|
Second Opinion:
Mind-Body Connection
Hosted by Abigail Trafford
Washington Post columnist
Tuesday, June 12, 2001; 2 p.m. EDT
Welcome to Second Opinion, a weekly column and Health Talk discussion with Post Health columnist Abigail Trafford.
The "placebo effect" no longer exists. Placebo in Latin means "will please." In medicine, the placebo effect means that if you believe a treatment works, you will feel better. For decades physicians and patients have thought that the placebo effect harnesses the power of suggestion and unleashes the mind over matters of the flesh.
Now a review article in the New England Journal of Medicine
concludes that there is no evidence for the placebo effect. Bah humbug on wishful thinking! If the placebo effect doesn't exists, what does that say for the mind-body connection?
To discuss this is perspective is James Gordon, director of the Center for Mind-Body Medicine and chair of the White House Commission of Complementary and Alternative Medicine Policy.
Below is the transcript.
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Abigail Trafford:
Welcome everyone. Do you believe in the mind-body connection? Send us your comments and questions.
Abigail Trafford:
Hello Jim Gordon and welcome to Health Talk. What about the news that the placebo effect doesn't exist? What's your view on the New England Journal of Medicine study?
James Gordon: First of all, I haven't examined the study in detail. There are so many studies that have shown the effect of optimism on enhancing physical functions and of depression on impeding a variety of physiological measures. So, one study that reinterprets other studies is hardly overwhelming to me. If the analysis had come out the other way, there would be many people criticizing it and saying that's only one interpretation. It's clear, for example, from work that Sheldon Cohen did and published in the New England journal some years ago, that people who are more pessimistic are far more likely to come down with colds. And also, from his and other studies, that pessimism and depression decrease immune functioning. We also know that hypnosis, which in a way is a mobilization of belief, can make a huge difference in the way we feel and in how our bodies function.
Abigail Trafford:
Tell us, what was the theory behind the placebo effect? Does it have scientific merit?
James Gordon: Placebos have been used for centuries as a way that physicians could give people a neutral substance, a sugar pill, and tell them that it would be helpful. It was a way to mobilize people's belief in healing without giving them an active and potentially also harmful drug, in a situation where it was felt that the drug was not necessary. Then, as research moved ahead, placebos, from the latin "I shall please", were used as a comparison with active drugs. So there was the "real" drug versus the placebo, and the effect of the "real" drug was its own effect minus the effect of the placebo. So if 5 out of 10 people got better on the tested drug and 3 got better on the placebo, the tested drug had a 50% rate of success and the placebo had 30%, with a difference of 20%. Then, in the 1950s Henry Beecher, who happened to be my professor of anesthesiology at Harvard examined all the placebo controlled studies, that is those studies that compared placebo to the active drug, and discovered that placebo had about 35% the activity of the active drug no matter what drug was being tested, an asthma drug or a pain drug like morphine, or a drug to work on anxiety or mood. Beecher wrote up his findings and from that time on many researchers became interested in maximizing the placebo effect - which was later defined broadly as the sum of all non-specific interactions in the healing process - belief in the doctor and the hospital for example, as well as in a pill.
Abigail Trafford:
Can you explain how hypnosis works? Does it have lasting physciological effects? What kinds of conditions respond to hypnosis?
James Gordon: Hypnosis consists of relaxation, focused awareness and a dissociation or detachment from the outside world. It is a state that some people can go into more easily than others, but that seems, to a greater or lesser degree, available to all of us. It's not sleep, though hypnos is the Greek word for sleep. It is a state in which the mind is easily able to influence itself and also physiological processes. Hypnosis has been widely used for pain and anxiety, but it can be also used for conditions like asthma, for allergies, for addictions, as well as for enhancing performance. I remember when I was a kid and played in tennis tournaments, that while every body else was rushing around all hyped up, Arthur Ashe was sitting very quietly with his eyes closed. I didn't know it at the time, but apparently he was doing a kind of self-hypnosis to relax himself and to focus his attention.
Abigail Trafford:
What are the main treatments that are based on the mind-body connection. You've talked about hypnosis. What are the others?
