The Placebo Paradox – and some thoughts about the placebo effect and healing

A fascinating Radio 4 programme about the placebo effect has given me food for thought about the nature of healing and medicine:

The Placebo Paradox

So often, when I was involved in health research, I was reminded of the parable of Nasruddin and the lost keys. It felt that rather like this sage/fool, the scientists were searching in the wrong places, simply because this was where it was easiest to see. They were not necessarily answering the questions we needed to answer in order to make wise decisions about health care – either personal or state funded provision. I found Professor Ted Kaptchuk’s placebo research to be of great interest at this time. At last someone was unpacking the placebo effect, and trying to understand more about it.

Ted is a small dynamo of a man with fantastic energy – I had met him in Oxford in the beginning of the 1990s when he gave a seminar for the Traditional Acupuncture Society – and I gave him lift back to London after the event, feeling very privileged and happy to listen to him talk more when I was just beginning my journey with acupuncture, and he was one of the biggest names. So it was wonderful to turn on the radio as I drove to Sheffield to meet a friend and colleague, to hear him on Radio 4 – talking to neurologist Ash Ranpura about his ongoing research programme at Harvard, which has much grown and developed over the last decade. People from all over the world join a multidisciplinary team led by Professor Kaptchuck, who sounded as enigmatic as ever.

My favourite section in the programme was when the producer asked Ted if there was not something bigger than science. and perhaps something mystical about the placebo effect. Push me hard on this question, asked Ted, and when it was all out he took a big deep breath and was silent for 30 seconds before answering. As if drawing from the space he gave himself to answer this important question and the potential of the silent moment, he responded that in all healing there is something intangible that can never be understood or explained by science. A person comes to a healer with uncertainty, suffering and a difficult present situation – they also have hope, and what he referred to as ‘tragic optimism’, which held the within it the potential for a better future. The next section of the programme moved on to talk about the body’s natural healing response, potentially another inconvenience for scientists trying to understand if an intervention is truly effective.

The programme ended by asking different stakeholders about their interest in the placebo – how important is it really to know if something has worked because of placebo or not? It was no surprise to hear a patient, who had knowlingly been healed by a placebo pill, answered that it was not important.

The programme raised several questions for me. Firstly, why is acupuncture so readily dismissed as placebo or connected with the placebo response? Talking therapies like cognitive behaviour therapy or counselling are not dismissed as placebo. It isn’t just ‘nothing’ to deeply listen to a patient, to connect with their disharmony in a way that resonates deeply within yourself, and to give support using theories and understanding that connect the practitioner to ancient wisdom and truths about natural phenomenon -and what might be needed to instigate the right sort of change and healing response. The needles are just part of the story.

Secondly I was  struck by how a physician/healer might help calm a person’s stress response down, which is very important in any illness where the person’s SES (social engagement system), is compromised. The SES and ventral vagus is is so fundamental to a person’s wellbeing and resilience – see previous blog. Again this isn’t just ‘nothing’. Its quite important.

So are my therapies placebo? I certainly hope so. Placebo isn’t the same as ‘nothing’ and I hope that one day we might understand much more about the nature of healing and how the body’s natural healing potential can be evoked by the right approach to help a person recover from illness. We also know, thanks to Ted’s team, that some placebos are better than others! Placebo acupuncture is more effective than placebo pills – so what does this tell us about acupuncture? That its all in the mind of the patient? That the impact of the care offered and received is all down to placebo and not worth funding? This would be like Nasruddin, looking for his keys in the light because he would be unlikely to find them where it was too dark.