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Placebo lurks everywhere

By David Butler Physio world, Education for all 03 Feb 2015

Digging through some older readings,  I was fascinated to read research suggesting that experienced violin players could not tell if they were playing a Stradivarius or a new violin. Most preferred the “playability” of a new violin. The report is worth a read and while there may be some holes in the research methodology, it’s not too bad. The record price for a Stradivarius is around $16 million, my musical friends tell me that good quality concert violins are available for $5,000.

Wow I thought – it’s a kind of “violin placebo”. Placebo, call it what you will – expectation, conditioning, brain power, suggestion, novelty, belief… raises its head in some odd places, but of course its everywhere.

Not just violinists

It’s not just violinists who will respond to the money factor. A recent study led by neurologist Alberto Espay published in Neurology demonstrated that people with Parkinson’s Disease performed better on motor skills tests when told they received an injection of a drug worth $1,500 per dose, compared to when they were told the injection they received cost $100. In both instances the participants received an injection of saline.

So what about the specialist whose consultation fees are hundreds of dollars per hour, or even the clinic up the road who charges more for a therapy visit because they have shinier equipment, flashier rooms and pay higher rent? Should we all be putting our prices up?

One thing for sure, I am not going to pay as much for my new fishing rod this year.

– David Butler

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  1. There are some people in Australia charging $800 for a 1 hour Physio consultation. And people pay, so it’s happening already. This is fact.

    IMO, Physio can be broken down into two active components: 1) placebo/expectation and 2) empathy/caring/attention. Anyone who reads the research will understand how weak and ineffective physical treatments are on their own, so I don’t count that aspect.

    And there seems to be two types of patients – those who just want their pain fixed, and those who want to feel cared for. My feeling is that there is a market for both, but that caring/empathy is where the big money is at because you ensure repeat business. A young bloke (client) once said to me: “you know for my Mum, going to physio is like going to meet up for coffee… she’s like ‘oh I think I’ll go and have some physio!'”. He was joking around, but I can see why such markets exist – low waiting times, 15-20 minutes of very personal attention, reasonably priced. It serves a very important function in people’s lives and it’s very much ‘in demand’. I’m not in any way rubbishing it.

    Over the last few months I have been focusing exclusively on placebo/expectation techniques and it’s been disastrous for my client numbers. I did it to further hone my skills and I can report that it’s definitely possible to switch off pain VERY, VERY RAPIDLY with such techniques. And the pain stays switched off. Whereas before I might work away at a ‘typical’ back/neck pain over say 4-5 treatments, now I can take massive chunks of the pain away and fix such problems in 1-2 treatments. I still have a few chronic clients I can’t help at all but that’s a separate issue. Chronic pain clients need high levels of empathy/caring *combined* with very skillful suggestion and that’s often beyond my reach.

    Part of providing a good placebo/expectation treatment should include the suggestion that “the pain will be very unlikely to ever re-appear”. But this is also problematic in a business sense… unless one charges $800 of course. Anyone reading this who would like a good demonstration of switching pain on and off RAPIDLY will like this video. It’s dramatized for TV, but the principles are sound.

    My attention is turning back to empathy/caring now. Despite my best efforts, I am way too patchy in my application. When it’s there it’s a really nice feeling, when it’s not…forget it. IMO this is a far harder skill to learn than hypnotic suggestion. Whilst rapid resolution of pain is possible with suggestion, it’s by no means the be-all-and-end-all of therapy.

    By the way Dave, did you get my email?

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