In my last blog, I discussed the role that the placebo response has played in influencing SSRI research outcome.
What is placebo? Put simply, the placebo effect is the biological impact of believing in a medical treatment. Incidentally, the history of the word placebo is revealing. It is the first word of a chant in medieval funeral rites – “placebo domino” – “I shall please the Lord” and professional mourners were paid to sing placebos. Their chanting was believed to be of value and to ease the grief of the family.
One of the most important and fundamental core beliefs in cell biology is that many of our physical and psychological qualities are “controlled” by our genes. The Human Genome Project is creating a great deal of research and excitement among scientists world-wide and new genes that they consider determine our health and behavior are being discovered almost monthly. Implicit in these discoveries is that biology is destiny. But is it?
Several years ago, a 15 year old English boy with a severe case of “warts” was referred to Dr. Andrew Mason, a physician who utilized hypnosis as the treatment of choice for this condition. A surgeon had been consulted but couldn’t help as the warts were too extensive all over the boy’s body. The young man had scaly, thickened deformed skin and the infection and smell were so bad that he couldn’t attend school.
Fortunately, the boy was an excellent hypnotic subject and Dr. Mason suggested the thick, disfigured, hardened and infected skin disappear one limb at a time and be replaced by healthy, pink normal skin. The diseased skin began to fall away within days and for the first time in his life, the boy had normal appearing skin.
However, at the case conference, Dr. Mason was stunned to discover that the pathologist who did the biopsy said that Dr. Mason’s diagnosis was wrong. This was not a case of warts but a severe case of congenital ichthyosis or Brocq’s Disease. It is a DNA mediated congenital disease that is considered incurable and victims of this disease have a relatively short life-span. The so-called alligator men of circus side-shows have Brocq’s Disease and they must be very careful as the slightest sharp movement will cause the skin to crack and bleed and be very susceptible to infection. The boy remained symptom free for at least five years at which point Dr. Mason lost contact with him.
Dr. Mason published this case in the British Medical Journal which prompted so many calls from around the world that the Journal opened a special switchboard to handle the volume of inquiries.
Other clinicians reported similar results and their published cases reported success rates ranging from 50% – 90%.
How can hypnosis have such a profound effect in a disease that is genetically determined? This is indeed extraordinary because Brocq’s disease is a hereditary, genetic condition that involves much more than controlling autonomic processes such as blood flow and immune system function. In means tapping into our DNA master plan – our genetic programming itself which suggests our minds and beliefs can over-ride even our genetic make-up in certain cases. In many scientific circles, this poses a rather sticky biological inconvenience.
Relevant to my last blog on SSRI’s or anti-depressant medication, in an eight week study at UCLA, patients were selected who had a long standing history of depression. They were randomized into two groups – placebo control and the experimental group receiving a new SSRI. Brain scans were done before and after treatment. The pre-treatment or baseline brain scans revealed what would be expected in depression – a dampening or reduction of electrical activity in the left pre-frontal cortex which mediates or reflects high spirits or positive feelings and a much more electrical activity in the right pre-frontal cortex which reflects a more depressive, sad or sorrowful state.
At the completion of the study, both the placebo controls and the experimental group receiving the active pharmaceutical – the anti-depressant showed significant changes in the electrical language of the brain waves between left and right pre-frontal cortices.
In other words, the placebo control subjects were able to subconsciously ignite and activate other neurological pathways in the brain with just belief and expectation.
However, there are two sides to the coin of belief and expectation. A Tennessee oncologist reported a single case study where a patient had been diagnoses with esophageal cancer. It is almost always fatal and the patient died. However, the autopsy showed no esophageal cancer but he did have two nodes on his liver – but they were not large enough to cause death. The doctor sadly admitted that the patient’s belief that he had cancer was more deadly than the cancer itself.
Thus, belief can be both a healer and a slayer – or the so-called nocebo effect. Dr. Edgar Mitchell, former astronaut, the sixth man to walk on the moon and the founder of the Institute of Noetic Sciences, in his book The Way of the Explorer, described a bitter-sweet experience of the placebo/nocebo effect. Dr. Mitchell;s mother was nearly blind with a deteriorating visual condition. Norbu Chen a noted Tibetan healer and shaman was being tested at the Institute. Dr. Mitchell asked Mr. Chen to utilize his Shamanistic remote healing abilities on his mother. The following morning, she was miraculously able to read without her glasses. Dr. Mitchell was astonished and his mother’s vision continued to improve over the next several days.
His mother, curious of course, then inquired about the healer and learned that Norbu Chen was not of the same faith as her Christmas religious fundamentalism. She then perceived her restored sight as something diabolic or perhaps the work of the devil. Within a few hours of her discovery, she was almost blind again. This was a dramatic example of how both belief and disbelief are powerful factors, especially in health and illness that can create either a placebo or nocebo response.
In a recent review of studies of the placebo effect published in the Journal of The American Medical Association the conclusion was that believing that something works – may indeed make it work. In other words, intentionality, hope and expectancy are critical to igniting the inner pharmacy that we all possess. However, contrary to myth, there does not appear to be a so-called “placebo personality”. Placebos can work on anybody – wise person and fool alike – not merely suggestible people. Under the right circumstances – namely – if the person believes that someone is trying to help them and thus expect relief – especially if that someone is an optimistic physician in a clinical setting. But also contrary to myth, the relief of pain or illness by the placebo effect does not mean the problem was make-believe or fabricated.
Placebos range in effectiveness from 31% to as high as 72% in studies involving pain management. There are at least two studies where placebos were 100% effective as the experimental pharmaceutical. Several studies have informed the subjects they were being given a placebo and astonishingly, 63% of them responded as if they were given the experimental or real drug. In another study, 15 patients were involved in trials where neither an active drug nor psychotherapy were offered. Instead, they were given a bottle of pills and the researchers told them frankly – “these are sugar pills which contain no active ingredients or medicine”. The patients took the pills three times a day for one week. They were given a symptom check list before and after the one week trial and 14 of the 15 subjects had significantly reduced symptoms.
In follow up interviews, half the group said they got better because they took the placebo while the other half claimed they improved because the placebo stimulated them to draw upon their own innate abilities to heal.
In other studies, subjects taking placebos were so convinced that the pills contained real medication that they reported experiencing a number of side effects and several subjects reported withdrawal symptoms from the placebos.
An amusing aspect of placebos is that when placebos – or real drugs for that matter are in the form of colored capsules – blue, green and purple seem to work especially well as sedatives and sleeping pills – whereas orange, red and yellow seem to work best as stimulants or energy boosters. One patient was totally convinced that his two colored capsules would not work unless he swallowed them green end first. Needless to say, he got what he believed.
In my next blog, I will discuss a fascinating phenomena – “The King’s Touch and the Placebo Response”.