What’s Obecalp Got to Do with Elvis Anyway? Another Post from the Extended Stay Hotel

I just recently re-encountered the word “obecalp” and this brings back memories of medical school. You know, “obecalp”, which is just “placebo” spelled backwards, turned up in Dr. Henry Nasrallah’s editorial in the August issue of Current Psychiatry, link http://www.currentpsychiatry.com/article_pages.asp?aid=9753. I had no idea obecalp was being marketed on-line. I also didn’t know that the term was allegedly coined by an Australian physician in 1998. I didn’t have ready, free access to the full-text article by Michael Axtens in New Scientist, link http://www.newscientist.com/article/mg15921467.300-mind-games.html, but it sounds like he was disenchanted by his experience prescribing antidepressants (which he rather unscientifically characterized as placebos) for his patients. My first encounter with obecalp was in my senior year of medical school, which incidentally was well before 1998 (and that’s all you’ll get out of me!).

I was doing a 4th year elective as a subintern on the Medical-Psychiatry Unit (nowadays the preferred term is Complexity Intervention Unit). My senior resident was trying to come up with a benign and effective intervention for one patient’s persistent medically unexplained physical symptom. He finally decided on what he called “obecalp”, and presented the idea to the treatment team one day on rounds. He began by writing “Obecalp” on the blackboard. We didn’t have whiteboards in those days. His short elevator speech and proposal to offer obecalp to the patient, who never failed to remind us that we were not addressing a most distressing symptom, met with a chilly reception from the co-attending faculty physicians, consisting of an internist and a psychiatrist. Nevertheless, they grudgingly accepted the proposal.

The patient got obecalp and was cured of the complaint within days. I think the recovery was as much a function of the resident’s dramatically persuasive and convincing explanation of the benefit of obecalp as the sugar-pill itself. He was a bright and engaging fellow, though his sense of humor was a bit twisted at times. One example was his impression of Elvis, which consisted of quickly dropping to the floor on his back, closing his eyes and folding his hands across his chest…in an obvious “rest in peace” pantomime.

Dr. Nasrallah says the placebo effect is more a function of the prescriber than the pill itself [1]. I’m a believer.

1. Nasrallah, H. A., MD (2011) The most powerful placebo is not a pill. Current Psychiatry 10,