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The doctor that believes

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Nirvanam
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The doctor that believes

#1 Post by Nirvanam » September 5th, 2010, 2:26 pm

I am not sure if this happens in your countries, but recently I was faced with a kinda contradiction. Basically it was a contradiction considering the typical Humanist viewpoint or at least I think so. Please help me understand your viewpoints...

The situation:
My friend was having a fever and a slight cold
We went to the doc and the doc said it's nothing to worry
He said don't worry I'll give you a placebo and you should be alright by tomorrow
He was alright by that night

The situation was similar to another situation which I faced quite regularly with my ex:
She has a really bad migraine which generally requires an injection of fortwin to subside
The doc, doesn't tell her but gives her a saline injection
Half an hour later (the typical time frame for the medicine to take effect) her migraine subsides
The doc told me the saline is a placebo

Initially I thought that placebo was some kinda panacea like thing. Its only later that I realized that placebo is a pseudo as in a term that is used to label a kind of event without explaining why or how things happened...like 'natural selection'

What do you make of this? Do doctors in your countries give you placebo medicines? What is the logic behind this? As I question this, I come across the following anomalies, as it were.

If the fever/migraine reduced naturally then what was the necessity to give a placebo?
Suppose the placebo was given just to please the patient, is it not an unethical practice because doctors/clinics do charge for the injection?
Suppose the placebo was given just to please the patient, what explains the regularity with which the ailments seem to get treated (No, the state of the ailment is not always the same for the patient to get better within the specific amount of time)?

ps: It would be wonderful if the discussion is truly viewed as a way to understand this phenomenon better for all of us (I will present some viewpoints/info before you and I want to learn how you would interpret it because my psychological inertia drives me towards interpreting it in one way which may not be the right way of interpreting it). Ridicule will not help, in fact when someone chooses ridicule over argument early in his posts, it is quite a sure indicator of the phenomenon expressed in the proverb, empty vessels make more noise.

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Dave B
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Re: The doctor that believes

#2 Post by Dave B » September 5th, 2010, 2:37 pm

If my doctor actually said, "I'll give you a placebo" he might just get a rather angry reaction from me!

As to whether or not doctor's do actually give placebos I am not sure. I do sometimes wonder whether or not some of the sleeping tablets they issue in hospital's are placebos, dummy pills that actually do nothing but which you are supposed think will work. GPs are very leery of prescribing sleepers because of the dependency problem but, in hospital, I have been given sleepers every night for up to a fortnight with no lasting effects (cardiac wards, with all the bleeps and alarums, are not good places for light sleepers!) Were they really sleepers? Wiki says that one of the favourites, Zopidem, is used for the short term treatment of insomnia - so I guess that is right (?)
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jaywhat
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Re: The doctor that believes

#3 Post by jaywhat » September 5th, 2010, 2:55 pm

A placebo is no good if you know that's what it is.

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Re: The doctor that believes

#4 Post by Nirvanam » September 5th, 2010, 3:06 pm

jaywhat wrote:A placebo is no good if you know that's what it is.
What does this imply?

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Dave B
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Re: The doctor that believes

#5 Post by Dave B » September 5th, 2010, 4:19 pm

Image
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jaywhat
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Re: The doctor that believes

#6 Post by jaywhat » September 5th, 2010, 4:37 pm

I must admit that the main meaning of placebo to me has always been something like a pretend medication that kids the patient into thinking it will do him good. It is regarded by some as a useful tool in some treatments because thinking you are going to get better allegedly can help you actually get better.

However, my ignorance becomes apparent when I look it up in Chambers dictionary and find meaning I knew nothing of. I am happy to admit this - because I have now looked it up and know more than I did 5 minutes ago. More below, but I should add in my defence, that in this particular thread my narrow understanding of the word holds sway.

Meanings of placebo -
1- vespers for the dead
2- a medicine given to humour or gratify a patient rather than to exercise any physically curative effect ??
3- a sycophant

and, of course, Placebo Domino = I shall please the Lord :smile:

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Dave B
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Re: The doctor that believes

#7 Post by Dave B » September 5th, 2010, 4:46 pm

2- a medicine given to humour or gratify a patient rather than to exercise any physically curative effect
I am not all that happy with the use of "medicine" there, even if a non "physically curative effect" really means a "psychological effect" can the sugar pill, or whatever, truly be called a medicine?

