Alternative Medicine

[Saffron]

Even if our minds could invoke some other change besides the lowering of cortisol, few of the others would matter. Lowering cortisol would have a noticable affect on many different ailments. When I say noticable, I mean larger than 1-5%, depending on the ailment. Blood pressure dropping toward normal would help many ailments. A more effective immune system would help even more.

This bit of your post caught my attention. I suspect that the lowering of cortisol is what we have called the placebo effect and if it is, the phenomenon needs to be renamed. The placebo effect was originally intended to mean a treatment that had no efficacy, but made a patient "feel better" and maybe even get better. If cortisol is the underlying mechanism behind what we see as the placebo effect then there is an active agent at work in the body.

My own thinking is that the placebo effect is one observable way we can see how the brain, mind and body are interrelated and work together as a system. I think as neuroscience expands our understand of how that "system" works we will also uncover exactly what the placebo effect is. Radio Lab often airs programs that discuss neuroscience research. Just last week there were two stories that tackled the mind/brain and body relationship.
http://www.radiolab.org/

[R. LeBeaux]

I do believe that a lot of what he likes about the alternative practitioners has to do with attention. It's perhaps harder to find a regular doc who shows genuine concern and is a sort of cheerleader or coach.

Sorry to jump back to a subject covered earlier in this discussion, but I recently came across an article by Maureen Dowd that addresses this subject excellently as it applies to the "cheerleader or coach" aspect and the patient becoming more intimately involved in his/her treatment. For those who might be interested, the article can be found at:

tampabay.com/opinion/columns/omniscient ... th/1194150

[nomsisa]

Do you mean the power of, what is it called, intercessionist prayer, or the praying that the sick person does because of his illness? I suspect you're not saying that praying for others cures them (esp. since you're talking about hospice), but that praying brings the person more peace around his imminent death, perhaps in a way similar to psychoactive drugs. It would be more controversial to suggest that prayer can provide pain relief in the last stages. Surely morphine is much better for that.

DWILL...Sorry for my mangled post.
Surely, morphine is better than prayer.... I do not suggest that prayer will ease the pain and suffering of a dying person. I only claim, that h i s prayer, as an addition to palliative care, will bring him an inner peace, solace and acceptance; and with that will make the last exit just a little easier.

[DWill]

The placebo (literally, "I will please") effect is too interesting for me to let go of just yet. I did a bit of reading on it. It was suggested that it instead be called the placebo response, which seems a good way of emphasizing that the treatment is thought to have no certain inherent properties, but that the person responds to it by stimulating an imagined or real healing. The placebo response has been an area of very high interest for a number of years. In 1980 alone, over 1,000 articles were published. I found a list of reports of the placebo effect/response, some anecdotal, some research-based. It's a long list that you might want to just sample.

The Power of Mind and the Promise of Placebo

By WRF in Alternative Therapies

For decades, the gold standard of medical research has been the double-blind, placebo-controlled clinical trial. You give one group of patients a medicine you want to test, and another group a dummy pill that has no active ingredients. Neither the patients nor doctors know who is getting which.

Placebo trials are used to tell researchers whether a tested drug has any healing effect beyond that which occurs a certain percentage of time when people take an inert pill. A patient’s belief in a pill – a supposed medicine, but chemically innocuous – is thought to activate their body’s healing powers.

I am fascinated that a major debate erupted when a group of doctors discussed the immoral and unethical aspects of utilizing a placebo. Their reasoning was that regular and beneficial medicine was being withheld from a patient.

The co-authors of an article addressing this topic, Kenneth Rothman, a Ph.D. From Boston University School of Public Health, and Karin Michels of Harvard School of Public Health, both stated that to give a patient a placebo, that has a ‘known efficacy of zero,’ was highly unethical.

Some other medical doctors and researches have jumped into the debate, stating that placebos are just a nuisance variable.

There has been sharp disagreement on this point, due to the fact that medical literature includes a great deal of testimony that the placebo effect routinely works 30 percent of the time, with Dr. Herbert Benson of Harvard stating that it may work up to 90 percent of the time.

