Belief, Placebo, and True Healing

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Healing should always leave room for the miraculous to occur, and our belief system is usually the foundation that allows (or does not allow) miracles to happen. Our belief system is also the foundation for the well-known placebo response. Placebo (meaning "to please") is by definition a self-satisfying experience.

There is a wealth of information attesting to the profound effect of the placebo principle affecting both positive and negative outcome in therapy. Depending on who you read and the particular situation, the outcome determined from placebo can range anywhere from 50-90%. I love reading about this subject and would like to share with you the following placebo studies:

Nine double-blind studies comparing placebo to aspirin concluded that placebos were 54% as effective for pain relief as the actual analgesic. Do you think the percentage would diminish if a stronger pain reliever were used? Six further double-blind studies found placebos to be as effective as morphine in relieving pain.

Acupuncture vs. Sham Acupuncture

Ted Kaptchuk, one of the world's leading exponents and pioneers introducing acupuncture to the West, has conducted a number of research projects comparing drugs to "sham" acupuncture, inserting needles in the parts of the body that have no theoretic basis for being effective for certain conditions including pain relief, asthma and IBS.

Certainly, one could argue, from a holistic point of view, that any part of the body can possess a relationship to another. After all, people have developed all sorts of acupuncture/acupressure methods for treating the entire body using corresponding points on distant, seemingly unrelated areas such as the hands, the feet, the thumb, the face, the ear, and the abdomen. So, from that perspective, it is hard to envision "sham acupuncture." But keep in mind here that the question is not whether acupuncture is effective, it is but whether its effect is completely dependent on a prescribed treatment protocol as opposed to an unorthodox one.

That being said:

A study published in the New England Journal of Medicine shows that there was 50% improvement using the albuterol inhaler while placebo accounted for 45% and sham acupuncture 46%. However all three interventions provided significantly greater relief than no intervention whatsoever which yielded 21%.

Sounds like the lesson here is something like "Do something even if it isn't right -- right?"

Another study compared the effect of sham acupuncture with theoretically based acupuncture for the treatment of 230 women with IBS. The result was that 42% of them had a positive response for the theoretically based acupuncture as opposed to 31% who improved receiving sham acupuncture. Again, the problem is not whether acupuncture is effective for IBS because one believes in it but whether its effect is completely based on placebo or sham acupuncture.

Acupuncture is absolutely dependent on a neurological response. It doesn't require belief to achieve results but belief and placebo as with all healing modalities do play a part in the outcome. If it were all a matter of belief in the power of acupuncture, homeopathy and herbal medicine for instance, these would not be effective as they are when used on domestic animals.

These studies point out the inherent difficulty of applying standardized placebo-controlled double-blind studies to a practice that is much more individualized and varied with considerable reliance on the skill of the practitioner. 

 

Placebo vs. Conventional Medical Procedures and Drugs

A similar vague result occurs when we consider a patient's response to certain types of surgery.

An oft-cited study from 1950 involved surgical intervention for angina pectoris (mild to moderate chest pains). This involved surgically cutting open and operating in the chest cavity and tying off the mammary artery. As shocking as it may seem (perhaps things were a little more lax back in the 1950s!), some doctors took it upon themselves to compare the results of patients in whom they did not tie off the mammary artery against the results from others who had the full procedure performed. Surprise, surprise: the results were the same rate of pain relief. Which procedure would you prefer?

To my knowledge, no one has suggested that both methods could be a basis for efficacy. The sham surgery on or near the site of pain may have served a similar purpose as would the kind of acupuncture that treats local sensitive, non-mapped points called a-shi ("ouch") points because of their marked increased sensitivity. So the real question is, how many of these patients would have had relief if it were just acupuncture and no surgery?

This doesn't mean that a patient may not respond to acupuncture or to surgery if they did not believe in it, but again, it shows that belief plays a potentially part in healing outcome.

Kaptchuk further states that these studies imply that placebo treatment is just as effective as active medication in improving patient-centered outcomes.

"It's clear that for the patient, the ritual of treatment can be very powerful," notes Kaptchuk. "This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson."

Now, if people can have a positive placebo response to a procedure, they can also have a negative one as well.

