One thing that consistently amazes me about the human mind is its intricate relationship to our health and well being. In anxiety, your muscles remain constantly tense and flexed, burning your energy supply, leaving you exhausted. Panic attacks can feel identical to heart attacks, as your body is flooded with stress hormones.
Every specialty has their own somatoform disorder. These are real physical symptoms that occur as a result of an outside stressor. They can include headache, irritable bowel syndrome, wheezing and trouble breathing, nonepileptic seizures, paralysis, chest pain, rashes or a host of other symptoms. Despite the tendency to claim, “It’s all in your head,”all of these conditions are very real and lead to the consumption of a lot of physician’s time.
Unfortunately because they are intricately related to the mind, they tend to be written off by doctors. We tend to see conditions as either physical or mental when the truth with any disease is that there are always strong components of both.
So where does this prejudice stem from? Oddly enough, I think it is rooted in our scientifically useful proof of the mind body connection, the placebo. It has been proven in study after study. Many studies suggest that problems like pain and depression respond particularly well to placebos. Blood pressure, cholesterol concentration in the blood, and heart rate are also affected by placebos, as are warts. Thegold standard for medical evidence of a medicines effectiveness is if it outperforms placebo in a double blind controlled, randomized study.
This our medications do often by very small margins. We have a concept in medical trials called number needed to treat (NNT). This is a statistic that tells us how many people need to take a treatment before you prevent a disease or relieve a symptom in a condition. A good number is under 20, which really means 20 people have to be treated before one of them has an objectively measured improvement beyond placebo or doing nothing.
What you will never see any trial do is the reverse placebo. I would truly be impressed if a medication showed effect after telling the patient they are just getting a sugar pill when actually giving them the real drug. No one would ever do this because it would truly be rare to ever find a drug more powerful than the mind. If we don’t believe in a treatment, it simply will not work.
If we do believe however, we can see amazing results. I believe this why doctors performed bloodletting, for example, in the early days of medicine. It really made people better, in spite of the fact you were probably harming them. In fact, the more noxious or painful a placebo the better it works. We have to believe in it more in order to be willing to try it. The evidence for this abounds. Just recently it was found that the more you pay for pain pills the better they work, even if placebo.
Gradually, doctors here and there are starting to understand the benefits of treating the mind at the same time as the body. In large part, I think this is due to competition as complementary and alternative medicine has sprung up as a major industry. Complementary medicine generally lacks scientific evidence, but focuses heavily on the feeling of well being, playing on fear of science and “unnatural” treatments, leading to comparisons with the snake oil salesmen of the 19th century. While relentlessly attacked by many physicians and others, many are learning to embrace it.
Personally, I think the alternative medicine approach can be very effective. Their therapies may be unproven, considered placebo effect by the medical establishment, but the fact is they do make people feel better. They are often much better at communicating, empathizing, and respecting patients than physicians. I think this is key, they are very good at helping meet the psychological needs of patients and actually winning their confidence. Medicine, in its endless quest for objectivity, evidence, and skepticism in the search for cures, is in danger of losing its soul. We neglect our patients and fall short when they become diseases and pathophysiological mechanisms. Holistic medicine is not a dirty word. I believe we must learn to treat the whole patient, distasteful and time consuming as that may be to many of us.
I think as we learn to integrate techniques like acupuncture, biofeedback, and vitamins and nutrition we can only come out ahead. These techniques have both evidence and the advantage of being intuitive and evidence based. Yes, they actually work. People may argue about the reasons they do, but you can’t argue with results. Skepticism seems to have shut ourselves off to a whole world of requirement for well being. I think we will have to overcome this somehow for both the future of medicine and for the well being of patients.