Overlooked by its critics in this discussion, is the fact that studies that have utilized placebos have produced some rather remarkable, and at the same time unexplainable, results. Rather than looking at it as a nuisance, we should be looking at the placebo as a key to ascertain a remarkable phenomenon that seems to be a part of the human psyche.

(The remainder of this article will present a number of interesting placebo statistics that have been recorded in the medical literature. Within this article, footnotes will not be used nor the studies listed, but all are from medical literature.) Here is a wonderful presentation of the power of our minds and our belief systems.

“In the 1950′s angina pectoris, recurrent pain in the chest and left arm due to decreased blood flow to the heart, was commonly treated with surgery. Rather than doing the customary surgery, which involved tying off the mammary artery, some resourceful doctors cut patients open and then simply sewed them back up again. The patients who received a sham surgery reported as much relief as the patients who had the full surgery.”

“The effectiveness of a placebo in any given circumstance also varies greatly. In nine double-blind studies comparing placebos to aspirin, placebos proved to be 54 percent as effective as the actual analgesic. From this, one might expect that placebos would be even less effective when compared to a much stronger painkiller such as morphine, but this is not the case. In six double-blind studies placebos were found to be 56 percent as effective as morphine in relieving pain.”

“In a recent study of a new kind of chemotherapy, 30 percent of the individuals in the control group, the group given placebos, lost their hair.”

“In a study of a tranquilizer called mephenesin, researchers found that 10-20 percent of the test subjects experience negative side effects – including nausea, itchy rash, and heart palpitations – regardless of whether they were given the actual drug or a placebo.”

In the book, The Psychobiology of Mind-Body Healing, written by Ernest Lawrence Rossi, we find the following mention about the 55-60% placebo connection, “In other words, the effectiveness of placebo compared to standard doses of different analgesic drugs under double-blind circumstances seems to be relatively constant…it is worth noting that this 56% effectiveness ration is not limited to placebo versus analgesic drugs. It is also found in double-blind studies of non-pharmacolgical insomnia treatment techniques (58% from 14 studies) and psychotropic drugs for the treatment of depression such as tricyclics (59% from 93 studies reviewed by Morris & Beck, 1974) and lithium (62% from 13 studies reviewed in Marini, Sheard, Bridges and Wagner, 1976). Thus, it appears that placebo is about 55-60% as effective as active medications irrespective of the potency of these active medications.”

“In a study of morphine, there was a 50% pain reduction in 75% of the patients treated. The placebo group had a 50% pain reduction in 36% of the patients.”

“In 1980 there were over 1000 articles dealing with placebos. Placebos had a high rate of activity in the areas of cough, mood swings, diabetes, anxiety, asthma, sarcoma, dermatitis, headaches, rheumatoid arthritis, radiation sickness, Multiple Sclerosis and Parkinson’s.”

“A group of patients were told they were given LSD when in fact they were given the placebo. They had all the physiological effects noted with LSD.”

“Dr. David Sobel, a placebo specialist with Kaiser hospital told the following: ‘a doctor was treating one of his asthma patients with a new drug. This new potent medicine worked within minutes. When the patient had the next attack the doctor gave the placebo. The man complained it didn’t work. Then the doctor received a letter that stated the first pill was actually a placebo that was sent by mistake.’”

“Ipecac is a substance know to always induce vomiting. A 28-year-old female who was suffering from two straight days of nausea and vomiting was given 10cc of Ipecac syrup and told it was a new drug that stopped vomiting. In twenty minutes the vomiting had stopped completely. Her stomach showed normal contractive activity.”

“During a study for headache, 120 our of 199 patients receiving the placebo obtained relief. In a test of Clofibrate versus placebo for cholesterol level and cardiovascular mortality, the placebo outperformed the drug.”

“Placebos effectiveness is in proportion to what the doctor and the patient think they are using. Two placebo pills are better than one and an injection always seems to be more effective than a pill. Placebo capsules are more effective than tablets. When placebos are administered, the yellow and orange are great for mood manipulators, the dark red as a sedative; white as pain killers and lavender as hallucinogens.”

