Neurology Rounds with the Maverick: Adventures with Patients from the Golden Age of Medicine by Patten Bernard

Author:Patten, Bernard [Patten, Bernard]
Language: eng
Format: epub
Publisher: Identity Publications
Published: 2019-09-14T16:00:00+00:00

Tableau Twenty-Two:

The Marvelous Effect of Placebos

Baylor College of Medicine

Neurology residents at Baylor put on a show each year at Christmas time. One of the skits was always about Doctor Patten treating over one-third of his patients with placebo. That was a gross exaggeration. The percentage was more like five, and those patients were happy and also experienced few side effects. Alas, the era of placebos is over for ethical reasons I don’t understand. Here’s how the placebo worked in the good old days of yore.

Blue Placebo Was the Most Powerful

Methodist Hospital had three placebos: red, white, and blue. If one did not work, you could switch the patient to another. In my experience, the blue worked the best. For example:

A 10-year-old boy was referred for evaluation and treatment of his muscle weakness, which had progressed over a five-year period to the point he couldn’t walk. So, he made his way around in a wheelchair.

On examination, he was weak with small muscles in no particular distribution. The muscle biopsy showed non-specific abnormalities, which consisted of small muscle fibers of both type I and type II. The type I fibers are the slow oxidative fibers, and the type II are the fast glycolytic fibers. Multiple blood tests were normal, and the electromyogram showed features typical of muscle disease, something we knew already. The kid had a muscle disease. But what was the cause? The muscle enzymes in the blood were normal, so the muscle itself was not breaking down. In short, after a pretty exhaustive investigation, there still was no explanation of the weakness. There was no diagnosis. No diagnosis was the end condition of about a third of the patients I took care of. These days, techniques and tests are more effective, and I would estimate only about 10% of patients end up without a definite diagnosis or without a clear explanation of the cause of the problem.

So, what do you do if you don’t have a diagnosis? What do you do if you don’t know what to do? Answer: analyze the situation and act accordingly.

The parents and kid were told I could not come up with a specific diagnosis, but I would like to try a treatment.

“The treatment is very powerful, and we will have to watch for side effects. Start with three blue capsules a day and call me in two weeks to report on how you like the treatment and how the treatment likes you.”

Mom called the next day: “It is too powerful for him. He is shaking all over and feels too much energy.”

Me: “Wow! That is a very good sign. Let’s cut the dose and build up slowly over several weeks until he can tolerate the full dose.”

Over the next six weeks, the dose was increased by one capsule every two weeks. The results speak for themselves. The kid got out of the wheelchair and walked. Eventually, he returned to normal and was able to play basketball at school. All this occurred because of the blue placebo, which consisted of small amounts of a three-carbon sugar called lactose.

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