The O.D. of E. gives: "a medicine or procedure prescribed for the psychological rather than for any physiological effect."

So, perhaps a "medicine" is any substance given in the course of medical treatment, whether or not it actually does anything therapeutic in physiological terms. So, it seems sugar pills are medicine if prescribed by a doctor!
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Nirvanam
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Re: The doctor that believes

#8 Post by Nirvanam » September 5th, 2010, 5:59 pm

Jaywhat, Dave,

Earlier, I used to think that placebo was some kinda panacea which works for most ailments. However, when I cam across explanations on this site, especially in the Homeopathy thread, when it was mentioned that there are genuine cases when ailments were cured using some homeopathic pills (let's not make this a homeopathy thread...just mentioning it for setting context), the guys here said it was because of placebo effect.

Now I have been a believer that we are not just the body, and that psychological health and physical health are connected. People "curing themselves" is something I myself have experienced (in small little ailments like fever, etc) so I had no problem believing that it is possible. But when I came across the arguments here pointing to placebo effect, I initially thought it was an actual physical effect caused by a medicine called placebo.

I looked it up on websites including medical journal sites and reading the description/explanation of placebo effect, it was pretty clear to me that placebo was a pseudo term...basically it was a word coined as a term for a medical phenomenon when we do not know how a cure/improvement happened. When I asked in this forum and other places on the net for a better explanation of placebo, all I got was copy-paste of definitions/descriptions from the web. I figured the guys here and other sites also were like me believing that placebo was some kinda physical effect although some of them knew that it was just a pseudo.

So, if placebo works only if the patient is not aware that it is a placebo medicine then what does that mean...it means the patient's mind is actively involved in his curing such simple ailments?

I wish people paid attention to the meaning of the term placebo and what implications it has.

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Emma Woolgatherer
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Re: The doctor that believes

#9 Post by Emma Woolgatherer » September 5th, 2010, 6:32 pm

Nirvanam wrote:My friend was having a fever and a slight cold
We went to the doc and the doc said it's nothing to worry
He said don't worry I'll give you a placebo and you should be alright by tomorrow
He was alright by that night
If the doctor actually said, "I'll give you a placebo," and prescribed some sugar pills or something similar, but did not explain to your friend what a placebo was, then he was perhaps fooling himself that what he was doing was perfectly ethical because he was admitting to prescribing a placebo. But at the same time he must have been gambling that your friend did not know the meaning of the term placebo and was not capable of looking it up. I can imagine a doctor being tempted to prescribe a placebo when confronted by patients presenting with self-limiting illnesses like colds or mild stomach bugs, but I'm surprised that any would actually do it. I'm also surprised that your friend didn't ask at the time what a placebo was and what it would do.
Nirvanam wrote:The situation was similar to another situation which I faced quite regularly with my ex:
She has a really bad migraine which generally requires an injection of fortwin to subside
The doc, doesn't tell her but gives her a saline injection
Half an hour later (the typical time frame for the medicine to take effect) her migraine subsides
The doc told me the saline is a placebo
You mentioned this before, when you started a thread on the placebo effect just over a year ago (although you said that your wife was having Demerol injections, and only started having the Fortwin injections after the doctor moved away). Again, I am surprised that the doctor did this, even if he was genuinely concerned about possible addiction to and side effects from the Demerol or Fortwin. And I think it was unethical that he told you what he had done, but not your wife. Did you tell your wife? If I'd been in her position, I'd have been furious.
Nirvanam wrote:Initially I thought that placebo was some kinda panacea like thing.
Initially when? When your friend was given a placebo by his doctor? Or when your wife was given the saline injections? But if your doctor specifically told you that he had given her saline injections (rather than placebo injections), then you must have realised exactly what he had done. You can't have thought that he'd been giving her some kind of "panacea".
Nirvanam wrote:Its only later that I realized that placebo is a pseudo as in a term that is used to label a kind of event without explaining why or how things happened...like 'natural selection'
You've mentioned this before, several times calling the term "placebo" a "pseudo", meaning "we don't know how it happened", although this is the first time you've compared it to "natural selection". I think I'll leave someone else to rise to that particular bait.
Nirvanam wrote:If the fever/migraine reduced naturally then what was the necessity to give a placebo?
There was no necessity. Perhaps it was done to get rid of the patient as quickly as possible. Doctors do something similar, I think, when they prescribe antibiotics to people with mild viral infections. Except that's worse, because it can contribute to antibiotic resistance.
Nirvanam wrote:Suppose the placebo was given just to please the patient, is it not an unethical practice because doctors/clinics do charge for the injection?
If we were talking about pills, and the doctor said something like, "Your condition will probably improve by itself in a couple of days. But I can give you some pills. They contain no active ingredients, and are mainly sugar. However, there is some evidence that people who take these pills do, on average, have slightly faster recovery times than people who have no treatment at all, though I cannot guarantee they will be effective in your case. Would you like me to prescribe them to you?" then one might possibly argue that it isn't unethical. Though it's incredibly patronising, and like Dave B. I'd be furious if my doctor said that to me.
Nirvanam wrote:Suppose the placebo was given just to please the patient, what explains the regularity with which the ailments seem to get treated (No, the state of the ailment is not always the same for the patient to get better within the specific amount of time)?
Sorry, I don't understand that point. Could you rephrase it?

