Chapter 7 price magic

Why does a 50-cent aspirin work but a 1-cent aspirin doesn't? Why do doctors' lies work so well? Is there a cure for all diseases in the world? Are $2.50 pain pills really more effective than 10-cent ones? Do high-priced sports drinks reduce fatigue better than cheap ones? Is "Royal Touch" really effective? Can tights really heal burns? mystical comfort therapy If you lived in the 1950s and had chest pains, your cardiologist likely recommended a procedure called thoracic artery ligation to treat angina.In this procedure, doctors give the patient general anesthesia, open the chest cavity from the breastbone, and tie off the arteries in the chest cavity.In this way, the problem is solved!The pressure in the pericardial phrenic artery increases, the blood flow to the myocardium improves, and everyone is happy.

Obviously, this kind of operation is very successful, and it has been popular for 20 years.But one day in 1955, Seattle cardiologist Leonard Cobb and several colleagues had doubts.Does this therapy really work?Does it really work?Cobb decided to take a very daring approach to prove the effectiveness of the therapy: He would perform real surgery on half of the patients and sham surgery on the other half.Then he wants to see which patients experience less pain and which patients actually improve their health.In other words, after 25 years of slicing a patient like a fish fillet, cardiologists are finally going to conduct a scientific and strictly controlled test of this operation to determine how effective it is.

To perform the test described above, Dr. Cobb performed conventional surgery on some patients and placebo surgery on others.When the actual operation is performed, as mentioned above, anesthesia is performed, the patient's chest cavity is cut open, and the thoracic artery is ligated.For comfort surgery, the surgeon only administers anesthesia, cuts the patient's chest muscles into two lines with a scalpel, and then sutures them, leaving two tiny suture marks, that's all. The results were astonishing.Both groups of patients who had a thoracic artery ligation and those who didn't both reported less pain.The results of the surgery lasted about three months in both groups of patients—and then began complaining of recurring chest pains.Meanwhile, electrocardiograms showed no difference between the condition of the patients who had the real surgery and those who had the placebo surgery.In other words, traditional surgical treatment appeared to provide short-term pain relief -- but so did placebo surgery.In the end, neither surgical treatment produced long-term results.

Doctors have tried a similar test with another medical treatment in recent years, with surprisingly similar results.Back in 1993, J.B. Mosley, an orthopedic surgeon, was increasingly skeptical about a certain arthroscopic procedure for knee joint pain.Does this therapy really work?Dr. Mosley and his colleagues recruited 180 arthritis patients from the Veterans Hospital in Houston and divided them into three groups. The first group received traditional therapy: anesthesia, three incisions on the knee, arthroscopic placement, cartilage removal, abnormal soft tissue correction, and 10 liters of saline to wash the entire knee.The treatment of the second group is anesthesia, three incisions on the knee, arthroscopic placement, and saline washing of the knee, but the cartilage is not removed.The third group received placebo therapy, which looked like the first two groups, with anesthesia, incisions, etc.; the duration of the procedure was also the same; but no arthroscopy was placed in the joint, in other words, it was just a simulated operation.

For two years after the surgery, doctors followed up all three groups (which, like other placebo trials, included volunteers) to see if and how much pain was reduced, and to measure their return to normal The time it takes to walk and climb stairs.How is the effect?The two groups that performed the full set of surgery and the arthroscopic insertion alone were very satisfied, and expressed that they would recommend this treatment to relatives and friends.But strangely—and here's the breaking news—the placebo group also experienced less pain and normal walking, just as the two groups that had the actual surgery did.In response to this startling result, Dr. Nelda Rey, a member of the Mosley experimental team, wrote: "The effectiveness of arthroscopic placement and cartilage debridement in patients with knee arthritis On par with placebo. That fact makes us question whether the $1 billion spent on this procedure should be spent where it is more needed."

If you expected the result to be an atomic bomb-like effect, you were right.After this research report was published in the "New England Journal of Medicine" on July 11, 2002, some doctors made a big noise, claiming that the report was falsified, and using various forms to question the research methods and results on different occasions.Dr. Mosley contends that the study was carefully planned and rigorously conducted. "As a doctor, the most important thing is not how good the operation is, but the recovery of the patient after the operation. Doctors who perform arthroscopic surgery frequently throughout the year are undoubtedly embarrassed by the efficacy of placebo therapy. You can imagine If they come out, they will use all their power and find all reasons to deny our research results."

No matter how much you believe the results of this study, one thing is clear: we should place a question mark on arthroscopic surgery in these particular patients, and strengthen the proof of the effectiveness of various medical methods. In Chapter 9 we saw that expectations change how people perceive and judge experiences.In this chapter, we will not only see that beliefs and expectations affect people's understanding and interpretation of sight, taste, and other sensory phenomena, but also that people's expectations can change their subjective and even objective experiences to exert influence on them—sometimes The impact is huge.

