Fake pills for kids?

Megan Ogilvie, health reporter for the Toronto Star, reported recently on Internet-marketed placebos for kids.

Obecalp is nothing more than a fruit-flavoured sugar pill meant to calm and soothe a child using the power of placebo. Though it may seem harmless, it raises a flurry of ethical questions about whether it conditions kids to always look for a cure in a pill.

I wouldn't worry about "angst bunny" grievances, but I do wonder about this:

When I was a kid (yes, fifty years ago), if an adult kissed the bruise, it got better.

Does anyone know how and why that stopped working?

Or ... is it illegal to kiss a bruise now? Is that the point?

Health can sometimes be fun, free, and painless: The placebo effect gets its own Web site

One of the non-material phenomena that Mario Beauregard and I wrote about in some detail in The Spiritual Brain is the placebo effect: You take a pill that you are told will help you feel better, and you do. That's pretty convincing evidence for the pill's curative powers - except for one thing. Studies* show that you might have experienced the same effect if the pill were only compressed sugar. Most people have experienced this action of the immaterial mind on the body.

A light-hearted Web site - sponsored by Australians Marg, Brian, Ludmila, and Michael - explores the effect in more detail, and addresses some common misconceptions - for example, that the placebo effect only works if you don't "know"that the pill is a placebo:

One of the rare studies into the action of the placebo effect in 'non-blind' clinical trials was undertaken by Lee C. Park and Uno Covi at the Johns Hopkins University School of Medicine in 1964. 'Non-blind' means that patients were informed that the pills they were issued were totally inert, that they were placebos, and in this case they were also assured that despite this the pills would be of benefit to them. The study concluded:

'The primary finding is that patients can be willing to take placebo and can improve despite disclosure of the inert content of the pills; belief in pill as drug was not a requirement for improvement.' (Ref. L. C. Park, U. Covi, Nonblind Placebo Trial - An Exploration of Neurotic Patients' Responses to Placebo When Its Inert Content Is Disclosed, Archives of General Psychiatry, April 1965, Vol. 12, pp. 336-345)

Research from the page also reminds us that nearly half of all physicians admit to prescribing placebos. As our Aussie "placebists" explain,

Whichever way we cut the arguments and the theories, the placebo effect is real and it is real because it engages those parts of human beings which defy reduction to the mechanical. It is real because it therapeutically engages human capacities and capabilities for which conventional medicine has only approximations and crude theorization, if not actual distrust. It may work in what to many are the scientific borderlands, but the important thing for us is that it works.

"The placebo effect can occur," as the physician Herbert Spiegel once put it, "when conditions are optimal for hope, faith, trust and love."

In my experience, most "skepticism" about the placebo effect - possibly the best attested effect in medicine - is linked to mechanistic materialism. If the mind doesn't exist, the placebo effect shouldn't work. But the one does ... so the other does.

On the main page, the enterprising placebists offer "Universal Placebo" pilules for sale. They are not, please note, claiming that it is a pharmaceutical. They emphasize that it is just plain sugar - add belief and swallow.

*Note: For more examples of such studies, see Placebo Effect: Your "mind's role in your health."

Placebo effect: Your mind's role in your health

Recently, a group of writers from The Word Guild got together and contributed essays to a book, Hot Apple Cider. I offered an essay that looked at some of the findings from The Spiritual Brain - what I learned about how mental states affect physical health. Here's part of my reflection, for your enjoyment:

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You probably aren’t waiting for science to come up with “the perfect pill for every ill,” but if you know anyone who is, he or she likely will be waiting a long time. Not because dramatic science discoveries will fail, but because the effect of many medical treatments depends at least in part on the patient’s expectation. Doctors know this by experience, of course, but research has shed new light on how powerful the patient’s expectation is.

