The Modern Practice of Medieval Medicine

 

“Medieval Medicine” is what doctors and other healers practiced for most of our recorded history (even before the Medieval Period, 476 AD through 1517 AD).  Medical practice was based on the defunct Theory of the Four Humors (balancing body fluids), ridiculous notions of anatomy and physiology, very occasional, haphazard and isolated scientific discoveries and results falsely associated with confirmation bias and the placebo effect.  The great hallmark of Medieval Medicine was that doctors did not follow scientific research and experimentation (because there was none) and allowed the healer’s individual, biased observations and the patient’s placebo effect to dictate practice.

Modern Medicine had to wait for the Germ Theory of Disease (germs carry disease not evil spirits or magical forces), precise knowledge of anatomy and physiology, treatment based on scientific experimentation and techniques coordinated with statistically successful outcomes (from about 1870 onward).  The great hallmark of Modern Medicine is that it follows years of scientific research and experimentation to remove doctor and patient biases and requires improvement above and beyond the patient generated placebo effect.

“Medieval Medicine” is placebo based folk medicine from our not too distant past.  Divorced from even basic biological knowledge and absent any research methodology, healers practiced according to their personal observations.  Unfortunately, almost any procedure was perceived to have “worked” because of the placebo effect and our natural survivability for most diseases.  In this setting of false associations and confirmation bias, bloodletting, prayer, poisonous purgatives and emetics, “…eye of newt and toe of frog, wool of bat and tongue of dog…”(Shakespeare), moxibustion, water, sugar, oil, alcohol based “snake oil” concoctions, etc, all appeared to work.  Everything “worked” because the placebo effect and doctor/patient bias was always present.

As these folk medicines trickled down through history, trial and error usually did away with those that were overtly harmful.  But even therapies that weren’t overtly harmful didn’t do any good either, since all they ever were was the patient generating their own placebo improvement.  In other words, the theatrics engaged in by these “healers” had no healing effect but since the patient usually improved on their own, the healer and the patient thought that their system “worked”.  For example, aromatherapy has a certain theatrical procedure, just as does iridology, reflexology and the pretty, fluid movements of reiki energy attunement.  The various theatrics of the different alternative systems do nothing.  “A placebo is a zero”, as Dr. Steve Novella, from Sciencebasedmedicine.org often states, but since the patient almost always improves, patient and “healer” fool themselves and confirm their own biases that their particular brand of theatrical “medicine” is working.

There are three situations where “Medieval Medicine” is still practiced in our world.  As we might expect, underdeveloped countries with few educational opportunities still practice superstition based law and medicine.  Every year there are still a few stories of “witches” being burned at the stake in some small village.  And then there’s this:

“As BBC explains, the tradition of cooking (human) albinos into potions is not a new one in Tanzania, and the parents of albino children are forced to fear that, at any minute, a band of men may kidnap their children to sell to wealthy sectors of society for use in witchcraft.” http://www.breitbart.com/Big-Peace/2014/12/10/Tanzania-s-Albinos-Killed-Like-Animals-For-Body-Parts-Used-in-Money-Attracting-Potions.

These backward, pre-scientific, superstitions in isolated places around the globe do not undermine Modern Medicine. However, the second, more troubling situation in which “Medieval Medicine” is practiced is the growing infusion of placebo based folk medicines into Science Based Medicine (SBM).  More and more (previously) reputable medical centers, MDs in private practice and medical insurance companies are becoming associated with these pre-scientific systems of medicine which are labeled complementary, integrative or alternative (CIA).

It’s hard to imagine that intelligent, well educated people can use ineffective, pre-scientific medical systems like homeopathy which are proven not to work or fool themselves into believing that invisible forces like reiki are real and will magically heal.  But just how outlandish and goofy can alternative medicine get?  Would you believe…doll tapping?   That’s right: if you have a headache, you tap your surrogate doll in the head.  Shoulder pain?  Tap the doll in the shoulder.  It’s very hard to believe that anyone thinks this nonsense could possibly have any effect but here it is: “Voodoo acupuncture doll tapping” (also known as Tong Ren Acupuncture): http://www.youtube.com/watch?v=fqp0PTigz7E.   The MDs at Science Based Medicine do not recommend watching this video while eating or drinking since the resultant hysterical laughter presents a very real choking hazard.

