By Rod Moser, PA, PhD
I have prescribed Obecalp in the distant past, perhaps 25 years ago. It comes in capsules or pills and is sold in various colors from yellow and red, to black. There is even a cherry-flavored chewable for children. It has been used successfully for certain patients and many will get immediate relief or improvement. It is inexpensive and can be used for a variety of chronic ailments that often fail to respond to traditional pharmaceuticals. In the right hands, for the right patient, Obecalp can be a miracle drug, but for many, it is just a placebo.
Never heard of it? Obecalp is a real placebo; nothing more than an inert powder stuffed in a colorful capsule, a sugar pill. As a matter of fact, Obecalp is placebo spelled backwards, and all pharmacists who get a prescription for it will know what to do. The name “placebo” comes from the Latin word meaning “to please”. If you come home and look up your medication, you may not find it in the list of drugs, but you will find many references on the Internet about it.
Some illnesses are psychosomatic, so why not treat fake illnesses with fake medication? Deceptive, yes, but in some rare cases, where every effort has been made to find an organic cause of a patient’s symptoms has been exhausted, many old-time medical providers will simply prescribe a placebo or Obecalp to see what happens. Some physicians used to give injections of sterile water or saline for the same effect.
Parents give children placebo treatments on numerous occasions. Have you ever kissed a boo-boo? A child mimicking a parent with a migraine will occasionally ask for a pill for their bogus headache, so you give them a vitamin (not technically a placebo, but can be used for one in this case) and the headache miraculously resolves. I vividly remember getting homesick pills from a church camp nurse that suspiciously looked (and tasted) like M&Ms. Kids were told that the M&M stood for Miracle Medicine. Since I liked M&Ms, I would get in line with the homesick kids for my own daily dose. Of course, one M&M doesn’t go very far.
There are ethical guidelines for using placebos in clinical practice, though some medical providers overlook them, possibly setting themselves up for an ugly situation. If a patient were to discover, which they now can by looking up Obecalp on the Internet, that they were duped by given a fake drug the physician-patient relationship would hit an all-time low, irreparably undermining trust. This is precisely why this practice is both controversial and should only be done strategically.
Early in my career, I worked at a clinic that had one physician who gave placebos to every patient, regardless of their complaint, in the form of a B-12 injection. His philosophy was that only “doctors can prescribed shots” and patients expect definitive care from doctors. He said that pills lack the psychological magic of a painful injection, so every patient got a shot. They may have received real medicine as well, but they all left the office rubbing their butts, because he also did not believe a shot should be given in the arm or thigh. He was firmly convinced that a patient who got a shot got better faster than one who didn’t. He finally retired and many of his loyal patients still came in demanding their B-12 injections.
The only placebo that I gave in my career was to a narcotic-seeking man who frightened me. He wanted something “really strong” for his lingering back pain, so I told him I would give him just a few salicylic acid tablets. The pharmacy had them in bright red and made him sign for them. He would get no refills and could only get ten. He was intrigued by the chemical name, how we controlled them, and the fact that he could not take them with alcohol. The next day (my day off), he came back, threatening to beat me up for giving him ten aspirin tablets, the other name for salicylic acid.
How effective are placebos? Under the right circumstances, placebos may be just as effective, if not more effective, than a chemical substance that has a real pharmaceutical effect. Colors play a huge role, according to physicians that I have known in the past who used placebos. White or light-yellow pills are for people who tend to get side effects. They are considered mild. Red capsules are the strongest, based on their alarming color and size. Black placebo capsules are rarely used since people are more likely to develop adverse effects from this color.
In the 1700s, surgeons would treat psychotic patients who were thought to have “rocks in their heads”. They sat in a chair, restrained by some large attendants, and the surgeon would make a painful cut on their scalp. Out of view, the surgeon would then drop blood-stained beach pebbles of different sizes into a pan in full view of the patient. With each clunk of a stone in a pan, the patient was told that they will be soon getting better, if not completely well. Surprisingly, many were cured.
Placebos have no place in my own clinical practice. Rather than give a patient a fake capsule or pill, I simply tell them that their particular illness or condition doesn’t require any medical intervention; that they will get better on their own, in a few days, no matter what I do. Honesty is my policy, but some people just do not like blunt truth.