The Placebo Effect

One of my favorite MASH episodes involves the 4077^th requesting morphine, but getting  a shipment of placebos instead. Lacking alternatives, they prescribe the little white pills for everything from pain relief, to making Klinger non-susceptible to the oppressive Korean heat.  Amazingly, with a little suggestion, the sugar pills worked about 80% of the time.

While MASH isn’t a REAL hospital, the placebo effect works – both in 1977 and in 2019. Today I saw a commercial for a pharmacy that will give people Vitamin B12 injections. They have a “standing order” from a physician that allows them to inject anyone who requests it, and they suggest a dose once a month.  Interesting that I saw the MASH episode rerun and this commercial in the same week.

Most people get more than enough B12 from the food they eat.  Vegans sometimes don’t, because B12 comes exclusively from animal foods. So those people might need supplemental B12.  I won’t go into all the details, but aside from vegans, few people have a B12 deficiency. (The actual statistic is about 90% of people with Vitamin B12 deficiency are vegans/vegetarians.)

Simply stated, the problem with B12 usually occurs not specifically with a deficiency, but with the body’s inability to utilize B12. Some people do not produce “intrinsic factor”, which binds with B12 and carries it to the body’s cells. This condition is “Pernicious Anemia”, and taking oral B12 still won’t produce intrinsic factor to utilize the B12. These people need B12 injections to bypass the stomach and hence absorb the vitamin directly into the blood. 

Sometimes people with bypass surgery or Crohn’s Disease, or other issues with the digestive system need B12 injections.  Also, it has been shown that the ability to absorb B12 decreases with age, so the elderly might benefit from B12 injections.  I say MIGHT because B12 is stored in the liver for a long, long time, so an actual deficiency can take years to develop.

“Recently, vitamin B12 injections have become popular among healthy people who don’t appear to have a deficiency. Advocates of this approach claim that regular injections can boost energy levels and help with weight loss and mood. However, there is little to no evidence to support these claims.” Helen West, RD.

The Vitamin B12 injection thing is the placebo effect at its finest, but it isn’t actually a “recent” phenomenon. It has been going on for years and years. Even back in 1966, when I started nursing school, we knew about it. Our instructors laughed, while our mothers were traipsing to the doctor every month to get their B12 energy shots. My very FIRST job, in a doctor’s office, involved giving B12 injections to mostly young women, who believed it would work a miracle for their energy.  So it did. It didn’t matter whether the injection was actually B12 or saline (like happened one week when we ran out of B12). The doctor said it didn’t matter, as long as the patients THOUGHT it was B12.  He was right.

But there is GOOD news.  Vitamin B12 injections are very safe. There are almost no side effects from B12, and only rare local allergic reactions at the injection site, so you won’t see a list of all the possible side effects. There is no chance of breathing difficulty, brain damage, heart failure, seizures, nausea, diarrhea, swelling in your hands or feet, blurred vision, impotence or death from your B12 injection.  But the BEST news is for the provider. The cost to the pharmacy or doctor of a single dose is about $1.75, so it is one of the most cost effective medications he or she can stock.  Oops! The BAD news is that you will be charged from $20 to over $50 for your single dose injection.

So here is a bargain for you: I will stick you with a needle and give you a drink of water for only $10. Also no side effects. The proceeds from this endeavor will help fund paying off my house this year.