For a country that spends an absolutely crazy amount on health care, Americans remain a depressingly sick bunch.
In 2013, said spending worked out to about $9,000 per person. And yet, how much good is that money really doing? That same year, a handy number called the "hospital readmission rate" was shockingly high -- nearly one out of every five people who left a hospital headed right back no more than a month later.
While it's impossible to find a consensus on an effective solution, a curious thing has happened over the past two decades. While Americans were shelling out more and more money for health care, the strength of the placebo effect -- roughly defined as the apparent improvement of a medical condition when a false or sham treatment is given -- has increased. That means people are getting better even when docs treat them with fake pills and fake surgeries. Why would you want to pay for real medicine when a fake pill works, especially for common issues like chronic pain?
Humans love getting what they want
Understanding the placebo effect is tricky business -- how can you even begin to explain a patient who feels less pain after taking a sugar pill? One theory is that humans have expectations, and we like to get what we want, or at least what we signed up for. A sugar pill can make you feel better for exactly that reason: It works to meet your expectations, and the entire medical system is designed to make you feel as though you're receiving treatment.
When you’re handed a medication and told it’s bound to relieve your headache, sure enough, just a bit later you feel markedly better. And if you’re told that your migraine will go away but you might experience a bit of nausea, like a good patient, you also feel slightly queasy. It works both ways.
Bonus points if an authoritative doc in a white coat gives you the pill. Enduring the waiting room and its home decorating magazines, having your blood pressure and temperature measured, and being interrogated and examined by a physician is all part of what anthropologists might call a "therapeutic act." There's a culture of healing you enter when you head to the doctor, completed by the ceremony of writing a prescription. You expect this whole shebang to be followed by feeling better. Usually, you're right.
Then again, humans might not be so different from Pavlov's dogs
While this perspective makes people seem pretty powerful and important -- an entire culture of healing created to exploit this magical effect! -- looked at another way, humans are just animals who can be conditioned into producing a physical response.
Think of a sick person as one of Pavlov's dogs. Some experts say that a sugar pill is the proverbial bell -- you take a pill, like ibuprofen for a muscle ache, the active ingredient enters your bloodstream, and you get better. This has happened many times. So when you take a pill that contains no active ingredients, but you think it does, you still get better! You thought you were so smart, did you? Your body just relieved your symptoms for no reason whatsoever, except that it knows what a pill is supposed to do.
This is your brain on (fake) drugs
The placebo effect has been a known phenomenon for a long time, and it's opened the door to a string of medical, philosophical, and anthropological opinions that are difficult to prove definitively one way or another. Like in any healthy scientific debate, people who believe one thing or the other are hitting each other over the head with academic journals about this, but there's a pretty good argument that either/both of the above theories can be true, depending on the situation.
With the development of brain imaging technology, however, researchers have new ways to examine the placebo response. When they looked at people's brains, they saw that taking a placebo actually changes your brain waves and gets your brain to launch neurotransmitters like epinephrine and dopamine, the drug-like chemicals that make you better. It all looks like something like this.
Fake surgery? Bring it on!
Scientists decided to take all these crazy theories further and instead of just fake pills, they started handing out fake surgeries. Don't worry, not for anything serious like a quadruple-bypass heart surgery.
Knee surgery is a different story. If you follow sports or have a grandparent, you have at least passing familiarity with arthroscopic surgery. In one landmark study, patients with osteoarthritis got either an actual arthroscopic surgery or a superficial cut that was stitched up. For a whole two years of reporting how their knees were coming along, patients who got the sham surgery were just as likely to report pain relief as those who got the real deal. What's more, more than a decade later surgeons found similar results in patients with a torn meniscus.
Down with high health care costs! Placebos for everyone!
One of the downsides of the placebo effect: it's screwing up science
The whole scientific method is based on using a control group, and all this time, researchers have been making the placebo the control group. Some patients get a drug. The other half gets a sugar pill. But what happens when the sugar pill has a pretty drastic effect too? Now we need another control group! That just confuses absolutely everything!
The scientific method is one reason that alternative treatments, like acupuncture, have been dismissed by researchers. Science doesn't explain why they work, so they must work for some people because it's all in their heads, they might say. Well, why is that a bad thing? Slowly but surely, it's becoming more and more accepted that the placebo effect is a real thing that can help people get better.
One ex-acupuncturist Harvard researcher even decided to do an experiment with no control group; every group got the so-called "placebo." You might see where this is going: Both sham treatments -- a fake pill and fake acupuncture -- produced results and side effects. Just like real drugs.
Coming to a doctor's office near you?
While placebos can’t be the only solution to health care costs, doctors are talking seriously about making them a real thing in medicine and part of real-life treatment plans. For example, a placebo can be used along with a real drug to reduce the dosage necessary.
Think handing someone a fake pill is unethical? The kicker to this whole placebo thing is that doctors don't need to resort to tricking people; telling patients they're taking a placebo still produces the same results. And it's a repeatable result, too -- patients with chronic back pain who were told they were taking placebo pills saw a 30% reduction in their symptoms. That's crazy, but also good news for anyone dealing with chronic pain.
Clearly you don't want to use a cornstarch pill to treat cancer. But with overdose deaths in America beginning to resemble the toll of HIV in the 1980s, and antibiotic resistance threatening the medical profession's ability to fight an entire class of illnesses, it's worth exploring ways to reduce the tendency to take prescription drugs for every ailment.
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