Emma

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Emma Woolgatherer
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Re: The doctor that believes

#10 Post by Emma Woolgatherer » September 5th, 2010, 7:14 pm

Nirvanam wrote:But when I came across the arguments here pointing to placebo effect, I initially thought it was an actual physical effect caused by a medicine called placebo.
But I thought you'd already come across the term "placebo" as used by your friend's doctor. Or did that happen after you'd encountered it on this site. I'm getting confused, Nirvanam.
Nirvanam wrote:I looked it up on websites including medical journal sites and reading the description/explanation of placebo effect, it was pretty clear to me that placebo was a pseudo term...basically it was a word coined as a term for a medical phenomenon when we do not know how a cure/improvement happened. When I asked in this forum and other places on the net for a better explanation of placebo, all I got was copy-paste of definitions/descriptions from the web
That is not a fair description, as you can see if you look back at the earlier thread, Placebo effect - Mind power: any connection?
Nirvanam wrote:I figured the guys here and other sites also were like me believing that placebo was some kinda physical effect although some of them knew that it was just a pseudo.
I don't understand the distinction you are making. My understanding is that a placebo is a pharmacologically inert substance (like a sugar pill or saline solution) that produces an effect similar to what would be expected of a pharmacologically active substance (like a painkiller). So there is "some kinda physical effect" but at the same time the placebo is "just a pseudo" in the sense that it isn't a real drug.
Nirvanam wrote:So, if placebo works only if the patient is not aware that it is a placebo medicine then what does that mean...it means the patient's mind is actively involved in his curing such simple ailments?
Yes. It seems reasonable to think that a person's expectations and hopes about the treatment they are receiving might have a significant effect on his or her neurochemical system. We know that our emotional responses to certain stimuli are associated with things like rises or falls in levels of serotonin or dopamine or endorphins or ... lots of other neurochemicals whose names I've forgotten. And it makes sense that those sorts of changes can themselves have an effect on other biochemical systems in the body, including the immune system, and that these can have an affect on someone's physical recovery from illness. We might not have a perfect understanding of all this, let alone an understanding of how to take advantage of it (which is perhaps even more important), but I don't think it's all that surprising or mysterious.
Nirvanam wrote:I wish people paid attention to the meaning of the term placebo and what implications it has.
Do you? Well, I'm all ears. Tell me what the implications are of the meaning of the term placebo, without repeating what you've already said about it being just a "pseudo".

Emma

Nirvanam
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Re: The doctor that believes

#11 Post by Nirvanam » September 5th, 2010, 7:28 pm

Emma, me responding to the other responses will probably sidetrack the discussion...I agree its my fault to have even mentioned them. I wanted to try and set a context to it however it doesn't seem to have worked the way I intended it.