The patients in this video look like well-educated, affluent and caring individuals.  But they’re also poster children for the Dark Ages.  If you’ve ever wondered what it was like to believe in witchcraft, magical forces and hobgoblins, these people are good modern day examples. This video even has Craig Benson, the former governor of New Hampshire, as an advocate of Tong Ren.  By all that’s rational, what’s next in the, “Annals of Alternative Medicine”: hand puppets?

The reason for this improper mixing of science and superstition in modern medical practice is the desire on the part of MDs to please the patient (placebo) when they have no statistically significant SBM therapy to actually heal the patient.  For example, back pain, knee pain, end of life situations, etc, all push scientifically minded MDs toward an attitude of, “Since I can’t do anything real for the patient, I’ll refer them to the “snake oil”, Voodoo, doll tapping people.  What’s the harm?”

Even though CIA medicine is a poor second to Science Based Medicine in this context, it is not the worst practice that MDs do to undermine their own profession.  The Board Certified MD who does not just endorse or refer patients to snake oil salesmen but actually practices it themselves is the worst use of Medieval Medicine in our modern world.  Some doctors still ignore years of scientific research and confuse their own biases, personal experience and the patient’s placebo effect with good medical practice. MD’s who set themselves up as Lyme disease specialists (LLMD’s) and anti-vaccine MDs fall into this Medieval Medicine category.  There is information about Lyme treatment here, http://www.noozhawk.com/article/victor_dominocielo_two_treatments_for_lyme_disease                                           and vaccines here, http://www.noozhawk.com/article/victor_dominocielo_vaccination_rates_dropping_in_santa_barbara_county        .

But the practice of Medieval medicine in our modern society can get even worse. Dr. Ben Johnson, MD, sells Harmonized H2O (Osmosisskincare.com) which he claims “vibrates” and sends “frequency messages” to harmonize internal imbalances in our bodies and enhance our tanning hormone. It’s magic water that will protect you from UV rays, in other words, drinkable sunscreen.  There is no known mechanism in physics, chemistry or biology that could explain these ridiculous claims but that doesn’t stop Dr. Ben.  Magic water at $30 bucks a bottle.  Sounds legit!

Then there is Dr Oz, an outstanding cardiothoracic surgeon, who gets a bit carried away with his beliefs in pre-scientific “energy medicine”, herbalism and the very profitable supplement industry.  Besides being hauled before a Senate Sub-Committee because of his use of misleading and deceptive advertising, Dr Oz lets his wife and her girlfriends “play” in his operating room.  “Occasionally, Oz even invites Reiki masters into his operating room, allowing them to tend to patients undergoing precarious surgeries like heart transplants. Drawing on viable unseen energies, Reiki masters like Pamela Miles and Julie Motz have melded their expertise with Oz’s mastery as a heart surgeon.”   http://iarp.org/dr-oz-and-the-healing-power-of-reiki/.  Talk about corrupting the practice of Science Based Medicine!  What kind of medicine are we practicing when we need a sign over the hospital entrance which says, “Please keep the Reikian Energy Healers out of the Operating Room”?

In the entire history of science, we have never gone deliberately backwards in our explanation of the natural world.  We don’t expect geologists to come up with pre-scientific, alternative explanations for volcanoes such as, “The gods must be angry; we’d better sacrifice a virgin”.  Unfortunately modern medicine can now claim that dubious distinction.  Dr. Mark Crislip, M.D., sums up the problem very succinctly: “It is an oddity of medicine.  I would wager that astronomy journals do not publish editorials touting astrology as a solution for difficult problems.  Similarly, psychology journals do not look to psi and chemistry journals do not advocate the methods of alchemy.  In medicine, the editors (of medical journals) have no problem with suggesting nonsense…” (sciencebasedmedicine.org/urinary-tract-infections-cause-depression-directors-cut/#more-30052).

When MDs refer patients to placebo based folk medicine, they are fostering the practice of “Medieval Medicine”, ignoring decades of scientific research and are providing recommendations and interventions based on their own biased clinical observations, biased patient reports and the patient generated placebo effect.  Modern Medicine has to grow up, keep moving forward scientifically and leave the pre-scientific superstitions and practices of medieval medicine behind.  Let’s keep the “medieval” out of Modern Medicine.

