Chapter 1.B.3--Illness, Healing,
and Alternative Medicine
"Medicine's
role is to entertain us while Nature takes its course." - Voltaire
Reviewing
literature on the placebo effect and arguing for law taking account of it much
more actively, for instance in pharmaceutical regulation and in defenses to
breach of informed consent, see Anup Malani, Regulation with Placebo Effects,
58 Duke L. J. 411 (2008). The AMA issued an ethics opinion in 2006 that
it is unprofessional to use placebos deceptively. Taking issue with this
position, see Adam J. Kolber, A limited defense of clinical placebo deception,
26 Yale L. & Pol'y Rev. 75-134 (2007). Many physicians disagree.
See Rachel Sherman & John Hickner, Academic Physicians Use Placebos in
Clinical Prctice and Believe in the Mind-Body Connection, 23 J. Gen. Intern.
Med. 7 (2007).
On
alternative medicine, see Anne
Harrington, The Cure Within: A History of Mind-Body Medicine (2007).
Further
exploring issues relating to trust,
see Richard Sherlock, Reasonable Men and Sick Human Beings, 80 Am. J. Med. 2
(1986).
Additional information on therapeutic jurisprudence is available on this web site: http://www.law.arizona.edu/depts/upr-intj/
As
Buckman & Sabbagh explain in Magic or Medicine? An Investigation of Healing
and Healers (1995), the healing processes that underlie the methods used by
conventional versus alternative healers may not be as different as they first
appear:
The placebo effect is one of the explanations of the . . .
unprecedented and increasing numbers [of] patients [who] are consulting
practitioners of every type of alternative or complementary medicine. Between
1986 and 1992, the proportion of people in one sample who had used
complementary medicine rose from one in seven to one in four. . . . Perhaps,
then, a homeopath's belief in homeopathic remedies and a crystal-therapist's
belief in the energy of crystals and an aromatherapist's belief in the value of
essential oils are all necessary to bring the healer close to the patient. Once
close to the patient, the healer can use her or his intuitive abilities, such
as counseling and empathizing, to their maximum effect. Perhaps the therapist
even needs to believe in the remedy
in order to be able to be a therapist or counselor -- and if so, that's fine.
If it needs a few white pills or a group of crystals or a sweet-smelling oil to
act as a catalyst for a therapeutic counseling and support session, then what
could be wrong with that?
At its most basic level, it may be that the placebo effect is a reflection of man's fundamental desire for a magic therapy -- we are so hopeful of a remedy that we imbue even an inactive remedy with magical powers. But the placebo effect also shows us something very plainly -- if the patient believes in the magic, the magic works. If that does illustrate a fundamental feature of mankind's reactions to illness, then that's all right -- but let's use it for the benefit of the patient and not ignore it. Of all the things that we can learn from the public's migration to complementary medicine, the placebo effect and the healer-as-drug effect are the most important lessons. To ignore them totally would be a terrible waste.
There
are several additional readings on this page. The first three provide more
insight into the phenomenology of illness:
The
other three readings focus on the contrasts and similarities between conventional
and alternative medicine:
A Philosophical Basis of Medical
Practice (1981)
Edmund D. Pellegrino and David C. Thomasma
How
unique is the state of illness? Is it not a common condition in many other
human situations? After all, the prisoner is deprived of his freedom and civic
rights; the poor and the socially outcast are constrained even in the most
mundane matters of life; none of us is totally free; we must all conform to
some set of social conventions. But in none of these situations is our capacity
to deal with our vulnerability so impaired as in illness. We feel, usually,
that we can cope with almost all of the other states of vulnerability if we
have our health. After all, we perceive health as a means toward freedom and
other primary values. We ask only to be released form prison, given a job or
money, and if we are healthy, we can rebuild our humanity and the integrity of
our person. In illness none of these things will help. Our essential
existential mechanisms for coping with all other exigencies have been
compromised, and more essential than that, we face the threat of loss of life
itself, or we are suddenly asked to live a life not worth living.
