Feature: Self-Healing as a Part of Health Care

IS THE PLACEBO RESPONSE A CLUE TO REDESIGNING OUR HEALTH SYSTEM?

            The human body’s “inner pharmacy,” discovered by medical studies involving placebos, can have a major impact on improving our national health care system.

            You’ve probably heard that the medical phenomenon known as “the placebo response” can be very powerful—so powerful that medical scientists have to go to great lengths in designing experiments to be sure that what they think is the benefit gained from a new wonder drug is truly a response to the drug and not a placebo response. Is the placebo response powerful enough to help patients help themselves? And is it powerful enough to point to ways in which we could improve our entire health care system?

THE SCIENCE OF THE PLACEBO RESPONSE

            It probably sounds very strange to offer the placebo response as a potential means of patient empowerment. Historically, we have associated the placebo response with a cure or relief of symptoms that occurs when a physician gives a patient a sugar pill or similar dummy, with the impression that it contains some powerful chemical. This suggests that the placebo response relies on trickery and deceit, and is something done to the patient by a manipulative doctor. But modern science has revealed enough about the placebo response to balance this incomplete picture. It makes much more sense to say that the placebo response is a change in the patient's state of health, due to the mental or symbolic impact of the medical treatment. That means that all medical treatments, not just dummies, can potentially be accompanied by a placebo response—which need not detract at all from the other powers that treatment might possess. And that goes for alternative as well as conventional treatment.

            One handy way to think about the placebo response is to envision the body's inner pharmacy. The body seems to produce many of its own healing substances which can reverse illness or injury; and these substances seem to be produced quicker and in larger quantity when the mind receives certain sorts of messages from the outside world. If we could learn what some of those messages are, then perhaps we could (in effect) start to phone in prescriptions to our own inner pharmacies. A clue to some of those messages may be found in another way to conceptualize the placebo response, the meaning model. Perhaps the inner pharmacy is turned on the most when we begin to attach a more positive meaning to the experience of being ill or getting treatment. That could occur when three things happen:

• People listen to our stories and then offer sound explanations of what is going on.
• People express care and concern for our plight.
• We sense a greater mastery or control over our symptoms.

            Today's medical science confirms that healing can be more rapid when these things happen. Science has also begun to identify the body's biochemical pathways, which can be activated by a change in our mental or emotional state, and ultimately produce healing changes in various organs.

APPLYING THE SCIENCE TO IMPROVE OUR HEALTH

            Doctors could use the meaning model to take better care of patients, increasing the chance that a positive placebo response will be added onto whatever other treatment is used. But why allow only doctors to use these insights? What could we do, ourselves, to take advantage of these meaningful messages which could help turn on the body's inner pharmacy? We propose that there are a number of modest, yet potentially powerful tools suggested by the science of the placebo response. We have elaborated them in detail in our book, so here is a quick summary:

             First, symbolic messages that stand in the way of healing need to be cleared out of the way. Two common interfering messages are a lack of desire or a fear of improvement; and unresolved anger and lack of forgiveness. 

            Next, a greater sense of meaning often comes from the stories we construct to explain our lives. There are ways to tell ourselves better stories about our illnesses, which point to better outcomes and healing actions. Stories do not work their full effect if no one listens to them. When social isolation has become a part of our illness, reconnecting ourselves can be a major contributor to well-being. Feeling that we are potentially in charge of things, rather than being passive victims of our ill health, is perhaps one of the most powerful changes that can stimulate the inner pharmacy. Various techniques can be used to take an inventory of how much power and powerlessness we now feel, and then proceed systematically to increase the power and decrease the victimhood. 

            We can do all of the above without seeking any professional guidance; but why go it alone when a partnership with a healing person could add much more to our efforts? Strategies can help us choose the right partner and then to get the most advantage out of each visit with that healer. None of these healing strategies is a magic bullet that will, with certainty, fix everything that's wrong with us. But, used carefully, these techniques can be a powerful add-on to all the other things we are doing to stay healthy. They can assure that we are using the full capacity of our minds to take the best possible advantage of the inner pharmacy.

            Fixing the way we provide health care in the U.S. will need more than the placebo response—and will certainly need more than placebos. But at least one important lesson emerges from the study of the placebo response. If we try to save money on health care by making visits with our physicians ever briefer and less personal, then we are likely to see worse health, and higher future medical costs, as a consequence. The inner pharmacy seems to be telling us that positive human relationships, in themselves, can be healing. With the placebo response as an add-on to other medical treatments being relatively cheap, and virtually without side effects, we'd be silly not to try to design our health system to maximize its healing potential wherever possible.

GOOD NEWS FOR A BETTER HEALTH CARE SYSTEM

            If we gathered a group of thoughtful people and talked for a while about what sort of health care system this country needs, we suspect they would eventually arrive at a list like this:

• Scientific medicine
• Humane medicine
• Personalized medicine
• Ethical medicine
• Affordable medicine

            One reason so many people feel deeply frustrated with our present health care system is that these desirable features seem to be on a mutual collision course. For instance, all too often, modern scientific medicine seems increasingly inhumane and impersonal. As medicine becomes more technologically advanced, it also becomes unaffordable. So the mechanisms we have used to keep down costs, such as managed care, seem today to be producing inhumane, depersonalized, and occasionally unethical medicine. Is there any way out of this tangle? The hard truth is that to some extent trade-offs are inevitable.

            With advances in science and technology, health care does get more expensive; and as the average age of the population increases, people require more medical care. So it's likely that in the future we'll either have to pay more or get less. Nor is it clear that the increased use of alternative medicine will do much to bring down costs, since most Americans use alternative medicine in addition to, rather than in place of, conventional care.

            Before you get too discouraged, let's imagine that we were about to start afresh in designing our health care system. And let’s imagine further that we used as our point of departure a special sort of relationship between physician and patient. This sort of relationship has been a focus of teaching in the medical schools at MSU for many years.