By Patrick Marsolek (8/2014)
Skeptics of complementary therapies have often claimed that alternative modes of healing are affective only because of the placebo response and are thus shams and shouldn’t be accepted as legitimate. Recent studies however are suggesting much of traditional medicine might also be placebo and we need to give more weight to the validity of the placebo response. The British Medical Journal recently did an analysis of 2,500 common medical treatments that showed only 36 percent of these procedures were shown to be “beneficial or likely to be beneficial” and another 46 percent with “unknown” effectiveness. This is sobering when compared to the placebo response which has been shown to be effective between 30 to 50 percent of the time.
There are also studies suggesting that even well-accepted and beneficial medical procedures may also be affective mostly because of placebo. Consider one surprising study where a widely used joint surgery was compared with a sham placebo surgery in the treatment of osteoarthritis. In this study, one group received arthroscopic joint surgery while another group was given the same anesthetic preparation, three stab wounds in the skin with a scalpel and no other invasive procedure. Both groups showed similar levels of improvement with respect to knee pain at six months following their “surgeries,” suggesting the effectiveness of this procedure may be a placebo response.
At the core of the debate with placebos is the growing understanding that our belief in what works affects the outcome of whatever treatment we’re given. Even the patients who received the “sham” knee surgery believed they would get better and did. For years, many proponents of western medicine claimed that placebo was a superstitious leftover of primitive forms of healing and that with enough rational understanding, we could excise belief from the practice of medicine. Yet the placebo response has persisted and won’t go away. Richard Kradin M.D., in writing about the psychology of healing suggests that the placebo response is on the threshold of entering a new phase in its history, where it will be recognized as a scientifically definable natural form of healing that is rooted in the mind/body connection.
More and more scientists and doctors are recognizing that biology and healing are nonlinear, complex phenomena where the mind of the patient, the expectations they have and the meaning they give a doctor’s action plays as strong a role in healing as chemical compounds that are given or the procedures that are done. The placebo seems to be leveling the playing field of different modalities of healing and reminding us that our faith in a particular system of healing in can have a tremendous impact in our own healing.
So what exactly is a placebo? In recent history a placebo has been thought of as a harmless pill, medicine or procedure that is prescribed more for the psychological benefit to the patient than for any physiological effect. Implicit in this is the assumption that psychological changes have little or no effect on actual healing in the physical body. In the day-to-day practice of medicine, sugar pills, saline solution or even the sham surgery mentioned above may make you feel better, relieve your depression or help you walk. These same placebos are used in medical research as a control against a new drug being tested. If the drug being tested has more success than placebo, it is thought to be proven effective.
Those schooled in western, allopathic medicine claim that witch doctors, shamans, and purveyors of most alternative therapies like acupuncturists, chiropractors and hypnotists, all deal in placebos. If we do acknowledge the power of belief in alternative therapies, then placebo may indeed play a large roll. Yet clearly, it also plays a large roll in allopathic medicine and doctors practicing arthroscopic surgery. Research has shown that the white coats and stethoscopes can produce the same placebo effect as does the placement of the acupuncture needles or the laying on of hands of the faith healer.
Michael Brooks included the placebo effect in his book on the mysteries of modern science; 13 Things That Don’t Make Sense. He describes how from 1969 to 1982, diazepam, also known as Valium, was the top selling drug in the United States for use as an anti-anxiety medication. Yet in 2003, a report showed that diazepam had no affect on anxiety when it was administered without the patient’s knowledge. One half of the study group was given the drug while being told by a doctor that they were being given a powerful anti-anxiety drug. The other half was hooked up to an automatic infusion machine and given the same dose of diazepam, yet no one told them they were being given a drug. Two hours later, the first group reported significant anxiety reduction, the second group reported no change. To date diazepam is still frequently prescribed and it is unclear how much of it’s effectiveness is due to placebo.