James Gordon: There are many ways to use the mind-body connection. Relaxation is really the doorway. Once you're relaxed, you can use this state to find out what's troubling you. You can take a few deep breaths, in through the nose and out through the mouth, let your eyes close, and ask yourself a question. "What am I upset about?" "Why did I have 5 colds this winter when I usually only have one?" or "What should I have for dinner?" This is self-awareness. Then there's relaxation itself, breathing deeply, for example, balances out the fight or flight stress response, our reactions to threat or danger. When we feel threatened, the heart beats fast, blood pressure goes up, muscles get tense. When we breath deeply, blood pressure goes down, heart rate slows, muscles relax. So this kind of technique, and there are many ways to relax, can help lower blood pressure, decrease muscle tension, etc. Imagery is very much like hypnosis. It's important to remember that images can come through all the senses. Auditory, kinesthetic, olfactory, as well as visual. Biofeedback is a way to give signals about our biological functioning back to us. Actually, our brain seems to be smarter than we are because it can take these signals, for example a read out about low temperature in the fingers which may indicate tension, and help to reprogram our nervous system so that the temperature goes up and we relax. Finally, and perhaps most importantly, is meditation, which I see as a combination of self-awareness and relaxation. Meditation comes from the same Sanskrit root word as medicine. It means being present moment to moment. Other mind-body techniques include exercise, yoga, dance, Qi Gong, and other ways of using the body to relax itself and quiet the mind. Our work at the Center for Mind-Body Medicine is to teach people a variety of techniques so that they can find the one that suits them best.
Arlington va:
I know it's out of the box for most US doctors but if your talking mind over body why not take some leasons from the shalin monks. Incorparate meditaion and iner healings. I witnessed a shalin monk break an iron bar with his head, bend a sowrd with chop cucumbers with a meat clever on his belly and be lifted into the air buy 8 spear heads. It may not be proven but it's the same prinicple as a placebo. They belive and train to do it. Any thoughts?
James Gordon: Yes. The Shaolin monks are great teachers. All martial arts are in fact, mind-body approaches and combine relaxation and focused attention. And of course, most of us who use mind-body approaches, have learned them from the spiritual traditions of other cultures as well as our own.
Southern Maryland:
Several years ago I took a college course in London comparing the American attitude of drug use and the English attitude. One lecturer, a Dr. Twycross, spoke about the English hospice system and the practice of giving heroin to terminal cancer patients. The operative word here is "terminal" -- these folks have only months, weeks or days to live. One of his bone cancer patients was given massive doses of heroin to ease pain; she went into remission and the heroin was stopped "cold turkey." The woman did not go into withdrawal, proving that addiction to drugs is psychological, not physical. Are you familiar with this case or instances like this?
James Gordon: Yes I'm familiar with similar cases. The hospice movement is deeply intelligent, using medications for pain relief wisely without excessive fear of addiction. All of our medicine needs to be more focused on individual people and their unique situation. Drug addiction is, in my experience, and I've worked with thousands of addicts over the years, psychological, social and spiritual, as well as physical. One final word, people with cancer and many other illnesses can enhance the power of the medications they take and often decrease the need for medication by using mind-body approaches.
MD:
I just quit smoking a week ago. Feels great! Now I go round bragging about it. I just wanted to tell everyone: it's easy!! You don't need any of those patches or pills. Thanks for listening - I'm just sharing the joy. Abigail Trafford:
What did this person do in his/her mind to give it up. Or does it mean this lucky soul wasn't physiologically addicted to nicotine, so it was easy to give it up?
James Gordon: There's a saying in the East that when the student is ready, the teacher arrives. My own experience as a physician and as a former smoker, is that when the time is right for you, and it's different for each person, then there are many techniques that will work. When you're not ready every technique is going to be highly problematic.
Washington, DC:
I work in a stressful environment, not so much the work that is making it stressful but the office politics and everything that goes on 'behind your back'. I have been passed for a promotion that everyone has me in line for (even though I am not supposed to know this yet). My guess is that they hope I will never find out, the place is so secretive that they can assume something like that. With this 'stabbing' going on all around me, I feel that emtionally and physically it might be a hazard for me to stay here. Can you tell me what are the long-term effects on health of working day-to-day in an environment like this? I do believe that there is a mind body connection and wanted to know if I should start looking for another job for my health's sake. thank you.
