Reviving the old sermon of medicine with the placebo effect

Abstract

Reviving the old sermon of medicine with the placebo effect Revivendo o antigo sermão da medicina com o efeito placebo A b s t r a c t Objective: The message of the importance of a caring doctor-patient relationship is now like an old sermon which does not impact anyone's mind or action. Observing the healing practice of the old time physicians, who valued their attitudes and relationship with their patients more than the actual interventions, this paper reviews the literature on their main therapeutic device -the placebo effect -as a novel way of delivering this old sermon of medicine to contemporary doctors. Discussion: There are countless historical and contemporary examples of the impressive placebo effect and although contested by some, it seems real and significant. The classic conditioning theory and the expectation theory explain reasonably well the mechanisms of the placebo effect, especially in conjunction with each other. The underlying biochemical pathway, according to the limited current knowledge, involves endorphins for pain and dopamine for Parkinson's disease. Finally, human factors such as the doctor's positive attitudes and a good doctor-patient relationship seem to be more essential than the placebo itself in eliciting the placebo effect. Conclusions: Given the body of evidence supporting the existence of significant placebo effect and the importance of the doctor-patient relationship in determining it, the human factors of the medical treatment should be emphasised in order to maximise the placebo effect and consequently the overall therapeutic effect of the healing acts.Keywords: Placebo effect; Endorphins; Dopamine; Doctor-patient relationship; Classic conditioning; Expectation; Human factors Resumo Objetivo: A mensagem sobre a importância de uma boa relação médico-paciente é como se fosse um velho sermão que não tem mais impacto no pensamento ou na ação de ninguém. Observando a prática dos médicos dos velhos tempos, que valorizavam mais suas atitudes e o relacionamento com seus pacientes do que as intervenções em si, este artigo revisa a literatura sobre o seu principal dispositivo terapêutico -o efeito placebo -como uma nova forma de pregar este velho sermão da medicina aos médicos contemporâneos. Discussão: Há incontáveis exemplos históricos e contemporâneos do impressionante efeito placebo e este, ainda que seja contestado por alguns, parece real e significativo. A teoria do condicionamento clássico e a teoria das expectativas explicam razoavelmente bem os mecanismos do efeito placebo -as duas em conjunto os explicam melhor ainda. A intermediação bioquímica do efeito placebo, de acordo com o limitado conhecimento atual, envolve as endorfinas para a dor e a dopamina para a doença de Parkinson. Finalmente, os fatores humanos, tais como as atitudes positivas do médico e uma boa relação médico-paciente, parecem ser mais essenciais do que o próprio placebo para provocar o efeito placebo. Conclusões: Dado o corpo de evidências que apóiam a existência de um efeito placebo significativo e a im...

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