The Power of Hope: A Doctors Perspective

Retackling the subject of his previous book (Doctors, Patients and Placebos,1986), Spiro, a professor of medicine at Yale University School of Medicine, finds placebos everywhere in American medicine: ""in clinical trials as a substitute for treatment and in practice as therapy."" After defining a placebo as a ""medicine prescribed more to please the patient than for its therapeutic effectiveness,"" Spiro carefully investigates the ethics of using placebos (especially in scientific research); the mind-body connection in the ""placebo response""; and the nature of pain. He asserts that complaints for which no disease can be found ""often seem unreal to physicians."" Spiro argues, quite eloquently, that when physicians consider all the aspects that go into managing a patient's pain and suffering--physical, emotional, spiritual, financial, etc.--any treatment offered, be it pills, procedures or even surgery, will be more successful if it serves to engage the patient's power of hope. For the doctor, the key to this ""placebo response"" is creating a bond between patient and physician. Sometimes, he notes, the bond alone can serve to heal--although Spiro adds that in the age of managed care it is becoming ever more difficult to create that bond. His book is an excellent addition to the literature on the mind-body connection and on the power of the mind to relieve pain and suffering. (Dec.)