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Beware Those 100% Placebos
The Placebo Effect. Do Placebos Work?
I'd like to start this off by telling you a short story. It's a true story (only the names have been changed), but it's one that most serious therapists will have come across at fairly frequent intervals during their careers.
The phone rang and it was a gentleman with a bad back seeking treatment. I made an appointment to see him for Spinal Touch Therapy later that same day. Now, it has to be said that Spinal Touch Therapy is one of the band of Light Touch Therapies, and this fact will give you an idea of why Jim reacted in the way that he did subsequent to the work.
I gave a reminder phone call a couple of days prior to the follow-up treatment and Jim said he wasn't coming. Well I was sorry to hear that but I was happy to concede that if Jim wasn't sure that the treatment was for him, then that was fine, he was free to find something more to his liking at another practice. Oh it wasn't that, said Jim, I didn't feel as if you did anything! I asked him to explain what he meant. He said, those silly little squiggles you did with your fingers up my back. They couldn't possibly have had that much effect because I could hardly feel it. So it must have been a placebo effect. Yes, that's it. It was all in my mind. Which means I got better myself.
I'll tell you now, this was from somebody who had to be helped out of his car by a work colleague, supported into the treatment room and helped onto the couch. Who then subsequently walked out on his own, up a short hill and back to work, proclaiming to his work mates how wonderful he felt.
I DON'T BLAME JIM. I BLAME MYSELF for not explaining it properly to him, that something so beautifully simple and light could have such a profound effect on the body. We call this, THE APEX PROBLEM. For those who haven't heard this term before, the Apex Problem is a name given to the seemingly strange notion that many clients don't give credit to the treatment they are receiving for their successful results. Instead, they tend to try and "explain it away" or ignore its impact altogether, almost as though it didn't happen. For example, some patients are quite happy to believe that those tablets they've been taking for months, which haven't been working at all before now, have suddenly kicked in and started working at the exact moment this other treatment finished. They've been conditioned to expect the tablets to work, so despite all the previous dissappointments, as they are feeling better, it must have been the tablets that finally kicked in, and not the treatment. I guess it doesn't matter one iota, what makes you feel better really, just as long as you get better. The Apex problem isn't a problem in and of itself. It is simply a reminder to us therapists that we must change our ways and adapt our delivery to fit within our client's belief system.
So, just as a farewell, I asked Jim, "How is your back Jim?". He said, "Absolutely perfect thanks, not a twinge anywhere". And despite not coming back himself, at least 10 of the other 200 people that he works with have been down since, based entirely on his recommendation.
Complementary therapy at its best is so empowering that it can change somebody's whole life. It encourages us to recognise our own self healing abilities and to develop a more active approach to our own health care that goes beyond the classic doctor/patient relationship. And clearly, in a subconscious way, this is what Jim picked up on, in reality, making him the ideal candidate for this kind of alternative treatment.
Don't run off with the idea that the Placebo Effect only applies to complementary therapy. Mainstream medicine actively ignores the clinical significance of its own placebo effect, and drug companies go to great lengths to hide the facts about the placebo effect versus their own products.
Should the NHS Embrace Complementary Medicine?
1. The patient
2. The practitioner
3. Patient/practitioner interaction
4. The nature of the illness
5. The treatment and setting
Michael Dixon, a Devon GP, takes the bold step to argue the case for an integrated health service and has even conducted his own non-scientific trials using conventional and complementary therapies, involving spiritual healers. Which is why my ears pricked up when I heard about it.
Dr Dixon's book - The Human Effect in Medicine: Theory, Research and Practice - examines the power of human interaction in medical consultation and seeks to provide a combination of modern philosophy and current evidence, which demonstrates the importance of the human effect and how to apply it.
The TrialDr Dixon's trial began when many of his patients began making statements about visiting a spiritual healer and feeling better because of it. In his own words he almost felt an anger at the patient and the healer. You know, why am I having this conversation when it's all barmy and illogical, and really shouldn't be allowed. This was a bit like an artist in the middle of a masterpiece when a member of the public comes along and starts colouring it in.
