The is the third instalment of “Offensive Health” by one of our Affiliated tutors, Austin Burn-Jones. The book is a very accessible and easy to read guide to key areas of our health and wellbeing. Later this year we will be bringing you a one day course, based on the book.
Chapter 3 – Placebo vs Nocebo
Placebo is a much maligned word, yet it is possibly one of the most misunderstood and probably one of the most important when it comes to our health.
The word comes from the Latin meaning ‘to please’ and it’s opposite which few people appreciate as just as significant is Nocebo; again from the Latin meaning ‘to harm’.
Sadly even the official definition of Placebo really doesn’t help much:
- a medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect.
- a substance that has no therapeutic effect, used as a control in testing new drugs.
- a measure designed merely to humour or placate someone.
So somehow we have turned something that quite literally shapes our very view of the world and how we feel about it, classifying it as ‘fake’ or ‘just in your head’ and then, crime of crimes, separate all this from the physiological effect that it has on the entire system! Once again we are in the realms of insanity – is it any wonder that mental health is such a growing problem in the developed world.
The irony here is that the very basis of the Health System is heavily reliant on Placebo – in the sense that the building, uniforms and titles within it are all designed to make you believe that you are seeing the right people, and that you believe, at least in part, that they will make you well.
I once had a patient who contacted me several months after they had chosen to see someone else. He apologised and admitted that he didn’t really believe the advice I had given him at the time, so had decided to go and see someone with the letters ‘Dr.’ at the beginning of their name, privately and at considerable expense. After nearly £2500 worth of advice and expensive supplements later, he realised that what the Doctor was telling him in a space of three sessions was identical to the advice I had given him in one (without the unnecessary expensive supplements). I am thankful to him for having the courage to phone me and admit it, and indeed apologise – which was unnecessary, but nice to hear.
This is a fine example of how we get in the way of ourselves based on the Placebo and Nocebo effect.
A famous piece of research was done in recent years which changed the idea of what Placebo means and what effect it really has on the human body both psychologically and physiologically.
I am paraphrasing the experiment here:
There are two groups, and they are asked to drink a Protein Shake. This shake is identical for everyone, and contains 300 calories. However, in group 1, the cup holding the shake has the words ‘diet, low fat shake, 150 calories’ written on it. In group 2, the cup has the words ‘super max protein drink, 450 calories’ written on it.
Three phases of results were taken; Firstly, they asked both groups what they thought, and how they felt about the drink. Secondly, they took readings from the body of how many calories the body thought it had received. Thirdly, the researchers looked at subsequent biochemical reactions in the system.
The results are rather interesting.
The Human Body was not fooled for a second. Every Body, in both groups, received 300 calories – no surprise there.
The folk in Group 1 (diet group) expressed that they liked it but still felt a bit hungry.
The folk in Group 2 (Max drink) said they liked it and they felt full.
So this would be the Placebo effect, because of what they believe to be the case, they feel different, which is rather important given the context of what they are saying.
However this is where it gets interesting: The subsequent biochemical reaction in the body was different in the two groups.
In the diet group, the brain released a hormone called Grehlin, otherwise known as ‘The Hunger Hormone’. Whereas in the Max Drink Group the brain released a hormone called Leptin, which is the ‘I’m Full, Stop Eating Hormone’.
So, regardless of what the Body knows, what the Mind believes supersedes that and will cause a different physiological effect. This means that Placebo can’t mean that it’s all made up. It literally means what you believe can change your mind and your body.
Conversely Nocebo can have quite a detrimental affect on our system. If we believe something will fail or do us harm, then it is likely to do exactly that. This strangely is much easier to believe. Example of this would be things like Phobias.
The logic of Phobias is usually quite flawed. For example, the fear of spiders in the UK is unlikely to have come from any actual experience of life threatening spider bites, as all spiders in the UK are mostly harmless. However, people who suffer from arachnophobia can be literally terrified of these little chaps – the very belief in their minds is so strong that their life is threatened that the biochemical storm that goes on within their bodies is very real indeed, and can in no way be claimed as being ‘made up’.
There was a case of a lady many years ago who was terrified of baths; she was convinced that she would die in one. For one reason or another she ended up in hospital for some unrelated issue and was told she needed to have a bath, she refused and tried to explain why. Sadly, the nurses thought she was being stupid, so forced her to take a bath, at which point she died of fright.
Regardless of how silly we might think this is, we have a certain understanding in our bones that we know this is real, when it comes to Nocebo. However we have much more difficulty accepting that Placebo could be just as powerful in the opposite direction.
Some people would have us use the term positive thinking, which has its place and is commendable but it is not quite the same thing. With Placebo there does have to be an actual belief that something will work, we are not trying to convince ourselves with hope, it is a very real belief.
Within medicine it has, up until very recently, been discounted from trials as giving a false result and/or being irrelevant. Fortunately however the Royal Society of Medicine has realised that if we can improve the Placebo effect of an effective medication then there is a much greater chance of success.
Hitherto in medical trials, medication would look something like this:
The average Placebo effect of medication would be around 30% – which means that even tablets that had nothing in them stood a 1 in 3 chance of working – which lets face it is pretty good odds.
However the average Nocebo effect was also about 30% – that means that regardless what was in it, 1 in 3 patients believed it would fail, and so it did. Yes indeed, 1 in 3 of us in effect gets in the way of medication working, we prevent ourselves from getting better! Crazy but true.
So this leaves 40% for the actual work/effect of the medication itself.
Just think if you could get a medication that makes use of both the Placebo and the actual medical effect of a tablet to work together you would get a maximum 70% chance of the treatment being successful – got to be worth a try surely?
