Ultram and the placebo effect

Perhaps we should not find good in the Europeans. After all, they have death camp hospitals where doctors decide who lives and dies. At least, this is how the more excitable GOP politicians seem to think other democratic countries work. Quite why any government could survive ten minutes if its doctors were systematically killing people off is not explained. It is simply assumed all socialist systems are dangerous to the health of those who live there. That these myths survive is proof, if you needed it, that ideas can have a powerful and long-lasting effect on people. Put another way, if you believe in something strongly enough and make it a part of your life, your belief often comes true.

In medicine, an early problem facing researchers when designing clinical trials was the so-called placebo effect. It has long been recognized that people who believe strongly enough in the cure will often be cured. So we need to start off with a definition. A placebo is a chemically inert substance or liquid that can have no effect on the human body. In a clinical trial, people are randomly assigned to one of two groups. One gets the real drug. The other gets the placebo. But there is no way anyone can know which is which. So a doctor in a white coat gives you encouragement, a smile and the “medicine”. The volunteers then describe how they feel.

Consistently, about one-third of participants report feeling better after taking the placebo. No matter what the researchers have done to eliminate the placebo effect, all they have succeeded in doing is produce a mountain of evidence that people who expect a treatment to work feel better. So, if you run a practice, a clinic or hospital, you can make a third of your patients feel better if you manage their expectations well. Physicians dress and act the part, listening carefully, carefully examining, ordering tests where appropriate, and then prescribing something that will “do the trick”. Even if this something is chemically inert, it will be an effective treatment in at least one-third of cases.

In this, it makes no different what the source of the pain. It can be a severe headache or a broken bone. The strength of the patient’s belief is the key to relieving the pain. There always has been a role for ritual and suggestion. The shamans have exploited this over the centuries. Modern medicine continues the same traditions, albeit in a different form. This is not to say the result of clinical trials are to be doubted when they show a drug effective. Many drugs like Ultram are effective no matter what the patients believe, i.e. though you may not tell a patient exactly what drug you are giving and what the expected outcome is, people routinely experience less pain. But the converse is equally true. Many people who have pain can control it without having to use a drug like Ultram. All it requires is a belief strong enough to make the pain bearable. It is this placebo power that is exploited in the European approach to pain management and a good reason to feel grateful we live in America (or not, depending on what you believe).