The Placebo Effect

For a while in my life I had to take a lot of prescription drugs, right now I am not taking anything thankfully, but as an example, during the height of my Sarcoidosis journey I had to take 18 tablets every day, sometimes 19.  When you take so many tablets there is a thought that dwells on your mind and that thought is what are they actually doing to you?  The clinical explanation is quite simple, each tablet is prescribed to treat a given symptom or condition and they have their stated purpose.  The question of what they actually do however goes a little deeper.  Not all medications are created equal, and whilst many are effective, no drug is ever 100% reliable, there will always be cases where it works better than expected, and cases where it works worse than expected, part of the reason for that is that our physiology although similar does deviate from person to person.  Tolerance in medical terms is defined as the level of a drug your body can withstand before it has an effect and that can vary quite a bit.

Beyond the clinical explanation however, or to be more precise the pharmaceutical explanation, there are other factors at play that determine what a drug actually does when you take it.  One factor I find fascinating is the influence of Psychology on the effectiveness of treatment.  Most people will be aware of the placebo affect and have a basic understanding of what it is, namely that a drug only works for a patient because they think it will or because they expect it to, not because of the chemical composition of the pill - in fact some medications are nicknamed 'sugar pills' for the fact they contain nothing of any real substance - no pun intended.

Whenever you get a cold, the first place most people turn to are the various remedies that people believe provide a cure.  In some cases they even turn to medical professionals seeking out medication to treat their cold - if a doctor is worth their weight in this situation they would be direct with the patient and advise them to simply get some rest, stay hydrated, and try and maintain a healthy diet, all of which are things we're supposed to do anyway.  A bad doctor in this situation will prescribe the patient a drug they fully know and understand will do nothing whatsoever to treat that cold, for the simple reason that the cold and the flu - related, although different - are both caused by viruses.  In the UK we have legal restrictions on certain drugs to prevent you from buying them over the counter or from a pharmacist without a prescription, one class of drugs that are controlled by these restrictions are antibiotics.  There is still a perception held by the general public that these can be used to treat the these conditions - they cannot.  Antibiotics will not treat viral infections.  In years gone by, it was common for doctors to prescribe antibiotics to the patient, knowing they wouldn't actually work, but also knowing that a typical cold or flu lasts no more than a few days, or a week at most, so giving a patient a 2 week course of antibiotics would "buy" the doctor enough time for the patient to naturally recover.

This happened much more so in the past, today of course this practice is discouraged, partly because antibiotic resistance is a growing problem caused by their overuse, but also in part because of austerity.  There is a cost associated with these medications and preventing doctors from prescribing them lowers that cost.  The fact that these drugs didn't actually treat the condition they were prescribed for, seems not to have played a factor at all in the decision to stop prescribing them - which leads you to question how many other drugs are prescribed knowing they won't actually treat the conditions they are prescribed to treat; more than this, it makes you question how many treatments actually rely on the patient perceiving an effective treatment being administered for them to recover - in other words, how common is it to be prescribed what is essentially a placebo even if the pill you are given is pharmaceutically active?

You can also flip this question on its head and ask how many conditions do people develop in the first place because they expect to develop them - something referred to a psychosomatic condition, or to define it more explicitly, a physical condition that develops as a result of a mental condition like stress, anxiety, or depression.  If a placebo is a drug that doesn't treat a condition but makes it disappear because you believe it will, then psychosomatic conditions can be seen as the antithesis, as conditions that develop in the first place because you believe they will.  It's important to note here that not all placebos actually work, and that not all psychosomatic conditions develop out of expectation, there are exceptions as there always will be and as with many things, there can often end up being more exceptions than the rule to begin with.

Still of all, the question remains, how much of our physical health is determined by what we think and feel, in whichever direction it heads, either in recovery or in malignancy.  There are times whenever the desire to overcome something without any treatment at all would be an incredibly bad idea, particularly those conditions which can be fatal, but for conditions that we can recover from without treatment, how effective is it to rely on psychological based treatments as opposed to pharmaceutical based treatments?

You might find yourself asking why I would contemplate this question, as I am not a medical professional, but the answer to that is rather simple.  I have seen through my own experience and through that of others both in my immediate and extended family, as well as the experience of friends, and the experience of people through social media who I do not know personally, a correlation, where time and again they have been advised by doctors to focus on condition management rather than pharmaceutical treatments.  In the past 10 years the UK has experienced one of its strictest periods of austerity in a generation, some would argue in several generations.  One area that has been a particular focus of that austerity is Healthcare, despite the best efforts of successive governments to purvey propaganda to the contrary, with headlines claiming billions extra in funding is being spent, the trouble is most of that increase doesn't even bring you anywhere near reversing the cuts that were made in the first place.  More than this, there have been many cuts that have been delivered in ways which are obfuscated, they do not grab headlines, nor do they garner much attention from the general public because they are done in ways that are not immediately perceived as being what is defined as a "cut" - for example freezing recruitment for several years caused the number of people employed by the health service to fall, and fail to keep up with population growth, the end result is a cut that is made against the projection rather than the headline figures.

Healthcare is not the only area of the UK economy where this has been the case, these hidden cuts have been employed in many different areas and are not limited to the UK either, several other nations employ the same tactics, the USA for example has succeeded in hiking taxes on its citizens aggressively whilst making them believe their taxes have been cut.  This was achieved through the use of tariffs, additional costs on goods and services that are paid for by the consumer in the price they pay for those goods and services or by the company that produces them - these tariffs in reality are hikes to VAT and Corporation Tax respectively they just aren't referred to as such, and the guise of international trade disputes are used as justification, just as the guise of austerity is used as justification to cut public services in the UK in a way that isn't directly viewn as a cut.

The emphasis on using condition management, relying on pain management techniques and visualisation instead of prescribing painkillers, I believe is motivated by cost and austerity, not by any clinical justification, moreover, if this approach actually works then it would raise serious questions as to why those drugs were prescribed in the first place if they never actually worked or if they were relying entirely on perception to be effective.  If however, this approach was to ultimately fail, then in the coming years there will be a health crisis that will develop as a result when a nation of sick people have gone untreated for years allowing their conditions to progress, in many cases to points where effective medication may no longer work at all.  Which brings us back to the question we asked before, how effective is it to rely on psychological based treatments as opposed to pharmaceutical based treatments?