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On “ethical placebos,” Medicine, and Mind/ Body interactions: A book review

Cure_bookWhen I was 10 years old, I hat­ed doing the dish­es. In an attempt to talk my par­ents out of mak­ing me do this hat­ed chore, I pre­tend­ed to be ill by hang­ing my head, sigh­ing, snif­fling, and walk­ing lethar­gi­cal­ly to my bed­room, all to no avail—I still had to do those dish­es.

But, the next day, I woke up with the flu —a 104-degree fever and stom­ach pains to match. Boy, were my par­ents sur­prised! And, so was I. But, how many of us have had sim­i­lar expe­ri­ences, where our minds seemed to some­how impact our bod­ies in weird, unex­plain­able ways? How many of us have made doc­tors’ appoint­ments only to watch our fevers drop or held our chil­dren close and stopped their cough­ing fits? Clear­ly, some­thing is going on, isn’t it?

This is the sub­ject of sci­ence writer Jo Marchant’s new book, Cure: A Jour­ney into the Sci­ence of Mind Over Body. Marchant inter­views sci­en­tists from around the world, delv­ing into how place­bos, hyp­no­sis, mind­ful­ness med­i­ta­tion, and warm social con­nec­tions affect health out­comes, reveal­ing the com­plex ways that our brains and bod­ies inter­act. Not only does she uncov­er some pret­ty fas­ci­nat­ing research on mind/body inter­ac­tions, she also calls upon the sci­en­tif­ic com­mu­ni­ty to pay more atten­tion to these effects in order to improve future health­care.

In Greater Good, we’ve cov­ered the sci­ence on mind­ful­ness show­ing how it impacts psy­cho­log­i­cal and phys­i­cal health. But I per­son­al­ly found Marchant’s report­ing on the place­bo effect rather mind-bog­gling. Appar­ent­ly place­bos (pills or treat­ments that don’t con­tain an “active ingre­di­ent” and are often used as con­trol con­di­tions in exper­i­ments) are not quite as inert as sup­posed. While many sci­en­tists nor­mal­ly assume a pos­i­tive result from a place­bo indi­cates that peo­ple would have got­ten bet­ter any­way or that their con­di­tions real­ly had no phys­i­cal basis in the first place, Marchant’s report­ing sug­gests oth­er­wise.

In one inter­est­ing exper­i­ment recount­ed in the book, 262 patients diag­nosed with irri­ta­ble bow­el syn­drome (IBS) were split into three groups: one receiv­ing no treat­ment, one receiv­ing a place­bo deliv­ered from a cold and uncar­ing prac­ti­tion­er, and one receiv­ing a place­bo deliv­ered from a warm and car­ing prac­ti­tion­er. All the patients were told explic­it­ly that they were receiv­ing a place­bo with­out any active ingre­di­ents.

Patients in the first group improved 28 per­cent just from being in the tri­al; those in the sec­ond group improved by 44 per­cent; and those in the last group improved by 62 per­cent —“as big an effect as has ever been found for any drug test­ed for IBS.” This sug­gest­ed to the researchers that psy­cho­log­i­cal fac­tors are at work that can be har­nessed for treatment—perhaps the mind sig­nal­ing the body to pre­pare for heal­ing or to relax enough to let the body heal itself. To Marchant, it also sug­gests the impor­tance of empath­ic doc­tors.

If an empath­ic heal­er makes us feel cared for and secure, rather than under threat, this alone can trig­ger sig­nif­i­cant bio­log­i­cal changes that ease our symp­toms,” writes Marchant.

In anoth­er study, chil­dren suf­fer­ing from ADHD were split into three ran­dom groups. One group received a stan­dard med­ica­tion dose for two months; anoth­er received the stan­dard dose one month and half the stan­dard dose the sec­ond month, and a third group received the same reg­i­men as the sec­ond group, but with an added fea­ture: they also took a dis­tinc­tive green and white cap­sule along­side their med­ica­tion that they were told was an inac­tive place­bo. The hypoth­e­sis behind this exper­i­ment was that, through the pow­er of asso­ci­a­tion, the brain could be tricked into believ­ing that the pill was respon­si­ble for the ben­e­fits of a full dose.

Results showed that the third group of kids did do as well as the first group of kids, even though their active med­ica­tion lev­els were halved, while the sec­ond group did not do as well, pre­sum­ably because they did not have the ben­e­fit of the place­bo. Although one could inter­pret these find­ings as indica­tive of no real ADHD or inef­fec­tive med­ica­tion, Marchant sug­gests that this miss­es the point.

By using expec­ta­tion and con­di­tion­ing togeth­er, eth­i­cal place­bos could poten­tial­ly help to reduce drug dos­es for mil­lions of patients around the world, in con­di­tions from pain and depres­sion to Parkinson’s and ADHD,” she writes.