The main point is this:

What is a placebo effect? And what does the placebo effect imply when a doctor uses them to "treat" patients, and the patient actually gets treated/improves.

ps: not for the topic to get derailed, when I say something is a pseudo, I mean that it is a terminology created to refer to a phenomenon. People thinking that the term actually explains the phenomenon as in how it happens, when, why, etc, etc, may be intended or accidental. The way I have seen people use the term placebo here is that it is some kinda physical effect which clearly it is not. Therefore if people are interested to really know what this placebo means and what assumptions they are making, or possibly closing their minds on possibilities, etc...this thread could help us all clear our myths and have a healthy discussion on that.

pps: the ref to natural selection...hopefully it won't be a bait coz we have already spoken about Evolution and it is fairly clear that natural selection is also a pseudo

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Alan H
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Re: The doctor that believes

#12 Post by Alan H » September 5th, 2010, 7:39 pm

jaywhat wrote:A placebo is no good if you know that's what it is.
Not entirely true. There is some research that found that there was sometimes a placebo effect even if the subjects were told they were getting a placebo. If I come across the reference, I'll post it, but I think Ben Goldacre mentioned it in his excellent video on the placebo effect.
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Re: The doctor that believes

#13 Post by Nirvanam » September 5th, 2010, 7:44 pm

Emma Woolgatherer wrote:I don't understand the distinction you are making. My understanding is that a placebo is a pharmacologically inert substance (like a sugar pill or saline solution) that produces an effect similar to what would be expected of a pharmacologically active substance (like a painkiller). So there is "some kinda physical effect" but at the same time the placebo is "just a pseudo" in the sense that it isn't a real drug.
In other words a person can have a physical effect in his body without actually having a chemical/substance/drug to cause it? If this is so, what do you think is the cause behind such an effect.
Emma Woolgatherer wrote:
Nirvanam wrote:So, if placebo works only if the patient is not aware that it is a placebo medicine then what does that mean...it means the patient's mind is actively involved in his curing such simple ailments?
Yes.
Yes as in it is possible for an individual to cause changes to his physical body (I am not talking about growing one more head but get rid of a fever) by the strength of his mind...focusing his mind?
Emma Woolgatherer wrote:It seems reasonable to think that a person's expectations and hopes about the treatment they are receiving might have a significant effect on his or her neurochemical system.
If I reword this as...a person's emotions/thoughts about something can alter its effect on him (even if it is infinitesimal)...would it be correct?
Emma Woolgatherer wrote:We know that our emotional responses to certain stimuli are associated with things like rises or falls in levels of serotonin or dopamine or endorphins or ... lots of other neurochemicals whose names I've forgotten. And it makes sense that those sorts of changes can themselves have an effect on other biochemical systems in the body, including the immune system, and that these can have an affect on someone's physical recovery from illness. We might not have a perfect understanding of all this, let alone an understanding of how to take advantage of it (which is perhaps even more important), but I don't think it's all that surprising or mysterious.
Same as above
Emma Woolgatherer wrote: Do you? Well, I'm all ears. Tell me what the implications are of the meaning of the term placebo, without repeating what you've already said about it being just a "pseudo".Emma
For one, the implication is that a change in the physiology or ailment of an individual has been caused by a non physical substance...possibly the person's own will power/mind or collective mental focus.

Secondly, that there is some form of energy changes that have happened (if a physical change has happened then obviously there is some energy change that has happened). It is possible that the energy changes cause the physical changes. And if that possibility is further investigated and suppose it is true, it opens up a whole area of health sciences that are focused on energy

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Re: The doctor that believes

#14 Post by Dave B » September 5th, 2010, 7:57 pm

Psychological "symptoms" can seem every bit as real as the "real thing" to the sufferer. I can attest to that with the anxiety attacks I suffer, even though I know, rationally, that I am not about to have a seizure and collapse. I recognize the symptoms and can differentiate between them and my cardiac problems, but they still have the power to cause physical symptoms (shaking, breathlessness, high BP, pallor etc.)

To the suggestible suffering such I think it is possible that being offered a placebo and told this will fix things will actually fix things - if those symptoms are genuinely of a psychological nature. I wonder if it would work in the case of an actual cardiac event?

One just hopes like mad that the doctor can accurately differentiate between the psychological "false" symptoms and something more serious. I know a few doctors who could not.
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Re: The doctor that believes

#15 Post by Nirvanam » September 5th, 2010, 8:02 pm

Dave B wrote:Psychological "symptoms" can seem every bit as real as the "real thing" to the sufferer. I can attest to that with the anxiety attacks I suffer, even though I know, rationally, that I am not about to have a seizure and collapse. I recognize the symptoms and can differentiate between them and my cardiac problems, but they still have the power to cause physical symptoms (shaking, breathlessness, high BP, pallor etc.)

To the suggestible suffering such I think it is possible that being offered a placebo and told this will fix things will actually fix things - if those symptoms are genuinely of a psychological nature. I wonder if it would work in the case of an actual cardiac event?

