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Teach Medical Students How To Be Placebos

Posted by Ishani Ganguli January 17, 2014 12:07 AM
Enjoy this guest post from Karan Chhabra, a medical student at Rutgers Robert Wood Johnson Medical School and co-founder of the blog Project Millennial. Connect with him on Twitter at @krchhabra.

Placebos work. This isn't news. The term "placebo" was coined 60 years ago to describe how one-third of people respond to pills without any active drug in them. Twenty-five years later, we learned how they work: through endorphins produced by the body that work just like morphine. Today placebos are everywhere: from mothers kissing boo-boos to international drug trials. 

A recent paper, though, shows that all placebos aren't created equal. As expected, the authors found placebo pills effective for reducing migraines in about one-fifth of patients. But it gets better. Take sham acupuncture, which doesn't target traditional pressure points and doesn't penetrate the skin. Despite being "fake," sham acupuncture reduced migraines in 38% of patients, making it as effective as real migraine drugs. The authors also studied sham surgery, in which doctors give anesthesia and cut the skin, but stitch it back together without doing anything to the tissues underneath. These fake operations helped 58% of migraine patients, potentially even more than active drugs. 

What does this tell us? It depends on whom you ask. Some might say we need to figure out how to predict a good response to placebo (and are trying to do just that). Others might say we need to test more procedures against shams, to make sure they're effective. Yet others might say sham surgery is unethical outright. These are questions without quick answers. For the rest of us, what can the placebo effect teach us about medicine as a whole?

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In the New Year, a new mom in medicine

Posted by Ishani Ganguli January 7, 2014 07:00 AM
Months before my life was upended, a doctor friend tried to explain my forthcoming role in terms I'd understand. "Imagine being on call 24 hours a day, seven days a week," he said. "You're in charge of a single patient, but she is needy as hell." 

Medical training prepared me for motherhood in some ways (the assortment of facts blurrily retained from my pediatrics rotation in medical school; the skill, or delusion, of combating the inertia of sleep), but not at all in most others. And now, after two months devoted to tummy time and 5 a.m. staring contests with my sweet, saucer-eyed baby girl, I join the ranks of countless men and women attempting the uneasy balancing act of work and parenthood. I'm doing so at a time when the terms of re-entry for new mothers into medicine seem particularly disputed.

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About the author

Ishani Ganguli, MD, is a journalist and a third-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her More »

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