the-placebo-effect

I was listening to the radio news as I was getting ready for the day on May 7, and suddenly I laughed out loud. What was it that I found so funny? Well, the news just came out that antidepressant drugs do not perform any better than a sugar pill, or placebo, in overcoming depression. Wow, that bit of information could have saved some people a lot of money – including the insurance companies. Later that night on TV the same news was mentioned, and they discussed the case of one man who had been through some serious clinical depression, joined the clinical trial of an antidepressant drug, got totally better, and later found out he’d been on placebo. On TV he said he was delighted, and it seemed to be because he found himself more mentally powerful than he had thought – after all, he had gotten better without the medicine.

Then there was another study, in the New England Journal of Medicine of May 2001, that completely disparaged the placebo effect. In fact, it said there is no such thing as the placebo effect. The study looked at 114 published trials and the difference between people who got placebo and people who got no treatment at all, and found none. This finding caused a great deal of anguish to the myriad researchers who attend to the golden standard of research methodology: the double-blind, placebo-controlled clinical study. In such a study, the pill (or capsule) is what is given to the “cases,” the sugar pill (or capsule) is what is given to the “controls,” and neither the participants in the study nor those who administer the pills know which is which. If the latter know, it is “single-blind.” What is studied then is the difference between the cases and the controls.

Placebo studies originated with the practice of homeopathy in the 1800’s, although the use of dummy medicines goes back much further than that. It is very easy to do a placebo trial with homeopathic remedies, because they are actually milk sugar (lactose) pills, either with or without the homeopathic substance. They do not appear substantially different to the perception. Therefore, if during a trial there was a noticeably positive difference between the active pill and the placebo, it was considered that the remedy was successful. It took almost a hundred years before the practice of placebo-controlled studies was taken up by allopathic medicine.

The placebo effect is powerful, widely known, and frequently used. Howard Brody, author of The Placebo Response (HarperCollins, 2000) performed some experiments in the 1980’s that showed that placebos had a clinically favorable effect even if the people had been told they were being given sugar pills! A hundred years ago, when doctors compounded their own medicine, they frequently gave inactive remedies to their patients, without telling them, because they had nothing better — and then watched these sick people improve anyway. That is why it is called placebo, meaning “I shall please,” as the doctors found that their patients were more pleased when they were given something, anything, than if they were told, “don’t worry, you’ll get better on your own.” With the rise of consumer education, the demand for informed consent, and the lawsuits that enforced it, the practice fell in disuse, although placebo use became entrenched in research.

But the questions remain, and in fact, as the recent studies on antidepressants and lack of effect show, the questions loom larger every day.

What is it, actually, that heals the body? Is it the medicine? Is it the body’s own healing powers? Is it the care and attention of the health practitioner? Is it the patient’s expectation? Does the illness just follow its natural course and resolves on its own? Is this truly mind over matter? Brody defines the placebo response as “the body’s reaction to some healing signal in the environment, which acts through the mind.” (P7) The signal, he says, is symbolic – that is, it carries meaning for the patient, and therefore can be almost anything. I assume it has to be really personal for the symbol to really make a difference. What heals, then, is what the body says. Brody talks of an “inner pharmacy” that knows what medicines to dispense when properly prompted in cases of illness. It can be prompted by drugs, by placebo, by stories, and of course, by food.

Does changing your diet really heal? I believe that, truly, it often does. I have seen too much of it to think otherwise. But is it the food that does it? From the point of view of these placebo studies, I would have to say, maybe. Maybe good food (whole, fresh, real, natural) is in itself sufficiently powerful to induce the body to abandon disease. Or maybe a change in diet is a really powerful “healing signal” for the bodymind to make improvements in its functioning. Would it matter, if the latter is the case, what the diet is? Perhaps there are cases where “healthy” food (whole grain, vegetables, sea vegetables) fail to give the healing signal. About 20 years ago I saw a young woman for a consultation who was feeling totally weak and miserable. She was unwell enough so that I went to see her in her own home. I found her thin, listless, and pale; her belly, on the other hand, protruded a bit, and that worried her. She had been eating “healthy” foods for a couple of years. I’m not sure my initial recommendations helped much. Later I would have recognized the belly as a sign of malnutrition. I heard from her a few months later: she had gone home to Italy, had eaten with her family, all the usual Italian fare – pasta, soups, chicken, vegetables, dessert. Lots of “unhealthy” foods. She was feeling much, much better. I suggested that she keep eating that way, more widely and joyfully, and forget worrying about food. For her, the healing signal had been her family’s food. For myself and others, the healing signal had been a change towards a whole food kind of regime.

I have a come to believe that change itself is a powerful healing signal. That means that, if one is unwell, a radical change from what one is eating – – no matter what it is — could be the way to go. If one is a meat eater, one might try going vegetarian; or vice-versa as well. Business as usual may not do it. Finding out what to change from, what to stop eating, and what to take up or return to, that is the real challenge.

Here is a recipe for warm days ahead.

Balanced Grain Salad

2 cups cooked brown rice or barley
1/4 cup diced celery
1/4 cup diced carrots
1 Belgian endive, cut crosswise into ½” slices
2 Tablespoons chopped parsley
½ cup cooked, flaked fish, or 1 small can salmon or sardines
3 Tablespoons lemon juice
5 Tablespoons extra virgin olive oil
1/4 tsp salt (optional)

1. Place the grain, celery, carrots, and parsley in a large bowl. Separate the endive pieces and sprinkle over all. Put fish on top.

2. In a small jar, mix the lemon juice, olive oil, and salt. Shake well, pour over the salad ingredients in the bowl, and mix gently. Serve on top of Romaine lettuce leaves. Makes 2 servings – try it for lunch.