“I’m hopelessly addicted to placebos.” Stephen Wright
Placebos. The sugar pill. Woo woo medicine. Doctors insult our intelligence about knowing when we’re sick and in pain by fobbing off this kind of thing on us, don’t they? Well, wait a minute. Maybe not. Not always. Hear me out on this one because I have some thoughts, and they might actually make sense. The word placebo is Latin for “to please.” A medical dictionary published in 1811 defined placebo as “an epithet given to any medicine adapted more to please than benefit the patient.” In days gone by, bleeding the patient was the most common response to illness. Clearly a placebo, and one that brought about death rather than life. Our own President George Washington is an example.
According to the American Cancer Society, one study found that when the patient believes the substance will work “the patient’s mind somehow causes short-term physical changes in the body.” Researchers say the positive effect of the placebo may be due to the release of feel-good hormones, known as endorphins, in the brain. Another study cited by the American Cancer Society involved Alzheimer’s patients. In that case, when the participants were given doses of actual pain medication, they felt less reduction in pain than would have been expected. The Alzheimer’s patients may have required higher doses of the pain medication, possibly because they forgot they were getting the drugs or perhaps they had forgotten that the pain medication had worked for them previously. You can read more about it here, in this interesting article.
Medicine is a tricky craft to practice, and that’s why so many are sub-standard at it. Page after page of support groups on the web where sick people go to beg for the name of a doctor who can actually DO something for them, and not just brush them off or force antidepressants on them. You arrive at the office on time, but get in for your appointment 40 minutes late, and the doctor comes flying in, doesn’t make eye contact and openly seems to begrudge you eight full minutes of his or her time. The higher the specialty, the worse it gets. After all, shouldn’t YOU have to take the brunt of an over scheduled, under invested endo or rheumy? It’s not their fault. You’re the one who’s sick, not them!
This seems to be the complaint of almost all of us chronically ill folks. It’s a pain, and I mean literally. Add in the fact that a percentage of patients go in meekly, unprepared, and fail to give an adequate amount of information or lie altogether about their symptoms, out of embarrassment. The doctor has to pry, wheedle and interrogate the patient, and still doesn’t have enough to make even a stab at a diagnosis. To make matters worse, many doctors don’t have very good listening skills either and are prone to making snap judgments and often incorrect diagnoses – as Doctor Jerome Groopman puts it: “We use shortcuts. Most doctors, within the first 18 seconds of seeing a patient, will interrupt him telling his story and also generate an idea in his mind [of] what’s wrong. And too often, we make what’s called an anchoring mistake — we fix on that snap judgment.” So, tests are run, pills are prescribed and money is rapidly spent, and in the end the illness is still not really addressed at all. In fact, many meds are prescribed to mask the symptoms rather than treat the root cause. And this scenario plays out with dismal repetition everywhere in the world on an hourly basis. Tricky craft, indeed!
In my last column, I talked about fighting illness with moxie, belief and intent. I mentioned that it was no big surprise that people who meditate, pray or simply refuse to accept illness heal better and recover more fully than those who don’t. What I didn’t go into was why. Why does this hold true? Well, there have been some recent studies that might explain it. And it’s not something anyone who is invested in being sick wants to hear. But for those of us who are determined to not be or stay sick, it’s like having your greatest hope proven right.
A Closer Look at the Placebo Effect
ScienceDaily (July 13, 2011) — Placebos are “dummy pills” often used in research trials to test new drug therapies and the “placebo effect” is the benefit patients receive from a treatment that has no active ingredients. Many claim that the placebo effect is a critical component of clinical practice. Whether or not placebos can actually influence objective measures of disease has been unclear. Now a study of asthma patients examining the impact of two different placebo treatments versus standard medical treatment with an albuterol bronchodilator has reached two important conclusions: while placebos had no effect on lung function (one of the key objective measures that physicians depend on in treating asthma patients), when it came to patient-reported outcomes placebos were equally as effective as albuterol in helping to relieve patients’ discomfort and their self-described asthma symptoms.
And it’s not just asthma patients for whom this works, but depression patients as well. PET scanners and MRIs peer into the heads of patients who respond to sugar pills, and researchers have discovered that the placebo effect is not “all in patients’ heads” but rather in their brains. New research shows that belief in a dummy treatment leads to changes in brain chemistry. “Researchers are just starting to appreciate the power that the mind can have over the body,” says Tor Wager, an assistant professor of psychology at Columbia University. “An emerging idea right now is that belief in a placebo taps into processes in your brain that produce physical results that really shape how your body responds to things,” he says. “The brain has much more control over the body than we can voluntarily exert.”
As Stephen King wrote in “Firestarter,” “The brain is a muscle that can move the world.”
So what does all this mean to those of us with congenital disorders? With crippling illness not of our own mental construct, but real, tangible, progressive illness? What about people born sick, with diabetes or neurological disorders, autoimmune disorders, heart disorders? Well, the answer may not be as simple, but might instead lie somewhere in the middle. The truth is many patients across a broad spectrum of illness have found a relief of symptoms through placebo-styled intervention. It should be noted that most of the physical response was in pain management and symptom control, rather than actual physiological changes. And, many patients see no improvement whatsoever when they are put on placebo medicines. But a more significant percentage do.