There
is a special dimension of anguish in illness. That is why healing cannot be
classified as a commodity, or as a service on a par with going to a mechanic to
have one's car fixed, to a lawyer for repair of one's legal fences, or even to
a teacher for repair of one's defects in knowledge. The teacher-student,
lawyer-client, and serviceman-customer relationships have some of the elements
of the physician-patient relationship in that there is also an inequality of
knowledge and skill, and one person seeks assistance from another who professes
to provide it. What is different is the unique ontological assault of illness
on the body-self unity, and the primacy of the freedom to deal with all other
life situations which illness removes. Without denying the possible analogy
with, let us say, the lawyer-client relationship, it would be difficult to
argue that the degree of injury to our humanity and the kind of injury we
suffer in litigation are identical in their existential consequences to being
ill.
Food Allergy and the Health Care Financing Administration: A Story of
Rage
David M. Frankford
1 Widener L. Symp. J. 159 (1996)
Reprinted with Permission
[I]llness is lived; it is a life of illness.369 For the ill person, chronic illness is only partially or not at all the disembodied disease states formulated by the nascent biomedicine of the late nineteenth and early twentieth centuries. It is not even the more robust impairment of physiologic function described by the more recently developed pathophysiology. Instead, [illness] is lived as the disruption of the activities of daily living.... It is the inability to tie one's shoes, to negotiate a curb, to attend a meeting, to read a book to one's child, and to spend time with a spouse.
Most
fundamentally [illness] is the loss of bodily or mental integrity. In ordinary
life our bodies are our taken-for-granted friends. In many if not most tasks we
are barely even aware of their existence. We just go about our business, doing
things with our bodies, which perform as if they were on autopilot. In illness,
however, this taken-for-grantedness, this integrity, is lost. The body
"mal-functions," it fails to perform, and this occurrence of the
unexpected makes us painfully aware of bodily presence. The body is no longer
the taken-for-granted friend but an object of concern and, perhaps, scientific
study and attention.
As
Kay Toombs describes so well, this objectification of the body is accompanied
by a loss of wholeness, by a loss of the bodily assurance lived by the well. We
ordinarily live our lives under the presupposition that certain things are
assured. One goes to bed assured that the tree outside the window will still be
there in the morning. One also goes to bed assured that in the morning one's
legs will continue to work....
With
chronic illness, however, this sense of assurance is lost.... [The body] is a
capricious, often malevolent enemy that threatens to disrupt such plans and
pursuits at any time:
Like a mother who can never be depended on, the body fails
the sick person when needed most. Persons with active arthritis never know when
the pain will destroy an event, a day, a week. They go to bed feeling fine,
perhaps looking forward to some celebration the next day, and awaken impaired.
They look for reasons in their diet, emotional state, or the weather, but no
consistent explanations present themselves. The body is so untrustworthy that it
does not even misbehave consistently. As with arthritis, so it is with severe
asthma, ulcerative colitis, multiple sclerosis, and other chronic illnesses.
[Cassell, supra note 369, at 57.]
The
body becomes an it -- an alien and
uncontrollable thing -- a prison from which there is no escape and an object of
rage and frustration, something to be hated, even punished, and most of all, an
enemy to be monitored at all times....
Perhaps
the most salient result of this existential shock is the effacement of self or
the reconstitution of self in illness. For our purposes, self can be defined as
an individual's articulated and dramatized lifestory, a narrative and a
dramaturgical presentation that has temporal dimensions -- a self has a
self-constituted past, present, and future -- and multiple substantive ones.377
The latter include matters of private identity--an individual's conceptions of
her values, interests, sentiments, and aspirations--as well as the presentation
of this self to a public world--a private face and a public one, as it were....
