In response to my blog post Scientific Proof You Can Heal Yourself, Mind/Body Medicine expert Dr. Susan Bernstein wrote a comment that bears highlighting. In a rousing conversation in the comments, we were debating whether doctors should be actively prescribing placebos when patients suffer from conditions for which we have inadequate treatment.

Dr. Bernstein brought up the issue of whether it’s actually the placebo pill that demonstrates the healing effect or whether it’s the doctor in the white coat doling it out that’s responsible for the profound treatment effect we often see in research studies when people are treated with placebos?

Dr. Bernstein’s Thoughts

Knowing a lot about the placebo effect from my own research as a PhD in Mind/Body Psychology, my thought is that placebos are probably more likely to work when the patient trusts the doctor. That means that the doctor needs to be able to build trust, even knowing that a placebo is being prescribed. Can all doctors keep a straight face when they're doing that? Or build trust if they know that they believe in the placebo, but they're not disclosing it's a placebo? I don't know. I imagine it depends on the doctor.

In psychology, extensive research has been done to look at the different modalities and methods used to heal clients. For example, looking at art therapy, cognitive behavioral therapy, or Jungian analysis, what patients really say helps is the relationship. At least from a psychological standpoint, most of our wounds happen in relationship, so we need relationships to heal us.

It used to be that we had plenty of time to talk with our doctors, and with that rapport, we built a level of trust. In a way, a doctor could be a shaman, and help us to heal because we believed in that individual. In that case, I imagine it's the resonance -- the alignment, between doctor and patient -- that creates the conditions for healing.

Susan’s Healing Journey

Over the past five years, I have experienced a health issue that initially took me to a homeopath, an acupuncturist, and a naturopath, all of whom contributed something, not only to my healing, but to my personal development. I chose these people because they reflected back to me values and approaches that felt right. I am not the type to trust a doctor simply because of his or her credentials. Harvard, Stanford, that's nice, but it's not the university that heals. It's the practitioner and his or her ability to touch something in me that's ready to hear and take in the guidance, be that pills, surgery, exercise, or some other prescription.

I'm a big believer in the theory that we have everything we need inside of ourselves to thrive (no wonder, on the career front, I call my company "Work from Within"). We may not always know how to tap that inner wisdom, but I think it's the relationship with the practitioner, even more importantly than the placebo pill, that promotes our inner resources to move us into a state of well-being.

Grumpy Doc Vs. Kind Doc

Let's put it this way: I bet if we did an experiment and compared an uptight, angry, arrogant doctor who had a so-called "miracle cure," and a really kind, empathic, caring doctor who had a cure that was likely to work but uncertain, most people would get better with the kind doctor. Now, I could be wrong. Maybe some people actually trust the arrogant doctor more. We'd have to test for preference of personality as part of the experiment, of course.

All that said, I'm in favor of a strong, caring relationship between doctor and patient, one that builds trust. I believe that, in the long-run, that's a prescription for preventative wellness.

Back To Lissa

Well said, Susan! I totally agree. In fact, those who study the placebo effect explain the treatment effect in 5 ways that I’m writing about in my book Mind Over Medicine: Scientific Proof You Can Heal Yourself. (I’ve added #6 on my own, because nobody seems willing to talk about God in scientific studies, but it seems like an obvious possibility to me!)

6 Explanations For the Placebo Effect In Clinical Trials

1. Positive Belief/ Expectation/ Hope - Because of the ethics of informed consent, patients know they will be receiving either the real treatment or a placebo, but many patients in a placebo group believe they are getting the real treatment when they’re not and so they expect to get well. Expectation and belief can be self-fulfilling prophecies.
2. Classical conditioning - We all know the classic Pavlov’s dog experiment. Not only did Pavlov’s dog salivate in response to his Scooby snack. He also started salivating when he heard the bell that accompanied his Scooby snack. While salivation in response to food is an unconditioned physiological event, salivating in response to the bell is a conditioned response. In other words, the body responds to a signal from the mind, and perhaps the placebo effect works the same way. If you’re used to getting a real drug from a person in a white coat and subsequently getting better, you may then be able to trigger the body to get well by simply receiving a sugar pill from someone in a white coat.
3. Emotional support - A patient in a clinical trial receives attention and nurturing - sometimes even healing touch - often by a person in a white coat, which has historically come to represent health and healing. Someone cares how these patients are doing. Someone listens when they complain. Someone cheers when they start feeling better. We all want to feel seen and heard, and the therapeutic relationship alone can relieve symptoms.
4. Spontaneous Remission - When patients in a placebo group get better, some of them might have gotten better anyway. Many diseases, left untreated, will resolve on their own. After all, the body is a self-healing organism, constantly striving to return to homeostasis.  So even if you stuck patients in a dark room, treated them with nothing, and ignored them, a certain percentage of them would likely improve. Although their study had many design flaws and was later largely discredited by scientists,  Hrobjartsson & Gotzsche’s New England Journal of Medicine article “Is The Placebo Powerless?” brings up a valid argument, claiming that we can’t claim that any study demonstrates a clear placebo effect unless the study also includes a no treatment group (which most don’t).  If they did, we could clearly tease out spontaneous remissions from other factors that contribute to the placebo effect.
5. Co-treatments - While most studies try to carefully screen these out, patients in clinical trials may also be surreptitiously seeking other treatments that may confound the data. If someone gets better while in a placebo group, it’s possible that the other treatment they’ve been sneaking under the table is responsible for the improvement.
6. Divine intervention - Obviously, I won’t be using any scientific studies to support this claim, but to be fair to any Higher Power who might intervene on behalf of someone in need of healing, I’ll argue that one explanation for why someone gets well when treated with a placebo is spiritual. Perhaps God (or Source or The Universe or whatever name you choose to use) waves a healing magic wand and someone is cured. I’m a deeply spiritual person who believes in many things I can’t prove, so I feel compelled to include this as a possible explanation, even though you might argue it’s not “scientific.”

How patients get better doesn’t matter as much to me as that they do, but understanding the process can certainly help us facilitate the self-healing superpowers that lie within us all.

Committing to helping you heal,

Lissa

Lissa Rankin, MD: Founder of OwningPink.com, Pink Medicine Revolutionary, motivational speaker, and author of What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend and Encaustic Art: The Complete Guide To Creating Fine Art With Wax.