A recent study of a tranquilizer, mephenesin, revealed that 10 to 20 percent of the test subjects who were told what side effects might occur, experienced those same negative side effects of nausea, itchy rash and heart palpitations whether they took the drug or a placebo.

In the 1950s, a pseudo-drug called Krebiozen, which by analysis consisted of a mineral oil and a form of creatinine, was touted as a cancer cure. One man dying of advanced cancer took it and found his tumors "melted like snowballs on a hot stove." Then Krebiozen was shown to be ineffective and after reading this, the tumors recurred. His doctor then told him that there was a "new, improved version" and once again his tumors shrank. The doctor had only given him water.

With a conservative estimate of 30% of all drug and healing interventions, positive and negative, conventional or alternative-holistic, being due to the placebo response, distinguishing the so-called true from the false poses a great challenge. This challenge extends further to individual beliefs in dietary reactions to any number of substances, some with known detrimental or beneficial value, such as tobacco, sugar, gluten, coffee, dairy, cooked versus raw food, meat, fruit, and more ad infinitum.

 

The Efficacy of Shamanic or Magical Healing

Belief is also the basis for a wide number of shamanistic and pseudo-shamanistic practices. In parts of the world where shamanism is an established belief system, it has its positive and negative effects just as Western medicine does. But just because a healing modality is alternative or claimed to be alternative doesn't automatically make it better or free from abuses commonly associated with conventional medicine. In the Amazon where shamanism and herbal medicine is widely accepted and practiced, one educated native who was running an Amazon botanical reserve in Peru said he was a retired shaman. He said that he found the amount of energy he had to put out to ward off hexes and attacks from rival shamans made it difficult to nearly impossible for him to help his local patrons.

It is probably true that a wide range of healing practices are more or less based on placebo. Along with conventional Western medicine, these include the "sacred cows" of alternative medicine, including: acupuncture, herbalism, dietary therapy, homeopathy, Network Chiropractic, and massage. Don't forget the various modalities that fall under the rubric of "energy work," such as Reiki, flower essences, spellwork, mantras, iridology, dowsing, Emotional Freedom Technique (EFT), Ericksonian hypnosis, Tarot healing, medical i-ching, neuro-linguistics, Reif machine, and many, many more.

The bottom line is, if someone feels they are made better by any of these alternative treatments, who's to argue? The real challenge, which extends now all the way up to the discussion of the use of placebo in place of chemotherapy drugs in cancer treatment, is how do we as healers harness the healing potential of the estimated one-third positive placebo response that can occur with practically any type of healing modality?

Last month I described how I made a healing talisman for a woman whose nearly daily uncontrollable fits of anger and fights between herself and her boyfriend were threatening to tear apart their relationship.  She was open to the possibility of working with the special talisman I made for her, holding it in her hands several times each day and more frequently as needed as she recited a Sanskrit healing mantra I gave her.

I checked in with her after a month and she reported that within the first three days she and her boyfriend had another big fight but since then, after months of destructive quarrelling and rage, they seemed to reach a new plateau of mutual acceptance, with only a few minor disagreements. She was extremely happy with the results of her process with the talisman and mantra and said anytime she felt angry she picked up the talisman (which consisted of a semi-precious crystal and pinches of dried herbs symbolically combined in a small sewn pouch) and chanted the mantra.

Were the talisman and incantation both necessary? For some perhaps not, but it seems that together they served to reinforce each other.

An even more remarkable story was that of a 74 year-old man, beloved patriarch of a large family, recently diagnosed with pancreatic cancer and given three months to live by oncologists at the prestigious Stanford Medical University in Northern California.

After politely refusing palliative treatment and surgery, his family brought him to my clinic to see if there was anything I could do to at least ease the expected excruciating pain as the disease progressed. He did not speak English, and I do not speak Italian, so our ability to verbally communicate was severely compromised and required his son or daughter-in-law to translate.

I remember telling him and his family that since pancreatic cancer is considered the most serious and incurable of all cancers and they had rejected conventional treatment because it offered no hope of survival, let's just forget that he has cancer and treat whatever else comes up.

