Published Messenger Newspapers, Adelaide, May 21, 2003


ONE LUMP OR TWO GOOD FOR WHAT AILS YOU


A MATE of mine had an old dog that stretched out in front of the fire one evening and did not move for two days. He and his wife became worried. They tried feeding and patting it but the dog never shifted from the spot. It was a very old dog and the wife suggested the humane thing would be to have the poor creature put down by the vet. But my mate objected to paying the vet's fee, saying he would get his .22 rifle and do the job himself in the morning. He then left the room to go to the toilet and on returning, the dog was standing there wagging its tail. This is known as the placebo effect. The mere threat of a .22 bullet in the head brought about a remarkable revival in the dog's zest for life, as it would in mine too. In medicine, a placebo is usually a sugar pill given to an unknowing patient in a ``double blind'' test to check on the effectiveness of a real drug by comparison. Sugar is used because it is an inert, inactive ingredient that has no direct effect on the ailment under treatment. Supposedly. The placebo effect is a quite remarkable phenomenon, which is said to be particularly effective in patients suffering pain or depression. Even when sugar pills are given to people in pain, their blind belief in the treatment is sufficient for up to 50 per cent of them to say they feel better. So long as it works, who cares? In other documented cases: skin warts were removed by painting them with a coloured dye and promising they would disappear when the colour wore off; people suffering pain after tooth extraction felt relief from an ultrasound machine even though it was switched off; and among a group of patients with inflammed intestines, 50 per cent felt and looked better after treatment with a placebo. In some cases, a sham surgical procedure worked better than real surgery. In other cases, people who took plain sugar syrup suffered the same unpleasant side effects such as vomiting as those caused by the real drug. One of the placebo rules is the patient cannot know of the deception. Imagine afterwards, when your condition had improved, being told you were cured by sugar pills. Now start to worry. Or, if plain sugar is so effective, could it be the magic cure-all that the drug companies are keeping secret from us? Should it be repackaged as medicine and made available only from chemist shops? Perhaps this is what Pan Pharmaceuticals had in mind when, in the mid-1970s, most of the painkiller paracetamol in a batch of headache tablets was replaced with sugar. In fact, according to the story I read in The Australian, where the recipe called for 30kg of paracetamol, only 2kg was used and the remainder was sugar. Were the sufferers who thought it was the real deal left feeling better? Probably. Like the dying dog, a hopeful attitude and positive expectations can make all the difference. I have never heard of a placebo curing cancer but how did that Mary Poppins' song go again? ``Just a spoonful of sugar...''