THE POWER OF PLACEBO
"I am not suggesting that all surgery is ineffective or harmful. I am a surgeon and I spend a considerable part of my working life performing surgery. It is fair to say that I am skeptical of many of the claims of surgery, because scientific inquiry so often shows the effectiveness of many treatments to be less than initially claimed. For many complaints and conditions, the real benefit from surgery is lower and the risks are higher than you or your surgeon think." Dr. Ian Harris, from an online Australian Newspaper, The Age (Book Extract: Surgery, The Ultimate Placebo)
In response to a recent article I wrote on TISSUE REMODELING, 'Slammin Sammy Jon' commented (I deleted it) "You damn chiropractors talk a good fight but about all you're good for is giving desperate people an expensive boost of placebo power." Although this individual was off base in his assessment of MY CLINIC, his comment raises an interesting question among anyone delivering healthcare --- Chiropractors, MD's, Naturopaths, Massage Therapists, RN's, Homeopath's, etc, etc, etc. Just how big a factor is Placebo in medical treatment?
Back in January of 2010, the "gold standard" of research meta-analysis, THE COCHRANE REVIEW (Placebo Interventions for All Clinical Conditions), looked at almost 250 studies on the subject published between 1966 and 2008. Their conclusions; "We did not find that placebo interventions have important clinical effects in general." Fortunately, "in general" was not the end of the story. Listen to the author's caveat. "However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain...... Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed. Larger effects of placebo interventions were associated with physical placebo interventions (e.g. sham acupuncture)..... as well as in trials that did not inform patients about the possible placebo intervention."
Interesting. Physical interventions --- the very thing I do all day long in my clinic --- also happen to have the greatest Placebo Effect. This is not to say that what I do is a "Placebo" --- it's ALL TOO OBVIOUS that this is not (at least not entirely) the case. However, in light of what we know about the healing power of listening to patients and actually touching them (patients complain to me all day long that some specialist told them what was wrong with them from across their desk), I am not surprised. Just yesterday I had a patient come from a distance to see me. His reason? He had heard that I was the best in the area. The truth is, in cases like that, my work is already half done. But all of this begs the question of whether the "Placebo Effect" is real, or all in one's head? The truth is, it's both.
Let me give you an example using CHRONIC (TYPE III) PAIN. In some cases, pain can get locked into the nervous system where it plays on a loop --- sort of like a record player, whose needle is stuck in the same groove of a record. Is this person's pain real? Darn straight it is! But in many cases, there's no tangible, touchable, measurable, physical basis for it. This is because oftentimes, it's in their head --- locked into their BRAIN. And in the same way we can use advanced neuro-imaging techniques to map the parts of the brain affected by Chronic Pain (even though we can't find any physiological reason for said pain), we can likewise map the parts of the brain affected by the "Placebo Effect". Listen to what seven neurologists, neuroscientists, and radiologists from UCLA had to say about this phenomenon in a 2003 study that was published in the November issue of Neuro Image (The Neural Correlates of Placebo Effects: A Disruption Account).
"Neuroimaging research on placebo effects has focused primarily, though not exclusively, on the neural outcome of placebo effects—identifying changes in the brain regions that most directly relate to subjective changes in symptoms, and comparing these changes with those stemming from active pharmacological agents. This research has been critical in demonstrating that top-down, belief-related placebo effects modulate the activity of brain regions ordinarily affected by other treatments that presumably operate through bottom-up mechanisms that are not belief related. Such work speaks to the longstanding concern regarding whether placebo effects and other expectancy effects are real, experimental artifacts, or self-presentational effects."
Decades before I was born, the brilliant BJ PALMER wrote, "The beauty of Chiropractic is it that it works with natural means. It puts nothing new into the body and takes away no natural gland or organ. Chiropractic simply releases life forces within the body, sets free rivulets of energy over nerves, and lets nature do her work in a normal manner." He also coined the phrase "Above Down, Inside Out" (ADIO). His points are simple to understand. Although BJ would have largely agreed with the quote from the very top of the page, he also realized that true health only comes from within the body ---- from the top down; not from something UNNATURAL you put into it or cut out of it. Here's the cool thing.
The study in the highlighted paragraph above (which, by the way, pertained to IBS) concluded that, "These individuals reported significant symptom improvements over the course of a 3-week placebo regimen." According to these authors, the effect on the body is the same; whether it originates in the brain as the result of a placebo, or whether it originates in the periphery as the result of drugs or surgery. Which brings me to an interesting take on the relationship between pain and "mind over matter".
