For millenia, healing has been achieved by helping people find balance within their community and their relationships, with nature, and in their spiritual life. As human beings, we are generators of meaning. We name things, we relate to things, and we compare things. Meaning is essential to our experience, and it has a huge impact on how we feel, and on our overall health and well-being.
With the development of the modern, rational medical paradigm, we have moved away from meaning and purpose as primary influencers of health and disease. The advent of the microscope, and the development of heroic, life-saving medicines like antibiotics and steroids, and invasive procedures like surgery and endoscopy have brought great focus and resources to bear on the reductionist approach. It’s not surprising, and it’s truly incredible to see what we have been able to achieve in the realm of emergency medical care.
However, when it comes to chronic disease, the single molecule – single target approach, and the use of heroic interventions have not provided the benefits that these truly remarkable inventions have produced in the context of emergency medicine. In large part, this is due to complexity. The field of complexity science is founded on the realization that in living systems, the parts do not explain the whole, and they are not merely additive properties. What we are finding is that with greater levels of complexity, new properties emerge, with new dynamics.
A placebo is anything that appears to be a medical treatment but actually isn’t. Most of us are familiar with the placebo effect as it pertains to the use of an inert substance, such as a sugar pill, to evaluate the effect of pharmaceutical medications in randomized controlled trials. Placebo’s are also used in evaluating medical procedures, although their use is more controversial, and their application more difficult. A placebo pill or shot does not contain an active substance, and a placebo procedure omits the specific therapeutic intervention, i.e. surgery, or acupuncture.
A placebo or “sham” procedure includes a set of “non-specific” factors that make up the ritual of performing an actual intervention, such as surgery, arthroscopic surgery, or acupuncture. It includes all aspects of the actual intervention (surgery or acupuncture) minus the actual intervention. We can consider this a function of “ritual,” and how the use of ritual alters the context in which we are applying a medical intervention, leading to improved or diminished effects, depending on the rituals chosen and their influence on patient perception. It has been difficult to carry out such comparative trials in human beings due to the ethics around human suffering and the delivery of effective treatments. Some of this has been overcome through participant consent, but the number of trials and participants is severely limited, making the amount of data we have in this area lacking.
Thankfully, pioneers in the realm of “placebo research” are uncovering more about this fascinating aspect of human health, and how we can apply it in medical practice. However, we are at a difficult place with our understanding of the “placebo effect,” what it is, how it works, is it real? and if it is, how to cultivate it? The term itself is an unfortunate convention that has been used as a blanket term to cover a wide range of “effects,” whether psychological, physiological, neurobiological, etc. Owing to its wide application, unclear definition, and to the complexity of human health and healing, the term is now the source of much debate.
What is commonly referred to as the placebo effect was first popularized in the medical media after a report by Henry Beecher, MD, describing how he was able to ease the pain and suffering of soldiers in World War II by giving them saline solution injections when he ran out of morphine. However, this effect, better termed “the healing power of the mind,” has arguably been a part of healing and medicine for as long as medicine has existed.
The bulk of the research into the placebo effect has been in the field of pain management. People’s experience of pain is known to be influenced by many factors, including their level of stress and anxiety. For example, expectations have a powerful effect on the perception of pain, stress reduces placebo analgesia, and depressed people get less effect from opioid pain medications. Recent research reveals that it is not merely a change in perception that affects people’s pain experience, but there are distinct, measurable physiological changes that take place in the body.
Placebo induced analgesia has been connected to increased levels of endorphins, and has been shown to be reversed by the opioid antagonist naloxone, which suggests that activation of the endogenous opioid systems is responsible for some of the analgesic effect. Using functional MRI technology, the majority of neuroimaging studies of placebo analgesia indicate that the reduced pain ratings during placebo analgesia are paralleled by decreased activity in the classical pain processing areas including the thalamus, insula, and the somatosensory cortex.
Holistic medicine implies an observation and treatment of the microscopic and the macroscopic, the molecular and the cultural. It applies therapeutic interventions that affect the individual on as many levels as possible to have the most profound impact on health and disease. By improving relationships between the doctor and patient, within the patient’s family, and in the cultural context that the patient lives, therapeutic effects are enhanced, and outcomes are improved. What is now dismissed as the placebo response could be used as the basis for inducing optimal healing that is personalized to the patient, their culture, and context.
In this webinar, we will begin by examining the “placebo effect,” what it is, and how we can begin to separate it from the larger effect of holistic medicine on patient outcomes. For most clinicians, it is obvious that the mental, emotional, and spiritual state of a patient has a significant role to play in their outcome, no matter what condition they may be suffering from. If we look at the research today, it is undeniable that there are medically relevant effects from the way that patients perceive the experience they are having, and by taking a deep look at our past, while re-visioning of our future, we can shape the way we practice medicine to encompass and to cultivate the Healing Power of the Mind.
Jonas W. B. (2019). The Myth of the Placebo Response. Frontiers in psychiatry, 10, 577. https://doi.org/10.3389/fpsyt.2019.00577
Jonas WB, Crawford C, Colloca L, et al
To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open 2015;5:e009655. doi: 10.1136/bmjopen-2015-009655
Karin Meissner, Ulrike Bingel, Luana Colloca, Tor D. Wager, Alison Watson, Magne Arve Flaten. The Placebo Effect: Advances from Different Methodological Approaches.
Journal of Neuroscience 9 November 2011, 31 (45) 16117 16124; DOI: 10.1523/JNEUROSCI.4099-11.2011
Krippner S. Common aspects of traditional healing systems across cultures. In: Essentials of Complementary and Alternative Medicine. Philadelphia: Wolters Kluwer Health; (1999). p. 181–99.
Note: This webinar is intended for healthcare practitioners.