Georg Ivanovas From Autism to Humanism - systems theory in medicine

2.4 The placebo effect

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d) systems approach and individualisation

The whole problem of placebo is solved if a different approach is chosen. It must be so as ‘placebo’ is a result of ‘specificity’. In a concept without ‘specific disease’ the placebo problem does not arise.

In a systemic view the human is an interconnected system reacting to a stimulus or perturbation (chap. 4.8). According to the principles of goal-orientation and equifinality (chap. 4.7), the reaction of the system does not necessarily depend on the initial conditions, nor are the reacting pathways traced out. The system is not concerned about V, P and S. It will react according to the present situation.

That is, the reaction to a defined stimulus might be different in disease A and in disease B, in state A and in state B, in patient A and in patient B. On the other side, the reaction might be the same to different interventions, be it a drug, a placebo, an injection, a verbal suggestion or the smile of the nurse.

The reactions to a placebo are necessarily nontrivial. This is an obligatory conclusion according to systems theory. It is also the result of placebo research of the last years.

Stoessl found in Parkinson’s disease that placebo induced about the same secretion of Dopamin in the brain as the verum does (Fuente-Fernández et al 2001). This was confirmed by Benedetti et al, who showed that the same region in the brain (Nucleus subthalamicus) reacted (Benedetti et al 2004). Similarly Petrovic found the same neuronal patterns in placebo- and opoid-analgesia (Petrovic 2002). In contrast, Leuchtner proved that anti-depressive drugs (fluoxetine, venlafaxine) induce a different neuronal pattern than the placebo leading to an increase in prefrontal reaction not found in the verum group (Leuchtner et al 2002). This corresponds to findings that cognitive therapy leads to a different neuronal pattern than drug therapy. Cognitive therapy increases activity in hippocampus and dorsal cingulate and decreases it in dorsal, ventral, and medial frontal cortex, whereas drug treatment (paroxetine) dose somehow the opposite (Goldapple et al 2004). As Leuchtner's investigation was made with quantitative electroencephalography and Goldapple's with positron emission tomography, the patterns are not directly comparable. However, the conclusion remains that there are different pathways to recover from a specific disease.

All this shall demonstrate that P, V or S are just theoretical constructs of an observer. They are notions based on an underlying theory, in this case the theory of specificity. These notions reveal a lot about the observer, sometimes even more than about the observed. This is a typical characteristic for a state where an undecidable question has been decided (chap. 3.4).

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