I was reading a blog post on Science-Based Medicine (SBM) about pain management the other day, and the post included a very brief discussion of proglumide as a placebo enhancer. I haven't read the studies, but the summaries and abstracts I've seen tell an interesting story. When patients suffering from ischemic pain were treated with either a sugar pill or proglumide, but were told that they were being given a powerful pain killer, both groups showed a reduction in their pain. The effect was more pronounced for the proglumide group. Another group was treated with proglumide, but they weren't told that the drug would have any impact on their pain (again, I didn't read the studies, so I'm not sure how this part of the study worked. Patient: "Doc, I'm in pain." Doctor: "Here take this pill." Patient: "Will this make me feel better?" Doctor: "How should I know?"). In this third group, the patients showed no improvement. So what does this all suggest? The sugar pill cohort improvement was definitely due to the placebo effect. However, since proglumide showed no benefit when the patients didn't expect it to help, the benefit in the first proglumide group was probably also due to the placebo effect. But the placebo effect was more significant for the proglumide group. This suggests that proglumide actually enhances the placebo effect.
Why do I find this so interesting? I think the general population dismisses the placebo effect as sort of fake. "Just in your head" type stuff. But it's important to remember that things that take place in our minds require real biochemical processes. So, yeah, you have to believe proglumide is going to help you in order to get any benefit from it, but the benefit is a product of understood biochemical interactions (in this case, cholecystokinin antagonism). It's scientifically acceptable faith healing.
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