[I]llness has the potential to, and often does, shake this self to its very core. We define ourselves at the most mundane level with reference to a field of possible engagement with the world and with others. Illness seriously limits this field spatially -- I may be confined to my bed or unable to climb stairs, cross streets, eat food I have not prepared, and so on.... Analogously, illness can be confining temporally. I may be totally immersed in the present because the struggle to maintain a life is all consuming. Further, I may be so dis-abled that I cannot even conceive of a future worth living, and I thus believe my self to be condemned to live in a painful, tortured and torturing present. Finally, but not least by any means, illness is often socially confining as the ill individual can no longer engage in his prior social life....
The
result, then, is that often the [ill] person no longer has a sense of self. The
prior self was constituted around the assurance -- perhaps conceit -- of
eternal health. This sense of bodily integrity is lost, as are the many
activities and lifeplan through which the self constituted its self-identity.
Deprived of this internal anchor and cut adrift from the mirror of social
interaction, which enables us to see and to express ourselves, the ill person's
self is gone. Social stigma is internalized, and the ill individual has become
so foreign that she no longer recognizes herself. She is then often stuck in
her past life, real or imagined, unwilling to surrender it. She has no future
because that prior self has been lost, because she remains in a constant state
of mourning, and possibly because the future is too uncertain -- or horrible --
to imagine.
369 My account of chronic illness is drawn from my own experience and from the secondary literature. The following sources have been particularly important: Eric J. Cassell, the Nature of Suffering and the Goals of Medicine (1991); Kathy Charmaz, Good Days, Bad Days: The Self in Chronic Illness and Time (1991); The Humanity of the Ill: Phenomenological Perspectives (Victor Kestenbaum ed., 1982) [hereinafter Humanity of the Ill]; Arthur Kleinman, The Illness Narratives: Suffering, Healing and the Human Condition (1988); Marianne A. Paget, A Complex Sorrow: Reflections on Cancer and an Abbreviated Life (Marjorie L. DeVault ed., 1993); and S. Kay Toombs, The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient (1992).
377 One could write endlessly about the self, as Charles Taylor has done magnificently in Charles Taylor, Sources of the Self: The Making of the Modern Identity (1989). For present purposes it suffices to say that my definition has been heavily influenced by symbolic interactionism and existential phenomenology, albeit in my definition all aspects of self are linguified.
-------------------------------
Shortly before he died from prostate cancer in 1990, literary critic Anatole Broyard gave the following profound and moving remarks about his experience with physicians and serious illness:
I wouldn't demand a lot of my doctor's time. I just wish he would brood upon my situation for perhaps five minutes, that he would give me his whole mind at least once, be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness, for each man is ill in his own way.... Just as he orders blood tests and bone scans of my body, I'd like my doctor to scan me, to grope for my spirit as well as my prostate. Without some such recognition, I am nothing but my illness.
These readings provide more spotlight on the
contrasts between conventional and alternative medicine.
Pressure from Our Aging Population Will Broaden Our Understanding of
Medicine
Charles F. Longino
72 Acad. Med. 841 (1997)
Reprinted with Permission
The
existing paradigm of modern scientific medicine may be called the Western
biomedical model. It relies on an essentially mechanical understanding of
causation, one derived from science. Repairing a body, in this view, is
analogous to fixing a machine. Furthermore, this view of causation leads to a
remarkably optimistic expectation that each disease has a specific cause that
is awaiting discovery by medical research. Finally, because the body is the
appropriate subject of medical science and practice, it is also the appropriate
subject of regimen and control. Although we may not consciously think of
medicine in these terms, these are, nonetheless, the doctrines of the
biomedical model and thus form the subconscious cultural context out of which
our thinking, professional conduct, and medical education arise.
Because
it has been so successful in dealing with the deadly infectious diseases that
have decimated human populations for centuries, medicine has worked itself out
of much of its original job (the cure of diseases and relief of patients'
sufferings) and now faces a large population of patients and potential patients
that expect the same successes and advances in dealing with chronic conditions
and the accumulated debilitations of advanced age. Unfortunately for physicians
and their patients, scientific medicine cannot cure these conditions, and
medicine will have to change its essential self-understanding if it is to be
successful in the future. . . .
