Journal of Sacred Work

Placebo: Latin for "I shall please."
Nocebo: Latin for "I will harm."
   Belief…does not have a strong place in the anatomy-centered world of
modern medicine. – Dr. Robert Hahn, epidemiologist, Centers for Disease Control and Prevention.

   
For nearly a century, most doctors have been flat wrong about a key aspect of health. Current
evidence, together with a century’s worth of scientific studies, is profoundly convincing about the high impact of thoughts on physical health.
   What Dr. Hahn describes about American medicine is a long-running tragedy. The stubborn refusal of most physicians, and the medical schools and residency programs that train them, to appreciate the impact of thoughts on health is a blind spot that must be corrected (click on cartoon to enlarge.) The studies are fascinating and largely irrefutable…

   We’ve all heard of the placebo effect: the positive result in a patient caused by the patient’s belief that the sugar pill (or other inert substance) they are taking is actually a helpful medication. The nocebo effect is essentially the reverse. It describes the negative result a patient experiences based on the belief that a given pill or treatment is harmful. In other words, if you think something you’re swallowing may hurt you, this thought may cause you harm. The same goes for side effects. If you think you are likely to experience a given side effect from a pill, this thought pattern may increase the chance you will experience that side effect.
   Consider findings reported in a 2002 article in the Journal of the American Medical Association (JAMA) and summarized in a Washington Post story by Brian Reid (4/30/02):

• In 1992, researchers established that women who believed they were prone to heart disease were four times more likely to die as women with similar risk factors who did not have such a negative view.
• In the 1980s, 34 college students were told an electric current would
  be passsed through their heads, and the researches advised that the
  experience could cause a headache. More than two-thirds of the students
  reported headaches even though not a single volt of current was used.
• In 1987, researchers at three different medical centers studied aspirin and another blood thinner in heart patients. Patients warned about possible gastrointestinal problems were three times more likely to have this side effect than patients at one of the sites who were not cautioned.
• In one study from over a century ago, doctors introduced a rose to a person with a rose allergy. The patient immediately began to sneeze and develop other allergic reactions. The rose, however, was a fake.
• In 2001, researchers found that patients with Parkinson’s disease given a placebo released the needed dopamine just as the brain exposed to the active drug would do.

   The recent released study by the Drs. Glaser from Ohio State University proving the impact of stress on wound-healing was yet another blow struck for the obvious: Our thoughts affect our health.
   Among the most powerful observations is the fact that 100% of pain occurs in the brain. Although my finger may be burned by  a match, it is possible for me, with self-hypnosis, to experience that as a non-painful event. It is the mind that mediates pain, not the injured part of the body. This phenomenon appears repeatedly in sports contests. Philadelphia Eagles quarterback Donovan McNabb was so engrossed in playing one particular football game that, unaware he had broken his ankle, he played on as if healthy.
   The nocebo and placebo effects (taken together, these are best referred to in Dr. Daniel Moerman’s phrase, The Meaning Effect) are so clear and common-sensical that it is astonishing these factors continue to be ignored by so many doctors. Why?
   Dr. Hahn says that these phenomena are, "conceptually difficult in our medical system…Health is thought to be a biological phenomenon. More psychosomatic elements are hard to deal with."
   Hard to deal with! What about we patients? Every care giver needs to appreciate the power of belief in delivering healthcare. As Harvard’s Dr. Herbert Benson says, "Surgeons are wary of people who are convinced that they will die. There are examples of studies done on people undergoing surgery who almost want to die to re-contact a loved one. Close to 100 percent of people under those circumstances die."
   In 2005, studies done at the University of Michigan under the supervision of Jon-Kar Zubieta, MD, PhD demonstrated that "just believing that a medicine will relieve pain is enough to prompt the brain
to release its own natural painkillers and soothe painful sensations."
   All care givers need to respect the power of thought and must be trained in how to use this knowledge to deliver more effective care. As the mind-body dichotomy continues to fade, we need to learn ways to help patients practice positive thinking approaches. We need to begin by practicing the same approach on ourselves. Entering each work day with positive imagery can help us sustain our health so that we may be effective in our sacred work.
   What are some practical approaches? The outstanding PBS series, "The New Medicine" reported that Blue Cross and Blue Shield of California now provides pre-surgical patients with visualization tapes to help them imagine successful surgeries. The goal of these tapes is to create a postive thought process in the patient. They claim that the inexpensive tapes are saving them as much as $2000 per patient in better outcomes, faster recoveries, and lower use of post-surgical pain medications.
   Drug companies obviously have nothing to gain financially by wider recognition of the meaning effect. But, clearly, insurance companies do. Imagine the cost savings if the public began to practice postive thought patterns around their health instead of relying so heavily on side-effect laden drugs! 
   The truth of all of this has been so clear for so long. How many more studies will have to appear before all caregivers accept the role of the mind in healing? You and I can begin practicing the truth of these findings by attending to our presence with patients. The way we encounter the sick, including our demeanor, our voice, and our facial expressions, can all have significant effects on one of the most powerful emotions any of us can have: hope.

-Erie Chapman