Placebo Power
October 1, 2002
If ... we finally pull back the curtain on placebo, will we destroy a power that depends on mystery?
Medicine has made miraculous progress in the last century, ironically
including ever-more-impressive studies of the placebo effect. Perversely,
better appreciation of the power of placebo undermines the very foundations
of medicine as science.
Recently, arthroscopic surgery took its lumps at the Houston VA
Medical Center where 60 out of 180 arthritis patients had "dummy knee
surgery." Patients awoke with the standard closed incisions, but actually
had no damaged cartilage removed. After two years this placebo group fared
just as well as those who had actually received surgery. This is
particularly notable in that we're all familiar with "sugar pill" placebo,
but ... surgery?
What roles do emotion, psychology, spiritual outlook play in disease
and its causes/treatments? Western medicine admits none. If you can get
your doctor even to discuss the matter, you've breached a very thick wall
of dismissal carefully bricked up during years of what was supposed to have
been a medical education. Meanwhile, these annoying placebo studies have
moved from sugar pills to invasive surgery. What next, chemotherapy? Organ
transplant? Joint replacement?
Consider, after all, how far "modern" medicine has *not* progressed
from the patient's perspective, where the power of placebo resides. For the
Houston study, imagine the surgeons as Paleolithic shamans. You've got a
demon in your knee that's driving you nuts. You go to the special healing
cave, where you are ritually cleansed, gowned and otherwise "prepped" by
anonymous attendants. In comes the weirowance in his distinctive costume,
complete with mask. It's only a surgical mask, but it serves the modern
imagination every bit as well as the fanciful museum pieces.
You undergo a change in consciousness, in this case the twilight sleep
of light anesthesia. You awaken to find marks of sacrifice on your body.
Ritual bloodletting, a staple in medicine well into the 19th century,
remains potent. The demon is expelled, thanks to your blood sacrifice and
the secret knowledge and power of the shaman. (*Substantial* blood letting
occurs when his bill arrives.) You have paid any guilt debt to the gods for
even unwittingly entertaining knee demons. Or, had you been enchanted, your
incision scars show where your magic overcame your enemies. Scarification,
tattoo, anything unique, and preferably permanent, will suffice.
An nasty experience is essential, even, perhaps especially, when
you've slept through most of it. The marks become indispensable in this
case, since you don't remember any pain. For conscious patients, physical
discomfort is mandatory. You need to *know* you've been "physicked." To
evoke placebo, the experience must be impressive, and pain insures this
while reinforcing the demands of sacrifice.
Patrick O'Brian, who studied early 19th century British naval medicine
for his 20 superb period novels, relates how sailors demanded the most
foul-tasting medicines possible, often containing asafoetida, camphor,
etc., not for any therapeutic function, but purely for their vile taste and
smell. The letting of blood was, of course, a perennial, along with the use
of literally explosive laxatives.
Laxatives *did* something, and powerful "purges" were the only actual
pills taken on the Lewis and Clark Expedition of 1804-5. The Corps of
Discovery's trail West can be traced to this day by digging up their
latrine pits for tell-tale traces of mercury from Dr. Rush's
"Thunderclappers," dispensed by Lewis (even for diarrhea!).
"Patent medicines" were all the rage well into the 20th century,
marketed under the broad moniker of "snake oil." What other product could
prosper under such a deliberately-unappetizing name? Nor is this penchant
for rigor some peculiarly Western fetish.
I have had acupuncture, and I can tell you some applications hurt. One
in particular (the "Flower Stone," I believe) involves three deep
penetrations of the ball of the foot. I recall stepping on a nail as a
child, and this was far worse. My acupuncturist smiled at the myth of
painless acupuncture, relating how overly-gentle American acupuncture
students in China are often dismissed by indigenous patients. Like patients
everywhere, Chinese need to *know* they have been treated, and, in a
practice involving lots of needles, pain is both the obvious signal and,
again, a token of sacrifice.
Since Einstein, physics has repeatedly proven that matter is energy.
The bold assert that energy is thought. The syllogism is tempting. Recall
that, however inconvenient for mainstream Christians, Christ was quite the
enthusiast for miracles of healing, and not just his own: "Greater works
than these shall ye do." There's even raising of the dead and removing
mountains with mustard seed-sized parcels of "faith." Perhaps this faith
could as well reside in aroma therapy. Or small incisions about the knee.
How much medicine is, in truth, placebo? Do we really want to know?
If, as in "The Wizard of Oz," we finally pull back the curtain on placebo,
will we destroy a power that depends on mystery? So far, after centuries of
rationalist assault, placebo prospers.
Conversely then, can we harness placebo so that it can be reliably
employed as needed? Maybe. "Take two aspirin and email me in the morning"
may ultimately prove as effective as all the elaborate panoply and
terrifying expense of modern medicine.
A futurist and commentator, Travis has been published nationally and internationally since 1978.
Copyright © 2002, Travis Charbeneau, All Rights Reserved.
travchar@mindspring.com
http://www.richmonder.com/charbeneau
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