Thoughts turn to a drug-free future; Can we really cure ourselves of disease by the power of the mind?

Abigail Wild learns of the latest scientific theory

This story about Placebo: The Belief Effect appeared in The Herald (Glasgow, UK) on 15 January 2003

Abstract:

Early claims that placebo was a panacea were based on little evidence. Cancer and schizophrenia can not be alleviated with a placebo, while inflammation, depression, and stomach ulcers can. There seemed no rhyme or reason to the diseases that could be treated with a placebo, and those that couldn't. Dylan Evans has now linked them with the acute phase response, a much-ignored biological process which bides the body time until it creates the antibodies it needs.

The theory is a convenient one for anyone determined to discredit alternative medicine. A placebo, says Evans, is anything that only works if you believe in it. By this rationale he argues that alternative medicines and psychotherapy are little more than placebos. What he doesn't answer is whether we will care what heals us, as long as we feel well. He only hints that this is where the importance of truth comes in, "and the best guide to truth in these matters is painstaking scientific research, not the wild pronouncements of prophets and gurus".

Any theory about the placebo effect is fairly new. Although doctors have been giving out sugar pills to cheer up their patients since before the Second World War, no evidence had yet been found to suggest that the non-treatment treatment could do any good. Hence the most fundamental of flaws on research carried out in the past 50 years are still being unearthed. In his new exploration into the little white lies that doctors prescribe, Dylan Evans uncovers a corker.

He argues that the biggest problem with clinical trials has been that most tend to compare the well-being of a group taking a placebo with those taking active treatment. If patients show some improvement with a placebo, there is nothing to say how much of it might be down to spontaneous recovery. Researchers have too often failed to test a group who received no pills or potions at all.

Evans speaks as both a scientist and a philosopher. However, this is also the man who took the trouble to write a book on Lacanian Psychoanalysis, the esoteric teachings of the eccentric French psychoanalyst, "mainly in order to make sense of the bizarre ideas".

Despite his scepticism, he went into private practice and began working part-time for the NHS, providing outpatient psychotherapy in1995. Eventually, he says, his doubts about the efficacy and validity of psychoanalysis became so great that he could not, with a clear conscience, carry on working as a therapist.

Little wonder, then, that he became fascinated with the placebo, a mysterious topic, inherently hinged to dead-end debates on belief and mind-over-matter. "Most things are like drugs and horseshoes," he says, "They either work or they don't work, and your beliefs have no bearing on the matter." Placebos are a different matter. While they are very much like methods of relaxation and hypnosis, in that they create a state of mind that could heal the body, the placebo can be also explained by science.

Early claims that placebo was a panacea were based on little evidence. Cancer and schizophrenia can not be alleviated with a placebo, while inflammation, depression, and stomach ulcers can. There seemed no rhyme or reason to the diseases that could be treated with a placebo, and those that couldn't. Evans has now linked them with the acute phase response, a much-ignored biological process which bides the body time until it creates the antibodies it needs.

The placebo represses the response, and the immune system, "which is why it works with stress-related diseases. Depression is mostly just an overactive immune system".

The theory is a convenient one for anyone determined to discredit alternative medicine. A placebo, says Evans, is anything that only works if you believe in it. By this rationale he argues that alternative medicines and psychotherapy are little more than placebos. What he doesn't answer is whether we will care what heals us, as long as we feel well. He only hints that this is where the importance of truth comes in, "and the best guide to truth in these matters is painstaking scientific research, not the wild pronouncements of prophets and gurus".

Evans raises a whole new bundle of ethical issues. While drugs have to go through stringent tests in order to be approved, alternative treatments are left to spread their claims unverified, invariably with someone making a profit along the way.

It's time for a proper debate on these things, says Evans. It's something he firmly believes.

Copyright 2003 SMG Newspapers Ltd.