FEATURE

The Placebo Effect

Prof. B. M. Hegde,
hegdebm@gmail.com

Placebo is an inert substance that has no effect on your body. In medical research, placebos are used as controls against which the effects of drugs are measured. The placebo effect is becoming a big headache for drug developers as they are finding it difficult to produce new drug molecules which are statistically more effective compared to a placebo. Interestingly this placebo effect is becoming more assertive in American clinical trials in the last one or two decades according to a Canadian researcher: The change in response to placebo treatments for pain, discovered by researchers in Canada, holds true only for US clinical trials. 'We were absolutely floored when we found out,' says Jeffrey Mogil, who directs the pain-genetics lab at McGill University in Montreal and led the analysis. Simply being in a US trial and receiving sham treatment now seems to relieve pain almost as effectively as many promising new drugs."

But even in Europe the same effect has been recently shown by Professor Bingel at all in Oxford. In an elegant study with functional MRI confirmation they showed that a powerful pain killer like morphia was only as effective as saline injection both intravenously when the patient was made to believe that saline was morphia and morphia was saline. (Science Translational Medicine 2011; 3: 70) In short, placebo effect is seen universally. So far so good as far as drugs are concerned. What about surgery? There seems to be relative dearth of placebo controlled studies in surgical operative techniques. It is also not imperative that placebo controlled studies are done before a new technique is let loose on the gullible patients. Surgeons are kept at a higher pedestal by lay people thanks to the hype and halo around them.

Be that as it may, in my area of interest there have been studies using placebo controls. A recent one is published in the American Journal of the College of Cardiology (J Am Coll Cardiol. 2005; 46(10):1812-1819) The abstract of the study goes thus: “Treatment with per-cutaneous myocardial laser revascularization provides no benefit beyond that of a similar sham procedure in patients blinded to their treatment status.” This was a well planned, prospective, randomized placebo controlled study done in a very prestigious US University. Cobb et al in 1959 and Diamond et al in 1960 had done similar studies where the placebo was just a skin incision in comparison to regular CABG of those days. Their conclusions were also similar. (Mammary artery ligation by a double-blind technique. N Engl J Med 1959;260:1115– 8. & Dimond EG, Kittle CF, Crockett JE. Comparison of internal mammary ligation and sham operation for angina pectoris. Am J Cardiol 1960; 5:483– 6.)

Another important study that raised so much controversy was the NETT (National emphysema treatment trial) for a new surgical technique of LVRS (lung volume reduction surgery) in the treatment of emphysema. This vigourously controlled study did show the LVRS in bad light. Surgeons usually do not accept defeat that easily and so the controversy rages on even to this day in surgical circles. The results did, however, show that LVRS was just placebo only. Interestingly, animals also have shown placebo effect elegantly in studies. One study is worth quoting here. Epileptic dogs have responded to placebo as well as anti-epileptic drugs.

We should learn from history. In the year 1750 Linnaeus in Germany published his own case of severe sciatica, the pain kept him awake all week and was incapacitating. Drugs did not give him any relief when his wife suggested that eating strawberries (it was the season then) will relieve the pain. He ate all strawberries at home at night and slept for two hours. Got up again to eat more strawberries and got his sciatica cured! Of course, many of you would dismiss this as anecdotal. The good news is that anecdotal N-of-1 studies are now considered better than RCTs (randomized controlled trials) even by journals LIKE Nature! “A major advantage of the N-of-1 approach over classical trials is that patients are no longer guinea pigs, whose involvement in a study may help only future generations. In N-of-1 trials, the effectiveness of different treatments are vetted for the actual participants. Indeed, members of hundreds of patient-advocacy groups, for instance for rare genetic diseases, are eager to be involved in studies to test candidate drugs. Physicians are having to become more acutely aware of the unique circumstance of each patient — something most people have long called for.” (Nature 2015; 520: 609=611)

