The placebo effect and health: combining science & compassionate care W. Grant Thompson, Prometheus Books; 2005, 350 pp $23.00 ISBN 1–59102–275–4
Grant Thompson, a gastroenterologist, has written a reasoned, careful analysis of many aspects of current health systems and how they have evolved. He writes very clearly and logically.
Physicians, and particularly family doctors, must have the time and appropriate technology to practise what Thompson clearly feels is the backbone of medical care in our society. Rushed medicine without the ability to access proper informative medical documentation is deplored and deservedly so — unfortunately, we all acknowledge that this lack of time and technology is still usually the norm in Canadian medicine.
But why such an emphasis on “the placebo effect”? Thompson carefully defines, describes and details the role of placebo in research. Doctors' behaviours in themselves can be placebos and correspondingly “nocebos” or negative behaviour producers.
I wish that Thompson had written about how long the placebo response lasted in the various studies cited. This reviewer believes in the concept of placebo. I would like medical students, residents and doctors to think in greater detail about how their actions influence the therapeutic response in their patients: how what they are saying and the way they say it can influence a patient's understanding of their illness (e.g., irritable bowel syndrome, low-back pain or fibromyalgia). How eliciting specific psychological and social information can contribute to patients' improvement at a biochemical, physiological and ultimately clinical level.
Thompson's formula for successful medical intervention includes seeking well-founded evidence-based medicine and an optimum medical system of family physicians and specialists working in technical and respectful harmony. Another “bottom line” gleaned from reading this book is that physicians have to care. We have to feel that what's going on between our patients and us is meaningful, worthwhile and actually works. We have to recognize as well that when we develop that unique patient–doctor bond, what we say and how we say it can be therapeutic in many ways.
The placebo and nocebo concepts are fine. Physicians are being urged by Dr. Thompson to get into the trenches and fight for the right to practise medicine the way we know it should be, before some of the bureaucrats and medical technocrats take over. Important facts and concepts are offered in this book to propel this argument forward.