The one thing Dr Dixon did concede was that it appeared to be safe for his patients to try, and soon started to encourage his patients to use the healer as he was being told about improvements, even though there was no evidence of how it worked. And to his credit, Dr Dixon next did something rather radical for a GP. He set up his own clinical trial to see if there was anything to these claims of healing and whether it really worked.
The trial consisted of 50 individuals in two groups. All had normal care and conventional treatments and were on the appropriate waiting lists. The groups were comparable in terms of how long they had had the disease and the types of conditions they were suffering from. One group had healing as an addition and the other group didn't.
It wasn't a controlled study, such as would be expected of an official clinical trial, but even so, this must be seen as a bit of a risk for a doctor to even be seen investigating healing in any serious way. Not just because of the potential for ridicule by his peers, but also patients were at liberty to complain that it wasn't working, or worse, to the BMA (British Medical Association), which would have wanted answers to several questions.
The results were, in the words of Dr Dixon, "Quite astounding!". 70% of patients in the group with healing got better, with 50% quite significantly better, as far as their main symptoms were concerned. 20-30% also got better in the control group. There was a significant statistical difference between the two groups of about 40%. This result surprised everyone because it seemed to show that healing could work in some instances and was around double the result of the other group. People were getting better and Dr Dixon seemed unable to explain why.
On the surface, people were getting better because they thought they were. For lack of another explanation, people were being healed, just by believing they would be. Most scientists just call this the Placebo Effect.
The power of the Placebo Effect is breathtaking!
I work as a healer and a therapist, I've seen the effects of both on people from all walks of life, and I happen to believe that it's not all placebo. I believe that I work with a kind of energy, a universal energy that is all around us. Most healers intuitively know it is there and some can even feel it. Is there a scientific basis for such a theory? Yes, we are surrounded by microwave energy that has been there for billions of years. The fact that we only discovered it 50 years ago doesn't mean that it wasn't there before, just that we didn't know about it.
It is a human weakness to dismiss everything that we don't understand. But the means to identify and measure what we are talking about hasn't been invented yet, so we must either believe or not believe, and this usually depends on which side of the science or spiritual fence you sit on.
As most placebo studies are done on adults who have informed choice, the other question relates to whether healing should work on individuals who are not capable of understanding the concept. For example, if it is all placebo, why does healing work on young children who don't understand the concept of it? How can it be that my cat, who is nearly 26 years old, instinctively knows when I am giving a healing as opposed to any other therapy? Outside of my therapy room is a suntrap and the cat will sleep there all day. I will do a Spinal Touch treatment, an Aromatherapy, Reflexology, or some other therapy and the cat won't budge. Somebody comes for a healing and she's scratching on the door to get in. If I let her in, she sleeps under the couch or the chair where the healing is taking place. This is not once, but every time! It got so bad I have taken to moving her so the session can proceed undisturbed. Did I leave a sign outside? No, of course not. Sam didn't understand the placebo effect either, but kept coming back for more, because just maybe, there is much more to healing than a simple placebo effect.
If research shows that aromatherapy is good for the skin, but only if you believe it will be, or, that reflexology is good for high blood pressure if you really think it will lower your blood pressure, then maybe that is a good excuse to actually go for these body works, rather than upsetting the body chemistry with drugs that force it to change in ways it may not want to.
As the number of drugs allowed to be prescribed by doctors dwindles, there are a number of complementary therapies that seem to be stepping up to the challenge of providing the choices that people are crying out for. The power of the placebo may be breathtaking, but the power of the body to repair itself is even more so. All it needs is to be shown the way forward and the means to acquire what it needs.
I believe it is the healers ability to bring "The Human/Spiritual Factor" into the equation, in the form of time, touch, empathy, hope, reassurance and the energy to make it all happen, that give us the edge and give us that extra 40%.
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If you have any thoughts on this, please write to me at:
Philip Chave © 2004-
Note: Please be aware that Healing, distant or otherwise, does not take the place of conventional medicine. Always consult a GP for an acute or infectious condition, and problems of an urgent nature. Continue with your prescribed medication. Healing is a complementary therapy that works effectively alongside orthodox/conventional healthcare, thus expanding your treatment options.
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