Medicine is a rigorous discipline grounded in hard science. What is the scientific evidence that therapeutic relationships make a difference?
Approximately 20,000 placebo controlled trials/year affirm the power of belief. These studies all compare treatment to placebo. The very need for these placebo-controlled trials demonstrates the power of belief. If the placebo effect was not potent, we would not need the multi-million dollar industry of placebo controlled clinical trials. Instead, we would compare a potential new treatment with no treatment
Unfortunately, we tend to disparage and minimize the placebo effect with comments like “Placebos aren’t real medicine, they just show how gullible and suggestive people are,” and “Real medicine doesn’t use the placebo effect.” But Herbert Benson, MD, a researcher at Harvard Medical School, provides a contrasting view in his book “Timeless Healing‐ The Power and Biology of Belief.” Benson substitutes the neutral term “remembered wellness” for the pejorative word “placebo.” He marshals evidence for the potent potential of remembered wellness. He also provides evidence about its opposite: the “nocebo” effect (you will experience problems if you expect to have to experience problems.)
The catalyst in every incident of remembered wellness is belief. Such belief may be your own composite of life experiences. The belief may come from your clinician and the product of his or her professional and personal history. Finally, the belief can be instilled in you by the confident and trusting tone established within therapeutic relationships.
Interesting examples cited by Benson include:
- Sham treatments with disconnected ultrasound probes reduced swelling by 35% after wisdom tooth extraction.
- Women with persistent nausea and vomiting of pregnancy swallowed balloon tipped tubes that allowed researchers to record stomach contractions associated with waves of nausea. The women were given a drug they were told would cure the problem. In fact, they were given the opposite, syrup of ipecac, a substance that causes vomiting. Remarkably, the patients’ nausea and vomiting ceased entirely and their stomach contractions as measured by the balloons returned to normal. Because they believed they received antinausea medicine, the women reversed the proven action of a powerful drug. With beliefs alone, they cured themselves. (Note: this study was performed in 1950, before the advent of Institutional Review Boards that likely would have disallowed it on ethical grounds)
- Individuals with asthma experienced deterioration in lung function after inhaling what they believed to be a chest constricting chemical (nocebo effect). But if the patients were treated with what they believed to be a powerful new chest expanding bronchodilating drug, they experienced no deterioration. In both instances they received a placebo of inert distilled water. Thus, bronchial constriction was caused by belief and prevented by belief.
- Boys who reported allergic reactions to lacquer trees were blindfolded. The researchers brushed one arm with leaves from a lacquer tree but told the boys it was a chestnut tree. They brushed leaves from a chestnut tree on the other arm and told the boys that the leaves were from a lacquer tree. The arm the boys believed was brushed with the poisonous lacquer leaves reacted with bumps, redness and itching (nocebo effect) while in most cases the arm brushed with the poison did not
Interestingly, naloxone, an inhibitor of opioid receptors used to reverse heroin and other opioid induced comas, can block some types of “remembered wellness,” indicating that “remembered wellness” is mediated by physiological pathways. This fact fills me with wonder. Why did humans evolve “opiod receptors” that block pain? I don’t think it was in anticipation of the pharmaceutical industry. Humans and other animals developed opiod receptors to support resilient self -healing.
Mind and body inseparable
Back in 400 B.C., Hippocrates, the father of Western medicine taught this: “some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” One thing that has changed since Hippocrates wrote this 2,500 years ago is that all roles and disciplines on the healthcare team—not just physicians—contribute to healing relationships. Otherwise, his statement is as true today as when he first uttered these words.