Belief and Healing

John Matzke was told he had only 18 months to live. His oncologist insisted he immediately begin aggressive treatment for the melanoma that had metastasized to his lung.

But John instead took a month off to strengthen his body before the grueling treatment began. He hiked, meditated, exercised and ate organic food. A month later, his lung tumor had completely disappeared on its own.

Though melanoma is one of the deadliest cancers, John never started treatment and thrived another 18 years.

Have you ever heard stories of “spontaneous remission?” You know, someone has a terrible, even life-threatening disease–only to have it disappear for completely unknown reasons?

The scientific and medical communities have struggled for decades to learn the combination needed to allow the body’s natural ability to heal.

Indeed, the mystery of healing—whether from disease, injury, trauma, or myriad other afflictions— has been at or near the heart of mysticism, philosophy, science, religion, and medicine since the beginning of human civilization. And yet, it seems the more we learn about the miracle, the less we understand.

But one thing is certain:

The mind is important, and perhaps even the MOST important factor in healing and recovery.

And yet this “mind effect” is most often spoken of in extremely negative terms. Ever heard of the placebo effect?

As you likely know, a placebo is a chemically or physically ineffective treatment, such as a sugar pill, given to patients who believe it works. The patient’s belief itself becomes the healing agent. Interestingly, red sugar pills seem to have a greater effect than blue sugar pills (colors have meanings), and two sugar pills work better than one. In fact, packaging even has a role—with fake name-brand drugs in fancy packaging working better than fake generic brand drugs in generic packaging.

Placebos don’t even have to be pills to be effective. Studies have shown that fake injections are more effective than fake pills and that some phony surgeries are just as effective as their real counterparts. In some studies, sham acupuncture works just as well as real acupuncture. It’s all rooted in the patient’s belief.
Controlled studies of the placebo effect have shown it to improve chest pain, warts, asthma, arthritis, cancer, and side effects of medication.

Clearly, the patient’s belief is strong medicine.

And speaking of medicine, the placebo effect is often the bane of medical care. New drugs must beat the placebo effect in clinical trials, which is becoming increasingly hard to do. Ubiquitous drug advertising and more powerful marketing have ironically increased public belief that a pill, any pill, is the cure for every ill. New drugs in clinical trials often have a difficult time showing any greater effect than the fake pill they must beat.

For ill or for good, the placebo effect is the manifestation of the first mental process the patient must possess before the healing process can have its full effect: Namely, the patient must believe s/he is receiving effective treatment. Patients will form this belief based on evidence and will seek evidence to support this belief until they find it.

In acupuncture, as in any other branch of medicine, patient’s belief MUST be engaged properly to bring about the maximum belief and healing.

Consider these questions, and leave a comment:

1. Is acupuncture merely an elaborate placebo?
2. Should we be encouraging patient belief, or trying to remain neutral to minimize the placebo effect?
3. In what ways does the atmosphere of your office encourage healing?
4. In what ways do your demeanor and bedside manner encourage healing?
5. What inadvertent messages, positive and negative, are you giving to your patients? How do those message affect outcomes?

 

It’s worth considering. Let me know your thoughts, and I’ll finish this topic in a couple of days. 

 

I also posed the question whether acupuncture is merely an elaborate placebo treatment, which, as you might imagine, elicited a number of responses. Thanks to everyone who commented.

I’ll tell you what I think: Yes, there’s a placebo dimension to acupuncture. There undoubtedly must be, just as there’s a placebo dimension to every other treatment, medication, procedure or interaction with a healthcare provider. Each of these does something to influence patient belief, which in turn influences healing. Just as the presence of a doctor in a white coat has been shown to increase blood pressure, the presence of a caring acupuncturist may bring feelings of well being. This is no surprise to anyone.

Of course, there are real problems designing good studies of “sham” acupuncture, because it’s hard to “fake” inserting a needle into the skin. The sham studies I’ve seen basically take two forms.

1. Studies that use real acupuncture, but in non-acupuncture point areas. This approach is problematic because any needle insertion is going to communicate with the body’s fascial network and affect the main meridians through collateral branches. There is no place in the body where you can insert a needle and not affect the body’s electrical system. Sham locations are not the same as sham acupuncture.
2. Studies that use “fake” acupuncture with elaborate, non-piercing fake needles, designed to deceive the patient into believing the needle has actually pierced the skin. In this case, there is a piercing sensation as the sharpened point presses on the skin without penetrating. The problem with this approach is that you are still stimulating the point with acupressure and nociceptive input. Should we be surprised if such stimulation produces the same results as needle penetration? No.

Not surprisingly, recent studies employing sham acupuncture have wrongly asserted that it is just as effective as real acupuncture. Let’s take a look at a couple of cases:

A 2009 study by Daniel C. Cherkin, PhD., treated 638 adults with chronic low back pain, using one of the following approaches:

• Individualized acupuncture
• Standardized acupuncture
• Simulated acupuncture
• Usual (medical) care

All three of the acupuncture approaches, including sham, produced similar results. The study’s authors asserted, “Collectively, these recent trials provide strong and consistent evidence that real acupuncture needling using the Chinese meridian system is no more effective for chronic back pain than various purported forms of sham acupuncture.” In other words, since real and sham got the same results, it’s a placebo.