 

Victor Dominocielo, M.A. 1/2/15

Victor Dominocielo, M.A., a California-credentialed teacher for 37 years, is the Human Biology and Health teacher at a local middle school. He earned his Master of Arts degree in Education from UCSB. The opinions expressed are his own.

 

 

 

 

 

 

As many know by now, there are two distinct and different treatments for Lyme disease.  One treatment plan voiced by the CDC, the Infectious Disease Society of America (IDSA) and every Emergency Room around the country is that there is no Chronic Lyme Disease (CDL) and that one or two, 10 to 30 day courses of antibiotics will definitively kill the Lyme disease.  However, if not caught early, systemic damage can take years to fade away.

The second method of treatment voiced by MD’s that call themselves Lyme Specialists or Lyme Literate MD’s (LLMD’s) advocates that there is Chronic Lyme Disease (CLD) and that it is best treated with long term antibiotics.

How does this happen?  How can there be two distinct methods of treatment in a scientific profession with the most educated, literate medical specialists on the planet?  How did this situation come about and how can scientific and historical analysis help to understand this troubling situation?

The first scientific precept to understand in this situation is that anyone can be fooled and that the easiest person to fool you, is you.  MD’s, Judges, PhD’s in physics and even Neils DeGrasse Tyson are susceptible to the prejudices and biases of the human species.  This is the fundamental basis for the existence of science: a methodology for understanding the natural world that is not anecdotal, that is not your personal story or your individual perception.

The second historical connection to be made is that throughout the entire history of medicine, this kind of dissention around the proper treatment for the same physical ailment is the norm, not the exception.  Over the last 3000 years, healers have been on their own or in small groups, using only their clinical practice, personal experience and desire to alleviate pain and suffering to help them decide the best course of treatment.  For thousands of years, medical treatment was hampered by completely inadequate theory (Four Humors and Spontaneous Generation), Stone Age tools (basically a knife) and personal experience/ guesswork.  Modern medicine began around the 1870’s with the introduction of the Germ Theory of Disease, the consolidation of scientific methodology (experimentation) in universities throughout the world, statistical analysis of treatment results and significantly faster communication technology (telegraph, 1838; telephone, 1878; radio, 1901) enabling the sharing and comparing of scientific results.

The definition of modern medicine is that clinical treatment protocols must follow research, rigorous experimentation and statistical outcome analysis of a clinical trial period.  If this scientific process is ignored and only clinical experience is used to evaluate and treat patients, then that physician is practicing “medieval” medicine.  How do you tell a renowned physician with 30 years of clinical healing experience, that the results he sees with his own eyes can be tainted and corrupted by his very desire to make patients well?  How do you tell a leader in the field of medicine that her 30 years of personal experience amounts to anecdotal medical stories…unless she is following experimentally based protocols?   It’s a hard sell.

When Lyme disease first started showing up in the early 1970’s, MD’s were on their own as far as treatment protocols.  Give antibiotics for a short time or for a long time were the two main avenues of treatment.  Over the next 40 years, treatment results began to accumulate and well-controlled experiments were carried out producing scientific protocols.  The main result of the scientific experimentation was that one or two courses of antibiotics kills Lyme disease and that symptoms and systemic damage caused by the disease can take years to fade away – whether or not long term antibiotics are given.  In other words, there is no such thing as Chronic Lyme Disease and long term antibiotic therapy does not improve the lingering symptoms.

The best history of this unfortunate situation is published in the Lancet here:  http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970034-2/abstract.