During
earlier periods of Western history - from the early Greeks to the end of the
medieval period - any complaint was considered to be the result of a
combination of factors, both natural (biological) and spiritual. Health (often
understood as "wholeness") included the whole person: body, mind, and
spirit. Gradually, the theoretical bases of medicine moved away from religion
and toward science. This change did not occur all at once, of course, and the
admixture of spirit and nature continued as a dominant part of medicine. The
ideas of René Descartes, however, introduced an important change. In the early,
1600's, he developed a philosophical argument that allowed nature to be
"rationalized" - nature, in other words, could be materialized and transformed
into an inert object. The thrust of Descartes' position is that the mind (res cogito) could be severed from the
body (res extensa). Matter is thus
freed from subjectivity, and pristine matter is available for inspection. Like
nature, the body becomes a material object to be observed, and factors such as
mind, soul, consciousness, and spirit are unimportant and dismissed because
they are intangible. Disease occurs in the body, which is envisioned to be
nothing more than physiologic organism.
In
keeping with Descartes' ideas, other changes began to take place that were
vital to modern medicine. The belief that facts could be separated
categorically from values took hold in a wide range of disciplines. This meant
that facts were considered external, separate from the mind, or were thought to
be associated with empirical indicators. Physicians could, thus, safely become
empiricists and attend solely to physiologic markers. The effects of
non-empirical factors (related to culture or biography, for example) on illness
became irrelevant. The experience of the person in the body was denigrated and
treated as epiphenomenal, that is, the person's experience was considered a
byproduct of the illness and therefore not relevant to understanding the
illness itself. Only "objective" factors were considered real.
Consistent
with this transformation in our understanding of nature - including the human
body - was the change in how physicians reformulated their thinking about the
role of causality in illness and health. Discussions revolved around
"causal chains" and "webs of causation." This imagery
enabled physicians to view events as structurally linked: accordingly, a sound
rationale could be assigned to the advent of illness. Physicians could
formulate propitious strategies because solitary causes are predictable and manipulable.
Because the source of any health problem could be pinpointed through rigorous
research, diagnostic activity became a scientific investigative process. . . .
A
final element of the rational worldview that grew from Descartes' ideas
pertains to how knowledge should be acquired. We would all acknowledge that
subjectivity or interpretation is a liability in the pursuit of valid data. In
order to curtail the corrosive influence of bias and subjectivity, the use of
quantitative measures is encouraged. Quantification is believed to be
value-free and to give unimpeded (direct, clear, "true") access to
reality. Quantitative methods are assumed to be divorced from interpretation,
and truth and objective reality are seen as one.
The
cornerstone of the biomedical model, then, is the "materialization"
of life - specifically, humans are approached as if they are simply physiologic
organisms. But this view does not make sense unless we accept several proposals:
dualism (that mind and body can be separated), empiricism (that reality is
limited to what can be experienced by the senses and their aids), mechanical
causality (that all causal relationships are linear), the equilibrium thesis (that
normativeness is the goal, and stability is possible), and the neutrality of
technique (scientific method removes interpretation and bias) . . . .
This doctrine is a barrier to understanding the psychosocial component of medicine, including the placebo effect, the connection between stress and illness, the importance of support groups, and the more general relationships between social support and health. Although the doctrine is no longer strictly adhered to, psychosomatic phenomena (i.e., the interactions between the mind and the body) are still often considered to be peripheral to scientific medicine. . . .
It
is possible to point to some of the features of an emerging paradigm . . . . In
some circles, this new philosophy is referred to as post-quantum theory, while
in others, the term is postmodernism. At the core of either viewpoint, however,
is the rejection of Cartesian dualism.