The year I GRADUATED FROM HIGH SCHOOL, Dr. John Sarno (an MD and former professor at the Howard A. Rusk Institute of Rehabilitative Medicine, New York University Medical Center) published his ground-breaking book, Mind Over Back Pain: A Radically New Approach to the Diagnosis and Treatment of Back Pain. Since then, he has published two other similar best sellers, been the subject of a documentary film on the 'Mind / Body' connection to Chronic Pain --- particularly chronic spinal pain, and even been called "America's Best Doctor' by none other than FORBES.
Although I would suggest you read the fascinating piece on him that was published in HuffPo just over a year ago (This Doctor Believes Your Back Pain Is All In Your Head), I was drawn to the article's comment section. It was an interesting mix of individuals singing Sarno's praises, and vehemently bashing the those singing said praises as gullible, mentally unstable liars. If you would have put these two groups of people in the same room, there would likely have been bloodshed.
Even though I can't buy everything he's selling, it's not difficult to see that Sarno is on to something big here. Once you start to understand things like FASCIAL ADHESIONS, STRESS, INFLAMMATION, ASYMPTOMATIC DISC HERNIATIONS, and the reverently embraced farce of EVIDENCE-BASED MEDICINE, you can start to see why Sarno is probably more right than wrong. Enter Dr. Ian Harris.
Dr. Harris, an Australian Orthopedic Surgeon who holds both a Masters and a Ph.D, and has a Curriculum Vitae that reads like a veritable Who's Who. Besides being a practicing surgeon, he is a Professor of Orthopaedic Surgery at UNSW Australia, Director of the Injury Research Stream at the Ingham Institute, and Director of the Whitlam Orthopaedic Research Centre, as well as being an administrator for the Agency for Clinical Innovation. His bio reveals that on top of all this, he loves to research.
"Prof Harris' research interests are clinical in nature, in areas such as clinical trials, surgical outcomes, patient satisfaction and systematic reviews. Prof Harris has published over 100 peer-reviewed articles and lectures nationally and internationally mainly in the field of evidence based medicine and orthopaedics."
Ahhhhhhh; there it is. EVIDENCE-BASED MEDICINE. Scroll through my links on the topic and you'll quickly realize it's not all that it's touted to be. Dr. Harris would agree --- particularly when it comes to SPINAL SURGERY, and he's busy letting the world know that the emperor has no clothes.
The October 4, 2012 issue of the Sydney Morning Herald (Push for Tougher Line on Surgery), wrote of Harris, "Surgeon and director of the Whitlam Orthopaedic Research Centre Ian Harris said less than half of the operations performed in Australia had been evaluated by rigorous trials to check they were better than placebos or non-operative alternatives. The concern comes as debate rages about the merits of several common operations, including arthroscopy for osteoarthritis of the knee, spine fusion surgery for low back pain and carotid artery surgery for people with blockages in their necks. In all three cases, there is mounting evidence the procedures are either ineffective or less useful than other treatments while exposing patients to the risks of surgery......." Risks of surgery are many. There are POST-SURGICAL ADHESIONS, SUPERBUGS, CHRONIC PAIN, and any number of others.
Dr. Harris took it to the next level and published a book that hit the shelves today; SURGERY: THE ULTIMATE PLACEBO. In the book, he talks about several surgeries that are likely no better than Placebo. This article specifically mentions APPENDICITIS, SPINAL FUSION, HYSTERECTOMY, KNEE SCOPES, and Coronary Stenting (something that Dr, Julian Whitaker has been screaming about for decades), not to mention the fact that fewer than 15% of all medical interventions are backed by evidence that they actually work (HERE). To see what Dr. Harris specifically has to say about Spinal Surgeries, you can read last week's article in The Age called Back Pain? Try Some Placebo Surgery (HERE).
For the record, how much better than placebo does a drug or surgery need to be in order to be considered "effective"? Great question. What I can tell you is that between statistical significance, P (probability) values, the difference between relative and absolute differences, UNDER-REPORTING SIDE EFFECTS, not to mention the plethora of devious ways that Big Pharma is gaming both the government and the public (HERE), we see that medicine and surgery are often worse than no medicine or surgery (HERE). And as for any Placebo Effect that occurs in my clinic? All the better! We'll take it any way we can get it.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).