altCure: A Journey into the Science of Mind over Body by Jo Marchant (Crown Publishers, 2016)

Jo Marchant is a scientist and a skeptic when it comes to alternative medicine, but could not deny the anecdotal evidence of its successes. In Cure she documents the efforts of researchers to figure out just what is going on with that, and concludes that the interaction of our minds and our bodies is a lot more complicated than we currently understand.

The placebo effect, and its evil twin, the nocebo effect, turn out to be much more powerful than initially believed, creating observable, measurable changes in our brains, and there are several ways to trick our minds into healing our bodies, some of them bordering on the absurd:  people can be healed by placebo pills even when they know they are placebos, even when they know the capsules they are swallowing are filled with nothing but air.

Hypnosis is fighting its way back from its circus sideshow beginnings and proving to be a powerful tool, especially in pain relief and autoimmune disorders. Meditation, too, is shedding its spiritual roots and looks promising for physical as well as mental problems. So does biofeedback. Virtual Reality therapy can apparently do a better job of controlling acute and chronic pain than high doses of addictive drugs.

As medical practitioners are pressed more and more to cut the time they spend with patients, evidence is mounting that health outcomes are greatly improved by listening, caring, reassurance, and ditching the traditional doctor-patient relationship for one in which the patient is considered a full partner in his health care. Family, friends, and social support also have a tremendous impact on health.

Cure is a fascinating book with two important drawbacks. The first one, the author recognizes:  acknowledging the power of the mind to affect the body may lead people—and/or their caregivers—to believe that their real, physical illnesses are "all in their heads"—or worse, that it's their own fault if they don't get well. Marchant hastens to explain that the mind-body interaction is a whole lot more complicated than that. I was reminded of the advice given by a pastor to the woman who reported that people were telling her she could throw away her cane if only she had enough faith. "Next time they tell you that," he advised, "Whack them over the head with your cane and say to them that it only hurts because their faith isn't good enough."

The second problem I doubt Marchant sees herself.  But the only section that disappointed me is where she tackled the possible effect of prayer on healing, and abandoned her otherwise balanced and open-minded approach. It shows through clearly that she didn't want to find any consequence of prayer that couldn't be chalked up to the placebo effect or a supportive social situation. Even worse, as is true of many researchers she treats "prayer" as if it were an abstract force independent of the particular faith of the pray-er and of whatever entity is on the receiving end of the prayer. As if the cause of a prayer's effect must be solely inside the person praying, so that there can be no difference whether one prays to Allah, Jesus, Thor, or the kitchen sink. With this weakness in methodology, it would have been better to skip the section on prayer entirely.

Here are a few quotes that stood out:

Big pills tend to be more effective [as placebos] than small ones. ... Two pills at once work better than one. A pill with a recognizable brand name stamped across the front is more effective than one without. Colored pills tend to work better than white ones, although which color is best depends upon the effect that you are trying to create. Blue tends to help sleep, whereas red is good for relieving pain. Green pills work best for anxiety. The type of intervention matters too: the more dramatic the treatment, the bigger the placebo effect. In general, surgery is better than injections, which are better than capsules, which are better than pills. There are cultural differences.... [A]lthough blue tablets generally make good placebo sleeping pills, they tend to have the opposite effect on Italian men.

[T]he placebo effect has a dark side. The mind might have salutary effects on the body, but it can create negative symptoms too. The official term for this phenomenon is the "nocebo effect" ... and it hasn't been much studied because of ethical concerns. ... Nocebo effects are even one explanation for the power of voodoo curses. ... [M]ost of the side effects we suffer when we take medicines are not due directly to the drugs at all, but to the nocebo effect. ... Italian researchers followed 96 men.... Some did not know what drug they were taking, whereas others were told about the drug and that it might cause erectile dysfunction. The percentage of patients in each group who subsequently suffered this side effect was 3.1% and 31.2%.

When we were prescribed Malarone as an anti-malarial, we deliberately did not read about the side effects, although I packed the information sheet just in case one of us started having weird symptoms. I guess that was a good idea.

[P]erhaps the most fundamental lesson from research on placebos [is] the importance of the doctor-patient encounter. If an empathetic healer makes us feel cared for and secure, rather than under threat, this alone can trigger significant biological changes that ease our symptoms.

Unfortunately, despite the public health disaster being wrought by prescription painkillers, there is relatively little research interest in non-pharmacological methods to help people deal with pain.... [P]art of the reason for the lack of enthusiasm is economic. Pain relief is a billion-dollar market, and drug companies have no incentive to fund trials that would reduce patients' dependence on their products.... And neither have medical insurers, because if medical costs come down, so do their profits. ... [T]here's no intervening industry that has the interest in pushing it.

