Nature is doing her best each moment to make us well. She exists for no other end. Do not resist. With the least inclination to be well, we should not be sick.
—HENRY DAVID THOREAU
Introduction
One of the fundamental principles of naturopathic medicine is the body’s innate ability to spontaneously heal itself. Evidence that this ability exists can be found by examining the placebo response. Undoubtedly you have heard this term. A placebo supposedly does not have a medicinal effect, yet these “sugar pills” and sham treatments often produce tremendous effects.
One of the more dramatic examples of the placebo effect reported in medical literature involves a patient of Dr. Bruno Klopfer, a researcher involved in the testing of the drug Krebiozen back in 1950.1 Krebiozen had received sensational national publicity as a “cure” for cancer. These reports caught the eye of a man with advanced cancer—a lymphosarcoma. The patient, Mr. Wright, had huge tumor masses throughout his body and was in such desperate physical condition that he frequently had to take oxygen by mask, and fluid had to be removed from his chest every two days. When the patient discovered that Dr. Klopfer was involved in research on Krebiozen, he begged to be given Krebiozen treatments. Dr Klopfer gave them, and the patient’s recovery was startling: “The tumor masses had melted like snowballs on a hot stove, and in only a few days, they were half their original size!” The injections were continued until Mr. Wright was discharged from the hospital and had regained a full and normal life, a complete reversal of his disease and its grim prognosis.
However, within two months of his recovery, a report that Krebiozen was not effective was leaked to the press. Learning of this report, Mr. Wright quickly began to revert to his former condition. Suspicious of the patient’s relapse, his doctors decided to take advantage of the opportunity to test the dramatic regenerative capabilities of the mind. The patient was told that a new version of Krebiozen had been developed that overcame the difficulties described in the press, and some of the drug was promised to him as soon as it could be procured.
With much pomp and ceremony a saline water placebo was injected, increasing the patient’s expectations to a fevered pitch. Recovery from his second near terminal state was even more dramatic than the first. Mr. Wright’s tumor masses melted, his chest fluid vanished, and he became a true picture of health. The saline water injections were continued, since they worked such wonders. He then remained symptom-free for over two months. Then a definitive announcement appeared in the press: “Nationwide tests show Krebiozen to be a worthless drug in the treatment of cancer.” Within a few days of this report, Mr. Wright was readmitted to the hospital in dire straits. His faith now gone, his last hope vanished, he died two days later.
What is the placebo response? Is it all in a person’s mind? Absolutely not! Recent research demonstrates that the placebo response is a complex phenomenon, initiated by the mind and leading to a cascade of real, measurable effects. In brief, the placebo response is the activation of the healing centers of our being in a way that produces profound physiological changes. The body has two internal mechanisms to maintain health. The first is the inherent internal healing mechanism, vital force, chi, or primitive life support and repair mechanism that operates even in a person who is asleep, unconscious, or comatose. The second mechanism involves the power of the mind and emotions to intervene and affect the course of health and disease in a way that enhances or supersedes the body’s innate vital force. The placebo response seems to involve activation of the higher control center, but that is not to say that its effects are solely in the mind.
One of the leading researchers of the placebo response is Dr. Fabrizio Benedetti of the University of Turin in Italy. He has conducted some very detailed studies trying to discover the underlying features of the placebo response.2 For example, numerous studies have documented that the pain-relieving effects of a placebo are mediated by endorphins, the body’s own morphine-like substances. In roughly 56% of patients in clinical studies, a placebo saline injection is as effective as morphine for severe pain; furthermore, this pain relief can be completely nullified by adding naloxone, a drug that blocks the effects of morphine, to the saline. As a result of these sorts of experiments, a great deal of the credit for the placebo response has been given to endorphins, but Dr. Benedetti’s research has shown that a placebo can produce much more profound changes than simply increasing endorphin levels. For example, he has shown that a saline placebo can reduce tremors and muscle stiffness in people with Parkinson’s disease. That is not surprising, perhaps, but what is very interesting is that researchers found that at the same time that the placebo produced noticeable improvements in symptoms, there was a significant change in the measured activity of neurons in the patients’ brains as shown by a brain scan. In particular, as they administered the saline they found that individual neurons in the subthalamic nucleus (a common target for surgical attempts to relieve Parkinson’s symptoms) began to fire less often and with fewer “bursts”—a characteristic feature associated with Parkinson’s tremors. Somehow the saline placebo resulted in the processing of the information by healing centers in the brain to specifically target an effect that would reduce the dysfunction in the areas of the brain affected by Parkinson’s disease.
