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WE CONTINUE THE DISCUSSION OF PART 1 PLACEBO | <~The Placebo Effect | Does This Explain Homeopathy?


After an in-depth conversation of many aspects of placebo with comments by Dr. MASJonathan Shore MDManoj SachDevaDebby BruckHans WeitbrechtSuhas Kotbagi, and  Dr Nikhil Kambli we have arrived at stage two. 

As this conversation moves deeper into the realm of "unbelievable" or "believable" possibilities of the mind's power, I begin to wonder whether "placebo treatments" can be a integrative form of medicine.

For instance, most likely homeopaths and doctors already have a thought and belief that their treatments will work. And, the patient, may or may not really have a belief the treatments will work.

When going to a homeopath with faith in their treatments, based on past success, they impart that intention, feeling, or mindset to the patient.

Now, if the patient has often been disappointed and let down in their past treatments for incurable or difficult diseases, how much does that affect the outcome? Can it be the homeopathic interview, which is taken at length, in depth, with a listening ear and good quality of guidance to awareness makes a shift or change in the belief of the patient?

Instead of trying to explain the placebo effect, or use it as an explanation for why homeopathy works, we are left to discuss "HOW" we can use it in case-taking. 

It is unfortunate, in my opinion, that so many doctors say they feel using the placebo is unethical and a deception to their patients. To me, if we have a method that definitely creates results, leaves no side-effects, and utilizes the individual's own ability to heal, why not use it? 

Just because we cannot explain something, does not mean we trash it into the waste basket. Each century, decade and year we are learning new things that open up a vista of new worlds. It is hard to envision change, but with our generations today, everything is about change. 

Before your new computer comes in the mail, already a new technology has made it obsolete. The problem is the medical system invests so much money, time, buildings, into a megalopolis that it is hard to let go and change directions, or to integrate something that does not fit well into the medical model. 

In the largest experiment of its kind to date, 1162 patients aged 18 to 86 years (mean ± SD age, 50 ± 15 years) with a history of chronic low back pain for a mean of 8 years were randomly assigned to receive acupuncture, sham acupuncture, or conventional therapy (a combination of drugs, physical therapy, and exercise) for their chronic back pain. Patients underwent ten 30-minute sessions, generally 2 sessions per week.

After six months, patients answered questions from the Von Korff Chronic Pain Grade Scale questionnaire and the back-specific portions of the Hanover Functional Ability Questionnaire to determine their chronic level of pain after treatment.

In the real acupuncture group, 47 percent of patients improved (defined as 33% improvement or better on the Von Korff Scale or 12% better on the Hanover Questionnaire). In the sham acupuncture group, 44 percent improved. In the conventional care group, 27 percent got relief.

Study Conclusion: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either real or sham, was almost twice that of conventional therapy.

Study Authors: Michael Haake, PhD, MD of the Orthopedic Department, University of Regensburg, Bad Abbach, Germany; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD, of the Institutes for Medical Biometry and Epidemiology (Drs Müller and Schäfer) and Medical Psychology (Dr Basler) and Centre for Clinical Trials, Philipps-University Marburg, Marburg, Germany; Heinz G. Endres, MD; Hans J. Trampisch, PhD, of the Departments of Pain Management, BG-Kliniken Bergmannsheil (Dr Maier) and Medical Informatics, Statistics and Epidemiology, Ruhr-University Bochum, Bochum, Germany; Albrecht Molsberger, PhD, MD, of the Centre for Clinical Acupuncture and Research, Düsseldorf, Germany.

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Excerpts ...
The roots of the placebo problem can be traced to a lie told by an Army nurse during World War II as Allied forces stormed the beaches of southern Italy. The nurse was assisting an anesthetist named Henry Beecher, who was tending to US troops under heavy German bombardment. When the morphine supply ran low, the nurse assured a wounded soldier that he was getting a shot of potent painkiller, though her syringe contained only salt water. Amazingly, the bogus injection relieved the soldier's agony and prevented the onset of shock.