A study in 1985 claimed that somewhere between 35 and 45 percent of all medical prescriptions are placebos. In 2004, a study published in the British Medical Journal determined that more than half of Israeli doctors prescribed placebos, believing them an effective treatment. Despite being so common, the use of placebos is a continuing sources of disagreement in the medical profession. Some doctors believe it is unethical to deceive the patient, prescribing something that is known to be a sham. The prescribing of placebos also forces others, like the pharmacist, to be an accomplice to the deception. There are even guidelines for the language pharmacists should use when a placebo is administered. On the other side, many doctors believe it is unethical to withhold treatment that works. In many cases placebo is the only treatment doctors have found to be helpful for some patients. Is it a “sham” when it is an effective treatment? Is it a “sham” when you don’t fully understand why your procedure works?
As placebo has persisted, researchers continue trying to fit it into a materialistic box. The common thinking now is that the placebo effect is “due to” chemistry, since studies have shown that changes in the chemistry in the brain with placebo are real. The classic chemistry explanation involves the use of morphine for pain control. Once a patient has experienced pain relief with morphine, a saline solution can be substituted. The patients will still experience pain relief as long as they are told the saline is morphine. From there it gets interesting. If you put naloxone into the drip instead of just saline, again without saying anything to the patient, they now start reporting feeling pain again.
The explanation for this is that naloxone blocks the brain’s natural endorphins. Initially, when the saline solution was substituted, the patient’s expectation of relief was enough to start generating their own endorphins in their brain. Then, when naloxone was administered, it dampened the natural endorphins and the patient started feeling pain again. If researchers conduct the same experiment starting with ketorolac instead of morphine, a painkiller that works with different chemistry in the brain, then the naloxone has no affect and the patients continue to feel pain relief with only the saline solution. In another twist, if the patients are told they are getting diluted morphine at the outset, then the naloxone has no effect. This is apparently because their bodies have already activated some other system in the body for pain relief.
This research suggests there are many, as of yet unknown, biochemical mechanisms in the body that are enlisted for pain relief and healing. Somehow people are able to enlist these processes. Researchers and writers like Brooks seem to be caught in the materialistic paradigm claiming it’s the brains as the underlying force putting these mechanisms to use. For example, Parkinson’s patients can experience relief from tremors if they have a microchip surgically implanted in their hypothalamus. Change the settings of the electrical stimulus there, and their tremors will change. Tell the patients the settings have been changed, without doing anything, and their tremors change. Brooks states, “It’s not just about positive thinking: it’s about the chemical or electrical signals that positive thinking produce.” It is clear that placebo is not just in our imagination -- there are physical correlates. Yet many researchers still shy away from recognizing the power that the mind has in these interactions. Brooks writes, “Placebo... is all in the brain - it is real,” leaving out further mention of the mind. Shouldn’t we study the amazing fact that the patient who believes she’s getting less morphine can enlist other systems in her body for pain relief when she has no conscious understanding of how her body does it?
Brooks later goes on to say that it’s important to recognize the limits of placebo, that it can’t cure cancer or slow the onset of Alzheimer’s or Parkinson’s. This statement echoes a belief in materialistic medicine that certain kinds of illnesses such as genetic conditions and cancer are off limits to any mode of healing. As if to say, “Since we don’t know how to cure these diseases, you certainly can’t do it with belief or prayer!” Isn’t it possible that this limitation could be the self-fulfilling belief, or disbelief as it may be, of the doctors? Hypnosis has been documented to cure the “uncurable” genetic disease known as Fish Skin or Brocq’s disease, where the outer layer of skin forms a thick scaly surface. In one example, a hypnotist treated a young boy with this disease assuming the boy had a severe case of warts. It is commonly known that hypnosis can get rid of warts, thus the therapist confidently started treatment. After one treatment, part of the boys body become completely clear, the skin became pink and soft and healthy again.
Yet between sessions with the boy, the hypnotherapist heard from the referring doctor that the boy suffered from Brocq’s disease rather than warts. When he saw the boy again he observed the improvement in the boy. Yet from that point onward in his treatment he had no more success, even though he didn’t tell even the boy what he now knew. It seems the therapist’s effectiveness was also diminished by what he “knew” was impossible - treating genetic diseases with hypnosis. Incidentally, there are also other documented cases of highly “susceptible” patients being cured of Brocq’s disease with hypnosis.