In 2004, University of Michigan researchers reported on a study of pain experienced by healthy young male volunteers. To induce pain, they injected saltwater into their volunteers’ jaws and measured the impact by positron emission tomography (PET). They then gave the volunteers a substance described as pain relief. Not only did the volunteers report feeling better thereafter, but a number of brain regions that activate when we experience pain showed a reduced response. In other words, there was external evidence that the volunteers’ subjective belief that they felt better corresponded to the reality of pain signals in their brains.

However, … and this is the key point … no pain relief drug had actually been used in the study! The volunteers felt less pain simply because they believed they had received a powerful drug. The researchers commented that their study demonstrates how our perceptions truly affect the amount of pain we experience. This study, along with many others, showed that the effect of what we believe is real and measurable in scientific terms.

This effect is usually called the placebo effect, after a Latin phrase meaning “I will please.” Some researchers prefer to call it the “meaning effect” or the “remembered wellness” effect. Whatever its name, the meaning you attach to a treatment helps determine how effective that treatment will be for you.

For example, anthropologist Daniel Moerman of the University of Michigan notes that various studies have shown that large pills work better than medium-sized pills and four pills work better than two, even when all the pills are sugar and all the injection are sterile water. And culture can make a difference in the relief we experience too. North Americans tend to believe that injections are more powerful than pills, so injections of sterile water may provide us more relief than a sugar pill (even though both are placebos). But that does not work for Europeans who do not think that injections are more powerful than pills. Blue sleeping pills work better than other colors—except when given to male Italian soccer fans whose team colour is blue.

Even sham surgery works. Sylvester Colligan of Beaumont, Texas, could barely walk before his 1994 knee operation. He was mobile and free of pain six years later. But, as he later learned, he was actually in the control group. Yes, he received three knee incisions, but he was just sewn up again afterward; no conventional arthroscopy was done. But his body did not know that because his mind did not.

Similarly, a 2004 study compared 30 patients who received controversial embryonic stem-cell implants for Parkinson’s disease to patients who received only sham surgery. The patients who thought they had received the stem cells reported better quality of life a year later than those who thought they had received the sham surgery—regardless of which surgery patients had actually received. Ratings by medical personnel tended to concur with the patients’ own views. That last point is significant. The more your doctor believes in a treatment, the more likely you are to experience relief from it.

At one time, doctors suspected that more emotionally expressive people responded more strongly than stolid souls, but that does not seem to be the case. Our minds are real, and what we expect to happen is important.

Still, there are limitations on the power of our minds. Placebos do not help to treat cancer (though they help cancer patients with appetite and pain control). Also, only a person who is intellectually capable of believing that a medication provides relief can experience the effect of hope. One study found that Alzheimer patients whose cognitive deficits interfered with their ability to expect relief did not experience it.

Still, looking at the big picture, the effect—call it “placebo” or “meaning” or whatever you like—is pretty powerful. All drugs are tested against it—not because it doesn’t work but precisely because it does. A medication must work five percent better than a placebo to be licensed for use. That makes sense. You certainly would not want to pay $159.95 for a prescription that worked only one percent better than faith that you will get well. The money would be much better spent on a day at the spa.

So... throw out the medications? By no means! They already have been tested and found to be more useful than placebos, or they would not be on the pharmacist’s shelf. But, as Moerman says, the power of expected healing shows that meaning—our interpretation of what is happening to us—can make a huge difference to how effectively medications work. He sums it up: “Meaning can make your immune system work better and it can make your aspirin work better too.” Whether medications are intended to help us with physical or psychological problems, we must actively cooperate with them to make them work their best for us.

Mind and medicine: Did your doctor just prescribe you a quarter teaspoon of coloured sugar?

One of the most misunderstood functions of our minds is their role in organizing our bodies' efforts to overcome illness. In The Spiritual Brain: A neuroscientist's case for the existence of the soul, Montreal neuroscientist Mario Beauregard and I looked in some detail at the medical and neuroscience evidence for the placebo effect - the effect of simply believing that you have received a powerful medication (whether or not you have).