Rx for Success
What turns a dummy pill into a catalyst for relieving pain, anxiety, depression, sexual dysfunction, or the tremors of Parkinson's disease? The brain's own healing mechanisms, unleashed by the belief that a phony medication is the real thing. The most important ingredient in any placebo is the doctor's bedside manner, but according to research, the color of a tablet can boost the effectiveness even of genuine meds—or help convince a patient that a placebo is a potent remedy.—Steve Silberman


Scientific American | Placebo Effect: A Cure in the Mind ( Preview )
Belief is powerful medicine, even if the treatment itself is a sham. New research shows placebos can also benefit patients who do not have faith in them
By Maj-Britt Niemi   


by Barbara D. Allan, Author of Conquering Arthritis

Doctors used to think that the placebo effect was psychological. Now scientists have direct evidence that the placebo effect is actually physical. In other words, the expectation that a pill or procedure will produce a medical benefit can trigger the same neurological pathways of healing as “real” medication.

What Research Has Found
At the University of Michigan, scientists injected the jaws of healthy young men with salt water to cause painful pressure while PET scans measured the impact in their brains. During one scan, the men were told they were getting a pain reliever, but what they actually received was a placebo. In response, their brains immediately released more endorphin—chemicals that act as natural painkillers by blocking the transmission of pain signals between nerve cells. The men felt better.

According to an Associated Press report, one of the researchers who carried out this study, Christian Stohler, stated, “Our brain really is on drugs when we get a placebo.” Results with some especially strong placebo responders suggest “many brains can actually stimulate that (pain-relief) system more (than drugs do.)”

How is that for demonstrating the power of positive expectations?
Another study was done in Italy. Researcher F. Benedetti gave Parkinson’s patients a placebo and measured the electrical activity of individual nerve cells in the brain. Those neurons quieted down by about 40 percent, a change that correlated with a reduction in muscle rigidity and with the patients being able to move more easily.

Once again, strong and measurable physical improvements were brought about by the power of expectation alone.

How to Use the Placebo Effect to Your Own Advantage
What you believe shapes your world. Positive expectations alone have the power to create positive outcomes in your body.
  • Make sure the treatments and medications you use are ones that you believe in. If you truly expect that they will help, not only will you get the inherent benefits of the treatment, you will get the added benefit of the placebo effect.
  • Make sure your practitioner believes in a positive outcome for you and takes the time to spell out in detail the exact nature of all positive changes you are likely to be experiencing. This will reinforce your own positive expectations.
  • Avoid people who have negative expectations for your healing, especially doctors. If your doctors are telling you they can’t help you, find new ones. If you are told there is 'no cure' for your condition, get another opinion. Look around until you find someone with a good track record of helping people with arthritis and who has a strong expectation that the treatments he or she offers can help you.
  • If you yourself have negative expectations, do whatever you can to replace them with positive ones. The truth is you have the power to heal yourself. Educating yourself on how others in your situation have already done this and noticing what thoughts and actions make you feel better are two excellent ways to shift your focus from negative to positive expectations.
  • Even if you currently have no conscious idea of how to tap into your inherent healing power, start imagining exactly what it would look, sound, and feel like for you to heal. Describe in as much detail as you can exactly what you are doing, saying, and feeling as you experience the benefits of the healing process.

Definition of Placebo from THE PSYCHIASTRIST

The term placebo is derived from the Latin verb ‘placare’, ‘to please’. The American anaesthetist Henry K. Beecher (1955) coined the term ‘placebo effect’. He reported that, on average, about a third of patients with a range of conditions improved when they were given placebos. This subsequently led to the development of placebo-controlled trials, whereby a new drug is said to have significant benefit only if it shows superiority over placebo. The placebo effect has also been a source of recent interesting debate in psychiatry with some claiming that a considerable proportion of benefit from antidepressant medication derives from the placebo effect (Kirsch & Sapirstein, 1998), whereas others (Leutcher et al, 2002) have stressed that response to placebo and to antidepressants involves distinct biological mechanisms.

