Better?

Better?

One of the consistent findings in the evaluations of pseudo-medicines is that it is only  the subjective components of an illness that are improved, not the objective components.

It is a bit odd to say that patients only think they are better, when in fact they are not.

That apparent contradiction is still best demonstrated in Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. When patients received various placebos for their asthma they reported feeling better compared to those with no interventions although there was no objective change in their pulmonary function. It sums up pseudo-medicines nicely: their effect is similar to beer goggles, at least the mythical function of beer goggles.

If a patient says they are better, they are. Right? Who am I to gainsay a response to a treatment or what their subjective assessment of their illness is. As patients often point out, they know their body better than anyone else. I have to say that does not apply to me. I am always being surprised by the nonsense my body keeps pulling on me. Aging is not fun.

But are patients the best judge of the severity of their disease? Maybe not.

There was a recent report, the Continuing to Confront COPD International Patient Survey where patients were asked about their Chronic Obstructive Pulmonary Disease.

One of the interesting results about the study is that patients underestimated the severity of their COPD

"In the U.S., 29% of patients reported that their disease was mild, 41% thought it was moderate, 24% stated it was severe, and 5% said that their disease was very severe. However, nearly 55% had to use a rescue medication every day or most days. In addition, 44% woke up every night or most nights due to symptoms. The average COPD Assessment Test (CAT) score was 23.3, which is high considering that a score on the CAT higher than 10.0 is considered significantly symptomatic."

They were more ill than they thought they were. Why? They speculate that patient become acclimated to their disease. There have been some studies that suggest part of the benefit from pseudo-medicines is the patient developing a different expectations for problems such as chronic pain. Patients can acclimate to illness in a multitude of ways, including the use of pseudo-medicines.

Response to illness and its treatment is complex and nuanced. When a patient reports improvement after a pseudo-medical, or medical, intervention, I have no doubt they are improved and am glad of it. But I will remain cautious as to the nature of the improvement and will always prefer an objective confirmation that they are indeed better.

Points of Interest 12/23/2015
Points of Interest 12/22/2015

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