Drug studies show that many people get better just because they have received a sugar pill that they are told is a powerful new drug. (It is an authentic example of your mind acting on your brain and body.)

Recently, Time Magazine ran a short article by Laura Blue asking "Is Your Doctor Prescribing Placebos?" And guess what - many are. Almost half of physicians surveyed in a recent study admitted as much:

Among the doctors who prescribed them, one in five said they outright lied to patients by claiming a placebo was medication. But more commonly, the physicians came up with creative ways to explain, saying the substance might help but wouldn't hurt, or that "this may help you but I'm not sure how it works."

A lot of unnecessary angst is generated around the ethics of using placebos, some of it captured in Blue's article. Some say it is wrong for the doctor to deceive the patient, but the underlying problem is that neither doctor nor patient readily accepts the role the patient's mind plays in kickstarting the healing process. Sometimes, the kickstart requires the "oval indigo pill just released by MegaPharma's top doctors ... " (with the same chemical content as the sugar bowl at home).

Maybe the oval indigo pill drama wouldn't be necessary if we accepted the role our minds play in our health?

Are prayer studies a waste of government money? No way!

A fellow blogger draws my attention to a column in the Waco Tribune by John Young who announces that he is "starting to long for the days when it was respectable enough for a Bible-believing American to say science was Satan’s tool." He lists many sources of grievance with the present science establishment, which - in his view - favours fundamentalists, including this one:

Our president’s type of "sound science" is that which authorized $2.3 million to study the power of prayer.

Did it indeed? Only $2.3 million? Well, I have some news for Young of the Tribune:

Here is what I wrote to some friends on the subject:

Anyone familiar with the placebo effect would consider $2.3 million to study the power of prayer money well spent.

Listen: The drugs you pay $$ for must perform 5% BETTER than your own belief that you will get well in order to be licensed for use.

That doesn’t mean that belief is 0%, as the vast majority of the lay public is encouraged to believe.

It means that any licensed pharmaceutical is at least placebo + 5%.

Have you ever read a label that said,

Phynyl causmungaphene

In the controlled study, 60% of the patients who thought their sugar pill was this medication got better and 85% of the patients who were actually taking this medication got better.

In the placebo group, 15% of patients required treatment for the "side effects" of the sugar pill and in the study group, 30% required treatment for the side effects of phynyl causmungaphene.

$44.95 15 tabs

(But this really IS the medication, honest. You can TRUST your pharmacist!)

No, I bet you didn’t read that. And you won’t either. But that’s not because this stuff never happens.

Look, I am NOT trashing pharmaceuticals. They wouldn’t be on the pharmacist’s shelf if they didn’t do anything at all. And doctors tend to know what works for their patients, so sure, we can trust an experienced physician and pharmacist.

But I was amazed when I learned what studies actually show about the difference that what you think is happening makes, in a wide variety of illnesses, while researching The Spiritual Brain (and Mario and I talk about that in some detail, too). After we turned in the manuscript, I read several more books that opened my eyes on the subject.

So even if people WERE praying to a Great Void (they're not), they might still gain some benefit. Research in these areas is critical for the following reason:

Aging people (of whom there are a lot just now in the settled and prosperous democracies) must sometimes take drugs that have unpleasant side effects or effects that counter each other (though both may be necessary, for different reasons). Research into the extent that mental states affect physical states may enable some individuals to manage with fewer or reduced medications that have undesirable side effects. And if they do it through prayer, whose business is that?

And that's not even saying that prayer studies will confirm that prayer has independent effects ... even if it didn't, prayer would still be highly effective.

Does behaviorism work?

Behaviorism was one of the now-discredited psychological theories of the last century, championed by B.F. Skinner, according to which mental states do not matter because behavior can be programmed directly. Mario Beauregard and I talk a bit about this in The Spiritual Brain.