Now that we have established that placebo is a reality we can go back to quantum physics and the new interpretation of human physiology to understand placebo science more precisely. Matter is not made up of matter. (Hans Peter Durr) Matter and energy are the two faces of the same coin (Durr’s a-duality and Indian Sages’ advaita). The matter, of which the human body is made up of, as we think, becomes energy waves, changing from one to the other nearly 1024 times in a second. (Planck’s constant) Just as an atom has the blue print of its molecule human energy waves know the blue print of their matter. To get rid of any disease and get back to original state of matter (cure in the true sense) one has to get into that higher level of consciousness (meditation) and suggest to energy waves to get the matter to original shape. This was the Indian Sages’ advice. Today science has shown that mindful meditation can even change the gene penetrance and telomere length for better! Changing disease into health should be a child’s play. Powerful suggestion like a doctor’s assertion in the form of a placebo should accomplish similar results. Autosuggestion comes too close.

Candace Pert, an accomplished NIH scientist who missed the Nobel by a whisker, writes in her book Molecules of Emotion, that instead of reaching the drug cupboard when one has a headache it is better to sit in a quiet place to meditate to elevate one’s consciousness where the forebrain produces much more powerful opioids to relieve the headache. This is my experience too in my humble opinion-a N-of-1 study! A great physicist of the last century, Annie Besant, in her celebrated book of 1920 AD, Occult Chemistry, describes her Yogic Siddhi experience where she thinks she develops a third eye like the eyepiece of a microscope and is able to visualize the inside of seven elements from Hydrogen to Helium. She writes that the inside of an atom is just empty energy (amorphic). The reality is that human consciousness turns modern science upside down. How did the epileptic dog get placebo benefit? Animals have their own individual consciousness. (Rupert Sheldrake). Each one of us, including animals live in our own consciousness of this world (Robert Lanza) and so there are many worlds, each one for each of us. So we live in multi-verses, the idea called biocentrism.

Placebo effect has come to stay whether we like it or not.

Demand for OBC Reservation: Get into the Tent to break it!

P. M. Kamath

Originally, the architect of the Indian Constitution, Dr. Ambedkar, provided for reservation to Scheduled Castes (SCs) and Scheduled Tribes (STs) for a period of ten years purely on the ground of their social backwardness; past oppression of the communities and denial of humane treatment. Most of us would have seen the inhuman treatment given to SCs and STs or experienced it. However, more than the ordinary people getting benefits of this reservation, during the initial decades, those who claimed to lead them, in the Congress Party like Babu Jagjivan Rams, Makwanas and several of them and their family members gained benefits. 

The Congress and various factions of the Republican Party of India originally founded by Dr. Ambedkar asked for the extension of reservation as the age old socially discriminated sections could not get fully liberated in ten years! As a matter of fact by the 1960s leading leaders of SCs and STs had developed a vested interest in keeping: The benefits of reservation limited to own families and their extended families; and the SCs and STs perpetually backward so that the leaders can use them as their vote-bank! Now it has become a holy cow! No one can get rid of it, at least in the near future! 

Movement for OBC Inclusion: 

The movement for reservation quota for the OBC is an outcome of the compulsions of post-independence decades of developing vote banks in parliamentary democratic politics. Lord Hutton who conducted the last census of castes in India in 1931 mentioned about upward mobility of the new castes/classes like car drivers. Will they call themselves as Fiatwala or Ambassadorwala? But 1931 census did not mention the OBC. Even today there is no clarity on what it means: Other Backward Castes or Classes? Is it decided by birth or is it by social conditions at a given time? What are the criterions to get included in it? Many such questions arise. But we may say that OBC is a collective term used by the Government of India to classify castes which are socially and educationally disadvantaged. 

