Placebos, Faith Healing and Modern Medicine

I began my studies of traditional Chinese medicine In the mid 1970’s, I was perusing an undergraduate degree while working part time as an animal handler at an equine veterinary clinic in Phoenix, Arizona.

Dr. Saum, the vet, had gone up to Vancouver BC to learn animal acupuncture from a famous Chinese doctor. When Doc returned he was so excited about acupuncture it was the only modality he wanted to use to treat the horses and other large animals we saw at the clinic.

One of my jobs was to take the horses from their trailers to the treatment stalls and “gentle” them with a brush or by caressing their muzzle with calming words and gentle songs while we waited for Doc. That was the best part of the job.

Because acupuncture was new to Doc and I was handy, he would talk to me about where each needle went, how deep and at what angle it should be inserted and all about what the Chinese said the needle would accomplish. I think by downloading the information so precisely to me he was keeping it straight in his own mind.

Once I overheard Doc and one of the cowboys whose horse we were treating talking about the placebo effect, the cowboy thought that was all there was to “this Chinese voodoo” that Doc was practicing. Doc asked the cowboy if he had had any conversations with his horse about acupuncture. The man said no. Doc asked me if I had been talking to the horse about the wonders of acupuncture and I said I hadn’t. Doc said as far as he knew the horse had no conception at all about the effects of acupuncture and had no personal opinion about medicine, Chinese or otherwise. “When I put a needle in a horse to make him eat, he eats. When I put a needle in to make him poop, he poops.” “There ain’t any placebo effect in animal acupuncture”.

Faith healing is modern Christianized term for shamanism. A shaman is a person regarded as having access to, and influence in, the world that exists between the physical and that which is beyond our normal senses.

A Shaman is one who practices divination and healing using herbs, incantation, ritual and imagery. Archeological evidence demonstrates that at the dawn of Chinese history, before the second millennium BCE prior to the Shang dynasty the primary health care providers were Shamans (Wu). This is in fact true for all cultures throughout the prehistoric world.

In ancient times disease was thought to originate from one of two probable causes. Either one had done something to aggravate the harmony of one’s ancestors or one had been invaded by an evil immaterial entity. There were two clear courses of therapy for these disease causes; either the ancestor was placated through ritual and offerings or the evil entity was induced to leave the host using shock and fright with loud noises and flashes of light like fireworks in China. The shaman might also menace a possessed host with scary chants and sharp sticks or spears to drive the evil entity away. Some anthropologists believe that the sharp stick thing eventually may have eventually evolved into acupuncture.

The current healthcare debate has brought up basic questions about how modern medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the barely tolerated field of alternative medicine that attracts millions of patients a year and embraces hundreds of treatment modalities not taught in conventional medical schools.

Conventional mainstream medicine promotes the notion that it alone should be considered medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends. Even the American Board of Medical Acupuncture an MD only organization, considers its members to be superior in the field of acupuncture with only 200 hours of training compared to the thousands of hours required by licensed acupuncturists. Their assertion is that their advanced knowledge of biomedicine fills in any gaps in their acupuncture training.

If a pill or surgery won’t do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.

The British Medical Journal recently undertook an analysis of common medical treatments to determine which are supported by sufficient reliable scientific evidence. They evaluated around 2,500 treatments, and the results were as follows:

  • 13 percent were found to be beneficial
  • 23 percent were likely to be beneficial
  • Eight percent were as likely to be harmful as beneficial
  • Six percent were unlikely to be beneficial
  • Four percent were likely to be harmful or ineffective.

This left the largest category, 46 percent, as unknown in their effectiveness. In other words, when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial. This is remarkably similar to the results Dr. Brian Berman found in his analysis of completed Cochrane reviews of conventional medical practices. There, 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”

For those who have been paying attention, this is not news. Back in the late 70’s the Congressional Office of Technology Assessment determined that a mere 10 to 20 percent of the practices and treatment used by physicians are scientifically validated. It’s sobering to compare this number to the chances that a patient will receive benefit due to the placebo effect, which is between 30 percent and 50 percent, according to various studies.

The news last fall that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking. Each year, hundreds of thousands of American patients receive stents for the relief of chest pain, and the cost of the procedure ranges from $11,000 to $41,000 in US hospitals.

In 2002, The New England Journal of Medicine published a study demonstrating that a common knee operation, performed on millions of Americans who have osteoarthritis — an operation in which the surgeon removes damaged cartilage or bone (“arthroscopic debridement”) and then washes out any debris (“arthroscopic lavage”) — worked no better at relieving pain or improving function than a sham procedure. Those operations can go for $5,000 a shot.

One root of the problem is that the coalition in favor of evidence-based medicine is weak. It includes too few doctors, commands too little attention and energy from elected officials and advocates, and it is shot through with partisanship. Naturally, pharmaceutical companies and medical device makers wish to protect their profits, regardless of the comparative effectiveness of other treatments (or cost effectiveness) of what they are selling.

While virtually all doctors support evidence-based medicine in the abstract, clinicians and medical societies seek to maintain their professional and clinical autonomy. Physicians are sensitive to being second-guessed, even when their beliefs about how well treatments work are based on their own experiences and intuitions, not rigorous studies.

So, do we dump conventional mainstream medicine? Of course not, I do not propose that we give up the life saving drugs and procedures that are the wonder of modern medicine, but I do suggest that blind faith in allopathic medicine is as misguided as blind faith in alternative medicine. Further research is needed in both allopathic and alternative medicines but it is slow going because the expense of research is often prohibitive. If we were to bring the cold eye of science to every aspect of medicine, accepting and using only that which had been fully scientifically validated and proven, we would have very little medicine at all.

Yours in good health,

Robert Kienitz, DTCM

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