Actually, the mere mention of the placebo effect should be enough to sink behaviorism as a theory. Basically, for many illnesses, mental states play a huge role in how well treatments work (placebo effect) - or DON'T work (nocebo effect).

Of course, W. H. Auden took a down-to-earth approach to how the theory was used in practice. He said,

Of course, Behaviourism "works". So does torture. Give me a no-nonsense, down-to-earth behaviourist, a few drugs, & simple electrical appliances, & in six months I will have him reciting the Athanasian Creed in public.

Behaviorist treatments for obsessive compulsive disorder have, for example, included forcing compulsive handwashers to touch toilets in public washrooms, after which they were forbidden the wash their hands. As a result, many refused to seek treatment. And if that's a new standard in enlightenment, we might as well move back to the Dark Ages.

Hat tip Toronto journalist David Warren for the Auden quote. Here are some other fun quotes about psychological and educational bad ideas.

If you do not take your sugar pill placebo, you are more likely to die?

Apparently. One thing that Mario and I discuss in some detail in The Spiritual Brain is the placebo effect: The way we often start getting better when we believe we will. In one study, according to "Do We Realy Know What Makes Us Healthy?" (New York Times),

The lesson comes from an ambitious clinical trial called the Coronary Drug Project that set out in the 1970s to test whether any of five different drugs might prevent heart attacks. The subjects were some 8,500 middle-aged men with established heart problems. Two-thirds of them were randomly assigned to take one of the five drugs and the other third a placebo. Because one of the drugs, clofibrate, lowered cholesterol levels, the researchers had high hopes that it would ward off heart disease. But when the results were tabulated after five years, clofibrate showed no beneficial effect. The researchers then considered the possibility that clofibrate appeared to fail only because the subjects failed to faithfully take their prescriptions.

As it turned out, those men who said they took more than 80 percent of the pills prescribed fared substantially better than those who didn’t. Only 15 percent of these faithful “adherers” died, compared with almost 25 percent of what the project researchers called “poor adherers.” This might have been taken as reason to believe that clofibrate actually did cut heart-disease deaths almost by half, but then the researchers looked at those men who faithfully took their placebos. And those men, too, seemed to benefit from adhering closely to their prescription: only 15 percent of them died compared with 28 percent who were less conscientious. “So faithfully taking the placebo cuts the death rate by a factor of two,” says David Freedman, a professor of statistics at the University of California, Berkeley. “How can this be? Well, people who take their placebo regularly are just different than the others. The rest is a little speculative. Maybe they take better care of themselves in general. But this compliance effect is quite a big effect.”

There is so much we don't know about the relationship between the mind and the body.

A third recent ChristianWeek column: Faith as one of the healing arts

Faith as one of the healing arts

by Denyse O'Leary

According to an article in Jewish World Review (October 3, 2006) hospitals in the United States have finally begun to pay attention to patients' religious beliefs. "The last thing you want to worry about while somebody is sick is that they might have to transgress on something they believe in," says Zahava Cohen, Englewood Hospital's patient care director (New Jersey). Cohen is surely right; and we can only hope that this trend spreads.

Yes, yes, illness and death come to us all. And serious illness may require abrupt actions and intimidating technology. But, especially among older people, many illnesses are chronic. There is no "pill for every ill." We adapt our lives to illnesses and illnesses to our lives, and go on from there. We instinctively resist being packaged as "the pancreas in # 209" or ultimately the "corpse" to be disposed of, with no acknowledgement that this is or once was part of a person who was in turn part of a community. After all, even in death, the silenced corporal reality is still "Nana" or "Unkie Joe." Acknowledging the community to which the sick, dying, or deceased belong, in which they will be remembered at least by a few for decades to come, is good medicine.

