(Ed. Note: Male readers, please do not flee. This is about you, too, if you stay with this.)

Some ladies of my grandmothers’ generation spent a lot of time going to doctors for what we all thought were imaginary complaints—many of which seemed to have their origins with gynecological or childbirth problems linked to producing their now long-suffering children, our parents.

Since it still was considered ladylike or a sign of good-breeding to have difficulty in child-bearing, we assumed this was part of the lady program. There never was any question that, in my grandmother’s case, the gynecological-obstetrical problems were very real, and yes, a risk to her. But, we thought, well, those problems were back then. Not now.

My grandmother and  friends were members of the last “vapors” generation as well.  (See Gone with the Wind for more information on this totally imaginary complaint. “Taking to her bed with the vapors” was a wily way of getting one’s way while appearing fragile. Don’t laugh. It worked very well for them. It did not enhance their credibility with their doctors and families.)

Nana’s circle of friends included women who were like her and those who were her opposite. These women barely had headaches.

You can see why no one really took Nana’s complaints, or her friends’ complaints, seriously.

Doctors then just thought they were bored, privileged housewives without enough to do except shop. Going to the doctor was a planned activity, much like playing bridge.

Doctors gave them pills in different sizes, colors and shapes but the truth was that these were sugar pills—known as placebos. They were not real medicine. The grandfathers knew this—and did not care if it brought some peace and quiet. Their adult daughters and sons knew this.  Everyone, in fact, but the patients knew this. Everyone needed relief from their symptoms.

A new study, summarized below, may help put an important piece of the puzzle of placebo effects in place.

The Lancet summary of the study says, “For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings. There is also evidence that placebo effects can exist in clinical practice, even if no placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical use of placebo mechanisms that are inherent in routine clinical care, and encourage the use of treatments that stimulate placebo effects.” (Emphasis added)

As a medical writer, I interviewed a leading gynecologist in the 1980s. This was the time when minimally-invasive surgery was offering his specialty important new ways to treat women.  As we talked, I made a comment about my grandmother and her friends, making the rounds of the town’s long-suffering doctors.

He asked a lot of questions.

“I would think you would be more understanding!” he exploded. “These women had nothing. Nothing. Of course they complained. Your grandmother’s generation was the last in which a well-cared-for female still could die in childbirth, although comparatively few did. Hers was the last generation for which there was nothing short of hysterectomy for all gynecological problems—fibroid tumors and onward. There was no symptom relief in any meaningful way. I am surprised at you.”

Today, there is a wide array of treatments for problems ranging from infertility through gender-related risks, such as bone loss. Women still remain under-represented in clinical studies but medicine has come a long, long way in the care of women. It still has a long way to go, too.

Having had my head handed to me, and deservedly so, I learned a valuable lesson from this physician.

When patients share a constellation of puzzling symptoms for which no current treatment works, maybe one trouble is that the treatment has not been found to truly deal with the patient’s diagnosis.

Maybe the problem is not the patient after all.

When doctors have used the available assessment and treatment tools without result, there is nothing else to do but decide the problem is the patient.

Patient-blaming seldom accomplishes anything other than to make the care-giver feel less frustrated.

Now, what is an example of a Nana-type problem today? The kind nobody thinks is real?

The first patients with fibromyalgia were dismissed in exactly the same way as Nana and her friends.

Now doctors know that fibromyalgia is a “real” diagnosis.

Here is what Mayo Clinic.com says about this diagnosis.

“You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can’t find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.

“Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain.

“Fibromyalgia occurs in about 2 percent of the population in the United States. Women are much more likely to develop the disorder than are men, and the risk of fibromyalgia increases with age. Fibromyalgia symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event.”

At first, a doctor might have had only one or two patients who reported these symptoms. They did not fit any known diagnosis although parts of their complaints did. Maddening. They could find out what this was not. Not what it was. For years, it was a problem without a proper medical name. Now it has one. Now there are treatments.

This week’s study says that the placebo effect is real, complicated and should be studied so that it can be used more effectively in treatment. Nana’s doctors did not know what they had going for them, it appears.

Medpage Today

“The placebo effect is a real and therapeutic psychological phenomenon that, with more research, could be exploited more systematically in medical practice, said Australian researchers. (Emphasis added)

“There is not one placebo effect, but many,” wrote Damien Finniss, MSc, of the University of Sydney in Australia, and colleagues in the Feb. 20 issue of The Lancet, arguing that recent research shows that placebo effects can exist even in the absence of an actual placebo. (Emphasis added)

“Much remains to be learned about the mechanisms underlying placebo effects as well as  the ethics of providing placebo-based treatments, but it seems likely that eventually these effects can be harnessed to improve patient care, they concluded. (Emphasis added)

“Finniss and colleagues reviewed the literature on the placebo effect, which suggests that it is far more complicated than many people think.’ (Emphasis added)

Source: Medpage Today, February 22, 2010

Citation: The Lancet, Volume 375, Issue 9715, Pages 686 – 695, 20 February 2010