New England Journal of Medicine further describes the lack of protocols and controls on LLMD’s: http://www.nejm.org/doi/full/10.1056/NEJMra072023:

“The diagnosis of chronic Lyme disease and its treatment differ substantively from the diagnosis and treatment of recognized infectious diseases. The diagnosis is often based solely on clinical judgment rather than on well-defined clinical criteria and validated laboratory studies, and it is often made regardless of whether patients have been in areas where Lyme disease is endemic…”

“How should clinicians handle the referral of symptomatic patients who are purported to have chronic Lyme disease? The scientific evidence against the concept of chronic Lyme disease should be discussed and the patient should be advised about the risks of unnecessary antibiotic therapy. The patient should be thoroughly evaluated for medical conditions that could explain the symptoms. If a diagnosis for which there is a specific treatment cannot be made, the goal should be to provide emotional support and management of pain, fatigue, or other symptoms as required.  Explaining that there is no medication, such as an antibiotic, to cure the condition is one of the most difficult aspects of caring for such patients. Nevertheless, failure to do so in clear and empathetic language leaves the patient susceptible to those who would offer unproven and potentially dangerous therapies.”

The LLMDs who chose long term antibiotic therapy were encouraged by their patients’ desire to please, vocal patient advocacy/support groups, laboratory companies that promoted expensive testing and even movie producers (“Under Our Skin”) who had an investment in producing certain results.  All of this corrupted, unblinded, emotional and anecdotal experience is filtered out by the scientific process to produce correct medical protocols.  When this tainted evidence is not filtered out by laboratory experimentation, then even the best doctors in the world can fool themselves into practicing “medieval” medicine.

Time will eventually filter out medicine practiced on the exclusive basis of clinical treatment.  More scientific studies will accumulate and it will become harder and harder for LLMD’s to justify the harmful effects of long term antibiotic therapy.

By Victor Dominocielo, M.A., 6/26/14

Victor Dominocielo, M.A., a California-credentialed teacher for 36 years, is the Human Biology and Health teacher at a local middle school. He earned his Master of Arts degree in Education from UCSB. The opinions expressed are his own.

 

 

 

 

 

 

 

 

 

Why do we get well?

 

After we get sick, why do we get well?

Modern, evidenced based medicine has only been around for about the last 140 years, so how and why did we get well in our early history and pre-history?  Thousands of years ago, how did we get well?

When we are sick, we get well for the same reason that all plants and animals get well after getting a disease: we are the result of 3.4 million years of our ancestors successfully surviving diseases.  In addition to that main process, nursing care (shelter, warmth, food, water and cleanliness when we are incapacitated) delivered by family members, clans and tribes, is a secondary, “social animal” factor for getting us through significant illnesses over the millennia.  In addition to these two main and significant evolutionary benefits, our very recent and modern evidence based medicine (since the 1870’s), clean water and reliable nutrition are responsible for nearly doubling our life span.

So, we get well because we are the survivors of millions of years of evolution, the actual “survival of the fittest” process in action.  However, this cyclical nature of disease, that is, our natural ability to heal ourselves and survive, opens the door to all manner of non-scientific, folk medicine “cures” and “snake oil” salesmen masquerading as evidenced based medicine.  The usual process is that as our bodies naturally heal, some “cure” or magic pill is presented to us and we convince ourselves through false associations and confirmation bias that the magic pill or procedure made us better…even though our bodies were getting better on their own.  Due to this typical false association, which continues to recur in every generation, the only way to know that one event causes another is to do repeated, double-blinded, placebo controlled experiments.

Instead, people tend to associate notable events before an illness as the cause and notable events toward the end of an illness as the cure.  “I got a flu shot and it gave me the flu” is an often heard refrain.  We remember the flu shot (a notable event) but we cannot sense when the flu virus actually entered our body and subverted our immune system, so we blame the notable event.  Flu shots contain dead cells so it is impossible for the shot to cause the flu.  As our body naturally fights off the flu virus over several days, we might try high doses of vitamin C, aroma therapy or homeopathic dilutions and falsely associate that those procedures were responsible for healing us.  But we were getting better anyway.

So with all these biases, false associations and placebos cluttering our decision making landscape, what is the best method for making decisions about our health?  The process of getting sick naturally causes us to focus on getting well and the sicker we get the more focused we become on getting better.  This process of being sick and getting well, repeated many times during our lives, puts us in a very vulnerable position and susceptible to believe in just about any placebo that promises to cure us and make us healthy.  The history of medicine through the ages is about believing that just about any strange practice will cure us and make us better.  Even today the equivalent of modern day shamans and “healers” scramble to benefit from our disease cycle of getting sick and then naturally getting well.  Bloodletting is still practiced as a folk medicine, invisible body parts are claimed to channel life energy, the body reacts to special vibrations of substances that cause harmony, magical water and sugar cures us, psychic surgery removes toxic substances, cranial massage and therapy realigns our biofields, aromas, auras, ear candling, moxibustion, chelation therapy and even magnets heal our body.  These practices, which take advantage of our suggestibility when we are sick, are individually described in the Skeptics Dictionary (Skepdic.com).

