Saturday, January 15, 2011

About That Miracle VS Placebo Issue

Recent studies say about fifty percent of our doctors do prescribe some form of placebos.

Before I get started on discussing whether one can tell a spiritual miracle from the placebo effect, I want to extract a few paragraphs from a lengthy article on Big Pharma's problems with the placebo effect. It's not just medical committees at the Vatican that have problems with the placebo effect, so does Big Pharma, and for a multitude of reasons. The scariest reason for Big Pharma is that the placebo effect is getting stronger. People seem to be more adept at mentally triggering the body to heal itself.  The down side? This also means that people are getting more adept at triggering the nocebo effect--getting the body to turn on itself.  But first here's some fascinating stuff about Big Pharma's problems as reported in Wired Magazine in August of 2009.

.....Last November, a new type of gene therapy for Parkinson's disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn's disease, an intestinal ailment, citing an "unusually high" response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.

It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger. (That's because it is.)

The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.

Why are inert pills suddenly overwhelming promising new drugs and established medicines alike? The reasons are only just beginning to be understood. A network of independent researchers is doggedly uncovering the inner workings—and potential therapeutic applications—of the placebo effect. At the same time, drugmakers are realizing they need to fully understand the mechanisms behind it so they can design trials that differentiate more clearly between the beneficial effects of their products and the body's innate ability to heal itself. A special task force of the Foundation for the National Institutes of Health is seeking to stem the crisis by quietly undertaking one of the most ambitious data-sharing efforts in the history of the drug industry. After decades in the jungles of fringe science, the placebo effect has become the elephant in the boardroom.

For me this increase in placebo effect was an exciting bit of news.  One of the ideas which has gained great prominence in psychic/spiritual circles is that humanity is experiencing a major shift in consciousness.  One of the indicators of this shift is an enhancement in the mind/body connection.  In other words our mental beliefs will have more potency in effecting the expression of our reality. The placebo/nocebo effect would be one example of this effect of belief on the expression of our reality.  We are what we think and believe about ourselves--and our bodies will reflect that thinking.  In this paradigm any dualism between mind/body or soul/body does not exist because they are intimately entangled on the quantum level of reality.  This has always been true, but for what ever reason, the effects, both positive and negative,  are expressing themselves more overtly and faster.

Further along in the article the author lists some of the behaviors researchers have identified which seem to enhance the placebo effect.  Not surprisingly they define this set of behaviors as 'therapeutic ritual': way that placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual.

In a study last year, Harvard Medical School researcher Ted Kaptchuk devised a clever strategy for testing his volunteers' response to varying levels of therapeutic ritual. The study focused on irritable bowel syndrome, a painful disorder that costs more than $40 billion a year worldwide to treat. First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who declined to engage in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition. (The empathetic pastoral approach.)

Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.

It doesn't take much of a leap to see that actual spiritual rituals specifically engaged in to heal someone could trigger a very powerful placebo response. In fact sometimes spiritual rituals are designed to trigger the effect. It's just not called placebo. Indigenous shamans and medicine people have known about this for eons and have gone to great lengths to design situations which enhance a given persons belief in the power of the ritual, strengthen their belief in God and in their own ability to heal themselves.  In most healing rituals the patient is not a passive recipient, but an active participant.  In other words, they are to some extent their own doctor, their own priest, establishing their own connections with God to bring on their own healing. I've witnessed and participated in these kinds of spiritual rituals numerous times and have seen some mind blowing results. A half a dozen of which would most certainly have met the Vatican's criteria for a miraculous healing.  That hardly makes me a saint.

This is a huge topic and deserves more than one posting so tomorrow I'll get into some of the biology of how this type of 'miracle' happens.  The truth is, knowing as much of the science behind the phenomenon as one can is important in Western culture because our faith and belief structures are heavily influenced by science. We are far more likely to give ourselves permission to trigger the effect if we understand to some extent how it might work.  Plus, knowing something about how this works can also help avoid triggering the nocebo effect, and that's just as important.


  1. Colleen this is a fascinating discussion and it is also a subject in its infancy. One thing I would like to say about the corporate pharmaceutical take-over of research universities has some fall out for this subject. That is that the use of "clinical trials" very often if not usually fails the definition of scientific method because the corporations attempt to never publish studies that disprove what they wish to prove. Synthroid is a very expensive thyroid replacement therapy. One of the major researchers at Stanford for this drug reported after 7 or 10 years when she no longer was under contractual obligations that Parts of her very significant studies were either under reported or not reported at all. When she was able to tell her story, she revealed that desiccated thyroid made from pig thyroid glands was a superior drug to Synthroid. By the time this was reported the very cheap desiccated thyroid was out of production.

    Only 30% of the initial research about prozac showed that it in fact even worked. The idea that this drug caused no side affects or effects was a very big lie. It only caused different but very serious other side effects (with drugs, there is no free lunch) that were not seen with the then standard therapies. The other problem was that even in some of the reported studies, the older and more cheaper drugs worked better. Finally, serendipity is a huge part of the scientific method. When scientists subject their hypothesis to observation, they often find unexpected results. This is very inconvenient for drug companies that feel they are loosing money when this happens. So these types of findings are often not reported and even worse often suppressed. One of the of the most important serendipitous discoveries of the past 50 years occurred when a catholic scientist at Harvard was looking for ways to increase fertility in women but discovered how to decrease it. He found the birth control pill. This scientist only had to battle Cardinal Cushing about his discovery and not some drug company that threatened to sue him and cut off funds. I will try to publish more later but am driving three eleven year old boys to the ski slopes tomorrow. Communicating with electrical forces in our bodies and how that might stimulate immune response is fascinating, but most of what I have to say does not come from expertise but from considered opinion. I do have many more ideas. dennis

  2. Fabulous piece.

    To support Dennis: Professor Beatrice Golomb, an expert in the use of statistics and evidence in medicine, presents her research on the subject of Medicine and Politics for the Science Network.

    At 6:00 into the video she discusses some of the published literature on antipsychotic medicine, but I think there is great power in viewing the entire 20 minute video.

    Here in Toronto there is the famous case of Dr. Nancy Olivieri, a clinical researcher who ran into huge problems when she reported findings that were not supportive of the drug being studied.


    It was a "miracle" that I discovered Dr. Golomb's work about the time I was experiencing adverse effects from a prescription drug.

    But to return to Colleen's point, it does matter what one thinks. It can make you sick and it can make you well. No doubt powerful healers exist. In most cases, I believe, they are able to trigger the subject's own internal power to heal, a power most of us are unaware we possess.


  3. p2p, that is exactly what the best healers do, alternative, allopathic, or spiritual--get people to heal themselves. Jesus said it plain as day and numerous times: "Your faith has healed you."

    A good consistent healer is akin to a catalyst, not an actual agent of the healing.

    Dennis, this is a hugely fascinating topic. For years and years I kept wondering when Big Pharma was going to get around to doing something more with the placebo effect that use it's existence to justify their drugs.

    Of course the big problems were placebo is much cheaper, has no side effects and can't be patented.

  4. The placebo effect seems to hold true mostly in cases where people are self reporting their perceptions of pain or discomfort. There obviously is some sort of mechanism there but I'll wager it is extremely subjective and limited. If you cast up two groups with compound fractures but only reset the bone in one group I think it's a safe bet that you won't find any sort of placebo effect. But you would find a lot of infection.