Recently, I read an article in care2.com written by Dr. Lissa Rankin. In the article, the recent studies and the idea of placebo-based healing was explored, and comments were welcomed. And I commented. Among the list of ailments claimed to be cured by the mind, with a 35% to 75% efficacy rate, were:
- Bronchi dilate in asthmatics
- Balding men grow hair
- Ulcers heal over
- Tumors melt away
- Headaches resolve
- Colitis gets better
- Angina disappears
- Depressed people feel happy
- Endometriosis symptoms resolve
- Knee pain goes away
- Parkinson’s improves
Naturally, as this is a very naturopathic-leaning blog, many of the comments were as “woo woo” as you can get! As can reasonably be expected, many people were perfectly healthy and had never themselves had to try to mentally re-grow cartilage, or melt their own brain tumors, but were adamantly certain that people who are sick are sick on purpose and willingly. Why, if they would simply envision sucking out the illness with a big metaphysical vacuum cleaner, voilà!!! Consider yourself healed, aaaaand you’re welcome!! Hmph. Riiiiiiight. And, might I add, insulting.
I posited that the people who were able to reduce symptoms and get well using this technique were probably already inclined to healthier behaviors, and were more likely to be compliant and use complimentary herbal and nutritional therapies. Then I got more comments about how anyone could be perfectly healthy with a little daily meditation. And, to be fair, there are documented cases of this phenomenon. As written in the Ventura County Reporter, in Buddhist monks who meditate 24/7, it has been shown that they have a perfectly sculpted brain as measured by the functional MRI. OK. But then why do these naturopathic people get major illness in the first place? Did they ask for it? What about death? Do we meditate that away too? Seems reasonable that if you can get rid of an illness as serious and deadly as cancer by concentrating on a vacuum, you could trip the Grim Reaper up with the push of a mental hand, right? And who has the time to meditate 24/7? I certainly don’t.
During a conversation with my LLMD (Lyme literate medical doctor) Dr. Marty Ross of the Healing Arts Partnership in West Seattle, WA, I asked him about this issue. Two months ago, fully believing myself healed and ready to get off some of the Lyme meds, I joyfully stopped taking them. I was absolutely certain I had kicked that illness in its germy butt! And I was stunned five weeks later when I lost all my momentum and slid back down into symptom-laden misery. How was this possible??? I should have been THE perfect example of how the belief that one was well subsequently negated illness and discomfort. Why didn’t it? Dr. Ross explained that it was a multi-pronged thing. That yes, the mind can certainly affect the body, and cause changes, both beneficial and negative. But the instances of a person being able to melt their own brain tumor are very rare, and unusual, and there’s likely something else going on there as well. Optimism, he said, is a good thing and can only benefit the patient, but medicine is the partner of optimism. Illness, disease and infection are real, and proper treatment is essential. I guess I should be thankful that I didn’t get totally gung ho and toss the meds I had left, thus sparing myself the expense of having to re-buy them!
Here’s what I think might really be behind some of it. And again, I’m not a doctor, but I do play one in my bathroom medicine cabinet! I think that the body is a machine, and the brain is the boss. I think that any machine with moving parts, exposure to corrosion and chemicals is likely to develop structural problems. Now, we all know that if an engine is short on fire or fuel, it’s not going to run. If the oil is too thin or dirty, the engine might seize. There’s a reason we’re told to change the oil. These things are simple and preventable. But, if you remove the battery, I don’t care how much oil or gas you pour into that car, it’s not going to start. If you remove the carburetor, that car will perform badly, and eventually overheat. Stick a potato into your tailpipe, and you can forget about getting to work. I’m speaking about the car, of course…
So while I can believe an asthmatic might be able to calm airways and breathe better with meditation, or a depressed person might cheer themselves with a little mental dopamine boost, I have yet to see a one-armed man re-grow that limb. And you’ll have a pretty darned hard time convincing me that the one-armed man wouldn’t REALLY like to re-grow that arm. We get sick because we are a complicated, amazing piece of machinery that is consistently exposed to germs, to infection, to structural injury and overuse and to the flaws of constantly replicating DNA over the course of decades.
I DO believe we have some amazing abilities with regard to healing. Some people are able to tap into that, and achieve amazing results. I’d like to believe I’m one of them, and if my doctors are any indication, I am. I think the lesson to take away from all of this is that if you are willing to educate yourself, make the necessary changes to your behavior, follow logical, appropriate doctor-recommended treatment, AND instead of focusing on the difficulties spend time each day visualizing a healing goal instead, you can get to a more comfortable place. Maybe you won’t re-grow a limb or joint, and maybe you won’t completely dismantle and rebuild newly perfect DNA. But you might be able to better manage symptoms, or even get well altogether. A whole lot of practical, with a just dash of woo woo. Now if you’ll excuse me, I’m going to my mental closet to grab that vacuum. I’ve got some bugs to kill …