Obstetrics & Gynecology in Augusta, GA

It’s All in Your Head!

“The doctor who fails to have a placebo effect on his patients should become a pathologist”

J.N. Blau, M.D.

     The lines between the art and science of medicine are often blurred.  Many years ago, when the earth was cooling and I was a medical student, I was assigned to shadow an older Ob/Gyn in private practice. The goal was to gives us young medical pups a sense of real world medicine.  Dr.Koronik was a gifted clinician as well as a crafty student of human behavior.  One afternoon we were speaking with a patient, a recently married young female, who was completing her yearly exam when she reported her libido, or sex drive, had driven off and she didn’t have the map!  Dr. K had done a thorough physical exam and knew anatomically everything was intact, and so he talked with her at length about her life situation and decided to get some baseline blood work.  She was to return when the blood work was back and review the results and discuss any treatment options.  After she left, Dr. K pulled me aside and said he felt her problem was more from the neck up and not the waist down.  He was not patronizing or minimizing her problem, it was just an honest assessment of what he surmised was the source of her lack of desire.  Upon her return, they reviewed the blood work which supported the idea that all was well physiologically, and Dr.K had a long discussion about stress, relationships, and other important factors in sexual well being.  At the conclusion he presented her with a bottle of tablets and told her that taking one on a daily basis may increase her libido.  I was taken aback and after she left I questioned his prescribing of a medication for what he seemed to think was an emotional issue.  He explained, in what was to be the first of many lessons in healing as opposed to curing, that the “medicine” was nothing more than sugar pills, and that he felt they would aid in minimizing her psychological issues with intimacy.  There are a number of ethical and legal issues involved with this “treatment” but remember this was almost 30 years ago and in a small town in East Tennessee. 

I didn’t see the young lady in follow up, but a few days later Dr.K reported a Ford 350 pickup truck backed up to the rear of his office around closing time.  A burly, six foot something cowboy straight off a movie set ambled out of the truck cab and sauntered to the back door of the clinic.

“Hey doc,” he offered as he thrust his hand in greeting.  “My wife came to see ya a few days ago about this…eh…problem she been havin’ ”.  No doubt, this was the husband of the libido challenged patient.

“I just wanted to come shake your hand for them pills you gave her cause, let me tell ya, I don’t ever want to run out of them things!  I brought my truck here to load up a batch!”

Say what you may but the placebo effect is a real and powerful scientifically validated phenomenon.  There are some amazing studies done with PET scanners, machines that “light up” areas of the brain that are functioning in thoughts and emotions, that confirm that feelings can be translated into physical changes in the brain.  When we feel happy or sad, specific areas of the brain are activated and in turn set off a cascade of hormones, neurotransmitters, and a cavalcade of substances that elicit amazing physical effects.  There is a branch of science called psychoneuroimmunology that studies how our thoughts and emotions effect our immune system.  For example, if you get int an argument with your spouse or yell at your kids getting dressed for school, not only do you feel stressed, but you are more susceptible to catching a cold!  There is even some evidence that chronically stressed or angry individuals are more at risk for certain cancers because their emotional state impairs their immune system’s natural ability to eradicate early abnormal cells.

The Mayo Clinic issued a series of findings on research done on the reasons the placebo effect is genuine:

“A patient whose doctor is supportive and positive may benefit more from any treatment, active or placebo.

A patient who believes a treatment will work is more likely to experience the placebo effect than one who doubts it.

Some patients respond well to frequent and intensive medical attention, whether or not a drug or treatment is potent.”

Indeed, the placebo effect is “all in your head” but it is just as real and often as therapeutic as a drug. 

Now if I could just find some of those “libido” pills!