Most importantly, I wanted to explore an underappreciated aspect of placebo therapy, the role of price in this phenomenon.Do high-priced drugs make us feel more effective than low-priced ones?Is it really biologically more potent than the lower-priced brand?What about expensive medical devices, next-generation medical devices such as digital pacemakers and high-tech stents?Does price really affect efficacy?If so, wouldn't that suggest that healthcare spending in the U.S. will continue to soar?Well, let's start from the beginning. The English word for "Placebo" comes from Latin - "I will satisfy you".The term was used in the 14th century AD to refer specifically to the false weepers hired at funerals to mourn before the dead. It appeared in the New Medical Dictionary in 1785, referring to "informal fringe medical methods or medicines".

One of the first medical records of the efficacy of placebo therapy was in 1794, when an Italian physician named Gerbi discovered something strange: rubbing an insect secretion on a sore tooth relieved pain, which This pain relief effect can last for a year.Jerby continued to administer the insect secretion to toothache patients, and kept very detailed records of the patients' reactions.68% of the patients who had applied the "medicine" told him that their teeth did not hurt again within a year.We have no more detailed information on Dr. Gerby and the insect secretions, but it is fairly certain that the insect secretions he used had nothing to do with toothache treatment.The problem is, Jerby believes it works, and so do most of his patients.

Of course, the placebos on the market weren't just Dr. Jerby's insect secretions.Before modern times, almost all medicines were placebos.Toad eyes, bat wings, dried fox lungs, mercury, mineral water, cocaine, electroshock devices: all were peddled as panaceas for all ailments.When Lincoln lay dying across the street from Ford's Theater, his doctor is said to have applied a "mummy ointment" to his wound - a paste made by grinding Egyptian mummy into powder, which is said to treat epilepsy , abscesses, rashes, broken bones, paralysis, migraines, ulcers, and a wide variety of other diseases and traumas.Even as late as 1908, "Authentic Egyptian Mummy" was printed on E? Merck's sales catalog for people to order - and it may still be used in some parts of the world today.

Mummy powder isn't exactly the scariest of drugs. In the 17th century, there was a prescription that "cured all diseases" as follows: "The corpse of a newly deceased male with red hair, uninjured, without skin damage, aged 24, and died within one day, will be hanged or wheeled." It is better to put them to death by stake...put them under the sunlight and moonlight for a day and a night, then cut them into slices or thick strips. Sprinkle a little myrrh and aloe vera on top to reduce the bitterness." We may think we are very different from the people we were then, but we are not.Placebo treatments still work their magic on us.Doctors, for example, have for years removed abdominal scar tissue in the belief that doing so would eliminate chronic abdominal pain—until researchers performed a mock procedure under strict control, and patients also reported the pain was gone.Encainide, flecainide, and mexiletine are all off-label (i.e., used outside of the drug label) drugs that doctors often prescribe to patients with arrhythmias—and they have recently been found to be potentially cause cardiac arrest.Researchers tested the efficacy of six of the most commonly used antidepressants and found that replacing them with a placebo produced the same effect in 75 percent of them.The same goes for brain surgery to treat Parkinson's disease. Doctors drilled holes in the skulls of a few patients, but didn't perform all the operations, to test the efficacy. It turned out that the patients who received the sham surgery had the same effect as the real surgery. .There are many, many more such cases. One could argue that these modern medical treatments and drugs were developed with the best of intentions.This is true.But that's largely how people used Egyptian mummy powder in the past.At times, mummy powder was as effective (or at least as effective) as any other medicine of the time. Placebos and placebos work on the power of suggestion, and they work because people trust them.As long as you see a doctor, you will feel better.You take a pill and you feel better.You'll feel even better if the doctor is a well-known specialist, or if you're swallowing a famous drug that works well.But how does suggestion affect us? Overall, there are two mechanisms that shape expectations and make placebos and placebos work.One is belief—our trust or confidence in a drug, procedure, or person involved.Sometimes, just a doctor or nurse coming to us to comfort and encourage us not only makes us feel better mentally, but actually activates the healing function in our body.Merely seeing a doctor's enthusiasm for a treatment or procedure can lead to a beneficial effect on a patient without treatment. The second mechanism is conditioning.Just like Pavlov's famous conditioned reflex experiment (the dog drools when he hears the bell), after repeated experiences, people can build up an expectation in their bodies.Say you phone to order a pizza, and the delivery guy rings the doorbell, and before you even smell the pizza, your digestive juices kick in.Or maybe you're on your honeymoon, snuggling up on the couch with your new wife.You are watching the crackling flames in the fireplace, and the love desire that you have in your ears and temples prompts your brain to release endorphins, which paves the way for your next intimacy, and pushes your sense of happiness to the depths of the river of love and the gentleness of the country. With regard to pain, good anticipation releases hormones and neurotransmitters, such as endorphins and sedatives, that not only suppress pain but also produce a strong sense of pleasure (endorphins activate receptors similar to those of cocaine).For example, I clearly remember lying in the burn ward in unbearable pain, but as soon as I saw the nurse approaching with the needle tip of the syringe still dripping with painkillers, I would breathe a sigh of relief that the painkillers were finally gone. coming!Pain-suppressing opioids began to secrete in my brain right away, even before the needle was in my skin.