During World War II, Henry Beecher, an American anaesthetist, made an extraordinary discovery.
Many of the soldiers he treated had suffered horrific injuries. He knew these injuries would be agonising, and quickly arranged for the soldiers to be triaged on the severity of their wounds so that those with the worst injuries could be given analgesia first.
But he began to notice something very strange. Over half the soldiers reported little or no pain, despite severe wounds, and didn’t request any pain relief. Pain management simply wasn’t the priority, and Beecher couldn’t understand why it wasn’t.
The men were not in shock and were still able to feel pain. In fact, Beecher noted that they complained about the intravenous lines in their arms just as much as other patients.
The placebo is a well-known psychological phenomenon whereby a person improves after taking a treatment simply because they have the expectation that it will actually make them better
What puzzled Beecher was that in peacetime, almost all his patients requested painkillers for injuries of similar severity. In fact, most would have wanted analgesia for far less severe injuries — and would complain bitterly if they hadn’t received it.
This puzzled Beecher: surely the same injury would cause the same amount of pain? It was then that he realised he hadn’t accounted for one thing: the power of the mind.
He saw that for the soldiers, a severe injury was actually a good thing, as it meant they would be discharged from the army and could return home. For civilians, however, it was a bad thing: a disruption to their life and routine, and it could mean financial hardship, too.
Worrying research this week showed that babies are at twice the risk of ending up in hospital with flu if their older siblings aren’t vaccinated.
With the school vaccination programme, this is so easily preventable, yet it seems only half of young children are getting the (nasal spray) vaccine.
In many cases, they are missing out simply because their parents don’t get the consent form, which languishes in school bags.
With fears this winter may see an epidemic of a flu strain (B) that directly affects young children, babies need to be protected. Delve into that school bag and sign the consent form.
He understood that it’s not necessarily the magnitude of the injury that’s important for how a person experiences pain, but the circumstance in which it occurs. He wrote up his findings in a research paper, just a few pages long, and published it in a journal shortly after he returned home.
It caused quite a stir, and led other medics to come forward with similar stories. This all helped spark entire theories about how the mind could control symptoms such as pain.
The only reason I know this story is because a wily anaesthetist told me it at medical school, as he was lamenting how, because of advances in pharmaceuticals, this aspect of pain management had been largely forgotten.
It’s precisely this power of the mind that’s harnessed in the placebo response — a well-known psychological phenomenon whereby a person improves after taking a treatment simply because they have the expectation that it will actually make them better.
This week, a fascinating study revealed that even if someone knows they’re receiving a placebo, it still reduces their pain.
This can be explained by several factors.
First, it’s an example of the suspension of disbelief, similar to when we watch a scary film. We know it’s not real, we know they are only actors, but our mind allows us temporarily to suspend this and experience the fear.
This fat op is doomed to fail
Liposuction was in the news this week after a 45-year-old woman ended up in intensive care at Sandwell and West Birmingham NHS trust following the procedure. She’d nearly died after developing a fat embolism, where a lump of fat enters the bloodstream, blocking blood vessels. This has led to doctors warning of the dangers of liposuction.
Yes, there are possible physical complications, but they are rare. The bigger issue, I think, is the psychological aspect. I have seen numerous patients and have even had friends who’ve undergone the procedure, and it rarely seems to achieve what people want.
Yes of course it removes unwanted fat — although often patients complain about an uneven surface. But most importantly, liposuction can’t hope to address the real issue of why someone is so unhappy with their body — which all too frequently is about low self-esteem. People’s relationships play a big part, too, with many holding on to the false belief that if, for example, they had a flatter tummy, then their boyfriend would love them. Even worse, if they fail to change their eating habits, they’ll just put the weight back on.
My advice: have psychotherapy for two years (at a fraction of the cost of liposuction) and work on your self esteem. If, after this, you still want it done, do it with my blessing.
So far, not a single person to whom I’ve said this has gone on to have liposuction, but they’ve all felt much better about themselves.
