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DATE: April 19, 2002

Physicians may help cure the sick by paying attention to the 'meaning' of treatment

DEARBORN---Some sick people get well when they are told their medicine is good for them.

Is this the "placebo effect"? Not according to a medical anthropologist at the University of Michigan-Dearborn and a colleague affiliated with the Uniformed Services University of the Health Sciences in Maryland.

"We argue that as currently used, the concept of the 'placebo effect' includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon," the researchers said. "We propose a new way to understand these aspects of medical care by focusing on the idea of 'meaning,' to which people, when they are sick, often respond."

Looking at the "meaning" of medical care will probably lead to far greater insight into how treatment works, and perhaps to real improvement in human well-being, according to the researchers.

UM-Dearborn anthropologist Daniel E. Moerman and Wayne Jonas, a medical doctor at the Samueli Institute and the Uniformed Services University of the Health Sciences in Maryland, discuss these issues in an article published in the April 5 issue of Annals of Internal Medicine, titled "Deconstructing the Placebo Effect and Finding the Meaning Response."

"Most elements of medicine are meaningful, even if practitioners do not intend them to be so," according to Moerman and Jonas. "The physician's costume (the white coat with the stethoscope hanging out of the pocket), manner, style and language are all meaningful and can be shown to affect the outcome."

In the article, Moerman and Jonas cite numerous studies that were intended to test the placebo effect, but found something else instead. One test, for example, changed the color and number of inactive pills provided to medical students, after asking them to test stimulants or tranquilizers. The students indicated that they thought red pills were stimulants and blue pills were depressants, and that two tablets had more effect than one.

"The students were not responding to the inertness of the tablets," according to Moerman and Jonas. "Instead, their responses can be explained by the 'meanings' in the experiment: red means 'up,' 'hot,' 'danger,' while blue means 'down,' 'cool,' 'quiet,' and two means more than one."

In a similar test among headache sufferers, researchers provided aspirin labeled with a well-known brand name and the same aspirin in an unmarked package, as well as inert pills in the brand-name package and unlabeled. That study found that headache sufferers felt more relief from aspirin in the branded package than from the unbranded package, and they also reported better results from the branded placebos than from the unbranded ones.

"Aspirin relieves headaches, but so does the knowledge that the pills you are taking are 'good' ones," according to Moerman and Jonas. "Ironically, although placebos clearly cannot do anything themselves, their meaning can. To say that a treatment such as acupuncture 'isn't better than placebo' does not mean that it does nothing."
The researchers emphasize that the meaning of medical care and the response that results can be of great value to sick people.

"Practitioners can benefit clinically by conceptualizing this issue in terms of the meaning response rather than the placebo effect," according to Moerman and Jonas. "For human beings, meaning is everything that placebos are not, richly alive and powerful. However, we know little of this power, although all clinicians have experienced it."

Sad to say, as modern medicine has come to rely more on science than on magic, "we have impoverished the meaning of our medicine to a degree that it simply doesn't work as well any more," according to Moerman and Jonas.

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