Should we care what works and what doesn’t?

Weight loss diets, convictions about “good” foods and fears of “bad”foods, and alternative medicines all share surprising similarities.

To some, this may sound like an outlandish notion. But seasoned dieters and health food advocates will be familiar with many of professor Waxman’s comments in his British Journal of Medicine article, “Shark Cartilage in the Water”:

...It is estimated that up to 80% of all patients with cancer take a complementary treatment or follow a dietary programme to help treat their cancer, writes Jonathan Waxman, Professor of Oncology at Imperial College London. Yet the rationale for the use of many of these approaches is obtuse – one might even be tempted to write misleading...

So why do patients take alternative medicines? Why is science disregarded? How can it be that treatments that don't work are regarded as life saving? Waxman believes that it is because the complementary therapists offer something that doctors cannot offer – hope. If you eat this, take that, avoid this, and really believe this then we can promise you sincerely that you will be cured.

And if the patient is not cured, it is the patient who has failed, not the alternative therapy. The patient has let down the alternative practitioner and disappointed his family who have encouraged his "treatment." As well as the complementary medicines they take, many patients will have changed their diets in order to cure their cancers, says the author....Why do patients change their diet? For some it is a way of taking back some control of a situation that is entirely out of their control, says Waxman. For others it is because of the pressure put on them by families, friends or vested interest groups to "go organic."...

Feel-good beliefs are also big business, he said. What many of these emotionally-charged diet and alternative ploys have in common is that they appeal through beliefs, faith and hope, and take advantage of the placebo effect. This effect describes how we all can be made to believe water or a sugar pill, an energy modality, a supplement or “healthy” food really helps us. Our minds can make our bodies manifest an extraordinary array of physical symptoms and make us believe we are experiencing better health, improvement from our ills (or worsening health), when nothing has actually changed. The power of placebos was described by Dr. Steven Barrett, MD, vice president of the National Council Against Health Fraud.

If we had to choose one thing to learn that could most protect ourselves from being taken in or harmed by fraudulent products, practices or worries, this would be it: the power of placebos...Yet it is one of the hardest things to understand.

It is so unbelievable, that no one realizes it is happening to them ... when it is. As incredibly as it may seem, we cannot rely on anecdotal evidence or experiences, even when they’re our own! When we expect to feel better, we very often think we do.

It is so profound that doctors and patients can be fooled. The placebo effect is so intense, clinical experiments are necessary to know if a health or dietary intervention is really effective or if it was the placebo effect.

In a recent placebo controlled clinical trial, people undergoing fake knee surgeries had just as good of results as those getting real arthroscopic knee surgeries, and the patients were so pleased they recommended the treatment to their friends! Imagine the surgeons’ surprise to learn that a treatment even they believed in was a sham!

This illustrates an important way that mainstream medicine and alternative modalities traditionally differ. When an alternative modality is shown to work, it is no longer “alternative” and becomes part of mainstream medicine. But when a treatment is shown to not work, medicine ideally looks for something that does, alternatives never do. Clearly, there are a lot of treatments the medical community has come to believe work. And, like alternative practitioners, they can be just as resistant to those who question them or want them tested, as Dr. Judith S. Hochman, director of the cardiovascular clinical research center at New York University medical school, found when she dared to test the belief in angioplasty that cardiologists have long held. But mainstream medicine generally embraces science and tests theories. And, in time (which can seem awfully slow, as in the case of “obesity”-related science), the medical community responds to clinical evidence and treatments change. “This is why we have clinical trials,” said Dr. Hochman. Trial results often surprise even doctors. Dr. Hochman and her colleagues expected to find that angioplasty would reduce heart failure, subsequent heart attacks and death, but it didn’t. With this knowledge, medical practice should change, she said, affecting some 50,000 patients a year in our country.

So when we are confronted with steadfast claims about the effectiveness of alternatives, the benefits of certain foods or diets, or any treatment, it can be beneficial to look closely at the evidence.

Oftentimes, the weakest evidence relies on subjective feelings, such as fatigue or energy level. Those are typically the placebo effect and suggestible. Simply doing something we believe in can also make us unconsciously change our habits, such as get more rest or activity, leading us to falsely attribute the changes in us to the placebo. Even participating in a study can also make us unconsciously change our habits, which is why control groups are necessary in clinical trials. The power of suggestion in affecting how we think we feel has been demonstrated in many investigations.

