Did it come as a shock?

How much morphine do you need to control your pain? Oddly enough one factor is whether or not you know that you are receiving it. A similar effect appears with diazepam, the common tranquiliser. It seems that the objective effectiveness of such drugs is significantly enhanced by your expectation that it will do its job.

Another researcher undertook some trials in which he was given a random series of electric shocks, some of which were mild, and some quite severe. He clearly knew the difference. In the trials the mild shock was preceded by a green light and the severe by a red light. After a number of cycles, the last series ended with a series of green lights and, so, mild shocks. Except that it didn’t. The final shocks were all severe but the researcher experienced them as mild. The clear inference is that he had been trained to associate the green with mild shock, and so that what was he felt.

Mind over matter – and the interesting question of placebos. In a recent survey in the US over half the doctors who responded reported that they used placebos on a regular basis. The type of placebo varied but a familiar example would be prescribing antibiotics for ‘flu, when it is known that they are ineffective against ‘flu viruses.

You can imagine how this complicates the double blind trials which are used to measure the clinical effectiveness of a new treatment. If the subjects who are given the placebo show improvements, sometimes equalling those receiving the active treatment, the results are hard to assess. Sometimes ingenious, and expensive, strategies have to be used to eliminate this effect.

Placebos are by no means simply a matter of imagination. For example, a placebo used for controlling pain can stimulate the same elements of the brain as the clinically effective drug. And an analogous effect has been measured with Parkinson’s Disease. No doubt studies of other ailments will in many cases show similar, measurable, biological changes.

Just to make matters a little more difficult, in certain therapies the type of placebo used can alter the results. In a study of irritable bowel syndrome sham acupuncture was used to measure the placebo effect. But some recipients received this accompanied by lots of attention, while others were just given the sham treatment. Both groups did better than those who received no treatment at all, but only the group who received attention produced results which were as good as those who were given the actual drug being tested. In another study, placebo patients were warned of the (relatively mild) side effects of the active drug. About a quarter of them reported experiencing these side effects.

Acupuncture is an interesting phenomenon. On the day of embryo transfer (in assisted reproduction) the placebo group received sham acupuncture (the needles were retracted, and only the sensation of being punctured was received). Lo and behold – the number of successful implantations was 25 per cent higher than in the group who received real acupuncture. In both groups the physiological and psychological effects associated with more successful implantation were measurable.

A similar trial for the treatment of nausea resulting from cancer therapy showed no difference between the sham and the real acupuncture groups. Both were highly successful, and this was put down to the additional care and attention all participants received.This brief account of a knotty subject is no more than a few examples taken from a large amount of data and reports, many of them recent. I have tried to be representative. But not only can we see why doctors and scientists are showing increasing interest in the subject of placebos but it raises some issues for us to consider.

First, we should not be surprised at the success of alternative medicine. It works, but often we cannot know whether it is the experience of treatment which brings about the cure, or the treatment itself.

From this it also follows that, even in conventional medicine, care, attention, taking symptoms seriously, and general “bedside manner” will not only complement direct therapy but may often be a substitute. Social skills are increasingly a part of medical education particularly for GPs, but this will take time to work its way through the system: doctors are no more talented by nature in communication than any other group. A remaining constraint is that bedside manner simply takes more time than issuing a prescription.

There are moral issues, too. Some doctors are concerned about the deception, implicit or direct, which placebo therapy normally (but not invariably) requires. The question may press particularly hard in clinical trials where some patients may be excluded from promising treatments in order to test the therapy.

Of particular interest to us is the extent to which our state of mind can affect not only our perceived outcomes, but our actual biology. We may often have limited control over our state of mind, but we certainly have a degree of control. And the behaviour of therapists (genuine or phoney) can influence our state of mind. So can the informal carers among our family and friends. What we think with our immaterial minds can affect, for good or ill, what happens to our material bodies.

I wonder, and it is just speculation, whether recognising in Jesus his authority and his messianic mission from his Father may have played a part in the healing miracles. If divine faith can move mountains then it can certainly move a few neuron connections or cells in the right direction.

Tell us about your reactions to all this on http://www.secondsightblog.com. Perhaps you have some experiences to share.

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About Quentin

Science Editor, Catholic Herald. Portrait © Jacqueline Alma
This entry was posted in Bio-ethics, Catholic Herald columns, Spirituality. Bookmark the permalink.

11 Responses to Did it come as a shock?

  1. claret says:

    The placebo effect has long been known. Mothers especially have learnt that a kiss and a sympathetic ‘cooing’ have remarkable healing properties when it comes to a bruised and bleeding knee after a tumble. Indeed its so good it has virtually a 100% success rate! Pain not quite gone but the cure is almost worth the fall.
    On a more adult level does not just the arrival of a Doctor at the house when making a ‘home call’ have the same effect. How many of us have felt a tinge of guilt that we don’t feel as ill as we did on his/ her arrival as when we called them out?
    So the ‘doing nothing’ when appearing to be doing a lot is the key to curing many an ailment.
    Many of Jesus’s miracles were of the ‘doing nothing’ variety. The recepients had faith in him and that was sufficient for them.

