October 25, 2002, Friday
By Barbara Lantin
The Daily Telegraph (London)
Sylvester Colligan was delighted with the results of his knee operation. Before the procedure, he could barely walk. Afterwards, he moved without pain, and, six years on, he is still mobile. But Sylvester now knows that his operation was a sham - a placebo control in a trial to test the effectiveness of different treatments.
The results of the trial - carried out in Houston and featured in Placebo: Cracking the Code on the Discovery Channel tomorrow night - were startling. Patients subjected to conventional arthroscopy, where the joint is cleaned out and cartilage scraped away, fared no better than those who were lightly anaesthetised and had three incisions made in their knees before being sewn back up again. The placebo effect is a powerful medicinal tool: in an average drug trial, 35 per cent of patients receiving dummy pills show an improvement in their symptoms. But the discovery that fake surgery can be as effective as the real thing is just one of many surprises emerging in the rapidly expanding field of psychoneuroimmunology (PNI) or mind-body medicine. In time, these revelations could transform the way Western medicine is practised.
"There is now a substantial amount of sound scientific evidence demonstrating that an individual's thoughts, feelings and spirit can have a profound effect on their endocrine, autonomic, cardio-respiratory, gastrointestinal and immune systems," says Dr Alan Watkins, lecturer in medicine at Southampton General Hospital. "A physician's attitude and approach can significantly influence a patient's mental, emotional and physical wellbeing, either stimulating or handicapping recovery."
Devon GP Dr Michael Dixon goes further. "The placebo effect is the strongest, most comprehensive and most proven medicine available to GPs. A proper understanding of it could greatly improve our therapeutic effect and reduce the cost of medicine and procedures."
For years, the placebo effect has had a bad press. Those organising clinical trials go to extraordinary lengths to rule it out when presenting their results, and any medical intervention that is deemed to be "no better than placebo" is dismissed as worthless. But the truth is that many know it works, and are quietly using that knowledge.
Drug manufacturers have discovered that large pills produce better results than small ones, red ones are more effective than white, blue pills are more likely to improve sleep, and four pills taken regularly work better than two. Although GPs are officially not supposed to prescribe a placebo, 63 per cent of 200 who took part in a survey said that they had done so.
Studies have shown a significant placebo response in conditions as wide ranging as cardiac failure, peptic ulcers, multiple sclerosis, dementia and schizophrenia. In some conditions, the more severe the symptoms, the better the placebo effect. Irving Kirsch, professor of psychology at the University of Connecticut, claims that data from the original trial on Prozac submitted to the Federal Drugs Administration shows that placebo is 80 per cent as effective as the active drug.
The word "placebo" derives from the Latin verb placere meaning "to appease or placate" and the term encompasses many intermeshing strands affecting healing. "There are a lot of different things disguised in what happens when somebody who is given an inactive substance seems to get better," says Dr David Peters of the University of Westminster. "It has to do with the patient, the practitioner, the medicine itself and a combination of all of these."
Even the setting can play a part. In one trial, post-operative patients were assigned either to a room with a view or one facing a brick wall. Those looking on to the meadow had a shorter stay in hospital, made fewer complaints to nurses and took fewer strong painkillers than those overlooking the wall.
If you are more prone to getting a cold when you are stressed, you will know that your state of mind can affect your body - and the effect can work for good or bad.
Work by Dr Steven Greer at the Royal Marsden Hospital has demonstrated that cancer sufferers who displayed a "fighting spirit" were 60 per cent more likely to be alive 13 years after diagnosis than those who felt "helpless and hopeless".
In a recent study at Imperial College, London, patients with chronic genital herpes that did not respond to medicine were taught to practise self-hypnosis three times a week for six weeks. "The recurrence rate of the condition halved, which is a phenomenal result in these severe cases," says John Gruzelier, professor of psychology at Imperial.
"We looked to see what happened when we injected a blood sample with the virus before and after the self- hypnosis training. After training, the cytotoxic [cell-destroying] effect of the body's natural killer cells stepped up immensely in two thirds of the group."
The study of PNI is in its infancy, but it is thought that the brain can reverse disease via a group of neurotransmitters called neuropeptides. These are triggered by the physiological equivalent of feelings and thoughts, and can lock on to cells all over the body. One is endorphin, the "feel-good" effect released by strenuous exercise. Others can boost the production of killer cells and lymphocytes and reduce levels of cortisol, all of which can strengthen the immune system.
The potential for mind-body medicine is enormous, says Prof Gruzelier, who is about to embark on trials of self-hypnosis for advanced breast cancer and early-stage HIV. "It's non-invasive, easy to teach and to do, and very cost effective."
Over the next few weeks, 30 families in Devon will begin a year-long trial of a form of Japanese family healing called johrei. "In England, we see more than 90 per cent of our patient population in any five-year period, but during my visit to Japan, I came across very few people practising this form of self-healing who had seen a doctor in the past 10, and almost none had taken any tablets in the last few years," says Dr Dixon.
"This may have been partly due to the healing, but also to their underlying philosophy, which sees much self-limiting disease as a positive experience and a means of allowing the body to clear out unwanted poisons and organisms."
During the trial, the 30 families will be closely monitored. Each includes a child with eczema, and the progress, if any, of this condition will be assessed, as will the family's general health, their use of NHS resources and medication, their levels of stress and depression and the quality of family and marital relationships.
"Modern medicine has lost its heart and soul and become mechanistic," says Dr Dixon. "The new GP contract talks about measuring cholesterol and blood pressure, but what patients want is a doctor who will listen, talk to them and understand them. What we call the placebo effect is really the human effect. Maximising it is not a question of deceiving: it is maximising the patients' ability to heal themselves - and that can be much more effective, 'natural' and less of a burden to the NHS than using drugs."
The Human Effect in Medicine, by Michael Dixon and Kieran Sweeney, published
by Radcliffe, priced pounds 19.95, is available from bookshops.
© Copyright 2002 Telegraph Group Limited