Placebos and Shams: The Crisis of Knowing How We Know – 2

When healing happens, what (or who) exactly, is in charge of the healing?

Years ago, in Bill Moyers’ 1993 publication Healing and the Mind, I came across an interview with Dr. Candace Pert in which she makes a stunning claim.  She told Moyers that in multiple personality disorders, it could be shown that within the same body, the chemical physiology of one personality would change when another personality took over.   “One person can be allergic to cats while another is not.  One personality can be diabetic and another not.”  Moyers challenges this: “But the multiple personality exists in the same body.  The physical matter has not changed from personality to personality.”  Pert responds, “But it does.  You can measure it.  You can show that one personality is making as much insulin as it needs, and the next one, who shows up half an hour later, can’t make insulin.”  There’s a wow.  I told one of my psychologist friends about this interview.   Without blinking, he said, “If it walks like a duck, quacks like a duck…”

Whether Dr. Pert is right about the insulin-making or not, the role the brain (or is it the mind?)  plays in health can hardly be overstated.  Let me take that back.  “Overstatement” of the mind’s ability to conduct the mysterious self-healing of the body is exactly what mainstream medicine accuses alternative therapies of peddling.   But according to David H. Freedman’s Atlantic Monthly article “The Triumph of New Age Medicine,” “alternative medicine” is gaining wider acceptance not only among consumers, but among major medical institutions as well.  Freedman explains that a whole “umbrella” of treatments falls under the moniker “alternative medicine”: “acupuncture, homeopathy, chiropractic, herbal medicine, Reiki, meditation, massage, aromatherapy, hypnosis,” and more.

Bottom line is that the practitioners of alternative medicine approach things from the point of view of creating health rather than fixing disease.   Poor diet, poor exercise, and high stress are without doubt (research supporting this appears to be wide and deep) the culprits in many, if not most, of our major health challenges.  The model on which mainstream medicine is built seems to be “come see us when you’re sick, and we’ll whack the sickness with a treatment, and get you back to business as usual.”   This model is especially important and successful in dealing with infectious diseases.   But when we’re talking about quality of life, the fixing of broken health is perhaps not the wisest target.  Perhaps the pursuit of healthy practice in terms of diet, exercise, and stress reduction should take precedence.

I watched a documentary about diet yesterday called FoodMatters, in which several physicians pointed out that in medical schools in America, doctors get very little, if any, training in nutrition.  (FoodMatters is an hour-long kick in the pants about nutrition…watch it.)  My point there is that the mainstream medical community has a very strong point of view about medical practice, and they are wary of anything that doesn’t produce hard numbers as a result of controlled studies.

All that to say that buried in Freedman’s article are a couple of funny little words that cuts to the heart of this issue of how we know what we know.   The first word is placebo, and the second is a phrase–sham treatment.

A placebo is sham medical treatment.  As in fake, pretend, or more cynically, as in lying to a patient.   The strange thing is…placebos work.  From ailments as seemingly sham-resistant as arthritis, osteoporosis, and irritable bowel syndrome (and many more), placebos are shown to be nearly as effective as the actual medical treatments.

The mind thinks its getting something that’s helpful to it’s healing, assumes it’s going to work, and…it does.   The mind (or is it the brain?) is at the heart of the matter.

“We tend to forget how powerful an organ the brain is in our biology,” Blackburn told me. “It’s the big controller. We’re seeing that the brain pokes its nose into a lot of the processes involved in these chronic diseases. It’s not that you can wish these diseases away, but it seems we can prevent and slow their onset with stress management.”

At the heart of the debate between mainstream and alternative medicines is a debate about the nature of knowledge.   What kind of “proof” do we need in order to “know” something? What kind of “evidence” do we need in order to “believe” a particular treatment will work?  And what power is at work when sham treatments cause the body to begin to make chemical and physiological adjustments, taking its cue from an imaginative leap?

Many people are at work researching the mysteries of the mind and the body.  And the discussion of how we know what we know lurks beneath many of the arguments over what is best for physical and spiritual health and well-being.

Tomorrow: one psychologist’s take on how the “knowledge” we’re teaching our kids about themselves may be ruining them.

Veggies, the gym, and prayer…