So powerful are the belief in the words Doctors use, they can be incredibly healing or have the potential to be incredible harming.
A question I have asked myself over the years regarding the subject of Cancer. And the power the very word has on those that hear it. The strength of belief in just how ‘powerful’ that diagnosis is, is, to my mind, part of the problem.
So much so, I can think of one lady who was found to have a tumour in her breast. Even though the doctors told her that it was small and not cancerous, and was perfectly operable, all she heard in her head was ‘Cancer’. She had heard the word tumour, and like many people, think of that word as being synonymous with cancer – which of course it isn’t. In fact it is possible to have a tumour the size of a grapefruit, and it be neither life threatening nor cancerous (The body is actually very good at quarantining stuff). It doesn’t mean they are pleasant, but they are a world away from cancer.
Within weeks this lady went downhill very rapidly, regardless of what doctors or family tried to say. In her mind she had been given a death sentence – a tragic example of the Nocebo effect and the power of just one word.
Another example I can think of is of a local artist who had a persistent cough for months so eventually went to see his doctor. After consultation and various tests he was taken into a room and told these words ‘I’m very sorry, but you have advanced lung cancer. We would estimate you have about two weeks to live’. Guess what; 15 days later he died.
What if the Doctor had said 3 weeks?
The argument against this is that we shouldn’t give false hope to people. Our culture continues on this path of ‘we have to be realistic’.
Once again this has its place, and one should not be deliberately misleading. However, it concerns me that we have become so obsessed with disease that it has a number of traits that resemble some of the less wholesome religions of the ancient world:
We all fear disease. Pain is the enemy. The Big ‘C’ is practically a God, where all bow before it. Almost everything within the medical treatment mainstream seems to be centred on getting rid of things, cutting things out, destroying cells etc etc. It is what some in the Body/Mind Work community might call an ‘Away-From mentality’.
The alternative, which is, thank goodness, now making some headway is an idea that dates back millennia in both Eastern and Western Medicine and was pushed forward in the late 1920’s but, sadly, was brushed aside by the success of antibiotics during the second world war; the idea of Pro-biotics, the promotion of health, the boosting of the immune system to fight disease, the understanding of pain etc.
The human body is built to repair. Its very function is a continual process of proactivity and regeneration. The very nature of the immune system is firstly the understanding of the invading forces and then creating unique soldiers (antibodies) that match the opponent.
Something also to bear in mind is that, in terms of number of cells, we are actually only 10% Human. The other 90% are bacteria. And 99.5% of those bacteria are living symbiotically with us and indeed are what defends us and makes our body and brain function. The other 0.5% or less are the bacteria that represent a threat. Assuming that the ‘good’ bacteria are in fine working order, the ‘bad’ bacteria don’t stand a chance, and the human body is healthy and disease free.
If however we bombard the system with foodstuffs that are packed with preservatives (that are in essence antibacterial) and consume courses of antibiotics (which are designed to kill bacteria) as a standard treatment, what might you think will happen to that majority of cells that make up the human body?
Is it likely that our immune system will start to be less effective? Is it possible that we are killing the very things that keep us from getting disease in the first place?
Add that to the belief that food, and indeed the world around us is somehow the enemy. That every time we have a meal that there is potential for that food to be harmful long term to our wellbeing, or that anything we do is done under a shadow of fear or stress. I don’t think there is a week goes by without at least one of the newspapers declaring that some food or other is cancerous or likely to cause heart disease based on some research study or other. If we are to believe the headlines, there is a paedophile around every corner lying in wait for our children, and that any immigrant with a beard is a would-be suicide bomber. Television seems obsessed with series that depict more and more elaborate brutal murders. The ones that aren’t dedicated to death are either the celebration of mythical creatures hooked on bloodlust or set in a hospital where the world is filled with weird and wonderful un-curable diseases.
I am not suggesting that we should suddenly ban such things, but it does seem that we are reaching a point where all the beautiful natural things are seen as out of date and irrelevant, sometimes even discredited; whereas the abnormal, the novel, the twisted and the unnatural are celebrated.
We might not see these things as connected but the world around us is part of what we are, or indeed a reflection of what we are likely to become.
What we See, Feel, Hear, Taste, our environment, the air we breathe, the people that surround us, all affect what we believe and how we think and how our body behaves. In turn that has a fundamental bearing on our health both in the short term and in the long term.
This is nothing new but it is worth remembering it.
The following is an excerpt written in about 5th/6th century B.C. by one of the early great physicians of ancient western medicine; Alcmaeon of Croton, who is also credited as being the father of Neuroscience, taken from a translation by another great western physician, Theophrastus Bombastus Von Hohenheim a.k.a. Paracelsus, who is the father of modern pharmaceutical medicine:
(xxx) Origin of health and disease.
Aetius, Plac., V 30, 1 ( Dox. 442 a 3) :- “Alcmaeon states that the maintenance of health depends upon equilibrium of the faculties, moist and dry, cold and hot, bitter and sweet and so on, and that the predominance of any is productive of disease: for the predominance of any single one of them is disastrous. He says that disease occurs in some instances from excess of heat or cold, in some owing to excess or deficiency of food and in some (from fault of) the blood, marrow or brain. With these must be included the occasional occurrence from extraneous causes such as qualities of water, soil or district or some unavoidable cause or things akin thereto. Health depends upon an evenly proportioned combination of qualities.”
Excerpt from ‘The Offensive Health Book’ by Austin Burn-Jones – available at www.thebodycurious.co.uk/books