This man and his wife immigrated from a small country village in Trieste, located in the Northern part of Italy near Croatia. There, as in many traditional cultures, people would invest their belief and faith and material gifts in an individual considered worthy to serve as their herbal and multi-faceted healer. It seemed obvious that he viewed me as the way he remembered his old-world family and villagers viewed their local healer, as people in South America and Mexico viewed their shamans and curanderos, individuals who cured with herbs as well as ritual.

I gave him a modest cancer protocol, consisting of a strong alterative tea of Western herbs, various mixtures of Chinese, Western and Ayurvedic herbs and a strict diet avoiding sugar, coffee, alcohol and processed foods. No alcohol for this man was a big deal because he delighted in making his own wine and put together his own still to make special high-octane grappa distilled from the must (skins) of the grapes.

Nevertheless he followed all my instructions perfectly including abstaining from wine and grappa, following my dietary recommendations and taking the herbs I recommended and receiving acupuncture on a bi-weekly basis. His faith and belief in what I could do for him was unquestioning and unconditional and for me, at times, quite intimidating. Before I'd treat him he'd grab one of my arms with both hands and pleadingly look up into my eyes saying in broken English "Help me, please, I need you." It was like he was praying to a favorite deity or saint.

As the months rolled by, all of his physical complaints appeared to be resolved. Eventually they evolved into his concern for the members of his family. It was a large family; resentments and petty jealousies and envy sometimes resulted in hostility between them. He then would use gestures to try to enlist my "extra" healing powers (which I didn't know I had) to ask me for something to assuage the anger, discord and generally negative energy of his family members. Eventually I figured out that what he was asking me for some kind of amulet, talisman or what common parlance would call "a mojo," I suppose like the kind of thing used in Italy against what is known as the "evil eye." I was unprepared for such a request and had never made such an object before, let alone even believing in such things as the "evil eye" and mojos that protected against it.

At first I tried to beg off the task but I soon realized that it was easier, given his view of who I was to him, to actually make one rather that insist that I would not because didn't even know if I believed in such things. So I made my first talisman by putting small pinches of herbs in a small piece of cloth which was then folded and tied it in a bundle. Despite my having no belief in it personally, I did hold it in two hands, emptied my mind for a moment of extraneous thoughts and imagined channeling healing energy from above through my hands. I then blew on it and took it to him. I told him to dig a hole and bury it under an old oak tree in the middle of the night on the next full moon. (I must have remembered something like this from some old Boris Karloff movies of my youth.)

More to my surprise I think than his, each time I would do this, he'd come back and report that the problem was better or completely resolved. I thought, "who am I to question success" and so this interaction happened over the entire first year of our healing work together. As was the custom in his native ancestral village, where bestowing special gifts on a healer was an expected convention, he would gift me with his delicious homemade wine and grappa, which even if he could not partake of them himself, he still enjoyed making, as well of gifts of envelopes stuffed with cash.

At first, I tried to refuse the cash gifts but he would hear nothing of it, I suppose because he felt that my acceptance of it had something to do with whether or not he would receive any benefit from the "magic pouches" I made for him. Besides, whenever I would adamantly refuse and walk away he always managed to leave the envelope with cash somewhere where I could find it later. I then decided to speak to his son thinking I could return the money to the family coffers. He said it was fine for me to keep the money and their family were also in approval.

After a year, the man had no further physical complaints but still faithfully came for tune-up treatment and herbs every two weeks. I completely forgot that he was supposed to have died nine months previous. His family said that the Stanford oncologists and students were calling to ask after their father. I asked why they were calling. It was then that they reminded me that it was because he had been diagnosed with pancreatic cancer about a year ago and they wanted him to return for a follow-up examination.

They asked what they should do. Flabbergasted, I said, "By all means, take him back for a follow-up examination!" To our delight and surprise, search as they might with all the latest equipment they used to discover the cancer in the first place, they could now find not a trace of cancer in his system. This man continued to return more sporadically over the next year and finally I heard some several years later that he peacefully passed away of natural old age-related causes.

So as we embark on a new year, and those of us who are doctors, healers, herbalists, acupuncturists and so on, continue our ongoing commitment to study, let's not forget the power of faith and belief in healing. As the great bard said through the lips of Hamlet, "There are more things on heaven and earth, Horatio, than are dreamt of in your philosophy."

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