DrSamGirgis.com has the pleasure of hosting the following post by guest blogger, Dr. Richard Andraws MD, who is a Board Certified Cardiologist
Tell your heart that the fear of suffering is worse than the suffering itself.
The cornerstone of modern medical research is the randomized, placebo-controlled trial. Before a new therapy is allowed into clinical use, its efficacy in treating a condition must be proven, beyond a statistical doubt, in identical groups of patients. Half of them are given the therapy, and half a “placebo”. A placebo is a substance that appears identical to the experimental drug in every way except for the active agent. In some cases (when the therapy is a new surgical procedure, for example) the placebo is a “sham” operation in which the procedure is not performed. Either way, we’re comparing a novel, innovative, tangible treatment to, well, nothing.
Turns out it’s not that simple. The placebo effect has been recognized for years as an actual phenomenon. A certain percentage of patients given a placebo feel and do better than expected (for taking, say, a sugar pill). The precise mechanism is debated, but a unifying idea is that belief in possible benefit on the part of the patient leads to biochemical changes in the brain and perhaps elsewhere in the body. It’s so real, in fact, that some physicians may use it in routine practice, although this generally is considered unethical.
Nevertheless, understanding how the placebo effect works is important because it hints at fundamental truths about ourselves and may profoundly affect how we understand and treat illness. In that spirit, German investigators recently described their findings on the effects of verbal suggestion on the function of the coronary arteries (i.e. the blood vessels that feed the heart).
The study consisted of 28 patients undergoing coronary angiography for chest pain (a minimally invasive procedure in which small tubes called catheters are inserted into the heart via arteries in the thigh and X-ray pictures of the coronaries are taken after injection of contrast dye). These patients had no evidence of heart attack, no significant blockages in their arteries requiring treatment, and were otherwise medically stable. Median age of the patients was 67 years and 23 were male. They were well-matched in terms of medical histories and medications taken.
After the angiogram but before the catheters were removed, a harmless, physiologic salt solution was injected into the coronaries. Half the patients received no verbal suggestion; the other half were told that they were receiving a very effective drug that would improve blood flow and make them feel better. The investigators analyzed how the two strategies affected coronary diameter, blood pressure and heart rate, the patients’ perception of chest pain, and an assessment of their well-being by questionnaire several hours later.
Patients receiving the injection and the verbal suggestion showed significant coronary constriction versus those who only received the infusion. Likewise, these patients felt as though their chest pain improved. There was no effect on heart rate or blood pressure in either group or on their sense of well-being. The findings were a bit counterintuitive in that constriction is often associated with worsened blood flow and chest pain. The mechanism involved is not obvious, but may relate to the verbal suggestion affecting the complex interplay between adrenaline, other messenger molecules, and vessel function. The authors speculate on whether the same effects would be seen in diseased coronaries, which are known to respond differently (and would be obvious therapeutic targets).
Ronel et al. should be applauded for an impressive, albeit modest, study. They provide us dramatic evidence of the mind-body link. Their work should encourage further research in this most intriguing niche of modern medicine.
Ronel J, Mehilli J, Ladwig KH, et al. Effects of verbal suggestion on coronary arteries: results of a randomized controlled experimental investigation during coronary angiography. Am Heart J 2011; 162:507-11.
Placebo Effect (Available at URL: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/placebo-effect)
Fässler M, Meissner K Schneider A, et al. Frequency and circumstances of placebo use in clinical practice – a systematic review of empirical studies (Available at URL: http://www.biomedcentral.com/1741-7015/8/15)