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Perhaps we should not find good in the Europeans. After all, they have death camp hospitals where doctors decide who lives and dies. At least, this is how the more excitable GOP politicians seem to think other democratic countries work. Quite why any government could survive ten minutes if its doctors were systematically killing people off is not explained. It is simply assumed all socialist systems are dangerous to the health of those who live there. That these myths survive is proof, if you needed it, that ideas can have a powerful and long-lasting effect on people. Put another way, if you believe in something strongly enough and make it a part of your life, your belief often comes true.

In medicine, an early problem facing researchers when designing clinical trials was the so-called placebo effect. It has long been recognized that people who believe strongly enough in the cure will often be cured. So we need to start off with a definition. A placebo is a chemically inert substance or liquid that can have no effect on the human body. In a clinical trial, people are randomly assigned to one of two groups. One gets the real drug. The other gets the placebo. But there is no way anyone can know which is which. So a doctor in a white coat gives you encouragement, a smile and the “medicine”. The volunteers then describe how they feel.

Consistently, about one-third of participants report feeling better after taking the placebo. No matter what the researchers have done to eliminate the placebo effect, all they have succeeded in doing is produce a mountain of evidence that people who expect a treatment to work feel better. So, if you run a practice, a clinic or hospital, you can make a third of your patients feel better if you manage their expectations well. Physicians dress and act the part, listening carefully, carefully examining, ordering tests where appropriate, and then prescribing something that will “do the trick”. Even if this something is chemically inert, it will be an effective treatment in at least one-third of cases.

In this, it makes no different what the source of the pain. It can be a severe headache or a broken bone. The strength of the patient’s belief is the key to relieving the pain. There always has been a role for ritual and suggestion. The shamans have exploited this over the centuries. Modern medicine continues the same traditions, albeit in a different form. This is not to say the result of clinical trials are to be doubted when they show a drug effective. Many drugs like Ultram are effective no matter what the patients believe, i.e. though you may not tell a patient exactly what drug you are giving and what the expected outcome is, people routinely experience less pain. But the converse is equally true.

Many people who have pain can control it without having to use a drug like Ultram. All it requires is a belief strong enough to make the pain bearable. It is this placebo power that is exploited in the European approach to pain management and a good reason to feel grateful we live in America (or not, depending on what you believe).

There’s a rumor going round the town that pain is a bad thing and should be eliminated at all costs. Big Boss Pharma has been lining up all its big guns and, no matter what level of pain you may be experiencing, there’s a pill with your name on it, assuming you get a prescription, of course. You may therefore look at the headline here and be a little surprised. How on Earth can anyone think pain is a good thing? Well, let’s go back to basics. Darwin, that inconvenient man who thinks we all evolved rather than were created, argued only the best-adapted species survived. When it comes to survival, the animal needs to know when it’s under attack. If it’s injured, it decides whether to fight or flee. So pain is a vital signal to the brain. It warns when the body is injured. We benefitted from that when we were less well-developed. Today, it’s still useful to know if we have accidentally injured ourselves or just picked up something too hot to hold.

The modern response is to seek medical assistance and then we complain when the pain message continues. So let’s move medical science a few years into the future. Rather in the same way we can switch off the burglar alarm when we know someone has broken into our home, a researcher develops a magic pill to switch off pain. It changes the brain’s chemistry so we are no longer aware of any pain. Would you take it? Before you rush to an answer, the scientist confirms this is an all or nothing pill. Either you feel pain or you do not. We will have to go into real science fiction to arrive at a treatment that only switches off the pain messages from the injured part of the body. In theory, it should be possible to neutralize the pain by interrupting the nervous system at key junctions, e.g. where an arm or leg joins the body. Unfortunately, this also risks paralyzing the arm or leg.

Anyway, back to the question. Would you take a pill to switch off pain? It would mean you would not know if you were damaging any other part of your body. Suppose you drink something that’s burning your tongue, or slip and make your existing injury worse. You would not know to stop drinking or seek further medical treatment. Completely turning off pain is dangerous unless you lie perfectly still and take no physical risks. Even then, you would not know if you were getting the first pain symptoms of a heart attack or warning indications of any other disease. The present situation is safer because a drug like Ultram simply reduces the intensity of the current pain. You can still feel if any other part of your body is injured or you are affected by some other disease or disorder.

In Europe, the trend is to teach people pain management techniques so they can achieve a good quality of life without having to rely on painkillers. This does not deny a role for drugs like Ultram. They will still be used for short-term relief should pain flare up. The hope is people can cope without risking dependence on drugs.