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.