Home > Psoriatic Arthritis > Placebo Effect in Medicine

Placebo Effect in Medicine

I want to be able to find this post again, so I’m posting it here.  A long and interesting discussion on accupuncuture, the placebo effect and modern medicine.


# # MedsVsTherapyon 17 Sep 2009 at 9:37 am ”Patients want to be listened too.”– Sure. I agree. But let’s be honest, and not fool ourselves and anybody else. In psychotherapy, we would technically, officially call this “supportive therapy,” or informally, amongst colleagues, hire-a-friend.” Empiricism: if it works, and the benefits are not outweighed by harms, and if pt. is informed, then go ahead: let’s listen to patients as an intervention. Studies have been done on this for pts. with “medically unexplained symptoms,” with high utilizers of medical care, etc. In practice, it really doesn’t go well to say: “hey this is all in your head – I am gonna refer you to a counselor.” But you can do this: “hey – along with medical treatment for [fill in the blank with the diagnosis du jour, recognized by its characteristic symptoms of: low energy, fatigue, difficulty concentrating, diffuse aches and pains, dizziness, etc.] – we know that lifestyle has a great impact on how a disease impacts your life – We need a holistic interevntion – I want to refer you to our health psychologist [or whomever] who trains people in how to manage chronic illness — stress management, wellness things like exercise, diet, and sleep, and things like that – I am going to refer you, and follow up to see how this works for you.” Figure out someone somewhere to do this for you. Figure out how to bill for it. Follow an evidence-based chronic illness management program such as Kate Lorig’s, and make sure to let the counselor know that they have liberty to add a healthy dose of “listening” PRN. Along with the empirical evidence, I have done the counseling part myself. One pt had terrible arthritis – you could see the swollen knuckles. Once we started talking, she skipped the pain mgmt agenda I had prepared, and she just went on to talk about: alcoholic boyfriend, lazy irresponsible young adult son, money management problems, etc. Across a couple months, her pain from arthritis disappeared from her agenda — use of pain meds decreased, sleep interference from pain decreased, etc., — pain relief disappeared from her list of “what the patient wants;” she wanted someone to listen, plus she needed to learn basic assertiveness and a few psycho-ed type skills like that. So, if what the pt wants is someone to listen — in a certain salubrious way – let’s do it; and let’s not carry on the charade of ineffective interventions (acupuncture, chakra re-alignment, magnetic therapy, tuning fork therapy, etc.).

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