Thus, placebo brings with it connotations of deception and inauthenticity. And some of the myths about placebos reflect this stigma. If a condition improves with placebo treatment, according to one myth, the condition is not real but all in the patient's head. Not true. Consider that placebo treatment is arguably the most consistently effective treatment for angina pectoris, an indisputably "real" heart condition. Placebo treatment not only relieves the pain of angina pectoris, it increases the victim's ability to exercise and in some cases produces improvements in the electrocardiogram.
Still, doctors and other healers are troubled by the placebo response. As noted earlier, much of both conventional and alternative medicine consists of treatments that are frequently prescribed, highly cherished—and scientifically unproven. The placebo's effectiveness challenges the value of these treatments. Further adding to doctors' discomfort is the lack of a complete understanding of how placebos work.
A Place For Placebos
Perhaps, though, the time has come to accept and harness this important part of healing. The treatment situation can be seen—like many conventional drugs—as a broadly effective treatment whose means of action is not entirely understood, and which is more effective in some conditions than others. How can patients take advantage of the placebo's power? Research offers some guidance as to how to enhance this component of healing:
- In order to boost your expectations of recovery, choose a healer in whom you have confidence. This idea is not new. In the second century, Galen, the Greek physician, observed: "He cures most successfully in whom the people have the most confidence." Even if the clinician you consult has been highly recommended and has impeccable credentials, if you don't have confidence in him or her you're better off with someone else.
- Choose a healer who is optimistic and upbeat.
- Look for a doctor who treats you as a collaborator, solicits your opinions, and involves you in treatment decisions.
- If you have a condition for which there are several equally effective treatments, ask for the treatment you believe will work best.
- If you have a recurrent condition that has responded well to a certain treatment in the past, use the same regimen again unless there is a very good reason not to, such as the availability of a clearly more effective or safer alternative.
- If you have reservations about a treatment your doctor suggests, express your concern. Other treatments more acceptable to you may be available. Should there be no other options, get more information regarding whatever concerns you. Hidden worries have more power than those in the open. Airing your fears makes it less likely that they will undermine the treatment's effectiveness.
Modern Medicine
The characteristics I've just mentioned may seem like nothing more than good medical practice, but they're all too often neglected. A patient's confidence is frequently enhanced when a physician listens attentively and conducts a thorough physical examination. The clinicians of the past seemed to know this intuitively. They didn't have antibiotics or insulin, but they did have a bag full of tonics and elixirs—all placebos—for any ailment and, more important, they wove healing rituals and symbols into a reassuring mosaic.
This personal style of medical care, of course, can require more than a five-minute visit. It is no small irony that at the same time the importance of placebos is being more widely recognized by professionals, changes in medical practice—such as the emergence of managed care—are restricting the activities of doctors, reducing the time they can spend with patients to an extent that threatens to eliminate important components of the healing situation. Managed care aims to make health care more efficient and inexpensive, but the erosion of doctors' freedom to give the attentive and thorough treatment that is crucial for the placebo response may make these goals harder to reach.
Another irony is that as conventional medicine becomes more sophisticated and scientifically based, Americans are seeking more and more of their health care elsewhere. Although new and indisputably effective treatments are developed every month, including diagnostic instruments and procedures that can achieve a level of accuracy unheard of just a decade ago, people are flocking to alternative treatments—herbs, megavitamins, acupuncture, spinal manipulation—even when there's little or no evidence these regimens provide specific, measurable benefits. But people get better from such remedies because, if nothing else, they boost expectations of healing. Perhaps now that we understand the molecular mechanisms by which many medical treatments work, physicians will feel more comfortable incorporating the powerful elements of healing that we don't fully understand.
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