Iie Power of ‘A Want to devise a new form of alternative medicine? No problem. Here’s the recipe. Be warm, sympathetic, reassuring, and en- thusiastic. Your treatment should involve physical contact, and each session with your patients should last at least half an hour. Encourage your patients to take an active part in their treatment and under- stand how their disorders relate to the rest of their lives. Tell them that their own bod- ies possess the true power to heal. Make them pay you out of their own pockets. Describe your treatment in familiar words, but embroidered with a hint of mysticism: energy fields, energy flows, energy blocks, meridians, forces, auras, rhythms, and the like. Refer to the knowledge of an earlier age: wisdom carelessly swept aside by the rise of blind, mechanistic science. B_ Oh, come off it, you’re saying. Something invented off the top of your head couldn’t possibly work, could it? Well yes, it could—and often well enough to earn youa living. A good living if you are sufficiently convincing, or, better still, really believe in your therapy. Many illnesses get better on their own, so if you are lucky and admin- ister your treatment at just the right time, you'll get the credit. But that’s only part of it. Some of the improvement really would be downto you. Your healing power would be the outcome of a paradoxical force that conventional medicine recogni: mains oddly ambivalent about: the placebo effect. THINS Placebos are treatments that have no digg effect on the body, yet still Work because the patient has faith in their power o hea, Most often the term refers o.a dummy pi, but it applies just as much to any devig or procedure, from a sticking plaster to 4 crystal to an operation. The existence of the placebo effect implies that even quackery may confer real benefits, which is why any mention of placebo is a touchy subject for many practitioners of complementary and altemative medicine, who are likely to regard it as tantamount to a charge of charlatanism. In fact, the placebo effect is a powerful part of all medical care, orthodox or otherwise, though its role is often neglected and misunderstood. D Atone level, it should come as no surprise that our state of mind can influence our physiology: anger opens the superficial blood vessels of the face; sadness pumps the tear glands. But exactly how placebos work their medical magic is still largely unknown. Most of the scant research done so far has focused on the control of pain because it’s one of the commonest complaints and lends itself to experimental study. Here, attention has turned to the endorphins, morphine-like neurochemicals known to help control pain. E That case has been strengthened by the recent work of Fabrizio Benedetti of the University of Turin, who showed that the placebo effect can be abolished by # drug, naloxone, which blocks the effectsdorphins. Benedetti induced pain in G of en Fi man volUneets by inflating a blood- ure cuff on the forearm, He did everal times | for several days, is $orphine each time to contro : ee on the final day, without ne he replaced the morphine with atine solution. This still relieved the sabi ects’ Pai placebo effect. But when he added naloxone to the saline, the pain relief disappeared. Here was direct proof srr pacebo analgesia is mediated, at least jn part, by these natural opiates. Still, no. in Hesows how belief triggers endorphin release, OF why most people can’t achieve placebo pain relief simply by willing it. Though scientists don’t know exactly how placebos work, they have accumulated a fair bit of knowledge about how to trigger theeffect. A London rheumatologist found, forexample, thatred dummy capsulesmade wre effective painkillers than blue, ereen, cones. Research on American led that blue pills make than pink, a color more ants, Even branding can f Aspro or Tylenol are ke for a headache, their equivalents pai anythings or yellow students. reveal better sedatives suitable for stimul make a difference: what you like to ta chemically identical generic may be less effective. it maters, too, how the treatment is de- livered. “Physicians who adopt a warm, friendly, and reassuring bedside man. wei” reports Edzard Ernst, professor of Complementary and Alternative Medicine at Exeter University, “are more effective than those whose consultations are formal and do not offer reassurance.” Warm, friendly, and reassuring are also alternative medicine's strong suits, of course. Many ofthe ingredients of that opening recipe— the generous swathes of time, the stronS hints of supernormal healing power—2e just the kind of thing likely «© #™ H patients, 1's Pe Ws hardly surprising, then, that : I, acupuncturists, herbal- ole. se ; em to be good at mobilizing the placebo effect alternative into The question is whether medicine could be integrated conventional medicine, as some would like, without losing much of its power. But for much of alternative medicine— especially techniques in which the placebo effect accounts for most or perhaps all the benefit—integration might well be counterproductive. After all, the value of alternative medicine depends partly on its unorthodoxy. “One intuitively feels that something exotic has a stronger placebo effect than something bog-standard. And some complementary therapists are very exotic,” says Ernst. Integration faces other obstacles, 100. Doctors would face serious ethical dilem- mas in recommending what they know to be placebo treatments to their patients. And complementary practitioners would likely be disparaged by their conventional coun- as they often are today. Integrated terparts, wut as much va- medicine “would have abot ldity as a hybrid of astronomy and asrol ogy,” wrote anesthetist Neville Goodman in the April newsletter of Health Watch. point out that a professor of surgery with @ confident manner, en expensive suit, and an {international reputa- tion who sees You privately and guarantees to solve your problem with 8 costly opera still unrivaled as a source of placebo doctors are beaten hands mative practitioners ymphooyte from @ know ishow that’s a big ont (3) ‘Some would also tion is power. But most down by countless alter who might not know 2