In general, a placebo is an inert substance that has no inherent pharmacological activity. It looks, smells and tastes like the active drug with which it is compared. An ‘active placebo’ is one that has its own inherent effects but none for the condition that it is being given for (e.g. use of atropine as the control drug in trials of tricyclic antidepressants). A placebo need not always be pharmacological. It could be procedural, for example, sham electroconvulsive therapy (ECT), where the patient is anaesthetised but not given ECT. Surgical placebo is a procedure where the patient is anaesthetised and superficial procedures (e.g. skin incision, burr hole) are performed without the actual surgery.

Dr. Mercola Adds This: 

Twenty-plus years of research on antidepressants, from the old tricyclics to the newer selective serotonin reuptake inhibitors (SSRIs) show that their benefit is hardly more than what patients get when they take a placebo. 

More and more scientists who study depression and the drugs that treat it are concluding that antidepressants are basically expensive Tic Tacs.

Research has found that patients do improve, often substantially, on SSRIs, tricyclics, and even MAO inhibitors. This improvement is the basis for the ubiquitous claim that antidepressants work. 

But when researchers compare the improvement in patients taking the drugs with the improvement in those taking dummy pills, they find that the difference is minuscule. 

Nonetheless, the number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005.

This is a very important point, folks.  In many cases, your beliefs are as or more effective than pills when it comes to achieving health.

The second article linked below frowns on the notion of homeopathy, because some people think it may work as a placebo.  But the article shouldn't be so dismissive.  The placebo effect is very powerful.  Thousands of clinical studies have found that the placebo effect can aid in healing or even cure disease.

What it comes down to is the crucial mind-body connection.  Those who have hope and belief in the solutions they try will likely find them working.  That's why it is so key to keep your health freedom, and pay attention to the huge corporations that continually discredit alternative methods.

Typically, more natural healing techniques won't harm you, and many of the drugs will.  In time, energy medicine will be better understood, and perhaps this placebo element will be utilized in such a way that no pill will ever be necessary -- your mind will be stimulated to heal on its own.  Similarly, those who pray or meditate for healing should not be ridiculed either.

Simply labeling something as a placebo and not pursuing it any further misses a key point.  The so-called "placebo effect" may very well point the way to the future or medicine.

Sources:



For our purposes the 'placebo' could be more than the pellets, but could include the interview and case intake and follow-ups.

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Replies to This Discussion

In the first organon aphorism, Hahnemann gave the high and only mission to physicians - to restore the sick to health. In the last two aphorisms he shows his approval of positive mesmerism as homeopathic.
Can mesmerism and likes, not be classified as placebo? And, if so, the natural and worthy question regarding the placebo discussion, that we are abandoning in the part 1, is – can we find ways to make our placebo, including intention, to complement our remedies? Can our interaction with the client take positive homeopathic qualities without knowing the name of the similimum?

I see the point to return to focus on ‘remedy’, once we have acknowledged the therapeutic gesture of placebo.

It is so aptly said that patient is a pattern. Also, each remedy is a pattern. Our job is just to find the right match. After that, cure is a law. Period.

But, unfortunately every homeopathic patient does not end in a cure. Why? Because our prescription was not accurate enough. Finding and matching the dynamic patterns are after all not all that easy.
Our client is not just one pattern. S/he is so many patterns at any given moment. Social, personal, private – so many faces. And then, biological, sensation-al, pathological, cellular, biochemical, electrical, keynotes. Depends on what we are looking for.

Also, we as observer influence the observed, our client. Self-confidence, Self doubt, arrogance, past experiences, prejudices, confusion, impulsive hurry, indecision and mistakes are all natural human endowments of all practitioners. Only in retrospect we can be sure whether our choice was right or not.

In such a scenario, it makes immense sense to focus our attention to the vital encounter – the case taking. After all it is during those crucial moments that we engage with our client and make the observations to see the pattern of the patient. What can we do to make our observation more truthful, complete and accurate?
Greetings Manoj
Just to add a little to what you have written I would like to attach a lecture on case taking. This version was written 10 years ago and was a revision of an earlier work. I make this point as my thought has evolved some since this time yet the basic tenets have been my practice and study all these years.
I would appreciate your ( and anyone elses comments )
Attachments:
Dear Jonathan,

I find this personal sharing very insightful and rich.