Broadening
the biomedical model into a biopsychosocial model of medicine is to consider
the patient as a social and emotional body interacting with physical and social
environments in ways that affect the patient's health. This model moves away
from the limiting focus of the biomedical model without losing its benefits.
However, it significantly broadens the earlier model.
The Biomedical Paradigm
from, Complementary and Alternative
Medicine:
Legal Boundaries and Regulatory
Perspectives
Michael H. Cohen (1998)
Reprinted with Permission, Johns Hopkins
University Press
The
biomedical paradigm generally views disease as a biochemical phenomenon that
can be classified into diagnostic categories through technological methods and
treated, where possible, according to standardized, objectively validated
mechanisms. The biomedical model gained ascendancy in the late nineteenth and
early twentieth centuries, when Newtonian physics and Cartesian dualism
dominated the intellectual world.
Newtonian
physics views the universe as consisting of fundamental, irreducible building
blocks made of matter. According to Newtonian theory, the motions and
interactions of all material bodies obey a few simple laws. The universe is an
immense, sophisticated clock, whose whirring objects follow predetermined
courses. The interrelationship of parts is rational and follows basic laws.
Cartesian dualism asserts that bodies exist in space, subject to mechanical
laws, while minds exist elsewhere, in an isolated, independent realm. It splits
the "outer" world (objective and amenable to rigorous research) and
the "inner" world (subjective, marginally accessible, and
scientifically unreliable).
In
keeping with Newtonian physics and Cartesian dualism, the biomedical model
views the body as a physical system, objectively analyzable in terms of its
mechanical parts. Mechanism (the "body as machine" metaphor) and
reductionism (the reduction of illness to a set of physical symptoms) dominate
biomedical thinking. Disease is an outside invader that preys on a particular
part of the body; treatment attacks the invader. Thus, some cancers are known
as "malignant" tumors; chemotherapy aims to "attack,"
"fight," or "beat" the cancer.
The
biomedical model provides a clearly articulated scientific framework for
understanding the disease process and mechanisms of remedy, and it excels at
treating infectious diseases and acute or traumatic injuries. Biomedicine
excels in emergency care: a patient who suddenly experiences heart failure
needs a cardiac specialist, not an acupuncturist. The model also cures many
conditions that have single, specific causes.
The
model is less successful with chronic, multifaceted, and terminal illnesses,
such as chronic fatigue, AIDS, and cancer. Biomedicine rarely cures chronic,
debilitating conditions such as arthritis, allergies, pain, hypertension,
depression, and cardiovascular and digestive problems, which account for 70
percent of the health care budget in the United States and affect almost 33
million Americans. The conditions exhaust current scientific knowledge,
challenge the biomedical model's approach to diagnosis and treatment, or
require treatments accompanied by toxic side effects.
The
biomedical model's orientation is frequently distant, detached, and deficient
in empathy and warmth. The model alienates patients from their own being when
their mental, emotional, and spiritual realities are seen as having little
bearing on disease or healing. Feelings of depression, rage, social isolation,
and bewilderment, and other subjective, but significant, experiences often are
discounted, invalidated, or denied as hallucinatory. Biomedicine creates
feelings of dependence and personal estrangement as individuals "exchange
the status of person for that of patient." . . .
The
Holistic Healing Paradigm
The
critique of biomedicine's medical and psychosocial limitations has led some
caregivers to examine multifaceted approaches to health care, in an attempt to
restore a broader role and meaning to the notion of healing. Holistic
modalities of healing adopt a wholeness or social paradigm of health care,
which aims at a nonmechanistic, nonreductionistic understanding of the disease
process. The holistic healing paradigm views diseases as having multiple causes
amenable to multiple therapeutic interventions through a variety of systems of
care, including biochemical, environmental, social, psychological, behavioral,
and spiritual systems. It views conditions such as arthritis and chronic pain
as having multiple, nonspecific causes (biological, environmental,
psychological, social), and thus as amenable to intervention on multiple levels
(pharmaceutical, individual or family counseling, support groups, nutrition,
exercise, relaxation techniques). In holistic practice, the goal is balance,
not only control of symptoms; subjective relief, not merely a favorable and
scientifically measurable clinical outcome. . . .
