Wednesday, October 1, 2008

Placebo Effect

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Doctors themselves can have a placebo effect.

A "good doctor" might be the most important placebo effect in medicine.

If a doctor is confident and charming, he can instil tremendous confidence. Patients can feel better simply because the doctor makes them feel better. I have experienced this myself. If the doctor doesn't do any significant harm with whatever he prescribes ("side effects"), the patient's own body may get busy and heal itself. Even if what the doctor prescribes does have a benefit, the doctor himself may provide an additional benefit. I wonder if this has been considered in drug trials?

"Well, of course they do, stupid. Medical research scientists think of everything. They have billions of dollars."

This "physician placebo" doesn't work on me any more, however. I am very sceptical of doctors today, after 60 years of maltreatment and abuse at the hands of some doctors I have seen.

People often remember their doctors fondly and think they were great. Of course they would. The people who remember their doctors are alive. The others are dead, or — significantly — if they weren't happy with their doctor, no one listens to them so their opinions are those of the dead. Every system has enormous inertia. Every organization, itself, fights to survive.

"We don't want to know about this."

Shamans and witch doctors have always done exactly what modern doctors do. The costume of a white lab coat over a business suit with stethoscope hung from the neck, or a surgeon's green fatigues, has the same function as a mask, beads, rattles and feathers: They instil awe and confidence in the suffering and in their relatives. Billions of dollars spent annually on propaganda to sell products helps make the magic work: Every newscast contains a story about some medical breakthrough that will save lives and alleviate suffering. These are followed by pharmaceutical commercials that pay for the broadcast.

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