“In a back pain sham therapy of four years, 40% of the placebo group improved.”

“In a sham tooth-grinding surgical procedure, there was a 64% total symptom remission.”

“Doctors Seidel and Abrams found that a hypodermic of saline was as effective as vaccines for chronic rheumatoid arthritis.”

“In a study for Raynaud’s Syndrome, utilizing an apparatus with saline and the clicking of dials, every case using the placebo improved. Six had excellent improvement and one patient great improvement after one year.”

“In postoperative patients, 14% had pain reduction using a placebo.”

“Psychologist Bruno Klopfer was treating a man named Wright who had advanced cancer of the lymph nodes. All standard treatments had been exhausted and Wright appeared to have little time left. His neck, armpits, chest, abdomen, and groin were filled with tumors the size of oranges, and his spleen and liver were so enlarged that two quarts of milky fluid had to be drainedout of his chest every day.

Wright heard about an exciting new drug called Krebiozen, and he begged his doctor to let him try it. At first the doctor refused because the drug was being tried on people with a life expectancy of at least three months. Finally the doctor gave in and gave Wright an injection of Krebiozen on Friday, but in his heart of hearts he did not expect Wright to last the weekend.

“To his surprise, on the following Monday he found Wright out of bed and walking around. Klopfer reported that his tumors had ‘melted like snowballs on a hot stove’ and were half their original size. Ten days after Wright’s first treatment, he left the hospital and was, as far as his doctors could tell, cancer free. When he entered the hospital he had needed an oxygen mask to breathe, but when he left, he was well enough to fly his own plane at 12,000 feet with no discomfort.

“Wright remained well for about two months, but then articles began to appear asserting that Krebiozen actually had no effect on cancer of the lymph nodes. Wright, who was rigidly logical and scientific in his thinking, became very depressed, suffered a relapse, and was readmitted to the hospital. This time his physician decided to try an experiment. He told Wright that Krebiozen was every bit as effective as it had seemed, but that some of the initial supplies of the drug had deteriorated during shipping. He explained, however, that he had a new highly concentrated version of the drug and could treat Wright with this. The physician used only plain water and went through an elaborate procedure before injecting Wright with the placebo.

“Again the results were dramatic. Tumor masses melted, chest fluid vanished, and Wright was quickly back on his feet and feeling great. He remained symptom-free for another two months, but then the AMA announced that a nationwide study of Krebiozen had found the drug worthless for the treatment of cancer. This time Wright’s faith was completely shattered. His cancer blossomed anew and he died two days later.”
(Brono Klopfer, Psychological Variables in Human Cancer, Journal of Prospective Techniques 31, 1957, pp. 331-40.)

I don’t believe that the use of placebos is immoral or unethical. In reality, it seems that the medical profession’s lack of understanding and utilization of the mechanism of the placebo in the healing process is tragic, shortsighted and cowardly. Cowardly in the aspect that it has been far easier for doctors to simply say that the placebo response is worthless, and nothing more than someone’s wishful thinking or trickery of the mind. The bottom line is the response; for whatever reason, placebos seem to work… patients get better.

An interesting statistic has shown that virtually all newly introduced surgical techniques show a decrease in success over time. Is this also a placebo response?

[Saffron]

Nice job, DW! If I could have thanked your post twice, I would have.

[Penelope]

If, as is broadly believed, over 75% of human illness is psychosomatic (this doesn't mean that people are not ill and suffering btw), but if the illness is caused through stress or anxiety, then a calming placebo, even in the form of music and sounds, will have a curative effect.

For awhile, both my son and my daughter worked at a centre for special needs children, many of whom suffered from violent epileptic attacks which threw them across the room, at walls etc., It was not clear what caused these phenomena, but playing music and soothing lights and aromas, seems to work to calm them as well as any drugs.

I think it is clear that all illness is not clinical....and so there must be a place for both kinds of treatment.

The human mind is very powerful but also very sensitive. We are easily influenced for good or ill.