Other studies have shown that both the placebo response and the experience of particular emotions produce demonstrable changes in brain activity visible through modern imaging techniques (e.g., CAT scans and MRIs). For example, one study showed that expectation or hope is able to stimulate the part of the brain that is activated by pain medications and associated with pain relief. In addition, numerous changes in chemical mediators of pain, inflammation, and mood have also been demonstrated with the placebo response. The bottom line here is that there is tremendous evidence that the placebo response is a highly specific and targeted healing effect that is triggered by both conscious and unconscious activity in the brain. Rather than discounting and trying to avoid a placebo response, modern medicine should be more intent on developing techniques and practices designed to stimulate the same healing centers within patients as noted in these studies with placebos.3
The Placebo Response in Medical Research
The development of the drug industry is based largely upon the perceived value of the placebo-controlled trial. In order for a drug to be approved it must show a therapeutic effect greater than that of a placebo. Because the outcome of a trial can be affected by both doctors’ and patients’ beliefs about the value of a treatment, most placebo-controlled trials are usually conducted in double-blind fashion: that is, not only are the patients unaware when they are receiving a placebo; the doctors are unaware as well. Nearly all studies conducted this way show some benefit in the placebo group. For example, in 1955 researcher H. K. Beecher published his groundbreaking paper “The Powerful Placebo,” in which he concluded that across the 26 studies he analyzed, an average of 32% of patients responded to a placebo.4 This is a generally accepted figure, although there is evidence that under some conditions in real-life clinical practice, placebo response may be as high as 80 to 90%. The reason is that in the real world the placebo response is enhanced by both the doctor’s and the patient’s expectations.
Conditions That Respond Significantly to Placebo
Angina
Anxiety
Arthritis
Asthma
Behavioral problems
Claudication, intermittent
Common cold
Cough, chronic
Depression
Diabetes (type 2)
Drug dependence
Dyspepsia
Gastric ulcers
Hay fever
Headaches
Hypertension
Insomnia
Labor and postpartum pain
Ménière’s disease
Menstrual cramps
Nausea of pregnancy
Pain
Premenstrual syndrome
Psychoneuroses
Tremor
The Holy Trinity of the Placebo Response
Noted Harvard psychologist Herbert Benson, M.D., has described three basic components to heightening a placebo response: the belief and expectation of the patient, the belief and expectation of the physician, and the interaction between the physician and the patient. When these three are in concert, the placebo effect is greatly magnified. Benson believes that the placebo effect yields beneficial clinical results in 60 to 90% of diseases. He states that the placebo “has been one of medicine’s most potent assets and it should not be belittled or ridiculed. Unlike most other treatments, it is safe and inexpensive and has withstood the test of time.”5 We agree with him completely.
As powerful as the placebo response is, it still requires activation. If the therapeutic interaction between the physician and the patient does not stimulate the patient’s hope, faith, and belief, the chances of success are measurably diminished no matter how strong or effective a medication may be. It has been repeatedly demonstrated in clinical trials designed to better understand the placebo effect that the beliefs of both the patient and the doctor, as well as their trust in each other and the process, generate a significant portion of the therapeutic results.
Conventional medicine often criticizes and belittles therapies that have not been stringently tested using the double-blind, placebo-controlled trial, but in doing so it is arguing against something that is time-tested—the art of healing. The bottom line here is that patients of a compassionate, warm, and caring physician will experience better outcomes and fewer medication-related side effects than patients of an uninterested, cold, and uncaring physician.
