Therapeutic effect
Encyclopedia
A therapeutic effect is a consequence of a medical treatment of any kind, the results of which are judged to be desirable and beneficial. This is true whether the result was expected, unexpected, or even an unintended consequence
of the treatment. An adverse effect
, on the other hand, is a harmful and undesired effect.
What constitutes a therapeutic effect versus a side effect is a matter of both the nature of the situation in which a treatment is used and the goals of treatment. There is no inherent difference between therapeutic and undesired side effects; both responses are behavioral/physiologic changes which occur as a response to the treatment strategy or agent. The most common nominal reason for preferring certain affects is avoiding death. However, those changes which are viewed as desirable, given the situation, are called therapeutic; those undesirable for the situation are viewed as unfavorable.
s, drug
s or supplement
s, perhaps because pharmacology
approaches are more often more rigorously evaluated by comparison with placebo
treatments, but this is not the case. It applies to any treatment approach, including surgery
, physical therapy
, psychotherapy
, treatment with compounds, faith healing
, hypnosis
, holistic methods, etc.; any method of which one can conceive.
The administration of a compound was selected for the pharmacologic example below because this form of treatment is more readily checked with the comparative treatment versus the placebo approach designed so that people are often unable to recognized the difference, at least at a conscious or group awareness level. Other therapeutic methods are typically more difficult to test because the test subjects can more easily recognize the key aspect of treatment which is being tested; it thus becomes far more difficult to apply the placebo control methodology. The placebo effect
is always relevant in all treatments; behavior and symptoms do change, however the presumed mechanism may primarily be the power of the mind which controls behavior and perception all the time, and the fact that if an individual believes that their situation will change then their situation actually does change.
To maximize the therapeutic effects and minimize the side effects of any treatment, recognition and quantification of the situation, in multiple dimensions, is a critical prerequisite. There are many situations in which the effects of a treatment, both those often viewed as both desirable and undesirable can be used in combination with other treatments in a complex strategy so that, for the individual being treated, the best end results actually depend on side effects contributing to the overall therapeutic benefit. Achieving this reflects a higher degree of physician and patient interactive relationship, trust, sophistication and skill. The same principles applies to all agents, including what most people view as simply food, water, air and oxygen. Situation, timing and great familiarity of the multiple usual responses to agents is critically important for wisely selecting all treatments. Maintaining and improving health strongly depends on promoting desirable effects while lessening the impact of undesirable effects of many interacting issues. However, the number of interacting issues, powerfully influenced by internal individual control mechanisms, make understanding and knowing all the issues a mind-boggling complex task which, at least in this day and age, is never totally understandable. There are simply too many complex interacting issues, never totally knowable, definable and predictable.
patient, too much water can lead to water intoxication
, which can result in death, such as in severe pulmonary edema
.
As a simple example, the therapeutic effect of diphenhydramine
, when used for nasal congestion
, is to lessen mucous membrane
secretions and the side effect is drowsiness. However, when used for insomnia
, as in many over-the-counter preparations, the therapeutic effect of diphenhydramine is drowsiness and the side effect is mucous membrane dryness, which is undesirable, especially if the person using the agent for sleep is already suffering from dry membranes. The more important issue is not the agent, but the situation in which the therapeutic agent is used; a change in the situation can easily totally reverse what is usually considered a therapeutic versus an undesirable side effect.
Diphenhydramine was originally marketed under the brand name Benadryl in the early 1950s. When taken orally, it typically induces two behavioral responses: (1) drying of mucous membrane
s, potentially helpful in cases of increased nasal congestion and (2) drowsiness. Diphenhydramine was promoted for reducing nasal congestion, thus response 1 was the considered the therapeutic effect. Since response 2, the drowsiness response, was typically not viewed as desirable, drowsiness was termed a side effect.