The way in which we receive health care makes a huge difference to its ultimate effect. This reality has long been disguised under the misnamed and misunderstood "placebo" effect. Literally, the word means "I will please." Originally, it referred to sugar pills given to a patient who believes that they are potent. Over one third of patients get better simply because they think the placebo is a powerful medicine. The placebo effect probably underlies traditional shamanism. The reason so many tribal Christians continue to surreptitiously visit shamans is not that they are deluded into believing that shamanism works but because it so often does work. Unfortunately, the shaman typically attributes the healing to specific bizarre practices rather than to the power of belief to trigger healing processes.

Indeed, since the 1970s, a proposed new medication is expected to perform about five percent better than a placebo, if it is to be licensed for use by physicians. Now, let's stop and think about what that means for a moment: We may be taking medications that are only a small percentage more effective than our own belief in them! The placebo effect is thus an interesting demonstration of the power of the mind over the brain and body. It might better be called the cognosco or "I am aware (of healing)" effect.

The placebo effect is not a cure-all; a recent study suggests that it is ineffectual against cancer. However, a 2004 study compared thirty Parkinson's patients who received controversial embryonic stem cell implants with patients who thought they were receiving them (but were actually undergoing a sham surgery). Those who thought they had received stem cells reported a better quality of life a year later than those who thought they had received the sham surgery, regardless of which surgery the patients had actually received. And the medical personnel's assessments of patients tended to concur with the patients' own views.

Doctors use the placebo effect automatically in their work. For example, they behave confidently and reassuringly even when completely stumped by the patient's symptoms or faced suddenly with a life-threatening disorder. They are right to behave this way. A doctor's anxiety would trigger the placebo effect's evil twin, the nocebo effect. "Nocebo" means "I will harm," and nocebos really do harm. Patients may be ill for longer periods and suffer worse symptoms if nocebo effects convince them that they are doomed.

Some consider the placebo effect a mystery. In March 2005, British science magazine New Scientist listed thirteen "Things That Don't Make Sense", and the placebo effect was number one on their list. Of course, the placebo effect doesn't "make sense" if you assume, as they do, that the mind either does not exist or is powerless. The traditional Christian view is that the mind is grounded in the brain so long as we live in this world. Therefore, what the patient's mind perceives expresses itself in the brain and body. Both the placebo and nocebo effects are strong support for the traditional view.

My other blog is the Post-Darwinist, detailing events of interest in the intelligent design controversy. My most recently published book is By Design or by Chance?, an overview of the intelligent design controversy.

Materialism run mad: Co-operating with nature is "anti-science"?

Here's a good one, from the Washington Post (October 30, 2006), about a Nebraska-based women's health and fertility clinic that adheres to Catholic teaching , while espousing all the high tech methods that are not in conflict with that:

The institute, which is attracting more than 700 new patients a year, melds modern medical facilities with the philosophy and symbols of Catholicism. The waiting room greets patients with a bust of the Madonna and Child and an illuminated stained-glass crucifix. Bulletin boards titled "Miracle Baby Hall of Fame" are filled with snapshots of children. Down the hall is a fully accredited lab for analyzing hormones. An ultrasound suite downstairs is equipped with the latest technology. A large statue of St. Therese stands in a stairway leading to the Chapel of the Holy Family, where Mass is celebrated weekly.

"This is anti-science," says Anita L. Nelson, a professor of obstetrics and gynecology at the University of California at Los Angeles. "They might as well be advocating prayer for infertility," quips Richard Paul, a fertility expert at the University of Southern California.

Actually, that would be a darn good idea. The placebo effect is very powerful and at least some barriers to fertility have a psychological component. Especially assuming that, as here, the patients are voluntary and supportive of the MDs' stance.

In any event, Hilgers retorts that

his work is based on numerous research papers that he and others published in well-known journals earlier in his career, and that he has compiled the results of his more recent studies in a 1,243-page textbook he produced in 2004.

Remember this when materialists claim that they are not "against" other faiths. They are.

My other blog is the Post-Darwinist, which keeps tabs on the intelligent design controversy.