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Explore This IssueOctober 2013
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A placebo works only if the patient believes it’s an effective medicine. Within strict limits, hope, it seems, can be transformed into biochemistry.
—Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark
Could a greater miracle take place than for us to look through each other’s eyes for an instant?
—Henry David Thoreau
Making the diagnosis was the easy part. There were so many obvious clues. The limping gait when she entered the exam room, the flaccid handshake, the swollen knuckles. A textbook case of rheumatoid arthritis (RA). Mimi managed an organic farm in southern Vermont. At the outset of her visit, she conveyed her skepticism about the benefits of traditional medicine. She confided that she only kept her appointment with me to placate her older sister, a biomedical engineer.
Mimi’s knowledge of RA was quite impressive. She subscribed to several reliable medical websites and was aware of the treatment paradigms for her disease. We discussed the various options, yet she was hesitant about starting any drug regimen for managing her moderately severe RA. She believed that all drugs used to treat RA were toxic. Though I vehemently disagreed, I could not really blame her. The sheaf of information sheets outlining the potential side effects of the various disease-modifying drugs that I provided Mimi seemed to prove her point. Nausea, hair loss, risk for serious infection, liver inflammation, low blood counts—all were unacceptable risks for her. She was a woman who ran a successful organic farm and believed that there should be a better way for doctors to treat disease than by prescribing “toxins.” She was more interested in hearing about complementary therapies for RA. I explained that the term complementary meant using a non-mainstream approach together with, and not in place of, conventional medicine. Mimi thanked me for my time. She said that she would contact me with her decision, though it was obvious that I failed to convince her to begin any conventional therapy. I was deeply frustrated. Unlike many of the other diseases that we manage, RA is highly treatable, so it was disappointing to see her leave my office without a management plan.
A few months later, much to my surprise, Mimi paid a return visit. Outwardly, she looked the same as she did on her first visit—bright and cheerful—though her joints were still quite boggy and swollen. She told me that she found a “completely natural” herbal supplement online, which she was using to treat her RA. Not only was this supplement extremely effective in reducing joint pain and fatigue, it had no side effects! She felt “like a million bucks.” I was pleased to hear this news, but her persistent joint swelling concerned me. Mimi countered that with, “my hands are doing fine, and I can still do all my chores. So I see no reason to make any changes.” We parted ways. That was the last time I saw Mimi.