Most unfortunately, last year Steve Jobs fell prey to this typical false association pattern:

“In 2003 Jobs was diagnosed with pancreatic cancer, which further tests revealed to be an islet cell or pancreatic neuroendrocrine tumor that is treatable with surgical removal, which Jobs refused.  ‘I really didn’t want them to open up my body, so I tried to see if a few other things would work,’ he later admitted with regret.   Those other things included consuming large quantities of carrot and fruit juices, fasting, bowel cleansings, hydrotherapy, acupuncture, herbal remedies, a vegan diet and a few other treatments he found on the Internet or by consulting people around the country, including a psychic. These other things didn’t work, and in the process we find the alternative medicine question, “What’s the harm?” answered in the form of an irreplaceable loss to humanity.”  (Michael Shermer, Skeptic Magazine, 7/10/13).

So, if the recurring “disease” of humanity is an overactive suggestibility to placebos when we are sick, then the cure, most certainly, is Science Based Medicine.  It can’t cure everything but it’s not a placebo, not a patient generated effect and it has the distinct advantage of not being invisible or using magical and undetectable forces.

Victor Dominocielo, M.A.

Victor Dominocielo, M.A., a California-credentialed teacher for 36 years, is the human biology and health teacher at a local middle school. He earned his Master of Arts degree in education from UCSB. The opinions expressed are his own.

 

How a Folk Medicine Gets Started:

A Sugar Cube and a Drop of Kerosene

The following is a family story from my wife’s friend, Janice, whose father lived in Ojai during the 1918 Flu Pandemic. The 1918 Spanish Flu/Swine Flu was by far the most deadly disease in history, surpassing even the infamous Black Death of 1347 – 1351. Janice’s father was about 5 when the flu moved through his family home in Ojai and he’s still alive at 99. There were about 10 people living in his home and they heard that a drop of kerosene on a sugar cube would “cut the phlegm” and help victims to survive. (The kerosene would probably make users gag and cough up mucus, providing a few minutes of temporary relief). All the family used this folk remedy except one young mother and her two very young children. In tragic happenstance, all the family members became sick with the flu and survived… except the young Mom and her two children. Compounding this terrible incident, the community required their home to be burned immediately along with all their clothes – as was often done during smallpox epidemics (a virus) and during the time of the Bubonic Plague (a bacterial infection carried by fleas on rats). Despite these tragedies, this family survived and thrived and I shook the hand of the 99 year olds daughter a few weeks ago.

The obvious false association was made, that a drop of kerosene on a sugar cube would help you survive the deadly flu virus. Family members gave heart rending anecdotal testimony of the lifesaving practice, convincing others in this desperate time. People compounded the falsehood by their own confirmation bias, looking for confirming examples and discounting contrary information. The placebo effect made people who took this remedy feel confident that they were doing the best practice for their health.

All countries have their folk medicine practices which come into and out of vogue in different historical time periods. Often, people from one country become enamored of a folk medicine from another, more exotic, country. In America, many people are currently captivated by Chinese folk medicine and Indian Ayurvedic folk medicine. German folk medicine, Homeopathy, still attracts millions of followers who spend billions of dollars worldwide, on their pills and potions. The greatest folk medicine of all time, spanning 3,000 years (up until the 1870’s) and several civilizations, from the ancient Egyptians to the Greeks, the Romans, throughout the European countries, to India and even to the Americas, was bloodletting. It is still practiced today as a folk medicine in India and other countries.

