Physician Patient

Archive for July, 2016

Placebos Work: So who should pay the doctor and for what?

Tuesday, July 19th, 2016

http://www.wsj.com/articles/why-placebos-really-work-the-latest-science-1468863413

Yes, they do. And we’ve known this (scientifically) for a while. We’re now learning that placebos work by the same biological pathways as do medications which are approved by the FDA for specified diseases.

The placebo effect is a mighty and mysterious force in clinical medicine. Its power and importance supports stepped up advocacy for (trusting) doctor-patient relationships which are governed by the doctor’s Hippocratic Ethics. We need the doctor-patient relationship controlled by the patient to be honored and enhanced in government and private health care debates.

Attempting to describe the placebo effect scientifically as “mental” (i.e. due to suggestion, authority, or shamanism) begs the question of its physiological mechanisms and the actual contingencies of reinforcement for the patient and doctor. (This question also applies to the power of prayer and measuring the consequences of charismatic leadership on our human behavior).

It’s no surprise that researchers are showing that placebos cause neurobiological effects on the brain and the body’s immune system. This is predicted by The Law of Effect (Edward Thorndike http://psychology.wikia.com/wiki/Law_of_Effect) via operant conditioning proven in nonhuman and human subjects: B = f(x) under c. Where B = behavior and x = consequences (reinforcers) under specified conditions (c).

It is also no surprise that many Minnesota parents whose children suffer from uncontrolled seizures or patients with intractable pain want access to (medical) cannabis, despite absence of studies showing marijuana’s effectiveness in mitigating seizures or pain and plenty of good evidence for its potential for addiction (Is cannabis a suitable substitute for opioids, or is it not?).

When personal testimonies prevail, who pays the doctor and for what?