Paying for Placebo part 2

Carl Marci, assistant professor of psychiatry at MGH, is reported to have studied the placebo effect since his days as a medical student. “During a course on alternative therapies, he was struck by the amount of time these practitioners of homeopathy, Reiki and acupuncture spent with their patients. Data showed that, with the exception of intense psychotherapy, people were spending far more time with alternative practitioners than they were with other health practitioners.” The article states: ”He began to suspect that the success of these providers had less to do with their therapeutic approach than it did with the time they invested in their patients.”

Marci is currently studying empathy, “the ability of the brain to accurately mirror the emotions it perceives in another.” He has applied his studies to the critique of clinical trials of pharmaceuticals in which the study providers’ interaction with patients adds a placebo effect which may skew the apparent benefit. In a busy practice a hurried physician may, however, have little time to empathize, and his treatment with any modality will be less effective. From Harvard medicine, summer, 2011

I’m reminded of reports of Medicaid patients who sought a new doctor, gave a history, had examinations and procedures, were treated, returned for followups and in time, found the doctor less interested and started the process anew, not reported their earlier consultations. Medicaid records identified these patients as over-users. If fact, they were lonely people bereft of family or friends and knew they would enjoy a social event with each new doctor. What they really needed was a social network.

In an internship, while in a crowded ER, a young physician had a patient in pain who was hard of hearing. He told the patient he would administer an injection to relieve his pain. “O. K., Doc,” replied the oldster. “O. K., Doc,” came a voice from an intoxicated patient in the next bed, behind a curtain. A few minutes later, the intern returned and asked: “Feeling better?” Yes, said the patient, thanks.” “Yes,” said the drunk, “I feel fine now.”

Physicians graduate burdened by debt and have deferred income during their years of training. The current economics of health care require them to be “productive” which means hurrying the patient through the interview. There’s little time for empathy. No wonder patients seek alternative and complementary practitioners and are willing to pay.