When we choose allopathic medicine to treat a health issue, there are two things to keep in mind. First, the medical profession is the leading cause of death. It began when death from prescription drugs bypassed traffic fatalities, and now, when one adds up death from prescription medication, hospital and doctor error, and super bugs, well, according to statistics, the most dangerous thing you can do is walk into a hospital, doctor’s office, or pharmacy. (Source: Death by Medicine)
The Placebo Effect
The second thing that we should be aware of is the power of the placebo, in part so that we don’t overestimate the value of any drugs or treatments we receive from modern medicine.
I’m sure most of you know what the placebo effect is, but just to reiterate, here is the basic definition: In a double-blind, placebo-controlled medical study (the gold standard), a control group is given an inert substance (usually a sugar pill), which gives researchers a baseline with which to compare the effectiveness of the new drug being tested. Subjects in such studies all believe they are getting the real drug, and surprisingly, a good portion of those given the placebo will have an improvement in their symptoms, a result of their belief in the potential power of the medicine they have been given.
The idea of the placebo can be portrayed as amusing, however when it has an effect of benefiting roughly one third of study participants, it is clearly something that deserves more attention. And, as I pointed out in a previous newsletter, the placebo effect is growing stronger.
Over the last two decades, clinical trials seem to be indicating that the placebo effect appears to be increasing in effectiveness. Recently, a study published in the journal Pain discovered that in 1990 pain-relieving drugs worked 27% better than placebo, but by 2013 that gap had narrowed to 9%. (Source)
It is easy, and common, to dismiss the placebo effect as meaningless, something that only applies to the weak-minded or susceptible. That is a nearsighted approach. For one thing, if antidepressants are only marginally better than placebo (Source), but have dangerous side effects which can include suicide (and even homicide), perhaps the placebo effect should be examined more closely.
(From a study on the subject published in the British Medical Journal: “The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants.” (Source)
Homeopathy
I used to believe that homeopathy may only be based on the placebo effect, and if so, it could count on at least a third of users finding benefit. And, for the rest of the users at least no harm was done, (supposedly the primary tenet of medicine), unlike with actual drugs, which do as much harm as good. However, since discovering that homeopathy studies have shown that homeopathic metals (including arsenic, cadmium, and lead) can cause the body to excrete these heavy metals, I no longer suspect that the benefits of homeopathy are placebo in nature. (I have covered the subject in this newsletter. Direct source material can be found here and here.)
I am fairly sure one doesn’t just excrete stored heavy metals from the body simply by believing it is so. (not to mention these are rodent studies, and I would assume animals would be far less prone to the placebo effect than humans). So, while a placebo working on depression makes sense to the rational mind, the very difficult removal of heavy metals from the body is a whole other thing, giving much credence to the field of homeopathy. And yet, as illustrated below, the placebo effect may be far more powerful than the rational mind can fathom.
The Most Dramatic Example of Placebo
Before I leave the subject of the placebo effect, I have one last illustration of its powerful potential, an example that is hard to wrap one’s brain around. In this study, knee surgery was compared to placebo surgery for the treatment of patients with “degenerative tear of the medial meniscus.” This is a form of physical damage that one would be told is only repairable by way of surgery.
Yet, the study concluded: “In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM (arthroscopic partial meniscectomy) were no better than those after placebo surgery.” That is, both groups surveyed had roughly the same level of “participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms”. (Study)
Our researchers ultimately came to the conclusion that if real knee surgery is no better than placebo surgery, there is no point providing any surgery for this condition in the future. I think they are missing the point here; something I will address further towards the end of this newsletter. Suffice to say, for now, that our deeply engrained (socially engineered) belief in the medical system requires that the doctor (healer/shaman) do something to bring our belief system online in order to facilitate healing.
“A total of 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated debridement without insertion of the arthroscope.”
Patients were followed up with for two years, after which researchers came to this conclusion: “In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure.” (Source)
Placebo surgery is a fascinating concept, but my point is perhaps our belief in the superiority of Western medicine is more reliant on the belief than the actual form of medicine used. To dig further into this idea, let’s now look at placebo’s evil twin.
The Nocebo Effect
While the placebo effect is well known and well studied, there is another side to that coin, one far less understood, and that is the nocebo effect.
The nocebo effect is simply the opposite of the placebo effect, whereby those taking the sugar pill, instead of having an improvement in symptoms, have negative side effects. In theory, this response is due to their belief that they are getting a real drug, having also been informed at the outset of the study of the pill’s potential side effects.
As with the placebo effect, scientists currently think that the nocebo effect is a result of the “combination of Pavlovian conditioning and a reaction to expectations”.
In 2001, German researchers published a review of the few (31) studies done on the nocebo effect. They set out to examine both the biological mechanisms involved and the problems this effect can have on medical research, and in clinical practices. They concluded that, though not well understood, the nocebo effect nonetheless was not uncommon, and should be taken into account by all levels of medical professionals.
This is what they had to say in summary: “On one hand physicians are obliged to inform the patient about the possible adverse events of a proposed treatment so that he/she can make an informed decision. On the other, it is the physician’s duty to minimize the risks of a medical intervention for the patient, including those entailed by the briefing. However, the studies just cited show that the patient briefing can induce nocebo responses.”
They then went on to suggest some strategies that could be used by medical professionals to mitigate the potential damage that the nocebo effect could cause in susceptible patients (more on this in part 2). (Study)
Now I’ll take a brief look at some of the studies they examined, just to give us a better idea of how this effect manifests.
Nocebo Studies
In many of the experiments studied in this overview, informing the patients of the potential for pain (some of these were procedures, not just drugs) resulted in statistically significant increases in pain-related side effects among participants.
In one study, 50 subjects suffering from chronic back pain were given a flexibility test, half of the participants being told the test may result in some pain, while half of the group were not given this warning. As you may suspect by now, the group given the pain warning experienced significantly higher levels of pain than the unwarned group. (Study)
In another study, finasteride was given as a treatment for benign prostatic hyperplasia (BPH), with half the subjects being told it could cause erectile dysfunction (ED), and the other half not receiving this warning. Fifteen percent of the uninformed subjects experienced ED, as compared to the informed group among whom 44% reported experiencing ED. (Study)
Okay, we all know that sexuality is easily influenced by psychology, but can belief be potentially deadly? The following case certainly suggests this to be true.
As the story goes, a young man who was on antidepressants had his girlfriend leave him, and he bottomed out. This led him to ingest most of his bottle of antidepressants in an attempt to commit suicide. After doing so, he immediately regretted it and called for an ambulance. By the time he reached the hospital he was seriously ill and unable to breathe properly. He experienced hypotension requiring intravenous fluids to maintain an adequate blood pressure, and was virtually near death.
In attempting to define the drug the young man had overdosed on, the doctors discovered that he was part of a study on a new antidepressant, and in fact this fellow was one of those receiving the placebo.
Because his mood had improved, ironically due to the placebo effect, he was convinced that he was receiving the real medication. Thus, when he “overdosed” on what he believed was a real drug, the placebo effect turned into the nocebo effect. However,
“once the true nature of the capsules was revealed his adverse symptoms then rapidly abated”. (Study) From this evidence we can see that the placebo effect and its contrary, the nocebo effect, are not just an amusing sideline to medicine, but more likely the mechanism underlying the true laws of disease and healing.
In Part 2 I will go further into the nocebo effect. And then things get really weird.