“In many disorders, one third or more of patients will get relief from a placebo,” said Dr. Barrett. “Temporary relief has been demonstrated, for example, in arthritis, hay fever, headache, cough, high blood pressure, premenstrual tension, peptic ulcer and even cancer. A large percentage of symptoms either have a psychologic component or do not arise from organic disease.” Perceptions, however, don’t mean that the actual disease process has been altered and relying on a placebo to cure real diseases, such as cancer, can be deadly.

Of concern to medical professionals is not only that patients may delay seeking medical care that has been proven to help or could cure them, but that nonscientific practitioners using placebo therapies often are those leading patients to believe other imagined dangers and illnesses, discouraging them from seeking healthcare and preventive care (such as immunizations), and selling dangerous quack therapies.

Pain is especially subjective. What we feel physically is partly emotion and anxiety, the body’s reaction to tension. So very often, things that help us feel less anxious, redirect our attention, or give us a sense of control can lessen the distress part of the pain and make us reinterpret our symptoms. Someone taking the time to talk to us can be all it takes sometimes to make us feel better. While this is used to support many healing modalities that work by placebo, many doctors believe that their relationship with their patients should be based on honesty, trust and respect. As patients, many of us would probably agree, and feel deceived to learn we had been sold a placebo.

Health professionals also note that placebos are not necessarily a cost effective use of oftentimes limited healthcare resources. In a clinical study of 321 people with low back pain, for example, chiropractic manipulations were helpful, but no moreso than giving patients an educational booklet on low back pain, at one-third the price. A recent review of 100 scientific studies found no credible evidence to support claims that organic food is more nutritious or better tasting — a point even echoed by the Organic Trade Association. Yet, while biologically no different and offering the same nutrition to our bodies as conventionally-produced foods, “healthy” all-natural foods can cost many times more.

What most often outwits even the most skeptical of us, however, is forgetting that most of our ailments are self-limiting and improve over time regardless of what we do. Or they have natural waxing and waning of symptoms — which can coincide with something we did, leading us to attribute our action to the change in how we feel. It is like suffering from a cold for 6 days, taking a special vitamin and feeling better the next day! We would have improved just as quickly had we done nothing, but it is easy to believe it must have been that vitamin. We can even believe our child or animal appears more comfortable, when their illness may have simply run its natural course or they’re calmer simply because we are!

Nocebo is the opposite effect: illness and unpleasant effects caused by the suggestion or belief that something is harmful. Nocebos are commonly used to scare us about “bad” foods and “obesity.” We are surrounded by real-life attempts at “aversion therapy!” But there is no credible evidence that any food is actually harmful (excluding, of course, rotted, germ-ridden foods and people with severe allergies or rare metabolic disorders) or that people die from being fat.

Trying to scare people that they’ll develop cancer or another horrible chronic disease, get fat, or die prematurely if they eat “bad” foods or are exposed to contaminants has become a familiar marketing tactic over recent years and the nocebo effect is at work in many. Yet, using fear is not benign and the nocebo effect can have very real harmful effects on our bodies. It is well known among scientists that beliefs and fears can create mass psychosomatic illness and shared delusions. There are growing examples of the nocebo in the scientific literature.

People who are told that they have high blood pressure (when they don’t) begin to feel sick and call in sick much more often. In double blind clinical trials, when healthy people are given a placebo drug and told of possible side effects, about 20% develop dizziness, nausea, vomiting and even depression. In another study, when patients breathed in a vapor they were told contains a chemical or allergen about half developed breathing problems, including some with full-blown asthma attacks. When given what they believed was a bronchodilator, they recovered promptly. In actuality, both the “irritant” and the “medicine” were nothing more than salt water.

Food and health scares have never been more rampant, and so are the fears. People who believe sugars, fats, refined white ingredients, processed foods, meat products or chemicals in their food are bad actually think they get sick when they eat them. Sadly, the belief behind forbidden foods is so strong that when they eat something they believe bad or wrong to eat, they have extreme symptoms, including headaches, chest pain, nausea, rashes and weakness.

We are not what we eat, we are what we believe.

Our memories are shaped by who we are and what we have been led to believe. We seem to reinvent our memories, and in doing so, we become the person of our own imagination. — Elizabeth Loftus, Make-believe memories, 2003.

© Szwarc 2006