Holism
and Mechanism
The philosophy underlying holistic practice was articulated earlier this century by Jan Smuts. In his 1926 book Holism and Evolution, Smuts described holism as the notion that "every organism, every plant or animal, is a whole, with a certain internal organization and a measure of self-direction, and an individual specific character of its own." In wholes, "all the parts appear in a subtle indefinable way to subserve and carry out the main purpose or idea." According to Smuts, nature expresses itself in wholes, ranging from atoms, molecules, and chemical compounds to "the creations of the human spirit in all its greatest and most significant activities." Smuts expressed this "whole-making, holistic tendency, of Holism" as an organic, creative evolutionary force in the natural world and human affairs.
Smuts
argued that a whole is more than the sum of its parts because the whole is not
purely mechanical but has inner tendencies and interrelationships between the
parts which give rise to something "more." . . .
To
understand the human organism as a whole, Smuts considered not only the
physical body but also the "field," the organism's presence as
"a historic event, a focus of happening, a gateway through which the
infinite stream of change flows ceaselessly." The organism in its field
"contains its past and much of its future in its present."
Smuts
contrasted holism with mechanism, the view that wholes are merely and
unalterably the sum of their parts. According to Smuts, mechanism views a
physical reality as a closed and complete system; holism values volition and
consciousness and views life as "an active creative process [which] means
the movement . . . towards ever more and deeper wholeness." The organism,
as a whole, is a "synthesis or unity of parts," and thus possesses
unity of action and a "balanced correlation of functions." Whereas a
mechanical system reacts to disturbance by adjusting to maintain equilibrium, a
holistic system creates a new unity or synthesis, "the making of a new
arrangement of old elements." In this way, "wholeness, healing,
holiness [are] all expressions and ideas springing from the same root in
language as in experience."
.
. . Holistic providers tend to . . . emphasize the inner healing process, as
well as relationship, over external results and professional authority. In
other words, the provider-patient relationship aims as healing as well as
curing. Curing involves the eradication of disease at the physiological level. Healing
involves a movement toward wholeness, growth, or greater balance on physical,
mental, emotional, and social levels, "rather than just [a focus] on
curing a given disease or disorder." A patient may be healed without the
disease being cured. A treatment that "cures" the patient often
leaves room for healing - as occurs when a breast cancer patient leaves the
operating room without cancer, but without a breast. By pointing patients
toward creative resolution of their disease processes, holistic therapies aim
to express the centrality of personal wholeness in health.
This excerpt discusses how physicians function as
healers, and the pervasiveness of the placebo effect, suggesting how the
biomedical and holistic paradigms might merge.
The Faith Factor in Healing (1991)
Thomas A. Droege
Reprinted with Permission, Trinity Press International
The
average physician would cringe at being called a "faith healer." Yet
physicians are faith healers in the sense that they invite expectant trust on
the part of those who come for treatment. The white coat, the stethoscope, the
prescription pad, the elaborate equipment in clinic and hospital, and the
supreme self-confidence on the part of the physician all contribute to the
faith people have in their doctors and in the health care system the doctors
administer. The greater the threat that sick people feel, the more they need
powerful symbols of authority to reinforce a belief that medicine can work
wonders in reversing the course of illness.
This
applies to all forms of healing, of course, whether it be Christian Science,
Pentecostal healing, shamanism, or prayer. Called the "placebo
effect" in medicine, the faith that people have in the treatment they are
receiving is an important factor in healing, wherever it occurs. . . . As noted
frequently in the literature, the history of medical treatment before the
Enlightenment is the history of the placebo effect. Most medications prescribed
by physicians were either pharmacologically inert or downright harmful. That
physicians were prescribing placebos without knowing it only escalated their
effectiveness....