The Opposite of a Placebo
The word placebo comes from the Latin term for “I will please.” Its polar opposite is nocebo, Latin for “I will harm.” The nocebo effect is just the opposite of the placebo effect. It describes the experience of having a side effect from an apparently inert treatment or substance. Healthy individuals have adverse effects from placebos about 25% of the time, but if patients are specifically asked about adverse effects, this figure can rise to 70%. While a nocebo response is usually used to describe an adverse reaction to a placebo, it could also be applied to describe an unusual or exaggerated response to a medication. Does that mean that a nocebo effect is not real? Not at all.6
Symptoms and Side Effects Produced by Placebos
Anger
Anorexia
Behavioral changes
Depression
Dermatitis
Diarrhea
Drowsiness
Hallucinations
Headache
Lightheadedness
Pain
Palpitation
Pupillary dilation
Rash
Weakness
The Power of Expectations
Just as the placebo response is influenced by a patient’s attitude, so too is the nocebo response. It is another example of the power of expectations. The classic example given is the fact that in the Framingham Heart Study, women were four times more likely to die from a heart attack if they believed they were prone to heart disease, compared with women with similar risk profiles who did not have that belief.7 Expectations are influenced by a lot of factors, all of which play a role in establishing the level of faith in the patient.
The Role of Faith and Spirituality in Medicine
Most physicians as well as patients ignore one of the most powerful healing techniques known. Prayer costs nothing, has no negative side effects, and fits perfectly into any treatment plan. No matter what faith you embrace, you can use the power of prayer to lead you to better health—of body, mind, and soul.
Most physicians are taught that any consideration of religious commitment is beyond the legitimate interest and scope of medical care. It should not be this way, but the reality is that many believe faith and medical science are mutually exclusive despite the fact that numerous scientific studies have now fully validated the efficacy of faith, prayer, and religion in healing.8,9
In addition, patients know that prayer works. In a poll of 1,000 U.S. adults, 79% endorsed the belief that spiritual faith and prayer can help people recover from disease, and 63% agreed that physicians should talk to patients about spiritual faith and prayer. Indeed, many medical experts feel that not to include a spiritual dimension in a patient’s plan for treatment and recovery is to be medically irresponsible.10
One of the leaders in bringing the healing power of prayer to the forefront is Larry Dossey, M.D., author of best-selling books such as Healing Words: The Power of Prayer and the Practice of Medicine (HarperCollins, 1993), Prayer Is Good Medicine (HarperCollins, 1996), and The Extraordinary Healing Power of Ordinary Things (Harmony/Random House, 2006). In these books, Dr. Dossey provides a thorough review of the scientific evidence. Not surprisingly, he found that prayer has received relatively little attention from the research community. His systematic analysis of more than 4.3 million published reports indexed on Medline (a bibliographic database compiled by the U.S. National Library of Medicine) from 1980 to 1996 revealed only 364 studies that included faith, religion, or prayer as part of the treatment. The numbers are small, but the conclusion is huge: the data show that prayer and religious commitment promote good health and healing.
Scientific investigation into the healing power of prayer has shown that prayer can affect physical processes in a variety of organisms. Specifically, studies have explored the effects of prayer on humans and on nonhuman subjects, including water, enzymes, bacteria, fungi, yeast, red blood cells, cancer cells, pacemaker cells, seeds, plants, algae, moth larvae, mice, and chicks. In these studies, prayer affected the manner in which these organisms grew or functioned. What scientists discovered—no doubt to their amazement—is that prayer affected a number of biological process, including
• Enzyme activity
• The growth rates of leukemic white blood cells
• Mutation rates of bacteria
• Germination and growth rates of various seeds
• The firing rate of the heart’s natural pacemaker cells
• Healing rates of wounds
• Size of goiters and tumors
• Time required to awaken from anesthesia
• Autonomic effects such as electrical activity of the skin
• Hemoglobin levels
Given the scientific support for prayer’s beneficial effects, not praying for the best possible outcome may be the equivalent of deliberately withholding an effective drug or surgical procedure.
If praying is good for others, can we do it for ourselves? Absolutely. Dr. Benson of Harvard found that patients who prayed or meditated evoked their body’s relaxation response. This response—the exact opposite of the stress response, the “fight-or-flight” reaction that we feel during tense situations—includes decreases in heart rate, breathing rate, muscle tension, and sometimes even blood pressure. The medical implications of the relaxation response are enormous and may serve as the underlying basis for most mind-body techniques, such as guided imagery (discussed below) and meditation. The relaxation response has been shown to produce useful effects in a variety of different disease states. For example, cancer patients who undergo chemotherapy and learn to evoke the relaxation response are significantly less likely to experience nausea and fatigue.11
CREATING THE RELAXATION RESPONSE
Here is a simple exercise that will improve your ability to breathe from the diaphragm, achieve the relaxation response, and reduce stress. Practice the following for at least five minutes, twice a day.