So, what does research like this ulti­mate­ly mean? The answer is: we don’t know yet. For one thing, there are not enough good stud­ies to be sure of what’s going on, and there is very lit­tle incen­tive to explore these effects fur­ther. Phar­ma­ceu­ti­cal com­pa­nies have no inter­est in fund­ing research whose results might ulti­mate­ly cut into their prof­its, argues Marchant, and they are the pri­ma­ry fun­ders of clin­i­cal tri­als. Sim­i­lar­ly, few sci­en­tists are will­ing to stick their necks out to study effects like these for fear of los­ing their cred­i­bil­i­ty.

And, there is anoth­er con­cern­ing issue: the pos­si­bil­i­ty that research like this might prompt peo­ple to put too much faith in their men­tal capac­i­ties for fight­ing ill­ness and to forego impor­tant med­ical treat­ments. Or, as some sci­en­tists warn, show­ing mind/body impacts on health may lead peo­ple to blame them­selves for get­ting sick in the first place—i.e., If only I had been more mind­ful or com­pas­sion­ate, I would not have had a heart attack.

Clear­ly this is not Marchant’s intent. Rather than eschew mod­ern sci­ence, which has brought us impor­tant treat­ments for many ill­ness­es, she is instead try­ing to encour­age sci­en­tists to open their minds. In an ide­al world, sci­en­tists could test these effects in a more rig­or­ous man­ner to dis­cov­er if and when mind/body treat­ments real­ly help. In many cas­es, she writes, the effects are prob­a­bly con­nect­ed to stress reduc­tion, dis­trac­tion, or increas­ing pos­i­tive emo­tions, all of which may sig­nal our bod­ies to release heal­ing hor­mones or redi­rect immune-response resources.

But, what­ev­er the mech­a­nism, it would be good for researchers to under­stand it, and to engage patients more in the process of their heal­ing, she argues.

Mod­ern medicine’s focus on phys­i­cal data and objec­tive test mea­sure­ments has undoubt­ed­ly allowed huge advances,” she writes, but “it has also led to an obses­sion with mol­e­cules and bio­chem­i­cal path­ways to the exclu­sion of how we actu­al­ly feel.”

The evi­dence of mind-body inter­ac­tions may be young, but it is grow­ing. Many of the sci­en­tists Marchant inter­views have found at least some evi­dence that mind/body treat­ments impact phys­i­o­log­i­cal mark­ers.

For exam­ple, one neu­ro­sci­en­tist was able to show that peo­ple who are fooled through mir­rors into believ­ing that a fake hand has been attached to their body will expe­ri­ence decreased blood flow to their actu­al, hid­den hand, caus­ing its tem­per­a­ture to drop—a response sim­i­lar to an aller­gic reac­tion. In anoth­er exper­i­ment, researchers at UCSF showed that high­ly stressed moth­ers had much short­er telomeres—caps at the end of chro­mo­somes which short­en with aging—and less telom­erase (an enzyme that rebuilds telom­eres) than moth­ers who were less stressed.

These exper­i­ments sug­gest that decreas­ing the stress response—perhaps through mind/body ther­a­pies like mind­ful­ness, hyp­no­sis, or self-compassion—could actu­al­ly impact longevi­ty. And it makes a case for pro­vid­ing more sup­port ser­vices for those who suf­fer from undue stress, such as care­givers and peo­ple liv­ing in pover­ty.

These phys­i­o­log­i­cal impacts will no doubt remain murky if not sub­stan­ti­at­ed by fur­ther research. Cure_bookStill, even if they aren’t cred­i­ble, cer­tain­ly any­thing that improves the psy­cho­log­i­cal impacts of illness—by decreas­ing pain, stress, anx­i­ety, or depres­sion, for example—should be con­sid­ered more care­ful­ly. Patients should not be dis­missed sim­ply because their ill­ness­es lack an obvi­ous phys­i­cal cause or don’t respond to tra­di­tion­al treat­ments, not when the brain and the body are so inti­mate­ly con­nect­ed. If we don’t try to study the mech­a­nisms behind effects like those report­ed in Marchant’s book—if we mere­ly cast results aside because they don’t fall under our cur­rent worldview—we could be leav­ing a pow­er­ful source of heal­ing untapped.

I am not advo­cat­ing rely­ing sole­ly on the mind to heal us,” she writes, “but deny­ing its role in med­i­cine sure­ly isn’t the answer either.”


jill_suttie.thumbnail– Jill Sut­tie, Psy.D., is Greater Good’s  book review edi­tor and a fre­quent con­trib­u­tor to the mag­a­zine. Based at UC-Berke­ley, Greater Good high­lights ground break­ing sci­en­tific research into the roots of com­pas­sion and altru­ism.

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2 Responses

  1. Howard says:

    How very inter­est­ing. My wife’s doc­tor has just changed her ongo­ing pre­scrip­tion from one 250 mg tablet to five times 50mg. Same total dose of course, but just pos­si­bly she may be apply­ing some psy­chol­o­gy. Good for her. I shall not ask or com­ment because that might skew results. We shall see.

  2. Thank you for shar­ing, Howard. Yes, sounds like a good idea 🙂

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