But the very next sentence, the one that wasn’t reported in the popular press, said, “However, both real and sham acupuncture appear superior to usual care.” Translation: even “fake” acupuncture gets better results than the medical approach to back pain. Take a look for yourself:

So why aren’t more doctors prescribing “fake” acupuncture for low back pain? Why do they continue to prescribe drugs, physical therapy, and surgery and get demonstrably inferior results? Is this malpractice?

The fact that we don’t fully understand WHY something works doesn’t mean we shouldn’t use it–particularly when it is so obviously superior to another approach.

Here’s another study to consider:

Klaus Linde undertook two studies of headache treatment for acupuncture. Here are the reported results:

Overall, following a course of at least eight weeks, patients treated with acupuncture suffered fewer headaches compared to those who were given only pain killers. In the migraine study, acupuncture was superior to proven prophylactic drug treatments, but faked treatments were no less effective. In the tension headache study, true acupuncture was actually slightly more effective than faked treatments.”

So what do you think the popular press headlines said? Yep–you guessed it. Acupuncture is just a placebo. Many didn’t bother honestly reporting the fact that even “fake” acupuncture is better than pain killers.

So, does placebo account for the totality of acupuncture’s positive effects? Certainly not.

In the first part of this series, we discussed the power of belief as it relates to healthcare outcomes. In part two, we discussed the placebo effect in acupuncture, and the tendency for medical studies to attribute acupuncture’s effects to placebo only.

Now that we’ve laid that groundwork, it’s time to talk about why acupuncture is more than mere placebo–and how you can combine patient belief with proper treatment to achieve superior outcomes.

First, let’s talk placebo. When I posed the question whether acupuncture was just an elaborate placebo procedure, I got several passionate comments about how acupuncture works on animals, for example, and therefore cannot be the result of belief. I agree, and I’ll even do you one better. And I happen to have some of the best objective evidence available anywhere that acupuncture is NOT a mere placebo.

I collected this evidence in conjunction with a research paper I published with two co-authors in 2011, titled “Skin Conductance at 24 Source (Yuan) Acupoints in 8637 Patients: Influence of Age, Gender and Time of Day.” Don’t let the boring title shake you though; this research won first prize at the prestigious International Scientific Acupuncture and Meridian Symposium (isams).

Why did it win? Let me break it down for you.

We analyzed the data from over 8,000 AcuGraph exams to determine what sorts of things influence the meridian readings. As the title suggests, we looked at age, gender, time of day, and a few other factors. This work had never been attempted on anything near this scale, and we found some amazing things. Here are a few of our findings:

• Male meridian readings average higher than female meridian readings
• Males and females have significantly different “normal” readings for different meridians
• Males and females show significant differences in upper/lower balance and yin/yang balance, but not in left/right balance
• Readings decrease with age in both genders

I suppose none of this should be surprising to acupuncturists, who recognize the constitutional differences between women and men, but it’s nevertheless reassuring to have valid scientific evidence of what was previously just theory.

Now here’s the interesting part: Assuming acupuncture is real, valid, and not mere placebo, then an objective measurement like skin resistance balance at acupuncture points should respond to treatment and trend toward better balance, right? And this sort of objective measurement–because it’s based on electrical measurement and statistical analysis rather than mere reported symptoms–cannot be faked by a practitioner or misreported by a patient. Much like a blood test, the readings are the readings and you get what you get.

So, to investigate this supposition, we studied a population of over 3,700 patients during the course of their first five exams. We found that ALL of the following parameters show statistically significant improvement over the course of five visits for all age ranges and both genders:

• PIE score
• Yin/Yang balance
• Stability Score
• Number of Splits

In other words, meridian balance improves significantly with treatment.

This can’t be faked, and this can’t be placebo.

It isn’t just subjective reporting of improvement; it is objective proof. Acupuncture works, and we’ve got the evidence to show it. 

I believe THAT, my friends, is why this research won first place in an international scientific competition.

So what does this mean for you? How do you use this information clinically? I have two thoughts.

1. It’s important to actually use the objective evidence available to you. AcuGraph gives you insight you can’t get any other way.  Traditional methods alone could never produce the evidence and results shown in our study. Combining AcuGraph with your other techniques will give you superior results.
2. It’s important that you use objective evidence to reinforce patient belief. We started this series talking about the important role of patient belief in any healthcare procedure. With patient belief fully engaged, you have a much greater chance of success. Call it placebo if you want, but the effect is real and measurable. USE IT for your patient’s benefit.

And remember, the absolute best way to use objective evidence and engage patient belief is to SHOW GRAPH RESULTS.

AcuGraph is your key to superior outcomes.

Next time you read another study that concludes acupuncture is just a placebo, you’ll know they’re wrong. We’ve got the numbers to prove it.

Need some proof of YOUR practice?

Click here to learn more about AcuGraph’s power of objective evidence!

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