All these folk medicines get started and have the same effect (the placebo effect) as the kerosene on the sugar cube remedy. But why does generation after generation, the best and the brightest of so many civilizations, continually make these wrong associations? There are two simple and straightforward reasons:

1. After we get sick, we get well for the same reason that all living things get well: we are the beneficiary of 3.4 million years of non-random, “survival of the fittest” selection (more recent information suggests that our Ardipithicus ancestors split from chimps about 5-6 million years ago). So while our bodies are naturally fighting off disease and recovering from injuries, any folk remedy or “snake oil” can step in and claim that it was their potion or procedure that made us better. This is why the tribal “medicine man” and “witch doctor” were tolerated: people tended to remember their successes (hits) and forget their failures (misses).

2. We have a pattern forming brain that is subject to consistent and continual human error. Sometimes we see patterns that are not there (sugar/kerosene) and sometimes we don’t see patterns that are there (survival of the fittest).
People who believe in the various folk medicines often say, “…but it works for me!”
What is actually working is millions of years of evolutionary benefits which are misunderstood with personal false associations, post hoc thinking, confirmation bias and the patient generated placebo effect.

The only way to insure that a particular remedy is producing a medical improvement is to do repeat, double-blinded, placebo controlled experiments at different research centers over several years. Then the results of the placebo control group have to be subtracted from test group to produce the evidence based improvement of the specific drug or procedure. That’s evidence based medicine and that’s the only medicine there is. As Harriet Hall, M.D. has written:
“We frequently criticize the media for gullible reporting of pseudoscience and inaccurate reporting of real science. But sometimes they exceed our fondest hopes and get it spectacularly right. On December 25, 2008, the Wall Street Journal gave us all a Christmas present: they printed an article by Steve Salerno that was a refreshing blast of skepticism and critical thinking about alternative medicine.”
“Salerno points out that 38% of Americans use ‘complementary and alternative medicine’ (CAM) and it is being increasingly accepted in hospitals and medical schools. He says this should be a laughing matter but isn’t because of the huge amounts of money being spent on ineffective treatments. Not to speak of the huge amounts of money being wasted on implausible research at the NCCAM. He highlights a painful irony: the same medical centers that once fought quackery are now embracing it, not because they think it will improve patient care, but because it will increase their revenue.”
“Salerno quotes Dr. George Lundberg, one of the many who have said there is no such thing as CAM…’There is only medicine that has been proven to work and medicine that hasn’t. If science showed that an alternative treatment really worked, it would be promptly and enthusiastically incorporated into standard medical practice and would no longer be considered alternative’. So the very term is misleading.”

“‘Alternative medicine’ is not a scientific concept. It is a political, ideological ploy intended to raise public respect for a mishmash of untested, unproven, and even disproven treatments that are rejected by the scientific community” – Dr. Harriet Hall, M.D.
Victor Dominocielo, M.A.

Victor Dominocielo, M.A., a California-credentialed teacher for 36 years, is the Human Biology and Health teacher at a local middle school. He earned his Master of Arts degree in Education from UCSB. The opinions expressed are his own.

The Placebo Effect:

It’s not just a little white pill

The typical scientific definition of a placebo is, “The placebo effect is the measurable, observable or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered.” – The Skeptics’ Dictionary (Skepdic.com).  The reason that the placebo effect is scientifically measurable is because the gold standard of any research on human beings includes a placebo control group, which is given a sham treatment or pill identical to the pill/procedure being tested but without the active ingredient or actual procedure.  The difference between the placebo group improvement and the actual procedure/drug being tested can then be measured.  This is the description of the placebo effect from the research point of view when a placebo is compared to an actual therapeutic procedure. There are a number of excellent articles on the placebo effect at Sciencebasedmedicine.org.

However, the placebo effect takes place whether or not you are comparing it to or measuring it against another pill, potion or procedure.  From the patients’ point of view, the placebo effect is a constellation of patient generated responses to the stimulus of a motivational story and a possibly therapeutic procedure.  The more dramatic the story and the more invasive the procedure, the greater the potential placebo effect that is produced. There is even a placebo continuum of sorts: sham surgery has a greater effect than a placebo injection; injections have more of an effect than placebo pills; brand name placebo pills have a greater effect than blank white placebo pills and taking placebos four times a day has a greater effect than taking placebos two times a day, etc.

Almost any procedure can have a beneficial effect if it is part of a “therapeutic” story.  What’s going on is a self-fulfilling prophecy: the healer is telling you that this procedure will make you well and you very much want to be well, so your body ralleys, physically and psychologically, to that end and a placebo improvement occurs.