James Gordon: Workplace stress is of huge importance. When I read over the manuscript of one of my books, Manifesto for a New Medicine, I discovered that almost everyone whom I wrote about at length, regardless of whether the diagnosis was heart disease, chronic pain, neurological problems or depression, had significant difficulties at work. A major part of helping them to heal was helping them either to change their attitude toward work or to find some work that truly fulfilled them, or to find a new place that was more congenial. There's a huge amount of research especially on the contribution of frustration at work to heart disease. The point for you is to find a way to be at home where you work, or to find another place or another way to earn your living. Our groups at the Center for Mind-Body Medicine, often give people an opportunity to learn relaxation techniques which can reduce their stress at work and elsewhere, and to come to know themselves in a new way which will help them make wiser choices.
Abigail Trafford:
Jim, can you be specific about how a cancer patient might reduce the need for medicines with mind strategies? How does the power of the mind enhance the effectiveness of chemotherapy for example?
James Gordon: I'm not specifically thinking of decreasing the need for, or the dose of chemotherapy with mind-body approaches. Chemotherapy basically works by attacking the cancer cells, whereas mind-body therapies work by enhancing immune and other natural healing mechanisms. So they can go together. One to attack the cancer, the other to enhance the body's own capacity for self-healing. I was thinking more of mind-body therapies being used to decrease the side effects of treatment - nausea, vomiting, pain, fatigue, etc. There is good evidence for their ability to do this. We've been teaching these techniques to people for many years.
Gaithersburg, Maryland:
I've been taking Norvasc - 10mg for the last 4 months and can truely say that I haven't felt 100% since taking the medication. I have high blood pressure that gave me some dizziness spells. Well, taking the medication also gave me dizziness, lethargy, and just not feeling quite right. Ultimately I'd like to get off all medication...have you any suggestions for alternative treatments for High blood pressure. Dieting and exercise weren't working.
James Gordon: Medication for hypertension often has side effects. Many of the mind-body therapies can contribute to lowering blood pressure, as can a number of nutritional and herbal therapies. If you want to use these approaches though, you're going to have to find someone to help you learn them and coordinate your efforts with these therapies with what your physician is doing. For example, if you were to do relaxation therapy and yoga on a regular basis, your blood pressure is likely to go down. So you need to make sure that your medication would be lowered appropriately. On the other hand, lowering the medication too fast can also be dangerous. This is why what we call an "integrative approach" is so important - monitoring all aspects of your care. My suggestion would be that you find a place where you can learn these therapies - you're welcome to call the Center for Mind-Body Medicine at 202-966-7338. Our groups are available to everyone regardless of ability to pay. And that you also discuss with your doctor your plans.
Orono, Maine:
The center's Web page says that one of its key goals is bringing the issue of mind-medicine to the forefront in the healthcare debate. Given that what you are really selling people is pseudo-science, isn't it irresponsible to suggest to people that they can forgo conventional medical treatment and will their way to good health? Abigail Trafford:
Whoa.... I don't think anybody is suggesting that people forgo EFFECTIVE conventional medical treatments. Jim, your response?
James Gordon: I hope that what our correspondent from Maine will do is take a look at some of the science. I think everyone agrees that there should be "a level playing field" for research on all therapies. Part of the Center's job, and of any physician's, is to help people find that approach which is most likely to be effective for them with the least possible harm. That means taking a look at what we know, and don't know, about mind-body, and indeed, all other therapeutic approaches. It's as unscientific to reject an approach without learning about it, as it is to embrace it.
Dover, Del.:
Isn't there a real danger that people will buy into this "mind-body" effect and forgo real medical treatment that could save their lives? Look at Suzanne Sommers, who has announced that she's planning on fighting breast cancer holistically. Why, in this age of technology, should any rational person opt not to have pursue a course of treatment that has been proven effective?
