The secret ingredient in medical science

A few months ago, I broke two bones on my right ankle. The story I tell people is that I attended a ninja conference which did not go well (and am sticking to my story). I was in a cast for 6 weeks, then wore an orthopedic boot and a few kinds of ankle support after that. I am ok now. I took only drugs that were prescribed for the great swelling for a week but after that, I pretty much was on my own for 3 months. My orthopedic doctor thought I healed faster than the average. Looking back, I think I healed fast, not only because of the treatment I got but because of the placebo effect that many patients take for granted.

“Placebo effect” is what you call a measure that on its own, is not designed to produce any effect on your condition but gives you a positive outcome. This measure is something designed to make you think you took a drug/treatment but you ended up with the intended effect of the drug/treatment anyway. It could be in the form of pills or therapy.

In a recent article in the New York Times that highlighted how much a conversation between a patient and his or her doctor could have a placebo effect, I was struck by how much that resonated with me. I have observed the same thing about myself: I get better faster when I see a doctor who would converse with me beyond the technical aspects of my condition.

When I need to address a condition, I first see a doctor assigned to me – one who does not usually go beyond the skilled but boxed diagnosis. But then, after that, I always go to either of two doctors who are very close to me. They tell me exactly the same medical thing that my first assigned doctor told me but this time, they take the time to tell me more and spend a lot of time encouraging me to get better and assuring me that things are going to be alright.

One of those doctors is a neurologist who always manages to put everything in perspective for me when something ails me and I bounce back faster after I spend time with him. The other one is my own brother who is not an orthopedic surgeon but a pulmonologist. Only 4 days after I broke my ankle, I had to travel which meant long flights and road trips. My brother went with me on one of those long international trips, sitting by me on the plane, supporting me as I walked in crutches to the bathroom. He even set me up on a scooter when we landed and arranged for special paraphernalia in our lodging so I could navigate with ease. He never replaced or took over any treatment that my ortho doctor did not prescribe but he explained a lot to me about what basically happens to my entire body even if I just broke a part of it. I just got better fast, with no complications even when my very first ortho immediately wanted surgery done on me.

Ted Kaptchuk has a very good TedMed about this subject. He is a professor at Harvard Medical School who has been studying the placebo effect. He had a very interesting beginning in Chinese herbal medicine and acupuncture and then went on to reconcile what he has observed in ‘alternative medicine” with medical science to give us a fuller understanding of what it takes not just to address an illness but to heal.

He cited experiments that showed how drugs for conditions like migraine, irritable bowel syndrome and Parkinson’s disease help with medical conditions but how placebos make those drugs work even better. This is also revealed in experiments done on patients with lower back pain. The placebo effect, including those from empathetic exchanges of patients with their doctors helped patients feel a lot better.

Placebos work because what scientists found is that whether you are told you are taking a placebo or not, your brain releases actual neurotransmitters – cannabinoids, dopamine and endorphins – which act to lessen your pain perception and actually make you feel good. Even when you are given a real drug but told it’s a placebo, it will not work as much as when you are given a real drug and told that it’s a real drug. Kaptchuk also says that so far, findings show that some of us have genes that make us benefit from placebos.

But Kaptchuk also reminds us that placebo effects are not cures and they only work in alliance with actual medical intervention, be it drugs or other therapies.

For the most part, how the placebo effect works is still a mystery. But Kaptchuk gives advice that you should make sure you have a bond with your doctor because evidence already shows that this helps you heal better. Thus, if you had to choose between equally competent doctors, a doctor’s “chemistry” with you as patient should be the deal-breaker.

Kaptchuk flakes the placebo effect even more – asking that research should be done to see what connections should doctors explore with their senses (gaze, touch) and with their demeanor and language – that can help patients heal better? He says that these patient interactions can “frame” or “nudge” the patient to feel better or deal better with their conditions.

A placebo is most often used in medical science to evaluate the effectivity of a drug, i.e., if a drug works better than a placebo, then, it most likely, works. But now, attention should also turn to investigating how placebo itself works as a drug or how it helps a drug work even better. Perhaps the secret ingredient in medical science is the art of conversation – or the art of being present to another human being. –