Placebos and the power of the mind

It’s been a while since I posted anything. I’ve had a busy few months but now I’ve found the time to write again.

Today I want to look at placebos. Put simply, these are medications which have no active ingredient, or they can be medications with an active ingredient given for a condition which they are known not to have any effect on.

The medical press and the mainstream press in Australia have recently given placebos more attention. This happens from time to time because placebos are as old as healthcare itself. This time the trigger has been a study published in the Australian Journal of General Practice.

https://www1.racgp.org.au/ajgp/2019/december/placebos-in-australian-general-practice

A survey of Australian GPs found that most GPs use placebos. This is the reason a medical journal article got the attention of more mainstream media channels. Antibiotics given for viral infections seems to be the most common placebo scenario.

From personal experience patients want antibiotics for their sore throat, toothache or cough because that’s what they have experienced as effective in the past or someone has told them that is the course of action to take. In past decades of more paternalistic or doctor-led healthcare doctors often gave patients antibiotics so that they felt they had been given treatment of some sort.

Both patients and doctors increasingly understand anti microbial resistance and how this is a growing problem. Consequently doctors are less likely to prescribe antibiotics and more members of the public are accepting this.

Even when patients know they are being given a placebo they often report benefit. This type of placebo is what is termed a open label placebo. This is where the power of the mind comes into it. A person knows they have been given a placebo but another part of their consciousness feels that they have taken treatment and for that reason they feel better. The feeling of having taken something outweighs the knowledge that the substance taken cannot possibly have made any difference.

This is such an important subject area that Harvard University has a Program in Placebo Studies to delve deeper in what placebos mean for medicine and treatment.

If this subconscious healing power of the mind can be harnessed in a meaningful way there could be potentially massive savings on medication bills around the world as patients take cheaper medication, but get the same level of improvement in their symptoms.

Dental Care in Australia

I’m not qualified to give dental treatment or advice so it might seem odd that I’m writing a blog post about it.

However it is increasingly common for adults to make an appointment with me (a GP/Family doctor) with toothache or other tooth problems. Other GP colleagues have had similar experiences. There appears to be a number of reasons for this. Most importantly seems to be access and cost. GPs are often a lot easier to access than a dentist, a quick phone call or a few clicks on a health booking app and you have a GP appointment. Dentists can be harder to book with and there is a longer waiting time in many areas. There is also no bulk billing or medicare rebate in the way there is for General Practice or Specialist Health Services.

There are a number of misconceptions which come up regularly such as thinking that all toothaches need antibiotics or needing to see a GP first for antibiotics before seeing a dentist. These beliefs are not true and are difficult to correct.

There is clearly a problem if you have to go somewhere other than the correct place for your treatment. Last month there was a report by the Grattan Institute calling for universal dental care to solve the current absence of comprehensive affordable dental care:

https://grattan.edu.au/report/filling-the-gap/

This report calls for universal dental care to be introduced by the government to rectify what seems to be a longstanding oversight. Medicare which provides universal healthcare for Australian citizens and permanent residents was established in various steps (backwards and forwards in the 1970s and 1980s) but has never covered dental treatment. There are publicly funded dental services, usually in hospital, but there are very narrow eligibility criteria for them and even if you are eligible there is a long wait and anyone who has a dental problem knows that waiting isn’t tolerable.

Dental care hasn’t had much attention from the main two political parties but the Greens have given a good level of detail on their “denticare” policy. The Greens will not likely be in power but often smaller parties can have their policies adopted and adapted by the main parties or can influence policy if their ideas resonate with the public. To give fair attention to the other political parties I have checked the ALP (Australian Labour Party) website and they talk about reversing dental cuts but not about any new investment or transformation of services. The Liberal Party has a broader coverage of information on healthcare than the ALP but there is no mention of dental care at all. There is no mention of dental care on the National Party’s website either.

Public funds for dental care are inadequate and at present there is little sign of any change. There would be a real quality of life improvement for big parts of the population if dental care was brought closer into line with Medicare. It would also cost less than expected because some people who are developing health problems due to bad teeth would not need to access other healthcare funding.

If you feel strongly about the lack of funding for dental treatment or the lack of government attention on this important area you should contact your federal MP and raise your concerns. The time before an election is the time you will most likely get heard.

Declaration: I have no affiliation or membership to any political party.