Magic sparkles.
(aired on All Things Considered November 17, 2004)

I was following a pediatrician who was about to give a five-year-old her vaccinations. She told me, `OK, so the important thing to remember here is that four- to six-year-olds believe in magic. And, I mean, they really believe in it.' In the exam room, the doctor told the girl, `I have good news and bad news. The bad news is we have to give you some shots today. The good news is when we're done, you're going to be all ready for kindergarten. And I also have some magic sparkle Band-Aids that are going to help you feel better. But I need your help, OK?' The girl looked to her parents. Her parents gave her reassuring nods.

`OK,' the pediatrician explained, `I'm going to give you a shot in your arm, and then I'm going to put on the magic sparkle Band-Aid. Then you blow on it hard to activate the magic sparkles, and it will make you feel better. First, let's practice.' She explained it again, then mimed giving the shot and the Band-Aid on the girl's shoulder, then said, `Now blow, blow.' (Makes blowing noises) The girl blew hard.

`OK,' the doctor said. `Good. This time let's do it for real.' Quickly, the doctor gave the shot, slapped on the magic sparkle Band-Aid and said, `Now!' (Makes blowing noises) And the girl blew as hard as she could on the sparkles as the pediatrician said, `More, more.' (Makes blowing noises) `OK.' The little girl stopped. `Does that feel better?' the pediatrician asked. The little girl nodded solemnly, impressed by the power of the magic sparkles. Then the other arm, same procedure, and that was that.

I didn't question this maneuver until recently when I was reading about the ethics of using placebo treatments for pain in teen-agers and adults. Placebos are sham treatments, like pills made with no active ingredient. Doctors and patients can use placebos together. In essence, we as patients can agree to be tricked in a way that we control and that we can stop. But if a doctor tried an adult equivalent of the magic sparkle Band-Aid trick on me, I'd be furious.

These days we put a high value on the principle of patient autonomy. Deception removes people's power over their own health-care decisions. But the pediatrician explained the magic sparkle procedure completely. And a five-year-old who believes in Santa Claus and imaginary friends will probably understand magic sparkles better than an explanation of how concentrating on a strenuous activity will reduce pain. Perhaps most importantly, her parents, who were responsible for making her medical decisions, were not being deceived.

So as a medical student, I'm ready to use magic sparkles for five-year-olds, just as I'm ready to agree when they tell me that Santa Claus is coming. But I think that the idea that doctors should or could dispense comfort like magic sparkles is only acceptable for children whose parents make decisions for them. The rest of us who suffer pain must also understand it.

copyright 2004 joe wright