Tuesday, February 05, 2008

Finding meaning in randomness

In the January 27 New York Times Book Review, noted physician/writer Jerome Groopman reviews Harvard professor Anne Harrington's The Cure Within: A History of Mind-Body Medicine. A timely book, observes Groopman. In the United Sates, visits to providers of complementary and alternative medicine -- homeopathy, acupuncture, herbal remedies, crystal therapies, and the like -- now outnumber visits to medical doctors, to the tune of $40 billion a year. Can all of this be mass delusion, or is there something real on offer?

Harrington looks at the deep history of the mind-body connection, and thinks it at least partly addresses the personal mystery of illness: Why me? Why now? What next? Positive thinking gives the patient some measure of being in control of her own destiny. And of course, there's the placebo effect, about which physicalist doctors understand very little.

Placebo Domino in regione vivorum, "I will please the Lord in the land of the living." This verse from the Latin Vulgate Bible brought the word placebo into the English language. It is the name commonly given to the Roman Catholic Vespers for the Dead, which has the biblical passage as the initial responsive verse. Long before the word showed up in medical literature, it had already acquired other English meanings -- flatterer, parasite. "To sing placebo" means to play the sycophant.

Today, we use the word almost exclusively for the famous "sugar pill" that physicians sometimes give to patients who insist upon medicine when none is strictly called for, and which are used as controls in tests of new drugs. The sugar pill has therapeutic effects, or so it has been claimed. It has long been gospel within the medical community that placebos have clinical benefits in as many as one-third of patients who take them. Can thoughts affect physical body functions by tricking the brain into releasing endorphins -- a natural morphine-like drug -- into the body?

A few years ago, two Danish researchers, Asbjorn Hrobjartsson and Peter Gotzsche, reported in the New England Journal of Medicine that the curative power of placebos is a myth. They tracked down 114 studies that compared placebos to no treatment at all, and found no significant differences, except possibly in the subjective relief of pain. In other words, the famous "placebo effect" does not exist.

In the meantime, 60 million Americans believe in therapies that have no recognized physical causation. Psychologist Barry Beyerstein lists ten reasons why these therapies sometimes seem to work, including (in addition to the placebo effect) spontaneous remission of symptoms, the power of suggestion by charismatic gurus who peddle alternative therapies, psychological distortion of reality (what psychologists call cognitive dissonance -- the denial of unpleasant truths), and the possibility that some allegedly cured symptoms might be psychosomatic to begin with.

Placebo means literally "I will please." Like everyone else, physicalist skeptics like me (and Groopman) have a tendency to please ourselves. More research needs to be done to discover the precise biochemical nature of whatever is meant by "the power of suggestion," "mind-body connection" and "psychosomatic." Until we know in some real physical sense how the mind affects the body, alternative therapies will continue to lurk in the dusky corners of medicine.