You are suggesting to treat it as not definitive but as a tentative paper. More like an instrument to inspire discussion. Sir, I feel privileged to have this opportunity.

I hope that I could get the juice of this poetic and intricate article about the most personal and most profound facet of homeopathy. I wish to reflect back what I learned in this passionate and authentic sharing of your personal process during a homeopathic interview.

I also wish that more and more sincere homeopaths join here to explore the mystery that you have revealed in this lecture. To discuss. To share. Their processes. Their insights. Struggles. Their journey. It is in the constructive dialogue that we will hit the gold.

Just join the discussion.

I agree with you that it needs courage on the part of the practitioner to trust the process. To be the co-traveler of the patient. To let her drive the session with trust that she will ultimately lead us to the core of her essence – the pattern.

As a practitioner, I will have my own reasons, anxieties and habitual momentum to assert and be in the driver’s seat. But, if I discipline myself in the process to primarily focus on the client, on the relationship, without being driven by remedy-chase, remedy will be revealed to me.

You are sharing how the awareness of my own habitual tendencies in the relationship is helpful in management of my ‘self’. Only then, I can focus totally, without distraction, on the patient. This opens up a different kind of sensitivity in the practitioner. Client’s vital dynamics start resonating in practitioner’s sensitive space.

This compassionate inter-personal process illuminates the core pattern of disease and leads to the similimum.

And, this process not only facilitates the discovery of similimum – this is also the deepest joy of homeopathy.

So, here we are.

And, I am tuned in to learn how these insights have evolved further in the last decade.

With Warm Regards
Manoj
Dear Jonathan,

I would like to see your case taking lecture, but I couldn´t open it.
Does anyone else have this problem?

Irmeli Lehtioksa
Yes Irmely..

I faced this problem. Try .doc extension in the open/save dialogue box.
the case taking differs in different settings and scenario..the objective remaining the same to HEAL THE PATIENT
the simillimum is just a means , a powerful means though...a very powerful means......

but where i practice it is often difficult to get the remedy in these manners..you have people who are not much in tune with what they feel... they have symptoms and those have to be treated as early as possible........so the idea is to understand their symptoms..and treat..... and leave loose threads every session and pick them up next..sometimes patients themselves pick them up......... and so on...and to complete the history...

there are various other ways to arrive at a simillimum.........

here is stratergies of case taking by Dr. Vitholkas picked up from a website
Attachments:
Yes of course the situation of of the practitioner varies greatly from one cultural context to another and even within the same cultural context. This is one of the most interesting facets of HWC - the mix of practitioners from all over the world - especially from those areas with which I have little familiarity.

On the other hand our practice and the patients we see tend to conform somewhat to our own interests. Thus even though the Indian culture is so different from that of California, I would say that having experienced the practice of Rajan Sankaran ( at least watched MANY videos of his interviews ) I would say that in essence his case taking has more in common with mine than there are differences despite the fact of these vast cultural differences.

So here, amongst all of us, it is not at all a question of which method is better or worse, but rather which method is best suited to the temperament and nature of the practitioner.

Thus while it is interesting to be exposed to different points of view, it is only those with which one has a resonance, a natural sympathy so to speak, that can lead to an actual exchange of techniques.
the case taking also differs what kind of socio economic class of patients you are dealing with..
Hello Everyone,

Nikhil is saying that his practice circumstances don’t permit him the luxury of detailed history. I am sure many of us in Indian subcontinent fully realize this situation. Low paying capacity, practical compulsion to dispose of as many patients as possible in the given time, socio-economic realities. These conditions don’t permit us to give more than few minutes to an average patient.

Jonathan has a very interesting observation that somehow we attract patients who resonate with our preferences and interests. He is also sharing that despite vast cultural differences his case taking has so much in common with Rajan. Are you saying Jonathan, that it is not so much of cultural difference, but some very personal chemistry of the practitioner, that largely sets the tone of case taking process? Some very vital thing?

While reading his zen of case taking, one thing that impacted me profoundly is how much he values the encounter as a mystical gate of transformation for practitioner himself. As the deepest joy and spiritual dimension of homeopathy.

