Placebo effect: A beneficial effect of taking a substance that has nothing to do with the substance itself
Nocebo effect: When negative expectations of a patient have a more negative effect than expected
In practice, these factors are observed regularly. Nocebo effect occurs in patients who, being anxious about taking a particular medication, read all the negative side effects and experience almost all - including the rarest of side effects. Or for example in pain control, a patient assumes that Drug X never works for me - and it never does. Also quite frequently, a patient will begin treatment and almost instantly feel relief - physiologically the drug hasn't even had time to work yet, but the patient is significantly improved. I've even experienced this myself, smirking at the power of my subconscious mind.
Placebo effects are now an important part of drug research, but for many years were not. In order for a drug to be considered effective, the therapeutic effects in the non-placebo group must be reproduced at a higher rate than the placebo group. Interestingly, most drugs used for depression and anxiety show the placebo group at equal recovery rates as the therapeutic drug group.
When I first learned that therapeutic drugs for depression had the same rate of efficacy as placebo, I was disheartened and actually went through a period of existential crisis. What was I doing peddling all these drugs to patients when they were no better than taking a sugar pill? Everything I do is a sham! Slowly I came to the realization that getting better is getting better and IT DOESNT MATTER how it happens. What matters is people find healing. I still peddle drugs - including ones that work at the same rate as placebo. I still support treatments that I know have no therapeutic value other than the patient believes that they do, therefore they do. The mind is the most powerful placebo/nocebo weapon, and the body for the most part is self-healing.
For further reading on this, I recommend Suggestible You by Eric Vance 2016
Another one on my list, but not yet read You Are the Placebo by Joe Dispenza 2014
With some knowledge of placebo and nocebo and does anything really work at all, let's now turn our attention to the body's own defense mechanisms.
Studies have been conducted on the immune response that shows that blood cells release immune-boosting proteins when a person witnesses another person sneezing.
You're welcome. Now, how's that for an amazing operating system? Without doing a conscious thing, your body is protecting you from disease.
When a patient brings an herbal supplement, or article about the new latest and greatest anti-aging product, my advisement is first, ensure the substance is not HARMFUL. Is it going to affect liver or kidney function, interact with your other medications, affect your personal medical conditions (do you have cancer history, immune-suppressive condition, diabetes, high blood pressure)? It truly is a unique decision for each person, and I strongly encourage you to consult your own personal health advisor to help with your decision-making.
After establishing that it likely won't cause direct harm, we then discuss the fact that otc supplements are not FDA regulated and studies repeatedly find that the actual ingredients and potency of stated supplement is often way off from advertised. Buyer beware.
Last, and most difficult to determine is the actual efficacy of a substance. Do we have peer-reviewed research to back the claim? Prescription drugs do, they must pass FDA approval. Foods, herbs, supplements, treatments sometimes do. That is what I hope to share through this blog.
Now back to all those things the store shelves are slam out of? Echinacea, Zinc, Zycam, Cold Eeze, Vitamin C, Vitamin E, Vitamin D. Elderberry. Are any of these scientifically proven to reduce the incidence of viral illness? Is it the substance itself? Anecdotal evidence? Placebo effect?
Let's look at a few:
ZINC
Theories about zinc include the idea that zinc coats the mucous membrane providing an extra layer of protection against viral invaders.
Cold Eeze zinc lozenges are evidence-based to shorten the duration of the common cold (a virus) by HALF. Two separate double-blind peer-reviewed studies in 1992 and 1996. Participants took 1 lozenge every 2 hrs while awake. Each lozenge containing 13mg zinc
Another study showed zinc at doses of 75mg per day was effective, but not less than.
Also of note, zinc taken intranasally can cause irreversible loss of smell. Not recommended.
Cold Eeze is absorbed directly through the mucous membrane and that is a very different delivery route than swallowing pills.
These studies were all performed on the common cold virus. Influenza patients were excluded. COVID-19 is a coronavirus that is in the same family of viruses as the common cold. Based on this data, I would suggest that zinc can be safely used and there is a possibility it may shorten the duration of symptoms by half.
VITAMIN C
In 2013, a meta-analysis of 29 trials showed a small 8% reduction in duration of symptoms. In soldiers, marathon runners, and artic skiers there was a 50% reduction. Why the variation in findings in this very small group was so different is unknown. Perhaps the vigorous body stress creates an increased demand for vitamin C? Just my own musings. However, if you are a vigorous exerciser more than 5 days per week, then Vitamin C appears to be of greater benefit than it would to an average active or more sedentary person.
ECHINACEA
Earlier studies prior to 2000 showed a reduction in severity and duration of cold symptoms, however many repeat studies in the next decade disproved this benefit showing no benefit of echinacea supplementation over no supplementation.
HAND HYGIENE
A resounding Yes. We have 100s of years of studies backing the fact that hand washing reduces and prevents the spread of germs.
EXERCISE
People who exercise 5 or more times a week suffer the same rate of viral infections as sedentary people. Personally disappointing to me, but certainly has other benefits to still recommend
SLEEP
People who sleep greater than 7 hrs have significantly less viral illness than people who sleep less than 5 hours a night who were three times as likely to get sick.
