The Strength Of The Medicine Depends On The Doctor. About Placebo. Part 1 - Research, Quality Of Life

Despite everything we know about placebos, new research is opening up new dimensions and depths of understanding. And these depths are, the placebo is a cool thing. Look at how much talent, money, and time the pharmaceutical industry is spending so that the effectiveness of drugs can even slightly exceed the placebo effect. A placebo is not a pill or a procedure; the placebo mechanism is between our ears, it is ourselves, and this is the key to who we are and how we are made. Let's look at a few experiments from this point of view. Does the strength of the medicine depend on the doctor?

Scientists at Research University Dartmouth College (Chen et al., 2019) conducted an ingenious experiment. They recruited students to play the roles of either patients or doctors. The "doctors" were told that they would hurt their "patients", but not much, by applying a hot tip to the shoulder. The tip was heated by a computerized system to exactly 47 degrees Celsius. This causes a little pain, but does not burn. Doctors had to test the strength of the placebo on patients, so before applying the hot tip, they had to apply an ointment to the shoulder: in one case, regular petroleum jelly, and in the other case, Termedol, a local pain reliever. The patients did not know what they were getting - the real drug or the placebo - but the doctors knew.

The doctors were allowed to try the ointments themselves, and they were convinced that the petroleum jelly did not work, and that Termedol did reduce the sensation of pain. Then the doctors started working with the patients, and it turned out that Termedol provided much more pain relief than petroleum jelly. The patients didn’t just say there was less pain - this was evident from the electrical activity of the skin - a proven and reliable measure of stress and pain - people were much calmer with Termedol.

But we didn't say in vain that it was a cunning study: both ointments were ordinary Vaseline. But how is it that the same placebo worked differently?

Scientists have deceived the "doctors". When they were hurt after Termedol, they simply reduced the temperature of the tip so that the doctors themselves believed in the action of the medicine.

Even in this study, a GoPro camera was attached to each patient's head to capture the doctor's face during the procedure.

All of these videos were then analyzed by a computer program trained to recognize the micromovements of facial muscles. It turned out that the expressions on the face of the doctor who thought he was giving useless Vaseline or a working pain reliever were different.

See also: How to reduce the side effects of drugs. About placebo and nocebo. Part 2

The program recorded that the doctor's face expressed pain experienced empathically with the patient to a much lesser extent when Termedol was used. The doctor knew and believed that the patient would not feel pain, just as he himself did not feel it.

The program also saw the doctor's eyes practically wink when the petroleum jelly was applied, but so quickly and imperceptibly that it could not be consciously noticed. The doctors unknowingly betrayed the doctor's attitude towards a useless ointment that would not help with pain.

The experiments were repeated to make sure these were not random effects. We saw another manifestation of placebo work, when instead of an inert ointment, another worked - the doctor's faith. The authors called this the socially transmitted placebo effect.

In another study by Stanford University (Leibowitz et al., 2018), participants were injected with histamine in the shoulder, which causes an allergic reaction in the form of a rash. After six minutes, allowing the reaction to start, the doctor told one half of the participants, "Now I will put an antihistamine cream on the place and the reaction will go away." In the second half, he said the opposite: "Now I will anoint the injection site with an ointment that will enhance the effect of histamine, and the reaction will increase."

After 10 minutes it happened. This was expected: in the first case, the rash disappeared, in the second it intensified. This is nothing new, and therefore psychologists were interested in something else - the social context: can it, like histamine, penetrate the skin?

Does the strength of the medicine depend on the doctor?

Scientists have modeled two types of doctors based on two parameters. The first parameter is empathy, where the doctor could be very attentive or cold. The second parameter is competence. The doctor of the first type was very sympathetic, asked, looking into the eyes, was genuinely interested in the interlocutor, she had a badge of the resident of the Stanford Allergy Center, there was order on the table, and the whole procedure was performed neatly and like according to a textbook. The doctor of the second type did not look into the eyes, asked questions formally, without expressing emotions, on the dressing gown there was a student-intern's badge, the table was cluttered, and the procedure was performed sloppily and awkwardly.

It turned out that the effect of the cream was enhanced when the procedure was performed by a friendly doctor. The words of the incompetent and cold doctor did not affect the effect of the cream at all

As we saw, in the first case, for the placebo effect to occur, the doctor had to have faith, and in the second case, the doctor himself had to be trusted. The doctor as a healer with a confident and open manner of communication, kind, with empathy for the patient, faith in himself and first-class knowledge - an important intervention in itself, no less significant than therapy or medicine. Where can I find such people?

Sources:

• Chen P.-HA, Cheong JH, Jolly E., Elhence H., Wager TD, Chang LJ Socially transmitted placebo effects // Nature Human Behavior. 2019.doi: 10.1038 / s41562-019-0749-5
• Leibowitz KA, Hardebeck EJ, Goyer JP, Crum AJ Physician Assurance Reduces Patient Symptoms in US Adults: an Experimental Study // Journal of General Internal Medicine. 2018.33 (12). 2051-2052. doi: 10.1007 / s11606-018-4627-z