  2. Iona says:

    Conversely, if they didn’t have faith in him he couldn’t work miracles for them.

  3. AMDG says:

    One the one hand we have the repeated occurences where Our Lord says to the victim of the illness “your faith has healed you” which might support the hypothesis. However (and pace Iona) there are numerous other healings that do not fit this model such as Jairus’ daughter, the son of the widow of Nain, the centurion’s servant and of course Lazarus. It would have taken some pretty reslient neurons to be activated either in a man who was some miles away from the healer or dead at the time.

  4. claret says:

    Without re-reading every single miracle that AMDG quotes they all ( from memory,) involve an act of faith from the person asking as opposed to the one receiving. Hence the centurions servant is healed because the Centurion had faith that jesus could do so without seeing the servant . ” I have not found faith such as this in the whole of Judea.” (Quote from memory not from the written word.)
    Similarly Lazarus’s sister , “I know that even now whatever you ask of the Father will be granted to you….”

  5. AMDG says:

    Claret: Precisely, the miracles I quote did not involve an act of faith from the person who then went on to be healed. If the hypothesis put forward is that the mind of a person can affect his or her physical state to the extent of bringing about a cure of that same person, my question is how can the mind of one person affect the physiology of another to bring about the same result, particularly if that person happens to be dead?

  6. claret says:

    It looks as though we are talking about two different things. On the one hand is the placebo effect as it appertains to healing (or at least gives an impression of healing,) and on the other the miracles of Jesus.
    I think we go down something of a blind alley if we mix up the two although there are bound to be some elements of similarity.

  7. AMDG says:

    Claret: Sorry my mistake I should have made clear my original comment was intended to answer Quentin’s question which was:-

    “I wonder, and it is just speculation, whether recognising in Jesus his authority and his messianic mission from his Father may have played a part in the healing miracles. If divine faith can move mountains then it can certainly move a few neuron connections or cells in the right direction.”

    He seemed to be suggesting that the recipient of the cure might actually be contributing to their cure by means of their “faith response” to Our Lord in a similar way to the placebo effect. My point was that this was at least arguable in the cases where it was the recipient of the healing who showed the “faith response” but surely not where the recipient was not present to Our Lord at the time or indeed was dead at the time?

  8. Let me just clarify that, in my “speculation” I was not attempting to exclude the miraculous aspect. But, as far as we can see, God makes use of the natural as far as he can even in his miracles. Indeed faith in Christ requires a gift of grace for it to occur. The secular placebo does not. I would certainly agree with AMDG that the possibility is limited to those healings where the sick person is capable of responding to the grace of faith.

  9. Horace says:

    In this post Quentin seems to be suggesting that many of the ‘healing miracles’ described in the New Testament may not be miracles at all (in the sense of happenings which override the ordinary laws of nature), which I am sure is true because many of the crowds who flocked to him were most likely suffering from illnesses of the kind described as ‘psychosomatic’.

    In today’s Gospel we hear about the cure of a child. The disciples were unable to cure him. The description in Mark 9:14-29 details the symptoms exhaustively (although the description in Matthew 17:14-20 apparently of the same incident, is much more dismissive).
    In both accounts much emphasis is laid on ‘faith’.
    In Matthew “Why were we unable to cast it out?” they asked. He answered “Because you have little faith. . . ” and goes on to talk about ‘faith’ in general.
    In Mark, however, “Why were we unable to cast it out?” “This is the kind” he answered “that can only be driven out by prayer.”
    From the case history given by Mark this was surely childhood epilepsy, the instantaneous cure of which had to be a miracle.

  10. Horace, just to keep me out of the fires of the Inquisition – I am not suggesting that Jesus’ healing miracles might have been natural events. You remember the woman cured of haemorrhage by touching his cloak – when he felt the power going out of him. Only that a placebo element might have played a part in some cases. The ways in which God uses the supernatural and the natural together is something I don’t know.

  11. Horace says:

    I brought up this episode because I was hoping that someone, better qualified in Biblical studies, might comment on this case (Mark 9:14-29/Matthew 17:14-20).

    Here we see Jesus exasperated (“You faithless generation!”) – and not for the first time (Matthew 11:16-19, Mark 8:11-13/Matthew 16:1-4).

    The crowds must have contained numbers of sensation seekers as well as members of the establishment anxious to discredit him. Many of those seeking a cure were likely to have been hysterics or sufferers from psychosomatic illnesses.

    Mark records the perceptive comment “This is the kind . . . that can only be driven out by prayer” suggesting that Jesus is indicating to his disciples a distinction between relatively trivial ‘cures’ largely due to simple ‘placebo effect’ and a ‘miracle’ which required divine intervention.

    Matthew, instead, goes on to talk about ‘faith’ moving mountains – surely didactic hyperbole!

    I would very much like to know what was the meaning, in the context of the time, of the word or words translated to us as ‘faith’ (Mark was probably writing in Aramaic, Matthew in Greek).

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