All over India since 1989 the then PM, V P Singh, used his livers of power to stir a social revolution by which he can consolidate and make his caste-based coalition, MAJGAR—(Muslims, Ahirs,  Jats, Gurjars, Adivasis and  Rajputs) as a coalition to give him political power at the federal and states’ level in the next election. He was facing the internal threat from his Deputy PM, Devi Lal, who belonged to Jat community. The BJP whose external support was also crucial for his survival in power was concerned with V P Singh’s effort to divide Hindus on caste lines. 

As a politician initially he was trained in the Congress Party culture, which had highest reputation in the country for making winning caste-coalitions in different states, like Kshatriyas, Harijans, Adivasis and Muslims (KHAM) in Gujarat or Alis, Bengalis and Coolis in Assam or Marathas, Muslims and other minorities in Maharashtra  etc. It is he who granted in 1990, 27 percent reservation for the OBCs to strengthen his caste-coalition. But he didn’t succeed. But he left people of his ilk like Mulayams, Lalus and Nitish Kumars to build winning coalitions dominated by the OBCs. Since then all over India, OBCs have reaped educational benefits, acquire political power and risen in social hierarchy.  

Since then every community that is left out from the benefits which come merely by including in ‘all inclusive concept of OBC’ have been demanding their inclusion under OBC. Thus in Rajasthan Rajputs, in Haryana Jats, succeeded in getting included to enjoy a sub-quota within the OBC. In Maharashtra Marathas along with Muslims were also given the benefits of reservation by the Prithviraj Chavan government. But these successful legislative acts were struck down by the Supreme Court of India (SCI)! On all-India basis continuous efforts are being made to add Muslims in OBC. To avoid the legal hurdle of ‘no religion-based reservation’ broader concept of ‘minorities’ was floated to include other religious minorities like Christians, Parsees, Buddhists etc. 

However, the State Reorganisation of 1957 has created another kind of minorities. These are the linguistic minorities. Every state in South India today has linguistic minorities, a majority of who are incidentally very poor. But the modern social reformers have never mentioned or include these minorities while creating their vote-banks! I know it for sure as I deal with broadly Kannada speaking slum children who may be Christians, Muslims or Telugus, Tamils and Malayalees!  But federal government though has a toothless Linguistic minority commission; all are focusing only on religious minorities!  

Patels as OBCs:

Be that as it may, Hardik Patel, a young man of 22 years, hitherto an unknown name, shot into prominence not only in Gujarat or all over India but throughout the US and western world: Because he kept Reservation pot boiling for Gujarat state and the federal government both under the BJP at a time when it was fighting an election to win power in Bihar state! He was asking for a quota for Patels within the OBC quota of 27%.This brings to a complete circle what began with former PM, V. P. Singh’s survival step that misfired for him in 1990! Hence the questions under considerations in this article: What are the driving forces for Hardik Patel to launch such a movement? 

After different dominant caste groups, like Rajputs, Jats succeeded to legally get themselves included in states like Rajasthan, UP, Haryana etc. in a sense it is natural for Patels in Gujarat to demand benefits of reservation. As everyone knows that there is a Supreme Court ruling which prohibits governments to exceed reservations beyond fifty percent, all dominant castes like Jats, Marathas and now Patels are demanding a sub-quota within the OBCs quota of 27 per cent. 

But what is interesting is the fact that at least twice the earlier governments in Gujarat had offered the benefits of reservations to Patels, which was rejected by them as they hated to be branded as ‘backward’. Patels all over the world is an affluent community. In the US for instance, 22,000 Motels as in 2012 are owned by Indians, 70 percent of these are controlled by Gujaratis of which three quarters are held by Patels. Even now, they support the reservation only on economic consideration. Those who are economically poor, irrespective of caste, need to be given benefits to improve their socio-economic status. 

The OBCs cannot be said to have suffered caste-based discrimination and humiliation as in the case of untouchables in the Hindu society, since untouchability was not a characteristic of these so called backward classes/castes.