How about treating cancer? There are thousands of cases of spontaneous remission of cancer. “Spontaneous remission” is a term used by the medical establishment, implying that the patient who recovered didn’t receive treatment or received inadequate treatment for their cancer. Is spontaneous remission a kind of placebo response? In her doctoral dissertation on spontaneous remission, Kelly Ann Turner questioned healers, physicians and cancer survivors about their theories of what caused the cancer’s remission. Turner describes six effective “treatments” that emerged from her study. These include: deepening one’s spirituality; trusting intuition regarding health decisions; releasing negative or repressed emotions; feeling love, joy and happiness; changing one’s diet; and taking herbal/vitamin supplements. Arguably, the first four of these “treatments” involve belief and actions of consciousness and are in the realm of placebo. Similarly, skeptics would claim that taking vitamin supplements and changing diet also fall mostly into the realm of placebo.
In addition Turner found three widely held theories about health among her participants. One, that the underlying conditions have to change for healing. This is a departure from the materialistic model which views cancer as a thing that has to be killed and removed. An aspect of this first belief is the understanding that each patient may have a unique change that’s required for healing that might include environmental and psychological factors. The second belief is that illness indicates a blockage somewhere in the body-mind-spirit system and health is restored with unblocked movement. This ties in with the third belief that human beings have at least three aspects -- spiritual, emotional/mental and physical -- and that thoughts and emotions have tangible effects on the physical body. Turner’s research shows that belief was significantly important for these cancer patients and it can have profound physical effects on other “untreatable” conditions.
Belief is just as powerful in areas where allopathic medicine does not have the answers. When the doctor says, “You have one month to live,” or “There is no cure for cancer.” He is essentially using the nocebo effect, casting a powerful incantation that harms the patient rather than heals. We give the healers and doctors we interact with that kind of power. When we’re sick, we ask them to cast a spell and tell us what we will experience in the future. As a testament to personal power, many patients who experience spontaneous remission enlist their own resources to heal themselves, essentially taking back the power they gave the doctor and saying “No” to the prognosis of death or chronic illness.
In indigenous cultures, the shaman often fulfills the role of the doctor, working with the beliefs of her patients to affect healing. She has the place of power in the society and uses it, with the knowledge of that power and the power of belief. They, like the doctors in white coats, are often very effective. In some ways, the indigenous beliefs are more in line with the results from the spontaneous remission study. They often exercise an awareness of spiritual and emotional dimensions, even though they may present them in different ways than Westerners do.
At the same time, this is not saying you should reject allopathic medicine and just pray every time you break your arm, or rely solely on acupuncture when you’re diagnosed with cancer. Each pathway for healing has value. The allopathic, materialistic model has been shown to work wonders for physical systems, though it may be sorely lacking in treating the mental/emotional/spiritual. Other systems, such as Chinese medicine may do a much better job enlisting the spiritual and the mental/emotional energies of the patient. Daniel Moerman, author of the book, Medicine, Meaning and tthe “Placebo Effect”, suggests that how we perceive what is being done to us as a healing process, the meaning we give it, is so critical, that we should be calling the placebo response the “meaning response”. The implicit faith or belief we have in a system of healing, a person in authority or a particular treatment can be tremendously powerful. Conversely, since nocebo is also very powerful, doctors have the responsibility to acknowledge the power of their patient’s belief and the limitations of their own.
As Anne Harrington describes in her book, The Cure Within: A History of Mind-Body Medicine, the stories we tell about our health, our bodies, and our healing may not only describe the world world we live in, but these beliefs may also help create new behaviors and possibilities that have not been before. Literally, one patient creates a “state change” in her story and her cancer can go into remission. Harrington suggests doctors should learn to embrace the narrative the patient has about their illness and healing. When a doctor labels a practice as a sham or a deceit, it may express their own beliefs, but it may not correlate to the beliefs, and the healing potential, of their patient. Our evolving understanding of placebo might help us bring the mind back into healing with the same weight as physical and chemical processes.
Patrick Marsolek is a writer, dancer, facilitator, clinical hypnotherapist and the director of Inner Workings Resources. He leads groups and teaches classes in extended human capacities, consciousness exploration, personal development, and compassionate communication. He is the author of Transform Yourself: A Self-hypnosis Manual and A Joyful Intuition. See www.PatrickMarsolek.com for more information.