That could be about to change, however. In March 2014, Facebook bought a little-known California startup called Oculus for $9 billion. The company specializes in VR [virtual reality] gaming and has just developed a headset called Oculus Rift, similar in size and shape to a scuba mask. Whereas the VR equipment [used with stunning success for pain relief] costs tens of thousands of dollars, Oculus sells its headsets for just $350 each. That promises to bring virtual reality within reach of ordinary consumers, who will be able to run wireless masks from their tablets or smartphones. ... Developments like this mean that people will soon be able to use virtual reality pain relief ... at home. It also means that virtual worlds are about to get much more sophisticated ... as video game companies throw resources at developing software to go with the new headsets. As well as better games ... that could lead to better pain therapies.... [W]e might soon see pain relief trials funded not by drug companies, but by the gaming industry.

Randomized trials comparing planned home and hospital births are almost impossible to do, because it's not practical or ethical to force women to give birth in a particular place. But there are plenty of large, observational trials.... These studies compare women who choose hospital birth with those who try to deliver at home (regardless of whether they have their babies there or end up transferring to hospital for pain relief or medical intervention). It turns out that simply by choosing home birth, women are less likely to require drugs to induce or speed up labor or relieve pain; less likely to be cut open or to tear; and less likely to need a C-section or instrumental delivery. Their babies are born in better shape and are more likely to breastfeed. ... It seems that when you replace easy access to technology with caring for a woman's emotional state, she and her baby fare much better—not just mentally but physically too. ... [T]he reassurance of someone we trust is not a trivial luxury. The right words can be powerful enough to replace aggressive medical intervention and transform physical outcomes.

All too often when we receive medical treatment, our mental state is seen as a secondary concern, and our role as a patient doesn't go much beyond signing consent forms and requesting pain-relieving drugs. ... The three projects described [in Chapter 7]—midwives supporting women during childbirth; radiologists changing how they talk to patients; and doctors discussing difficult questions with the terminally ill—instead give patients an active role to play. These might seem like commonsense interventions, but they all embody a fundamental (and for our medical system, revolutionary) shift in what it means to care for someone. Medicine becomes not an all-powerful doctor dishing out treatments to a passive recipient, but a partnership between equal human beings. This principle is at the heart of many of the other cases we've seen so far, too.... Instead of medicating their way out of problems with ever-greater doses of drugs and interventions, these medical professionals are harnessing their patients' psychological resources as a critical component of their care. They're doing this for adults and children; for chronic complaints and for emergencies; from birth until death. This approach provides a better experience for patients. It costs less. And it improves physical outcomes. Patients suffer fewer complications, recover faster and live longer.

[E]xperiences of social exclusion or rejection—such as being shunned in a game, receiving negative social feedback, or viewing images of deceased loved ones—activate exactly the same regions of the brain as when we are in physical pain.

The impact of loneliness ... depends not on how many physical contacts we have but how isolated we feel. You might have only one or two close friends, but if you feel satisfied and supported there's no need to worry about effects on your health, [researcher John] Cacioppo tells me. "But if you're sitting there feeling threatened by others, feeling as if you are alone in the world, that's probably a reason to take steps."

The most resilient kids were brought up by firm, vigilant parents.... But crucially, these parents were also affectionate, communicative and highly engaged in the children's lives. ... These kids knew where the boundaries were, and that there would be sanctions for bad behavior. But they also knew this was because their parents loved and cared about them.

I'm not sure why we needed a study to tell us that one.

Western medicine is (rightly) underpinned by science and trial evidence, and to many policy-makers and funders, physical interventions just "feel" more scientific than mind-body approaches do. Bioelectronics researcher Kevin Tracey is now enjoying millions of dollars of private and public funding to pursue his idea of stimulating the nervous system with electricity, even though as I write this, his largest published human study is in eight people. Gastroenterologist Peter Whorwell, by contrast, can't persuade local funding agencies to pay for his [Irritable Bowel Syndrome] patients to receive gut-focused hypnotherapy despite decades of positive trials in hundreds of patients.

At the heart of almost all the pathways I've learned about is one guiding principle: if we feel safe, cared for and in control—in a critical moment during injury or disease, or generally throughout our lives—we do better. We feel less pain, less fatigue, less sickness. Our immune system works with us instead of against us. Our bodies ease off on emergency defenses and can focus on repair and growth.

[R]ather than putting our faith in mystical rituals and practices, the science described in this book shows that in many situations, we have the capacity to influence our own health by harnessing the power of the (conscious and unconscious) mind. If you feel that alternative remedies work for you, I don't see any need to abandon them, especially when conventional medicine does not yet provide all of the same elements. But be critical of the advice that you may be offered by alternative therapists. And give your brain and body some credit. It's not necessarily the potions or needles or hand waving that make you feel better. Consider the possibility that these are just a clever way of pushing your buttons, enabling you to influence your own physiology in a way tha teases your symptoms and protects you from disease.

Or as Michael Pollen famously said, "Be the kind of person who takes supplements—then skip the supplements."

Posted by sursumcorda on Sunday, March 20, 2016 at 2:25 pm | Edit
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