When diphenhydramine is used as a treatment, these two effects, individual responses, are always bound together and cannot be separated. Even though the dose
can be changed and the relative degree of the two responses may be reduced or increased and the degree of the two different responses may be somewhat different at different doses, the two responses cannot be separated. For simplicity of illustration, only two typical responses are mentioned. For completeness, be aware that as with most treatments people usually exhibit additional responses to diphenhydramine beyond the two mentioned.
preparations, as opposed to less refined and regulated products, often marketed as "natural" to imply safety.
Products from nature are essentially always complex mixtures of large numbers of different chemical agents, many only partially understood in term of usual desirable and undesirable responses, relationships of these effects to specific doses and with varying amounts of dose present within any given sample available.
The pharmaceutical industry highly purifies, concentrates and sometimes makes very controlled modifications of agents obtained from natural sources, when there is no alternative source, so as to select out and greatly reduce the variables in the treatment agent offered. Ratios of relative responses, often summarized using the concept therapeutic index
, are utilized to help understand and communicate treatment responses.
A pharmaceutical grade agent does not make the patient any more simple but it does greatly simplify, narrow and make more definable and predictable both the usual desirable and undesirable effects of the treatment agent, based on careful tracking of the responses of many individuals who have taken the agent, in widely varying amounts and situations, in the past. This purification can greatly improve the probability for both the patient and the physician that the resulting responses to the treatment are likely to be more predictable and controllable.
Unintended consequence
In the social sciences, unintended consequences are outcomes that are not the outcomes intended by a purposeful action. The concept has long existed but was named and popularised in the 20th century by American sociologist Robert K. Merton...
of the treatment. An adverse effect
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, on the other hand, is a harmful and undesired effect.
What constitutes a therapeutic effect versus a side effect is a matter of both the nature of the situation in which a treatment is used and the goals of treatment. There is no inherent difference between therapeutic and undesired side effects; both responses are behavioral/physiologic changes which occur as a response to the treatment strategy or agent. The most common nominal reason for preferring certain affects is avoiding death. However, those changes which are viewed as desirable, given the situation, are called therapeutic; those undesirable for the situation are viewed as unfavorable.
Scope of treatments
Many people think of therapeutic and undesired side effects as only applying to medicationMedication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s, drug
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
s or supplement
Dietary supplement
A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet...
s, perhaps because pharmacology
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
approaches are more often more rigorously evaluated by comparison with placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
treatments, but this is not the case. It applies to any treatment approach, including surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
, psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, treatment with compounds, faith healing
Faith healing
Faith healing is healing through spiritual means. The healing of a person is brought about by religious faith through prayer and/or rituals that, according to adherents, stimulate a divine presence and power toward correcting disease and disability. Belief in divine intervention in illness or...
, hypnosis
Hypnosis
Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination."It is a mental state or imaginative role-enactment . It is usually induced by a procedure known as a hypnotic induction, which is commonly composed of a long series of preliminary...
, holistic methods, etc.; any method of which one can conceive.
The administration of a compound was selected for the pharmacologic example below because this form of treatment is more readily checked with the comparative treatment versus the placebo approach designed so that people are often unable to recognized the difference, at least at a conscious or group awareness level. Other therapeutic methods are typically more difficult to test because the test subjects can more easily recognize the key aspect of treatment which is being tested; it thus becomes far more difficult to apply the placebo control methodology. The placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...
is always relevant in all treatments; behavior and symptoms do change, however the presumed mechanism may primarily be the power of the mind which controls behavior and perception all the time, and the fact that if an individual believes that their situation will change then their situation actually does change.
To maximize the therapeutic effects and minimize the side effects of any treatment, recognition and quantification of the situation, in multiple dimensions, is a critical prerequisite. There are many situations in which the effects of a treatment, both those often viewed as both desirable and undesirable can be used in combination with other treatments in a complex strategy so that, for the individual being treated, the best end results actually depend on side effects contributing to the overall therapeutic benefit. Achieving this reflects a higher degree of physician and patient interactive relationship, trust, sophistication and skill. The same principles applies to all agents, including what most people view as simply food, water, air and oxygen. Situation, timing and great familiarity of the multiple usual responses to agents is critically important for wisely selecting all treatments. Maintaining and improving health strongly depends on promoting desirable effects while lessening the impact of undesirable effects of many interacting issues. However, the number of interacting issues, powerfully influenced by internal individual control mechanisms, make understanding and knowing all the issues a mind-boggling complex task which, at least in this day and age, is never totally understandable. There are simply too many complex interacting issues, never totally knowable, definable and predictable.
