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Placebo Effect and Lessons for the Physician-Patient Relationship

(Science Daily) The findings of a comprehensive review of the placebo phenomenon and its consequences for clinical medicine are contained in a new article… The effort, undertaken by physician-researcher Fabrizio Benedetti…, provides an in-depth biological and evolutionary approach to examining the placebo effect in relationship to the doctor-patient relationship…
Among the issues discussed in detail are:
          There is no one "the placebo effect." There are different mechanisms in play across a variety of medical conditions and therapeutic interventions. For example, a placebo effect takes place because there is expectation. The patient expects a therapeutic benefit, and this kind of expectation actually has an effect on the brain and the body.
          The connection between expectation and real improvement that may occur is due at least to two mechanisms. The first may be a reduction of anxiety. The second is between expectation and the activation of a reward mechanism by the region of the brain known as the nucleus accumbens (which also governs pleasure, reinforcement learning, laughter, addiction, aggression, fear, impulsivity and the placebo effect.)
          When a treatment is given to a patient, be it a placebo or real, it is administered in a complex set of psychological states that vary from patient to patient and from situation to situation. For example, when a placebo is given to relieve pain, it is administered along with stimuli which tell the patient that a clinical improvement should be occurring shortly. These stimuli can include the color and shape of the pill, patient and provider characteristics and the healthcare setting.
          Recent research has revealed a reduced efficacy of drugs when they are administered covertly to the patient. In fact, if the placebo/expectation component of a treatment is eliminated by means of a hidden administration (unbeknownst to the patient), the psychological component of the therapy is absent as well.
For physicians, psychologists, and health professionals these and other recent findings found in Dr. Benedetti's article can foster enhanced understanding of how their words, attitudes, and behaviors impact on the physiological profile of their patients' brains. This "direct vision" of the patient's brain will hopefully boost health professionals' empathic, humane, and compassionate behavior further. Moreover, understanding the physiological underpinnings of the doctor-patient relationship will lead to better medical practice as well as to better social/communication skills and health policy.
Community: The placebo effect is very powerful, and I’m glad there’s more research into its effects. If we could channel it, we could use it to help prevent or treat some diseases.
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