So, if this method demands more from the practitioner, it also offers a lot more… invaluable gifts to the practitioner. He finds it a privilege to be a facilitator of expression of so many facets in other human being. But, then, this method takes a lot of time.

Not every practice seemingly permits this. Besides, many of us have perfected our shortcuts and formulas so much that even thought of spending sooooo much time and energy on one patient must feel like foolishness and waste of time. Gives a sense of being more efficient and productive!

Then, I hope, that there are many homeopaths who have deep wish to make the transition in practice. Wish to make the sacred change. A new way that can transform both our professional as well as our personal lives.

I am sure, that, there are many pragmatic questions in every homeopathic mind concerning this issue.

About practicality of the change.
o Should I change? Why? Will it make a difference? Can I be any different with my patient in the available time? Will this change adversely affect my patients and my practice?
About our own capability and attitude.
o Can I learn at this stage of my practice? At my age? Should I? Do I have required patience? I will not feel natural with this change! Like any other change this change will be stressful!
About sincere guidance and support.
o Where I can learn this? Who can help me to learn this? How can anyone help me to be more unprejudiced, attentive and a better listener?
And many more..

Each one of us has our own unique concerns. . . Each one of us has to make this individual choice. And, sure, it is not an easy choice.

Here, we have the right opportunity to explore this practical issue.
Ah yes. Seeing as I have been pretty verbal on this thread it may be appropriate to add a little more personal background so as to clarify certain issues in my postings.
Having given my opinion on certain matters I will now give my opinion on myself:

Although quite well known in certain homeopathic circles I am not that great of a prescriber. I have felt for a long time that there are many many homeopaths who do better work, are more effective healers than I.

In part the reasons for this are that although I have practiced for quite a long time I have considered that my practice of medicine/homeopathy was and is subordinate to my personal development. That is to say that this homeopathy is in the service of a greater understanding and not an end in itself.

These are difficult issues to explain - I am a physician by destiny, by fate, not really by choice. So I have to do my job as best I can, but it is just a job given me by fate or karma or whatever we call it.

Thus my practice has evolved to suit my needs and interests.

It is in no way a ' one size fits all ' direction and its structure and methodologies are totally inappropriate for may excellent and highly qualified practitioners.

Despite all the above I have gained a certain knowledge and understanding over the years and am interested in sharing this with those whose circumstances and interests are close to mine - in other words with those to whom it makes sense.
Looking at case-taking as an opportunity for the clinician to grow, develop, evolve and learn from the experience is so important in the "give" and "take" of this work. Thank you for presenting these introspective questions.

I suppose every homeopath asks him/herself what he/she is doing in this profession? How they arrived in this position? What is he/she supposed to be learning? The answers may change over time. A person may go into the homeopathy with an image of what it is and what they will accomplish, then that changes once they are in the midst of the study, interactions with others, providing for other's care, managing an office, clinic or hospital [or website!]

Every day we wake up and ask the same questions and affirm, reaffirm or question our answers. Each day provides new opportunities, surprises, innovations, boredom, tedious chores, new clients and more. We then make choices. This moves us further in one direction, changes directions, stagnates or other movement or non-movement. Hopefully, there is always forward movement. whether in large or small increments.
Oh, Jonathan,
Me too not advocating one size fits all. Each practitioner has a unique approach. Yet, certain attitudes and procedures are likely to make the client feel safer and free. Empowered. And better understood.

This is irrespective of homeopathic leanings and approach. Practicing miasm, keynotes, essences, dreams or core delusion. One thing that is common to all is listening to the patient. And other, questioning.

I was wondering whether we can engage in exploring those basic, minimal, common traits/characteristics/state of being/mannerism/behavior etc that will ensure better, more objective and deeper observation.

I understand when you say that medicine/homeopathy practice has evolved to suit your special needs, in the service of personal development. Probably, you are suspecting that many people in the forum will not find it interesting and worthwhile. Because it is so personalized.

I suspect the contrary. Most will rejoice in your sharing and benefit from your wisdom. I assure you of my fullest attention. I see what you are saying makes great sense. And I am interested to learn from what you share.

Regards
Manoj

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