In the Biomedical Breakthroughs of Pluralistic World class, I learned the discoveries that lead to development of antibiotics and drugs. These advancements in diagnostic applications (e.g. Helicobacter pylori, HIV, Prions, Western Blot and PCR) are made possible by the understanding of how to combat microorganisms.
In discussion, we dedicate two weeks to a topic.
Week 1 | Antibiotic Resistance.
The first week we debated the concerning phenomenon of antibiotic resistance. There is an increasing case of antibiotics resistance due to their excessive use. Bacteria are generating resisting mechanisms to defend against antibiotics, and this is a great concern as there are currently few back up. Staphyloccucus auerus on the epidermis of the skin is generally harmless unless it invades another organ and causes infections. It is undesirable for S. aureus or S. epidermis to acquire resistance to the current available antibiotics because then those resistant strains can threaten the human population.
Week 2 | BRCA-1/BRCA-2 Breast Cancer.
The second week, we discussed whether genetic testing for mutation of tumor suppressor genes, BRCA-1 and BRCA-2, should be incorporated in the prevention of breast cancer.
Week 3 | Placebo Test.
Mr. Koh is interested in funding a research foundation and seeks for my advice on whether to research the placebo effect. Our group discussed decision on the current findings, medical ethics and efficacy of this phenomenon.
The placebo effect is the phenomenal mind-over-body healing effect generated by the expectation of an empty drug in which the patient believed to have therapeutic properties. The effectiveness varies on the individual basis.
Our group unanimously favored the research based the current findings, medical ethics and efficacy of placebos. I support the research, but would advise Mr. Goh the limits of the research should be within the scope of psychological and pain disorders. Neurologists are trying to figure out the region responsive of mind-healing phenomenon. It cannot be summarized in one circuitry as it involves the interplay of anatomical, biochemical and psychological factors. Patient’s perception of their sensory modalities–sight, hearing, taste, touch and smell– are all chemical signals that is translated in the brain.
Placebos are not limited to sugar pills, but can take form in just about any form such as sham surgery. Evidence that placebos work:
1. Painkillers. A painkiller administered by IV in front of a patient works better than the same dosage administered in private. Nine double-blind studies on aspirin show that placebos were 54% as effective as actual analgesics. Six double blind studies showed that placebos were 56% as effective as the actual morphine. This is because the perception of pain and pleasure are controlled centers localized in the brain. The stimulation of pain receptors results in chemical signals relaying into the pain cortex of the brain, informing the body the region of injury and to take appropriate reflex.
2. Sham surgery. A patient who received a placebo knee surgery recovered without having the knee tampered at all. In another case, patients with pectoralis angina who received sham surgery reported relief to their chest pain.
3. Acupuncture. A well-educated and informative acupuncturist who facilitated good patient care was more effective than a cold, quiet practitioner.
In particular with pain perception, studies show that placebos relieve pain half as effective as aspirin and morphine. I hypothesize placebo to work especially well on problems controlled by the brain such as depression or pain. Instead of relying on exogenous anti-depressants, why not try stimulating the natural antidepressants? This can be talking with family or friend, exercising and having a healthier diet. Communication between families can relieve worries and depression. Extensive research has already shown that exercise stimulates the endogenous endorphins to inhibit pain pathways. The cortex of pain perception center and pleasure center that releases serotonin and endorphin are both located in the brain. Their close proximity may facilitate relaying of the neurochemicals to inhibit the pain reception.
A directing physician from the University of Texas, Howard Brody asserts the importance of a strong relationship between doctor and patient influences the efficacy of the treatment. A friendly, heart-warming doctor who gives the same treatment as a cold doctor would is more likely to earn the trust and make patients feel better. What patients need is thorough explanation of their illnesses and a cheerleader who chants happiness and low-stress lifestyle are just as effective as medication itself. I’d like to surface the unsuccessful test results that are hidden by pharmaceutical companies from the public.
As a student of medicine, I firmly do not believe in deceiving my patients with empty pills. If their condition does not require prescriptions, I would tell them honestly and straight-forwardly. I would instead try my best to inform the patient of their condition, prognosis and how relaxing their stress would lead a good recovery.
Limitations of Placebos
1. Pharmaceutical companies. I’d like to surface the unsuccessful test results that are hidden by pharmaceutical companies from the public. The findings of placebo research may expel the misconception that drugs are the sole solution to all diseases. This breakthrough may challenge the pharmaceutical industry and redirect the funding of drug development to supportive groups (e.g., talk therapists, nutritionists, and exercise trainers).
2. Ethics of Deception. For liability reasons and prevention of iatrogenic malpractrice, placebo testing on patients with life-threatening, infectious diseases, terminal illnesses or cancers should be refrained. I specifically advocate the field of depression because the pharmaceutical industry racks in $11 billion revenue from antidepressants alone. Furthermore, more research should be conducted on talk therapy and exercise trainers.
