5. Worried about St. John's wort
Original antique bottles courtesy antiquebottles.com
Admit it. You take cough medicine. You think it works, and sometimes it does. But does it work cuz it, well, works, or because you believe it works?
Is
it real, or is it placebo? Is it medicine, or is it snake
oil?
It can be hard to know. "You believe therefore I cure" is the motto of the placebo effect. It's what happens when you take meds you think will work -- and they do -- even though the meds themselves are as bogus as a three-Euro bill.
The Why Files got interested in placebo during a session on complementary and alternative medicine, or CAM, at the American Association for the Advancement of Science meeting in February, 2002. (The session also covered hypnosis and St. John's wort, a plant medicine used to treat depression. We'll return to them -- promise.) Steven Straus, who directs the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NIH), says CAM includes "health care practices that are outside the realm of conventional medicine, and are yet to be validated by the scientific method."
Logically, complementary practices are intended to supplement conventional medicine; alternatives to supplant it.
For most of the past century, medical doctors have vilified CAM as "quackery" or "snake-oil." That hasn't stopped Americans from using it at ever-increasing pace. According to Straus, 42 percent of "the American adult population is trying ancient and modern CAM practices for a wide variety of human diseases and conditions and to promote and maintain health and well being."
The cost? $21 billion per year.
Functional magnetic resonance imaging shows the effects of acupuncture on the brains of normal subjects. Needle manipulation on either hand produced signal increases in the somatosensory cortex, but decreases in the nucleus accumbens and other brain locations. The Gollub Lab.
A big project
After long ignoring CAM, the medical establishment,
as embodied by the NIH, is suddenly fascinated at the notion that stuff
it doesn't understand could still work. The center Straus directs will
spend $100 million to study CAM during fiscal year 2002.
As Straus sees it, CAM is divided into five categories (each and every one anathema to conventional medicine, we might add).
Alternative medical systems: homeopathy, traditional Chinese medicine
Manipulative practices: massage, chiropractic medicine
Biologically based approaches: herbal medicine, diets
Energy healing systems: Qi gong, acupuncture
Mind-body interventions: meditation, prayer, hypnosis, placebo effect
Let's start our quest for CAM with the placebo effect, which recently made news when an English study found "conflicting evidence on the effectiveness" of cough medicines compared to placebo. When studies did have significant results, "the effect sizes were small and of doubtful clinical relevance," the researchers) wrote (or see Systematic Review... in the bibliography.
In other words, cough medicine worked about as well as the expectation of a cure.
Delusion causes a real placebo effect.
The placebo effect explains why:
If you believe sugar pills are real medicine, they can heal.
If you believe you're being treated for Parkinson's disease, your movement
may improve.
If you believe you're being treated for depression, your brain waves may
change.
Phony injections can kill real pain.
Real painkillers are less effective if given without your knowledge.
Pure water may taste sweet, if you're told it is sweet.
Red sugar pills quell pain better than blue ones.
Why fuss over the placebo effect? After all, it sounds like the perfect medicine -- since you may get better without real medical treatment or expensive drugs. Several reasons. First, the effect does not benefit everybody, and it's often temporary. Second, the effect drives researchers bonkers because folks in tests get cured after literally taking sugar pills. Third, because if the mind can affect the body so profoundly, it would be nice to get the lowdown on what's going on.
Placebo effect may be stimulated by the context of
medical delivery: Wisconsin physician's assistant student Cathy Kidd reviewing
patient charts.Jeff Miller, (c)
UW-Madison University Communications.
For all these reasons, placebo and other CAM techniques are poised to enter the medical mainstream.
Testing time at last
Research by the NIH, in other words, could mark the
beginning of the end of a long sojourn in the medical wilderness. The
techniques of CAM, once accepted or rejected on the basis of hearsay and
anecdote, are going to be tested.
Although Straus may head a center investigating some weirdo therapies, he's not gung-ho on aromatherapy or the healing hand. Instead, he's a hard-boiled medical doctor who wants to test CAM by the same standards used in conventional medicine.
At this point, however, he says most CAM cannot be accepted by medical doctors. "People may like them, may swear by them, but unless you study them, you just don't know" if they work.
If your mind can cure your cough, can it cure pain?
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