Now Patels are putting forward a grievance that a Patel candidate even with 90 percent marks cannot aspire to get a medical seat, while a SC/ST or OBC candidate can get through even with 45 % marks! But if one becomes a doctor engineer with 45% marks irrespective whether he is SC/ST/OBC or from a forward community, after failing several times before finally passing, he is likely to fail to make a name in his profession even if he is able to make a living. A forward class schoolmate of mine in 1957 with forty five percent marks got into high fee medical college. Now he makes a living by being a general practitioner. That living he could have made even if he had gone into several other professions available in the society. What the reservation has done today is to deny young highly deserving aspirants from a non-reservation category, admissions they deserve in medical or engineering.    

However, it is the OBC’s turn now to become another holy cow. Several intellectuals have suggested that it is time to review the issue of reservation. They belong to all political backgrounds and not necessarily to the BJP or RSS. Thus, for instance, the Congress Party General Secretary, Janardhan Dwivedi had suggested while the Congress was in power in the Federal government to end all reservations and quotas except for the economically weaker sections by bringing all communities under its ambit. But this was contradicted by Congress President, Sonia Gandhi when she said: “Congress is of the firm opinion that the system of reservation for SC, ST and OBC must continue. This is essential to deal with the discrimination imposed by centuries of subjugation and oppression (?).” This was also reiterated on behalf of the then UPA government in February 2014 by the then Union Minister of State, Rajiv Shukla when he stated in the Rajya Sabha that the “reservation for SC, ST and OBC will continue as per the constitution.” 

Hardik’s Motives 

Patels are thus recent converts to favour reservation policy as a panacea for social and educational discrimination allegedly they have suffered and also use of the reservation instrumentality to rise in the socio-politico-economic status in the society without much investment to acquire education or get a creamy job. Still many say these are not at all actual motives of Hardik Patel in initiating the agitation to promote Patel’s cause for reservation. Is he serious on the need for reservation? There are quite a few voices in favour of reservation for Patels, mainly on the grounds, mediocre amongst the OBCs getting admission even with a low percentage of marks; but with the similar percentage a Patel candidate doesn’t get the admission in Engineering College. But watching discussion amongst the Patels in ND TV in September last, created an impression in me that an overwhelming majority of Patels were against reservation.

Then why did Hardik Patel begin the agitation? There are many theories doing rounds. First, it is politically instigated with the likely aim of diminishing the high popularity of the BJP under Narendra Modi leadership in the country, generally and in Gujarat particularly. That is a plausible reason as the Chief Minister (CM) Anandiben Patel is the current BJP CM and hope of the opponents to use the agitation to affect her chances to continue as well. Second, Patels have been generally against the reservation. Hardik Patel has also spoken about ‘give us reservation or abolish reservations altogether’. 

Conclusions

Though in the Bihar campaign, PM Modi had said that reservations will continue indefinitely, it is not inconceivable that in future the BJP might think of gradually limiting the benefits of gains without pain to the OBCs and keep the reservations only to the SCs and STs. The government has valid grounds that the latter communities have really not gained benefits as originally envisaged. 

 If that is not done, OBCs drive for easy ride might take them to seek reservations in private sector, multinational companies, and academic institutions run by minorities or without government grants. Today a majority of artistes, cine stars, T.V.  actors are from forward castes. Who knows OBCs might ask for reservation in theatre, TV industry and Bollywood as well!

But of all theories, it seems more plausible that Hardik Patel really wants to take Patels into already overcrowded OBC tent and break it from within. Hence, it may be imprudence for the BJP to charge him with sedition and permanently alienate him. Why not try to co-opt him? The ultimate outcome of Hardik Patel’s movement to secure the benefits of reservation for Patels within the OBC, only the time can tell. But Hardik Patel will find a place of honour in the pantheon of leaders who fought for OBC reservation.    

Author is formerly Professor of Politics, University of Bombay and currently Hon. Director and Chairman, VPM’s Centre for International Studies (Regd.), Mumbai and Adjunct Professor, Department of Geopolitics and International Relations, Manipal University, Manipal.