[R. LeBeaux]

DW: Interesting data, though a lot of it is anecdotal in nature and involved very small samplings, much like the reports of studies cited by the manufacturers of so-called dietary supplements and “natural” cures, in order to hawk their products. There have even been “scientific journals” created and funded by these and “legitimate” drug manufacturers and their marketing arms, specifically for the purpose of publishing promising “studies” about certain drugs. Many of these so-called journals are located in small foreign countries and/or are shielded by layers of dummy companies, so that the connection to the real source is difficult to discover.

All that aside, I wanted to mention a couple of things related to the topic. One of these is the sometimes temporary efficacy of placebo-induced “cures.” I’ve mentioned before that my father was an MD back in the ‘40s and ‘50s, and that he often used “sugar pills” to induce the placebo response (which I agree, is a better way of describing the effect some placebos can have). I cannot remember the precise year, but I would guess it was around 1959, when Oral Roberts, the charlatan “preacher” who later became quite famous (or infamous), brought his traveling tent show to our home town and proceeded to “cure” several of Dad’s patients of various illnesses and afflictions. The problem was that many of these miracle cures turned out to be only temporary, as the patients began showing up at Dad’s office with “relapses,” some of which were far more serious than the original maladies they were suffering from. In particular, these involved orthopedic problems and instances where the patient, believing he/she had been cured, stopped taking the medications prescribed for them.

The second part of this story is one of family lore, so I cannot be sure of its absolute accuracy. However, as the story goes, Dad somehow managed to (angrily) confront Roberts with the fact that his little act was causing more harm than good, whereupon Roberts, climbing into his brand new Cadillac, said something to the effect of, “I’m crying all the way to the bank.” Again, this is a sort of family legend, and it does sound a little hokey to me now, but I am sure something of the kind occurred.

The point here is that, when describing and reporting these various anecdotal instances of the placebo response, there is one thing that seems to be missing, and that is any documentation of long-term follow ups. This is the same reason numerous drugs have reached the marketplace, only to be pulled a few years later because they proved to be dangerous in various ways when administered or taken over long periods of time. If someone seems to have been miraculously “cured” of a disease in a few days, weeks or months, and that’s where the report ends, it tells us nothing about that patient one, five, ten or fifteen years down the road.

The other thing I wanted to mention is in support of the placebo response and the perfectly logical and scientific explanation for it. And this has to do with that little blob of organic gray matter that serves as the electrochemical medical, emotional and psychological administrator of the body. In the end, what the brain does matters more than anything, since it controls everything. Clearly some chemicals create physiological changes in the body, but not unless the brain agrees and cooperates. This cooperation or lack of it is evident in the fact that drugs have different effects on different persons, even when control groups are chosen for their similarity in age, gender, size, lifestyle, and other factors.

One of the more exciting frontiers of medicine today has little to do with directly attacking disease at its source, either chemically or with surgery. Such direct treatments, we are now realizing, result in a tremendously complex network of bodily reactions that, in and of themselves, can lead to negative and/or only temporarily positive results. However, if we can properly harness the brain’s incredible capabilities and garner its cooperation in treating the body through the natural immune system, we may just be able to treat a plethora of diseases, chronic conditions, physical traumas and other ailments without destroying things in the process. I say “garner its cooperation” to make the point that we need to move away from the slash-and-burn techniques upon which so much of medicine has been based over the past centuries, and move toward a more “holistic” approach that takes into consideration all facets of influence on a person’s health.

In order to do this, we will have to continue our research into things like nutrition, lifestyle, the neurosciences, psychology, the endocrine and exocrine systems, our personal environments—in short, all the things that work in harmony to create or destroy good health. And this harks back to something I have mentioned in other posts called “Systems Theory.”

Systems Theory is far too complex a subject to explain in depth here, however, to put it in the simplest of terms, I might say that it means understanding the forest rather than just the trees. As opposed to the old ideas of seeing the human body as a machine whose parts can be isolated, extracted, or repaired, we need to start looking at the whole picture as a system that includes everything from the environment in which the body exists to the smallest subatomic particles that make up the basis for cellular structures. The key here is to understand that there is a constant exchange of information between these various levels, and it is that communication, those systemic interactions, that ultimately matter more than any particular part.