James Gordon: I address part of this in my last response. The interesting thing is that Suzanne Sommers actually had conventional treatment. She just made a choice to not continue with a particular kind of chemotherapy at this time. Making choices about treatment, particularly about cancer treatment, is extremely difficult - for just about everyone. Conventional oncologists don't always agree, and then there are all these other therapies which are both widely praised and condemned. It's important though to know that the vast majority of people with cancer use conventional therapies. The question they have is "What else can I do?". Meaning what is available in addition to the conventional therapies to help extend my life as well as to make me feel better. They are also asking "What can I do?". Meaning how can I be active on my own behalf. And this is extremely important as well. The Center for Mind-Body Medicine puts on a conference each year where we bring together the people who are doing the most interesting research in complementary and alternative therapies for cancer and the leaders in mainstream cancer care to discuss the most recent and promising research, and the ways in which we can help patients create individualized programs that are best for them. At a time when over half a million people are dying from cancer, and when 1.2 million of us are diagnosed with cancer each year, we all need to work together to find which therapies are most useful, when they should be used, and how they can be combined. Incidentally, you can read transcripts of that conference on our website, www.cmbm.org, and patients are all welcomed at the next Comprehensive Cancer Care Conference, October 17-21, 2001. Our goal is to help inform you, and our belief is that the better information you have about all therapies, the wiser choices you'll make, and the better you'll be able to plan your treatment with your physicians.
Albuquerque, N.M.:
If the placebo effect is no longer
recognized, how do you explain the
results of so many previous studies that
did acknowledge its existence? Abigail Trafford:
The Danish researchers reviewed more than 100 previous studies on the placebo effect. They found major flaws in them. In their analysis, there was "little evidence" to support a placebo effect. They did find some evidence for a placebo effect in the treatment of pain--but very slight, the equivalent of about a third of an aspirin tablet. But at least that's something. As David Spiegel, a professor of psychiatry at Stanford University put it: "They showed not that the placebo doesn't do anything, buyt that it doesn't do everything." Jim, your thoughts on this?
James Gordon: The issue is not just with the placebo effect as it appears in studies on "active" drugs. The more important issue is how can we mobilize that capacity for self-healing that we have tried inadequately to sum up as the "placebo effect". If we use our imagination, through hypnosis, imagery, or biofeedback, we can make very real and measurable changes for the better in the way we think and feel, and the way our bodies function.
Harrisburg, Pa.:
What is the Commission's purpose? Its resources? I'm thrilled to see 'alternative' in almost anything, but have my doubts about where this administration might take it.
James Gordon: The White House Commission on Complementary and Alternative Medicine Policy was created by President Clinton and the Congress. It is continuing under President Bush. The focus is on making recommendations about how the benefits of complementary and alternative therapies can be made available to the American people through research, services, public information, and professional education. The Commission was created with wide bi-partisan support - members of Congress like the people of America are using these therapies in very large numbers - perhaps 50% of all of us. They want to know, as their constituents do, what works and when to use it, how to put together truly integrative programs. They want their doctors to be able to guide them, and they want the best information possible easily available. We have every indication that the Bush Administration is quite interested in the Commission's findings. We'll be presenting an Interim Report on July 13, 2001 and offering our Final Report to the President in March 2002.
Leesburg, Va.:
Anyone who has experienced anxiety and stress and how these affect the mind & body know there is a connection between the two. Abigail Trafford:
Let's explore this, Jim. If you suffer from anxiety, what kinds of strategies that work on the mind can help relieve anxiety? Compare "talk therapy" with medication?
James Gordon: The stress response, or the fight or flight response, does indeed feel like anxiety - and that's because it is. All of us get stressed. And, in fact, our bodies are built to deal with stress, to respond in a beneficial way. So, if a lion is coming after you, you better be ready to fight the lion or to flee. That feeling is definitely a feeling of anxiety, as it should be. The problem is when that feeling persists long after the lion has disappeared, when we keep thinking there's going to be a lion around the next corner, or indeed, that when we come into work in the morning, or go home at night that there's going to be an angry and hungry lion there to greet us. Most anxiety is of this kind - a chronic state of high physiological and emotional arousal. I believe firmly that it's important to know what's making you anxious, and to differentiate real threats from fantasy. Talk therapy, of various kinds, can be very helpful. Both therapies that help you see the internal sources of anxiety in your own view of yourself and the world, and therapies that change your perception, the former are called psychotherapy, generally speaking, and the latter, cognitive or cognitive-behavioral therapy. I tend to think a combination can be useful, coupled with, always, mind-body therapies. These help you to become more aware of what's causing the anxiety in the moment it is happening, and teach you to use approaches which directly decrease the physiological symptoms (and reflections) of the anxiety.
Abigail Trafford:
Our time is up. This has been fascinating. Jim Gordon, thank you. Let's talk about these issues again. Thank you everybody for your questions. Sorry we couldn't get to all of them. Join me next week, same time, same place.
|
|
© Copyright 2001 The Washington Post Company |