One just hopes like mad that the doctor can accurately differentiate between the psychological "false" symptoms and something more serious. I know a few doctors who could not.
Thanks for sharing that Dave.

It's experiences like these that make me believe that our mind has some say in how our body functions.

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Re: The doctor that believes

#16 Post by Fia » September 5th, 2010, 8:12 pm

Nirvanam wrote:Secondly, that there is some form of energy changes that have happened (if a physical change has happened then obviously there is some energy change that has happened). It is possible that the energy changes cause the physical changes. And if that possibility is further investigated and suppose it is true, it opens up a whole area of health sciences that are focused on energy
my bold
Obviously? I'm no scientist, but that sounds to me like you're extrapolating too far... What energy do you refer to? We can clearly see the placebo effect in action, and as yet, we have not explained it. There are many theories, mostly to do with psychology, which imho is where the most logical explanation will be found... I'm sure it will be, and in the meantime I'm wary of jumping through many other hoops of vague new-agey possibility...

xposted, so adding: Yes, of course the body and mind work in tandem. There's no mind without the body and precious little body worth bothering with without the mind. I don't think anyone here is suggesting a mind/body split :shrug:

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Re: The doctor that believes

#17 Post by Nirvanam » September 5th, 2010, 8:24 pm

Fia wrote:
Nirvanam wrote:Secondly, that there is some form of energy changes that have happened (if a physical change has happened then obviously there is some energy change that has happened). It is possible that the energy changes cause the physical changes. And if that possibility is further investigated and suppose it is true, it opens up a whole area of health sciences that are focused on energy
my bold
Obviously? I'm no scientist, but that sounds to me like you're extrapolating too far... What energy do you refer to? We can clearly see the placebo effect in action, and as yet, we have not explained it. There are many theories, mostly to do with psychology, which imho is where the most logical explanation will be found... I'm sure it will be, and in the meantime I'm wary of jumping through many other hoops of vague new-agey possibility...

xposted, so adding: Yes, of course the body and mind work in tandem. There's no mind without the body and precious little body worth bothering with without the mind. I don't think anyone here is suggesting a mind/body split :shrug:
Fia, any form of energy...heat, chemical, mechanical, magnetic, electromagnetic, etc, etc. Our bodies are energy fields aren't they? Any physical object has at least some potential energy associated with it in a state of absolute rest.

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Re: The doctor that believes

#18 Post by Dave B » September 5th, 2010, 8:49 pm

It's experiences like these that make me believe that our mind has some say in how our body functions.
I don't think that has ever been challenged, psychosomatic phenomena have been well demonstrated. It is those that claim they can use their mind to control their bodies to the point where they can exist for months without food and water - or whatever the claim was - that is just a tad preposterous!

If you are leading up to a discourse on Yoga or something you might be advised to wear a helmet!
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Re: The doctor that believes

#19 Post by Nirvanam » September 5th, 2010, 11:18 pm

Dave B wrote:I don't think that has ever been challenged, psychosomatic phenomena have been well demonstrated. It is those that claim they can use their mind to control their bodies to the point where they can exist for months without food and water - or whatever the claim was - that is just a tad preposterous!

If you are leading up to a discourse on Yoga or something you might be advised to wear a helmet!
I am neither suggesting yoga nor am I talking about living without food. The truth of the matter is that I don't know much about either, at least the former I am aware of that yoga itself has many benefits...its like a kind of exercise but the latter I have no clue (besides I gain nothing what someone believes or doesn't). In theory though I wouldn't be surprised if it is possible to do so coz basically at the end of the day food is used to generate energy...if another source of energy can be found to replace food then that should be possible....thinking back with my TRIZ concepts - what we need is the function (produce energy) and not the system (food) :)

Anyway, let's leave that aside. If our mind has the capability to influence our bodies, would they be able to influence other physical things? If yes, why? If not, why not?

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Re: The doctor that believes

#20 Post by Alan C. » September 5th, 2010, 11:34 pm

Nirvanam
Anyway, let's leave that aside. If our mind has the capability to influence our bodies, would they be able to influence other physical things? If yes, why? If not, why not?
Are we getting into the realm of spoon bending here? If not; then what?
My mind has no ability to influence anything other than my own body. (That I'm aware of)
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