• Find a quiet, comfortable place to sit or lie down.
• Place your feet slightly apart and find a comfortable position for your arms.
• Inhale through your nose and exhale through your mouth.
• Concentrate on your breathing.
• Inhale while slowly counting to four. Notice with each breath you take that you are breathing effortlessly by using your diaphragm. You should feel as if the air is first expanding into your abdomen and up into your lungs, then expanding warmth to all parts of your body.
• Pause for 1 second, then slowly exhale to a count of four. As you exhale, your abdomen should move inward. As the air flows out, feel the tension and stress leave your body.
• As you begin to relax, clear your mind of any distractions by imagining a peaceful, healing environment.
• Repeat the process for 5 to 10 minutes or until you achieve a sense of deep relaxation.
If you find yourself having trouble learning how to relax or perform visualization exercises, find a practitioner who specializes in guided imagery by contacting the Academy for Guided Imagery at (800) 726-2070 or www.acadgi.com, or you can ask your doctor for a referral. Taking a yoga class is also a great way to learn how to breathe with your diaphragm and learn how to relax.
Jeff Levin, Ph.D., the author of God, Faith and Health, is recognized as one of the leading researchers in the field of spirituality and health. As a first-year graduate student in the School of Public Health at the University of North Carolina in Chapel Hill, Levin became intrigued by two articles that found a surprising and significant connection between spirituality and heart disease, a connection that remains one of the best-researched areas of the positive effects of religious behavior on health. His curiosity led to an in-depth evaluation and pioneering research on the impact of religious practices on disease.12 In God, Faith and Health, Dr. Levin notes that there are more than 50 studies in which religious practices were found to be protective against heart disease, decreasing the risk of death from heart attacks and strokes as well as reducing the incidence of numerous risk factors including high blood pressure and elevated cholesterol and triglyceride levels. In particular, Dr. Levin highlights the strong inverse correlation between religious commitment and blood pressure that was evident no matter what religion an individual chose to practice or his or her geographical location or ancestry.
Final Comments
Often practitioners of natural medicine are asked for a blueprint for good health and effective healing. Most people are looking for a simple answer, but our feeling is that living healthfully requires a truly comprehensive commitment in all aspects of being. Here are what we consider the critical steps to living with vibrant health:
QUICK REVIEW
The placebo response provides significant evidence of an innate healing ability.
• A great deal of the credit for the placebo response has been ascribed to its ability to increase endorphin levels.
• Placebos have been shown to have an impact on centers of the brain that stimulate healing.
• The placebo response produces numerous changes in chemical mediators of pain, inflammation, and mood.
• The overall placebo response is about 32% in clinical trials, but in some real-life clinical circumstances it may be as high as 80 to 90%.
• Patients of a compassionate, warm, and caring physician will experience better outcomes and fewer medication-related side effects than patients of an uninterested, cold, and uncaring physician.
• Numerous scientific studies have now fully validated the efficacy of faith, prayer, and religion in healing.
• There are more than 50 studies in which religious practices were found to be protective against heart disease, decreasing the risk of death from heart attacks and strokes as well as reducing the incidence of numerous risk factors including high blood pressure and elevated cholesterol and triglyceride levels.
• Step 1: Incorporate spirituality into your life.
• Step 2: Develop a positive mental attitude.
• Step 3: Focus on establishing positive relationships.
• Step 4: Follow a healthful lifestyle.
• Step 5: Be active and get regular physical exercise.
• Step 6: Eat a health-promoting diet.
• Step 7. Support your body through proper nutritional supplementation and body work.
The next section discusses these steps fully.
Last, one of the fundamental principles of naturopathic medicine as well as other time-tested systems of medicine is to first remove obstacles to a cure. What do we mean by obstacles to a cure? Well, a nutrient deficiency is often a major obstacle to true healing, as are things such as habitual expression of anger, contamination with heavy metals or environmental toxins, genetic predispositions and metabolic abnormalities, and obesity. These obstacles often make even the most powerful medicines—whether natural or man-made—ineffective. Establishing a relationship with a naturopathic physician or other wellness-oriented professional is often a valuable step toward identifying and eliminating obstacles to a cure. Removing such obstacles allows the healing power within the best opportunity for success.