.”

Does acupuncture work?  Depends by what you mean by ‘work’.   This study found that acupuncture worked no better than a ‘sham acupuncture’.  However, acupuncture does work.  Although acupuncture is equally effective as sham acupuncture, sham acupuncture actually does help improve health.  Further, acupuncture is more effective than taking a sugar pill placebo.  Thus, the quality of the placebo–in terms of perceived cost and ritual surrounding the placebo–does improve health.

What can Kaiser learn from these findings?  Combining best practice medicine with better placebos such as more elaborate rituals of patient-provider interaction may improve the quality of care provided.

Creating a warmer, placebo-filled environment could put the patient in a better state of mind and better allow the patient to use positive thinking to heal themselves.

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More Expensive Placebos Bring More Pain Relief

June 24, 2010 in Economics - General | 1 comment

Why do placebo’s work?  They work because the patient’s mind believes they offer relief and thus patient perception of pain decreases after taking a placebo.  A study by Dan Ariely finds that the more expensive the placebo, the more pain relief it offers.  In particular, a $2.50 placebo works better one that costs 10 cents.

Medical News reports the following:

With pain, Dr. Ariely said, “if you expect it to be worse, it could be worse. So what can we do in the marketplace so people don’t expect it to be worse?”  For instance, he added, poor people are often offered medicines at a discount. “Maybe we don’t want to advertise that it’s discounted,” he said.

One reason that more expensive medical treatments when work better in practice in randomized trials is that patients believe that these treatments will be the most beneficial. Further, treatments that patients perceive to be “high tech” or using big fancy machines may offer better health outcomes due to patient perspectives.

The question is, should physicians lie to patients and tell them that the treatment is expensive or cutting edge when in fact it is not?  Without even considering the moral implications of this strategy, the answer is no.  Although this strategy could be used intermittently to reduce cost and improve patient outcomes, if patients found out that physicians were lying to them about the technical sophistical or price of the treatment, then the pronouncements that a treatment was cutting edge would have much less of an effect on the patient (since they knew it was false).

Thus, knowing that high priced medicine improves outcomes still many not give the medical community an attractive means to improve quality and reduce cost.

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Physicians prescribing placebos

November 10, 2008 in Pharmaceuticals | No comments

Placebos are important for medical research.  In order to determine if a certain pharmaceutical is effective, researchers compare medical outcomes between one group given the drug and another given a placebo.

But should physicians give placebos to patients outside of clinical trials?  The Economist magazine reports (“Great Expectations“) on the phenomenon that many physicians are giving placebos as treatment to patients.  A study in the British Medical Journal by Jon Tilburt of the Mayo Clinic finds that 57% of practicing internists prescribed placebos on a regular basis. Few docs actually prescribe sugar pills, but 40% prescribed painkillers or vitamins as placebos.  This may seem odd since Asbjorn Hrobjartsson and Peter Gotzsche (NEJM 2001) concluded that “outside the setting of clinical trials, there is no justification for the use of placebos”.  

Why would doctors prescribe these placebos?  One reason is to get rid of nagging patients. Many patients want a doctor to “do something.”  If the physician is not sure what the patient’s actual illness is or they believe that the patient is imagining their illness, a placebo appease the patients desire for treatment.  The second reason is that placebos may actually work.

A study “…co-authored by Dr Benedetti and published in Nature, made the striking observation that telling a patient a painkiller is being injected into him, when the injection is actually a saline solution, is as potent as covertly giving him 6mg to 8mg of morphine. This is slightly below the standard post-operative dose of 10mg to 12mg, but the covert dose had to be increased to the full 12mg to surpass the effect of the placebo.”

Should doctors continue to “deceive” patients by using painkillers or sedatives as placebos even if this treatment is effective?

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