It’s the same with a placebo. Despite our mind knowing it’s not an active drug, we can ignore this fact and our symptoms improve.
The placebo effect is also down to another trick of the mind: while people know that a placebo doesn’t have any pharmacological effect, they also now know that placebos work — and so it becomes a self-fulfilling prophecy.
There is another, incredibly important element to placebo power. Sadly, it’s far easier to prescribe painkillers than to explore what might be happening in a patient’s life socially and emotionally that will be impacting on their experience of pain.
I often think this is why alternative medicine such as homeopathy is so popular with patients who have chronic pain or other complex medical problems, especially when conventional medicine doesn’t help their symptoms. It’s not just the fact that people believe homeopathy is going to work and therefore it does, but that the practitioner will talk to the patient for a considerable time. It’s this interaction that helps as much as anything else.
So while I know there’s absolutely no scientific basis for homeopathy, I support its use and think it should be available on the NHS.
Scientists often dismiss the placebo effect, but I’m in awe of it and use it a lot in clinical practice. For example, when I prescribe a drug that’s expensive, I will tell the patient how much it costs because studies show we assume more expensive drugs are more effective.
The fact that we can get better simply because we believe we will is, to me, testament to the incredible power of the mind.
While those who use homeopathy might believe it’s working in a different way, does that really matter? It seems a shame to discount the benefit they get from this unscientific ‘treatment’ when the fact is there is genuine science in its placebo effect.
Costly mistake that’s crippling our hospitals
‘Can I have a biscuit please?’ asked Mrs McMahon, who was in hospital after a nasty fall. I relayed her request to the nursing staff. ‘Don’t fancy your chances,’ replied one, frowning. ‘We’ve had some problems with biscuits, you see.’
‘A sandwich then?’ I ventured. The nurse just laughed.
At the time, I was working at one of the country’s first large-scale PFI (private finance initiative) hospitals. Under the PFI scheme, building projects and certain services are run by private companies, which the NHS then rents back off them.
The PFI scheme, which took off under New Labour in the early 2000s, was celebrated because it meant the government avoided having to spend money on buildings and maintenance, and could give the responsibility of paying the PFI companies to the hospital trusts.
But the scheme wasn’t all it purported to be: it was utter rubbish. One such PFI ‘service’ within the hospital where I was working was catering. The private company responsible for this insisted on locking the pantries on the ward to prevent ‘unauthorised consumption’.
Each hospital has its own contracts and arrangements, so another might have 24-hour access to biscuits, but no after-hours IT support, for example.
The nursing staff and I were so mortified that we couldn’t provide Mrs McMahon with anything to eat, that one enterprising nurse walked to the nearest petrol station on her break and bought Mrs McMahon a packet of Hobnobs with her own money. PFI doesn’t work for patients — or for the NHS. For not only is it grossly inefficient and restrictive, it is also very costly.
With PFI, all we end up doing is paying inflated prices for sub-standard services in order to provide healthy profit margins for private companies. Meanwhile, hospitals have been crippled by repayments.
Sherwood Forest NHS trust, for example, is spending 15 per cent of its entire annual budget on a PFI loan. Barts and the Royal London in East London currently pays more than £2 million a week in interest.
It’s bonkers, and I’ve been campaigning about this for years. Now it seems that finally someone is listening. Unfortunately, it’s Jeremy Corbyn, of whom I’m no fan.
This week, at the Labour Party conference, Mr Corbyn pledged to address PFI by buying our way out of the contracts.
But this would be phenomenally expensive. Instead, we should centralise all the PFI debt.
At present, certain hospitals are crippled with debt, while others are not. This is unfair. Centralising the debt will mean it can be taken from the overall NHS budget.
But most importantly, it will mean that by putting all the debt under one roof, as it were, the Government will be in a much better bargaining position to get the best possible repayment deal for the taxpayer. It will be far more effective — and cheaper — than individual hospitals trying to do this.
PFI was a hideous, costly mistake. We have to put this right.