Pharmacology example
For example, it is widely promoted that "natural" or "organic" agents are more healthy. However, everything in the world has multiple and varying responses when used; both desirable and undesirable effects are inherent parts of the total response. Even water – on which all life on earth depends – can have undesirable, even fatal effects; while increased intake of water can save a dehydratedDehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
patient, too much water can lead to water intoxication
Water intoxication
Water intoxication, also known as water poisoning, is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside of safe limits by over-consumption of water....
, which can result in death, such as in severe pulmonary edema
Pulmonary edema
Pulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
.
As a simple example, the therapeutic effect of diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
, when used for nasal congestion
Nasal congestion
Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.Nasal congestion has many causes and can range from a...
, is to lessen mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
secretions and the side effect is drowsiness. However, when used for insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
, as in many over-the-counter preparations, the therapeutic effect of diphenhydramine is drowsiness and the side effect is mucous membrane dryness, which is undesirable, especially if the person using the agent for sleep is already suffering from dry membranes. The more important issue is not the agent, but the situation in which the therapeutic agent is used; a change in the situation can easily totally reverse what is usually considered a therapeutic versus an undesirable side effect.
Diphenhydramine was originally marketed under the brand name Benadryl in the early 1950s. When taken orally, it typically induces two behavioral responses: (1) drying of mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
s, potentially helpful in cases of increased nasal congestion and (2) drowsiness. Diphenhydramine was promoted for reducing nasal congestion, thus response 1 was the considered the therapeutic effect. Since response 2, the drowsiness response, was typically not viewed as desirable, drowsiness was termed a side effect.
When diphenhydramine is used as a treatment, these two effects, individual responses, are always bound together and cannot be separated. Even though the dose
Dose (biochemistry)
A dose is a quantity of something that may impact an organism biologically; the greater the quantity, the larger the dose. In nutrition, the term is usually applied to how much of a specific nutrient is in a person's diet or in a particular food, meal, or dietary supplement...
can be changed and the relative degree of the two responses may be reduced or increased and the degree of the two different responses may be somewhat different at different doses, the two responses cannot be separated. For simplicity of illustration, only two typical responses are mentioned. For completeness, be aware that as with most treatments people usually exhibit additional responses to diphenhydramine beyond the two mentioned.
Reducing complexity
The desire to simplify clinical situations and variables is one of the important reasons that physicians often prefer highly refined and regulated prescription drugPrescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
preparations, as opposed to less refined and regulated products, often marketed as "natural" to imply safety.
Products from nature are essentially always complex mixtures of large numbers of different chemical agents, many only partially understood in term of usual desirable and undesirable responses, relationships of these effects to specific doses and with varying amounts of dose present within any given sample available.
The pharmaceutical industry highly purifies, concentrates and sometimes makes very controlled modifications of agents obtained from natural sources, when there is no alternative source, so as to select out and greatly reduce the variables in the treatment agent offered. Ratios of relative responses, often summarized using the concept therapeutic index
Therapeutic index
The therapeutic index is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes death or toxicity ....
, are utilized to help understand and communicate treatment responses.
A pharmaceutical grade agent does not make the patient any more simple but it does greatly simplify, narrow and make more definable and predictable both the usual desirable and undesirable effects of the treatment agent, based on careful tracking of the responses of many individuals who have taken the agent, in widely varying amounts and situations, in the past. This purification can greatly improve the probability for both the patient and the physician that the resulting responses to the treatment are likely to be more predictable and controllable.