And somewhere in between these micro and macro system elements lies that one enigmatic organ we call the human brain, an organ whose primary skill lies in communications, and whose most important job is to view and evaluate what it can of the entire system (from the macro to the micro) and make adjustments to the things it can influence in order to increase the chances of our (its) survival.

As we continue to gain knowledge about how the various system facets influence our survival and health, we can begin to develop treatments and therapies that convince the brain to cooperate, thus harnessing the incredible power that lies in its ability to regulate our own natural immune system.

[DWill]

Good points, LeBeaux, especially on the possible short-term effect of placebo cures vs. possibly more lasting ones from physical medicine. In the list I pasted in, one item stated that placebos come in at around 55% of the effectiveness of a cure with biological properties. I can't decide whether we're supposed to think that is good or not. I wouldn't think so myself, if the choice were given to me.

Going back to the article from the Atlantic that piqued my interest, it does seem that a lot is happening to further the systems approach you're talking about. I wonder how long before it filters down to my level. Maybe that's the wrong metaphor to use in this case, since the patient himself will need to know more about his body and be more responsible for his health, rather than receive verdicts from the doctor on high.

[Saffron]

Science Friday - my favorite radio program - had a spot on the Placebo Effect today. Immediately I thought of this thread. Ira Flatow spoke with Ted Kaptchuk, one of the leading researchers investigating the placebo effect. I believe science is getting very close to understanding just what is going on with regard to the placebo effect. Experiments have demonstrated that the placebo effect does not "work" equally for all conditions or at all for some. This observation provides hints at the actual phenomena that is occurring. In experiments in which inert pills given for conditions such as hypertension or asthma, where there is a physiological malfunction in the body there is no measurable effect in the body. In other words the lungs do not expel more air after using a phony inhaler as they would if an inhaler with albuterol were used. When used for conditions such as anxiety or insomnia they do produce an observable effect. There were several facsinating experiements dicussed on todays show - worth listening I assure you. The short of it as Kaptchuk sees it is that the placebo effect is the effect of receiving care.

Here is the link to listen and below that will be an excerpt from the WSJ.

http://www.sciencefriday.com/program/archives/201201061

Ted Kaptchuk, director of Harvard's Program in Placebo Studies and the Therapeutic Encounter, and colleagues demonstrated that deception isn't necessary for the placebo effect to work. Eighty patients with irritable bowel syndrome, a chronic gastrointestinal disorder, were assigned either a placebo or no treatment. Patients in the placebo group got pills described to them as being made with an inert substance and showing in studies to improve symptoms via "mind-body self-healing processes." Participants were told they didn't have to believe in the placebo effect but should take the pills anyway, Dr. Kaptchuk says. After three weeks, placebo-group patients reported feelings of relief, significant reduction in some symptoms and some improvement in quality of life.

Why did the placebo work—even after patients were told they weren't getting real medicine? Expectations play a role, Dr. Kaptchuk says. Even more likely is that patients were conditioned to a positive environment, and the innovative approach and daily ritual of taking the pill created an openness to change, he says.

Do placebos work on the actual condition, or on patients' perception of their symptoms? In a study published last year in the New England Journal of Medicine, Dr. Kaptchuk's team rotated 46 asthma patients through each of four types of treatment: no treatment at all, an albuterol inhaler, a placebo inhaler and sham acupuncture. As each participant got each treatment, researchers induced an asthma attack and measured the participant's lung function and perception of symptoms. The albuterol improved measured lung function compared with placebo. But the patients reported feeling just as good whether getting placebo or the active treatment.

[DWill]

I intend to listen to the program. I shouldn't say this before listening to it, but it seems that perhaps the research is merely validating that using normal compassion and caring for people, works; that what people, when at their best, have always done for each other can now be shown through science to have an effect (even though not always measurable physiologically). That's okay, I guess, but it seems somehow inverted and shows a lack of true trust in the social instincts of people. We seem to need data to tell us it's worthwhile to be compassionate.