By Matt Runde, July 6, 2014
Published in the La Crosse Tribune.
Respect the Placebo Effect
The patient was anxious. Four holes would be drilled through his skull, possibly into his brain. Though a willing participant, he did not know if he would have embryonic stem cells implanted into his brain or only the drill holes.
As the 2004 research study would ultimately show, it did not matter, as both “treatments” were equally effective in reducing the symptoms of Parkinson’s disease. The study was a formidable demonstration of the placebo effect, a result of the strong interaction between the mind and the body. All attempts at healing, whether through science or faith, are susceptible to this influence, and without a scientific approach we cannot know whether they are effective or safe.
The word placebo comes from Latin, meaning “I shall please.” It refers to a sham medical treatment (sugar pill, saline injection, etc.), which is not expected to directly produce a biologic effect. The placebo effect is not simply the patient imagining she is better. One’s mental state can produce a measurable biologic effect, either positive or negative. Until fairly recently, the placebo effect was really all the physician had to offer. Snake oil salesmen took advantage of this, selling panacea-in-a-bottle to desperate people. Regrettably, we can still see this today when Dr. Mehmet Oz hawks his magical fat-burning garcinia cambogia on television, despite the fact that studies do not show any effect greater than placebo. Psychologists Sapirstein and Kirsch published an analysis of 19 clinical studies on depression and concluded that 75% of the effect of the antidepressants could be attributed to placebo effect. Surgeon J. Bruce Moseley performed “sham” knee arthroplasty, making only a small incision in the knee and sewing it up without any operation. All of the patients reported improvement in function and pain level, despite the fact that they did not have any actual surgery in the knee joint. This and other research has led to the idea that the placebo effect is not just “in the head,” but is an actual, measurable biologic effect mediated through the mind.
Faith healing is the belief that disease can be cured through intercessory prayer. When the healer and patient honestly believe the practice can work, the placebo effect can produce real benefit to the patient. The type of disorder that responds best to this approach is typically one that has a strong subjective component, such as pain or depression, and in these cases one can conclude the healing was real, since the patient’s perception is really all that matters. Knowing that the placebo effect can cause the release of morphine-like chemicals in the brain, it is easy to believe there could be a real effect on pain from faith healing. Bethel Church in Redding, CA has a website with numerous testimonials to miraculous results in their Bethel Healing Room, and they are one of many such sites. Is this placebo effect or real effect?
A well-designed scientific study will always include a treatment group and a placebo group. Since our perception of illness can have as strong an impact as the disease itself, we must be able to separate that from actual clinical effect. Quality studies are double-blinded, meaning neither patient nor physician know whether the patient is receiving a placebo. Most modern medical studies are rigorously controlled for all variables and potential biases. Furthermore, research must be reproducible, and only when the results are consistent are the data felt to be reliable. However, faith healing leaves us unable to sort out the placebo effect from true divine intervention, as there is never a control group. If a faith healer could reproducibly bring about the regrowth of a missing limb, there would be no skeptics as this would be incontrovertible and far beyond the scope of modern medicine. Short of this type of miracle, a reasonable option would be to compare a large group of people closely matched for degree and type of illness separated into two groups, one of which would receive faith healing by clergy and another group receiving sham faith healing by non-clergy. The patients would be told all healers were genuine, thus revealing any placebo effect.
Too many cases of serious injury or death have resulted from attempting to treat children suffering from cancer, diabetes, or pneumonia with prayer rather than medication, and these cases are heartbreaking. Asser and Swan reported on 172 children who died as a result of using faith healing rather than traditional medicine and surgery.
Western medicine has made laudable progress since the days of leeches and bloodletting. Well-designed, reproducible clinical studies allow us to make informed decisions as to the safety and effectiveness of treatments. Unfortunately, faith-based healing has not had a similar evolution, and therefore we must be very skeptical of any claims involving it. Until it can be shown that faith healing works better than placebo, we should choose traditional medicine for our children and ourselves.
Matt Runde is a member of the La Crosse Area Freethought Society