Placebo & Nocebo effects in Homoeopathy: Pivotal observations in Homoeopathic Case Management

Dr Jaimin R Chotaliya

ABSTRACT
The word “Placebo” is known to every physician in medical field. This term derived from Latin Language i.e. to please. The controversial journey of placebo from the tag “fake treatment” to “The Powerful Placebo” reveals many interesting facts about Placebo in Medical field. Over the last several decades, it has been evolved as an essential scientific inquiry to many Research scholars & Physicians. Utility of Placebo in Randomized Controlled trials was one of the revolutionary steps which left significant impact of placebo in medical field. Homoeopathic system of medicine also supports utility of placebo in case management. Its proper Utilization and thorough understanding about  Placebo effects will bring many successful laurels for Homeopathic system of Medicine. This article aims to explore Concept of Placebo effects in medical field specially in context of Homoeopathic therapeutic system where its knowledge brings remarkable changes in Homoeopathic Case Management.

KEYWORDS – Homoeopathy, Nocebo, Observations, Placebo

Evolution ofConcept

Concept of Placebo & its effects have been evolving prior to scientific era of medicine. Detailed study about Perspectives of medical men towards placebo & effects explores many ambiguous observations as its utilization dated earlier before 13^th century. Earlier practitioners were utilized it to please patients where prescribed substance was void of any medicinal virtue. It remains common medical tools for many decades with mixed perspectives of medical men about its utility in practice.

Scientific practice of administering placebo in control group of RCT to lessen the concern of bias brings its wide acceptance in medical science. this practice was helpful in two ways during medical research. Firstly, it provides apparent satisfaction to patient that he/she is getting medicine during trial, and it helps in analyzing the distinct medicinal action of trial substance. Its utilization in research trial will help us to maintain drug response where associative pairing of drug and placebo was implemented during initial phase of trial. In this type of study, researchers have paired placebos & active drug followed by administration of this combination to participants where they later removed portions of active drug over time to observe effects of drug response.

Currently many trials related to placebo & effects of placebo drawing attention of medical scholars regarding psycho-biological process responsible for placebo effects. Many theories were documented regarding it explaining psychological and neurobiological mechanisms of placebo effects. Placebo effect could be studies more clearly in context of pain, Parkinson’s disease as studies showing many possible ways regarding mechanism of placebo effect. ^(1),(2)

Placebo to Nocebo
Although placebo is given to please the patient in order to manage case, but it is important to understand that there is not a single placebo effect after administration of inert substance. There may be possibility of manifesting wide array of reactionary pattern which occur through different mechanism in different conditions and diseases.

Nocebo is one of the reactionary patterns seen followed administration of placebo where outcomes were unpleasant and negative outcomes seen in case. There are many factors which determined the placebo effect after administration of inert substances to patient like physician’s words, hospital environment, physical characteristics like colour and size of pills etc. Out of these factors, nature of psychosocial stimuli in form of physician’s word has significant influence on nature of placebo effect. i.e. positive context may elicit positive expectations & ultimately positive outcomes, negative context may elicit negative expectations & ultimately negative outcomes like rise in pain intensity or some side effects reported by patients. So, Psycho-social stimuli in form of healthy communication regarding case management is necessary step towards healing sick. ^(1),(2)

HOMOEOPATHIC ASPECT –
As placebo and placebo effects are becoming an important scientific inquiry in medical field, it is imperative to understand this concept by Homoeopathic Physician as Homoeopathic Science also utilizing these inert substances in Case Management.

There are various reasons for utilizing placebo in Homoeopathic case management where some of important ones are following, ⁽³⁾

• To please the patient when nature of case is indisposition.
• When Physician needs time for analyzing the case data to find similar medicine for case
• To supplement the indicated medicine where repetition may do harm to patient.

Now sometimes, there may be possibility of observing some nocebo effects in Homoeopathic Case Management while using Placebo (i.e. Sac. Lac.). So, one must be able to understand the reasons and capable to handle the consequences for Case management.

For example, Homoeopathic Physician has prescribed Sac. Lac. (i.e. Placebo) in new Chronic case during first visit as he needs some time to analyze case data. In next visit, patient reports some symptomatology that develops after taking first Dose. Here,  to find the source of symptoms for case, there are following possibilities for nocebo effect.

• Hypochondriac patient
• Idiosyncratic patient
• Reappearance of suppressed symptoms in case (sometimes placebo is best prescription to get original clear picture of sickness)
• Progression of Disease Condition

A physician must Scrutinize above possibilities and prepare further strategies to manage case.

In Homoeopathic case Management, Homoeopathic Aggravation is one of the important phenomena in order to achieve cure in sick which is favorable observation in case management. But during Homoeopathic case management, patients may report aggravation of symptoms after taking medicated globules i.e. intensification in suffering and believes that it worsens his suffering. Here,  Scrutiny on Remedial action in Patient & Good Counselling play vital role in case Management.

Increase in intensity of suffering is seen in both cases i.e. nocebo effect & Homoeopathic aggravation. So, following table enumerates details about both phenomena.

NOCEBO EFFECT	HOMOEOPATHIC AGGRAVATION
This manifestation seen after administration of inert substance in case management	This manifestation seen after administration of dynamic (potentized) homoeopathic medicine which is  properly suitable for case
More emphasis on adverse effects and negative psycho-social stimuli are responsible for occurrence of Nocebo Effect in case	In order to expel disease condition, suitable homoeopathic medicine produce this kind of effect
Presence of nocebo effect in cases make it difficult to manage in terms of prognosis, while in clinical trials (where placebo is parallel arm) created confusion & Misunderstanding during analysis of data obtained from study	It a favorable action to cure sick but discrimination of physician affects case progress (*physician should be capable of discriminating various type of aggravations as there are many types of aggravation patterns are seen in Homoeopathic therapeutic system)
Positive context in form of psychosocial stimuli in case and avoidance of more systematic assessment of adverse events in clinical trials will limits the occurrence of Nocebo Effect.	A proper orientation about action of Homoeopathic medicine to patient and discriminating skills of Physician will help to manage case with favorable outcomes.

CONCLUSION
In Homoeopathic Practice, mere Knowledge of Medicines from Homoeopathic Materia Medica is not enough to be skillful Homoeopathic Prescriber. Careful observations regarding action of remedy & corresponding reaction from sick body will help us to learn many new aspects of healing phenomena that taking place in suffering bodies. Research in field of mechanisms regarding action Placebo & Nocebo effect bridges many disciplines in medical field which ultimately opens new doors to serve suffering humanity with logical approach.

REFERENCES 

• Frisaldi E, Shaibani A, Benedetti F. Understanding the mechanisms of placebo and nocebo effects. Swiss Medical Weekly. 2020 Sep 1;150(3536): w20340-.
• Colloca L, Barsky AJ. Placebo and nocebo effects. New England Journal of Medicine. 2020 Feb 6;382(6):554-61.
• Stuart C. The Genius of Homoeopathy-Lectures and Essays on Homoeopathic Philosophy.

Dr. Jaimin R. Chotaliya, M. D. (Hom.)
Assistant Professor [CL-2], Dept. of Repertory
Govt. Homoeopathic Medical College & Hospital,
AT & PO Dethali, Ta. – Siddhpur, Dist. – Patan, Gujarat.
Email – jaiminchotaliya@gmail.com