The placebo pills, potions and procedures do not actually affect the intended illness and the particulars of the various placebo procedures are incidental to any improvement.  Test subjects given sham alcohol will demonstrate the effects of being drunk; asthmatics given water in their inhalers will show improvement in their asthma symptoms and subjects who are not lactose intolerant and who are told that they are will produce symptoms of lactose intolerance.

All medical procedures produce a patient generated placebo effect.  Science based medicine, complementary, alternative, integrative, folk medicine, ridiculous snake oil remedies, etc, all produce a placebo effect.  Surgery, stitches, acupuncture, aromas, magically energized water and sugar, alcohol, a cold shower, a slap in the face, cranial massage, rearranging invisible bio-fields, etc, will all produce a placebo effect if the “healer” tells the patient that the placebo will be curative.  Even harmful procedures, like swallowing a long, thin cotton sheet and gagging as you pull it out, bloodletting, sticking pins in your skin or frequent enemas will produce a beneficial placebo effect if it is tied to a therapeutic story that gives the patient hope for relief of their symptoms.

So, how does the patient generate this placebo effect?   Here are the elements of the constellation of events that produces the patient generated placebo process:

1. Being sick, injured, miserable and in pain causes our natural skepticism to be replaced by suggestibility and hope as we seek any method to relieve our illness or injury. We quickly become willing to abandon the Germ Theory of Disease for invisible energy, magical vibrations and other “forces”.
2. We listen to the anecdotal testimony of others who were “cured” by some interesting potion, procedure or exotic folk medicine from another country. Personal success stories are colorful, emotional and we tend to trust the storyteller.
3. The process of treatment behavioral conditioning from childhood tells us that if we go to a healer, take a pill and/or subject ourselves to a healing procedure that we will get better. This is a, “If it worked before, it will work again”, type assumption.
4. Many illnesses and injuries heal naturally but we make a false association between the potion/procedure and our improvement. In a classical Post Hoc Ergo Propter Hoc thinking situation, we imagine that just because our improvement came after the folk remedy, that the improvement happened because of the folk remedy.
5. The drama effect: the procedure or ritual may be painful, risky and spectacular: surgery, bloodletting and stitches are very dramatic. So is acupuncture, moxibustion, enemas, induced gagging and vomiting.
6. The physical insult/rally effect: if the procedure includes a physical insult like induced vomiting/gagging, purgatives, bloodletting, needles, surgery, stitches, etc, then the body normally is stimulated to heal itself and overcome the insult.
7. The distraction effect: the greater the bodily insult, the more potential there is to distract the patient from their pain and condition. For example, induced vomiting and gagging will temporarily distract you from a headache.
8. Once our condition improves, even temporarily, we fall prey to confirmation bias, looking for supporting examples and discounting scientific evidence contrary to our personal experience (“…but it works for me!”). This self-fulfilling prophecy makes us habitually prone to finding what we want to find.
9. The confessional effect: speaking to a “healer” for 60 – 90 minutes who genuinely accepts you and all your bodily ills and is so concerned about you returning to good health feels wonderful.
10. Actual placebo improvement: the above process generates some improvement, not because of the particular procedure, potion or pill but because of the effects that this thinking and feeling process has on our bodies: adrenalin release, endorphins, stress reduction, memories of being taken care of by Mom, etc.

So, the next and obvious question, harped on ad infinitum by non-science based medicine promoters is, “What’s the harm?”  Well, if ALL medical procedures produce a placebo benefit, wouldn’t it be better to use science based medicine that subtracts the patient generated placebo effect and actually produces additional patient improvement?   Charging patients for their own patient generated placebo effect is harmful.   Claiming that patient generated placebo effects are produced by invisible and magical forces is untruthful and harmful.  Wasting patients’ time, energy, money and delaying and distracting them from obtaining often critical, science based medical care (as in the unfortunate case of Steve Jobs) is very harmful.  That’s the harm.

 

By Victor Dominocielo, 4/12/14

Victor Dominocielo, M.A., a California-credentialed teacher for 36 years, is the human biology and health teacher at a local middle school. He earned his Master of Arts degree in education from UCSB. The opinions expressed are his own.