Tag Archives: placebo

Building on our expectations

“The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.” Mark Twain made that observation years ago when jokingly offering his philosophy on what it takes to stay healthy.  Obviously, his expectations for lasting health were not too high.

Today we are treated to a similar message through various sources that a disease-free life is practically impossible to maintain without the intervention of diets, drugs, exercise routines, therapies, and more.  With the constant barrage in media to “do this to stay healthy,”  we are accepting a subtle, but relentless sub-message that illness is inevitable.

What are your health prospects?  It is an important question.  If living by a “Murphy’s Law” mentality you are essentially portending anything that can go wrong will happen to you at some point in time adding to a life full of doubt and anxiety.

On the other hand, giving your consent to living a life grounded by spiritual, guiding principles that supersede health uncertainties empowers you to be the expression of wellness.  Read more…

Nocebos: the Murphy’s law of medicine

iStock photo
iStock photo

“Anything that can go wrong, will go wrong.” Law or not, the old adage points to the negative expectations we sometime fall victim to whether merited or not. In medicine it might be called the nocebo effect.

We’ve all heard about the positive influence of placebos: take a pill with no active ingredients whatsoever and a healing response ensues anyway.  A nocebo is an ill effect caused by the suggestion or belief that something is harmful.  Think of it as the placebo’s sinister counterpart.

Researching the influence of nocebos on an individual’s health has lagged behind the study of placebos. Experts are just beginning to understand their importance through clinical studies.  These investigations point to a robust mental component when taking into account health maintenance and outcomes.

“For better or worse, our minds are as much a part of treatment as the pills and therapies we receive,” according to Matthew D. Erlich, M.D. and Lloyd I. Sederer, M.D. in, Should HealthCare Providers Be Afraid of the ‘Nocebo’ Effect?, published in the Huffington Post.

Expecting the worst after a treatment (which seems to be a common response) can actually make the patient feel worse.  Thus, doctors, nurses and other hospital staff are increasing their commitment to helping patients avoid the nocebo effect.

Case in point: the findings of researchers from Oxford University studying pain levels in patients.  Simply telling a patient the painkiller he had been given had worn off increased the person’s pain to the same levels before the drug was administered, according to a study by Irene Tracey and her associates.

Penny Sarchet discusses these findings in her winning essay, The nocebo effect: Wellcome Trust science writing prize.  From these results she concludes, “That a patient’s negative expectations have the power to undermine the effectiveness of a treatment, and suggests that doctors would do well to treat the beliefs of their patients, not just their physical symptoms.”

Sarchet points out an interesting dichotomy.  Doctors have a moral and legal responsibility to disclose the numerous side effects of the treatments they prescribe.  However, in doing so, they could be negating the very benefits they hope to confer due to the negative expectations brought on by divulging the side effects to the patient.  It’s a catch-22.

With the proliferation of sickly symptoms and so many new illnesses coming to the attention of the public, one has to wonder to what extent nocebo-induced conditions are swaying an individual’s health.

I recall once being told I looked tired.  Although I felt fine the comment bothered me to the point I soon began to feel limp and listless.

Looking back at that experience, I see the effect my thinking had over how I was feeling.  My expectation – and how I felt – changed due to the negative comment.  But other experiences and my own spiritual practice tell me we don’t have to submit to “Murphy’s law” thinking.

“I’d say you’ll do best by filling your minds and meditating on things true, noble, reputable, authentic, compelling, gracious—the best, not the worst; the beautiful, not the ugly; things to praise, not things to curse,” says Paul, Bible hero and healer.

That’s how I start my prayer – which helps to improve my mental outlook and my physical health.

Attitude, expectation and anxiety: these mental qualities do have sway over how you feel. When worry, dread, and apprehension are troubling you it’s time to eliminate “Murphy’s law” of negatives from your thinking.

