Irritable bowel syndrome: Unusually high placebo effects

Though dedicated to curing, doctors hate placebo effects. It messes up their clinical trials when a drug or treatment plan has an unusually high placebo effect (technically, it makes statistical significance, p < 0.5, nearly impossible to achieve). In addition, doctors never follow through on these critical observations, as if they have forgotten the real goals – (1) to cure disease and (2) to at least ease suffering.

When people suffering from irritable bowel syndrome (IBS) are given medications, one a placebo and one a drug that treats symptoms, and the outcome, in terms of percentage of people showing relief of symptoms, is similar, what does that tell us?

And in general, how can we make the placebo effect stronger? Why treat with a medicine that has obnoxious side effects when the placebo is working nearly as well?

Here is an example – and there are many- of a very strong placebo effect in people with IBS: Jewell DP, Truelove SC. Azathioprine in ulcerative colitis: final report on controlled therapeutic trial. Br Med J. 1974 Dec 14;4(5945):627-30. PubMed PMID: 4441827; PubMed Central PMCID: PMC1612983.

The data of Table 1 of this paper say it all: 40 patients with ulcerative colitis were treated with azathioprine or placebo for a month. 31 went into remission on the drug, 27 on the placebo. 27/40 got better on the placebo!

This tells me two things: (1) azathioprine is a poor drug for ulcerative colitis and (2) the support staff of this group did a great job holding the patients’ hands, making them believe in the treatment, giving them hope, and above all, a feeling of importance – a feeling of importance is something they do not get in their daily lives.

What is the strongest human desire? What is the least satisfied human desire? They are both the same: the desire to be appreciated, to feel important, to be valued, to be special to at least one other person and preferably many more. Compare the works of William James and John Dewey.

If this is true and if IBS is primarily a consequence of feeling unloved and under-appreciated, then it should be a very common problem indeed. Estimates vary tremendously, but upwards of 10% of adults may have some form of IBS. Not surprising, if this psychological source, this emotional hunger, nay starvation for affection, is the major driver.

As a whole, harried medical practitioners who actually see patients are very bad at making their patients feel important and genuinely cared for. Just the opposite. Government bureaucrats are nearly as good as medical practitioners and the former at least take their time in dealing with you. Hence, placebo effects in drug trials are usually low. But placebo effects in IBS drug trials are generally somewhere between high and very high. Why? Most likely because the people who suffer from this disease are feeling particularly under-loved, under-valued, and are noticeably angry,resentful, depressed and disappointed by this. These patients remember slights from 30 years ago as if they happened yesterday. In a way, they did. Frequent recall keeps the memory ever so fresh and ever so potent in its harmful effects.

The difference between their own (admittedly below average) feelings of self-worth and the incredibly shabby way others treat them, implying much less worth, is unusually high. Resentment is another prominent poisonous emotion in this syndrome. Nietzsche would say that resentment is more poisonous than any other emotion.

A person in such a state of mind does not do herself/himself good. If she smokes,  she smokes more. If she drinks, she drinks more. If she eats comfort foods, she eats more comfort food. Anything for relief of these nagging feelings.

Show these patients with IBS a little genuine concern and their mental states improve – and with it, the symptoms of their “disease” improve. Their disease, like most diseases, is at bottom, dis-ease or rather dys-ease.

Consistent with this observation is the sex distribution of IBS: twice as many women than men. As a whole, women feel under-appreciated more often and more intensely than men. Other diseases with a predominantly female sex bias, such as “autoimmune” diseases, likely have a similar psychological etiology.

Consistent with this idea is that the people suffering the highest grade of IBS have the most serious documented psychiatric problems. Is it a stretch to say that all IBS sufferers have psychiatric problems, although in some cases our psychiatrists are missing the obvious ones?

Proper psychiatry -nothing like our modern version- AKA “namian” psychiatry, is what we need to cure dis-eases and ease symptoms. Toxic medications are generally not needed. If doctors, nurses, and support staff genuinely cared about their patients, took their time with them (would save time due to fewer visits and phone calls), made them feel important, and confidently predicted cures (and express genuine surprise when the cure failed), the body would heal itself, i.e. placebos would appear to work as well as drugs, and without any of the awful side effects of the drugs.

What a backwards world we live in. As on the fictional planet of the magnificent “namian” people (Our Lovable Mirror Image), the primary care physician should be a properly trained psychiatrist, because the major sources of diseases of all kinds are mental disorders, which place tremendous stresses on the body.

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