There
are at least three dimensions of belief that are operative in the placebo
effect of medical treatment: (1) the patient's belief in the method, (2) the physician's
belief in the method, and (3) the patient's and physician's belief in each
other. If all those factors are working optimally, even bizarre treatment
procedures can produce real cures. If the opposite is true, even the most
scientific and rational treatments may fail to cure. . . .
Because
of its checkered past, there are a number of misconceptions surrounding the
placebo and its effects. The most pervasive among them is that the placebo
effect is "all in a person's head." The fact is that physiological
processes that can be objectively measured are affected in both organic and
functional diseases. A second misconception is that only neurotic and
suggestible people respond to placebos. The truth is that the placebo effect is
a factor in all healing where a person is responding under conditions that
evoke expectant trust. A third misconception is that the placebo effect is a
nuisance factor that needs to be eliminated from clinical practice. The fact is
that placebos are, on the average, 35 percent effective. This may be a nuisance
factor for a researcher who wants to determine the effectiveness of an active
pharmacological agent in the treatment of a disease, but anything that
facilitates healing ought to be studied and promoted. Finally, it is a misconception
to limit the placebo effect to occasions when patients think they are receiving
medical treatment but are not. The fact is that any intervention that enhances
positive expectations elicits the placebo response. . . .
Among
thecmedical treatments likely to be enhanced by the placebo effect, surgery is
at the top of the list, probably because there is so much drama and ritual
associated with it (hospitalization, operating "theater," masked and
green-robed surgical team, induction by anesthesia). In the mid-1950s, for
example, a new surgical procedure was introduced to provide relief from
symptoms of chest pain due to coronary heart disease. The procedure was called
"internal mammary ligation" and involved tying off an artery in the
chest. One out of three patients reported complete relief of pain while three
out of four reported some improvement. Since this procedure was considered
successful, ten thousand operations followed.
Some
surgeons were skeptical about the procedure because there seemed to be no sound
physiological basis for the treatment, especially since the relief from pain
was almost immediate, long before new vessels could have provided a fresh
supply of blood to the heart. In a study that would be considered unethical by
today's standards, seventeen patients severely limited by angina were recruited
to do an evaluation of the procedure. They did not know they were participating
in a double-blind study in which they were randomly assigned to receive either
that operation or a sham operation. In both cases an incision was made in the
chest. Patients in one group had their arteries tied while the others were
simply closed up with no surgery performed -- a placebo operation. The benefits
from the placebo surgery were as great as the artery-typing operation. After
these results were confirmed by a replicated study, the operation was
abandoned. . . .
Given
the limits of the conceptual framework within which biomedical analysis takes
place, it is no wonder that the placebo effect is judged as having nothing to
do with the "real" business of medicine, which is to intervene in a
disease process that operates in a quite mindless way. We need to look
elsewhere for more convincing alternative explanations.
The
most common explanation of the placebo effect is suggestion, the patient's
expectation of change being causally connected to the subsequent change. Some
form of body-mind communication, operating in the deep structures of the brain,
underlies this change. . . .
Conditioning
is another possible explanation for how placebos work. Have you ever had the
experience of no longer feeling ill while you were waiting to see your doctor
and wondering why you made an appointment in the first place? You associate
this medical setting with the relief of symptoms that came with previous
treatments received there. Later, the setting itself is sufficient stimulus to
initiate the healing response.
Both
of the above explanations, though persuasive, are limited in scope. Howard
Brody, both a physician and a philosopher, offers a much more comprehensive and
penetrating interpretation of how the placebo effect works by placing it within
the framework of the meaning of life. According to Brody, all healing practices
have two invariant features related to meaning: (1) a belief system that
explains illness in terms (natural or supernatural) readily understandable to
those who share the same way of looking at the world, and (2) a relationship
with a socially sanctioned healer occupying a role with parental-like power and
influence, which in turn stimulates caring responses from family and community.
. . .
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