 

Patient-centered care in an iPatient world

iStock photo
iStock photo

Ever think about the origins of the barber pole with its red and white strips and brass cup?  It represents the bloody bandages of the barber profession from centuries ago which included performing surgeries and dentistry for customers.  You can guess what the cup was used for.

Present day doctoring has advanced in so many ways since the days of knives and bloodletting.  Now there is robotic surgery and nuclear medicine. The training and expertise needed by today’s physician attest to the skills required to operate complex instruments and the software that runs them.  

And while the advancement of these innovating technologies has been welcomed in the health care community, experts are questioning whether the patient has been left behind in the push towards modernized medical treatment.  Welcome to the world of the “iPatient”.

“The patient in the bed has become an icon,” according to Abraham Verghese, M.D., renowned physician, author, and senior associate chair for the theory and practice of medicine in the Department of Internal Medicine at the Stanford University School of Medicine.   He spoke at the Fifth Annual Medical-Spirituality Conference sponsored by Boonshoft School of Medicine, Wright State University.

Verghese suggests the purpose of admission to a hospital is to “render the live 3-demensional patient into a 2-demensional image.”  In other words the patient is viewed from screens, displays and readouts. This rise in “remote diagnosis” is to help speed the treatment process, especially when several specialists are involved.  That can often lead to stress and other issues that adversely impact healing, according to Verghese.

The work that goes on behind a monitor and in the conference room on behalf of the patient can actually promote a feeling of inattentiveness on the patient’s part.  A sense of isolation and lack of connectivity ensue, feelings that do not encourage healing.  “We are hungry for Love, for the white-winged charity that heals and saves,” wrote Mary Baker Eddy, a late 19th/early 20th century pioneer in the research linking consciousness and spirituality to well-being.

A 2-demensional patient is really a misnomer.  In fact a 3-dementional patient is also an inaccurate rendering of man and womanhood.   The intangibles of being, things like love, compassion, confidence, hope and other qualities point to the multi-dimensional facets of the individual, aspects that cannot be ignored in securing healthy outcomes and furthering long lives.

Verghese points to the intricacies of patient care when referring to something as simple as a doctor’s tone of voice. He remarked during the conference that his or her bedside manner and attitude can have a placebo (positive) or nocebo (negative) effect on the patient.

A vocal advocate for patients, Verghese says that the new buzzword in health care delivery is “patient satisfaction.” While striving for quality has been the focus of health professionals for some time, patient-centered care is getting a lot of attention.  Seeing the patient as an integral part of the healing process will help in the drive towards quality care.

Verghese quoted Dr. Francis Peabody, early 20th century internal medicine specialist responsible for establishing hospitals in the U.S. and China. He too was a strong supporter of the patient. “For the secret of the care of the patient is in caring for the patient.”  That’s the bedrock of health care. 

Placebo’s “evil twin” impacts health

 “You look tired,” she said.  “Thanks,” I replied reluctantly.  I thought I felt fine, but after her comment I wasn’t so sure, especially when I soon began to feel limp and listless.

Why the sickly response to my friend’s innocent words?  Did she foresee something I didn’t?

Nope.  It turns out I was simply experiencing the “nocebo effect.”

We’ve all heard about the positive influence of placebos: take a pill with no active ingredients whatsoever and a healing response ensues anyway.  A nocebo is an ill effect caused by the suggestion or belief that something is harmful.  Think of it as the placebo’s sinister counterpart.  In either case, you quickly conclude there is a strong mental component involved when considering our health.

Searching for solutions to a myriad of health concerns, placebos and nocebos have garnered a lot of attention in the health community lately.  Their influence over health and wellness has been observed in clinical studies and, as you might suspect, the nocebo effect has significant health implications.

“For better or worse, our minds are as much a part of treatment as the pills and therapies we receive,” according to Matthew D. Erlich, M.D. and Lloyd I. Sederer, M.D. in, Should HealthCare Providers Be Afraid of the ‘Nocebo’ Effect?, published in the Huffington Post.   Read more