If acupuncture, a homeopathic remedy or another method of alternative healing has helped you with an ailment, you might be interested in a book by award-winning science writer Jo Marchant called "Cure: A Journey of the Science of Mind Over Body."
If you think alternative medicine is bunk, you should read this book too.
Marchant, who offers an eye-opening look at the role of the mind in medicine, was trained as a scientist. She has a Ph.D. in genetics and medical microbiology from St. Bartholomew’s Hospital Medical College in London, and she also holds a science communications degree. She turns her skeptical eye towards a host of subjects, from placebos and virtual reality treatments to biofeedback, to the root causes of longevity and fatigue. She says that by dismissing all the documented effects of alternative treatments, scientists aren't seeing the whole picture. And that's not just bad science, it's less-effective medicine.
Marchant writes in her introduction: "The healing power of the mind — or lack thereof — has become a key battleground in the bigger fight against irrational thinking. The trouble is, the more skeptics try to debunk wild claims by going on about logic, evidence, and the scientific method, the more they isolate those they attempt to convert. By denying what seems blatantly obvious to many people — that their mind does influence health; that alternative medicines in many cases do work — they contribute to a lack of trust in, if not a willful defiance of, science. If scientists say such remedies are worthless, it just proves how much scientists don't know. What if we take a different approach? By acknowledging the role of the mind in health, can we rescue it from the clutches of pseudoscience?"
The placebo effect
Marchant begins with a chapter on placebos and why they are so effective — oftentimes more effective than the drugs they're tested against. Marchant explains that our concept of placebo is the first problem.
"There’s been this idea of placebos as a negative, suspicious thing," Marchant told me in an interview. "That we’re being fooled by them, or that they are something that complicates clinical trials, or that the people would have gotten better anyway. But there’s something else going on. Placebos work through measurable biological pathways. It’s a biological effect, not a vague illusion."
There's not just one placebo effect, there are many, Marchant says. "With the placebo effect of a painkiller, you see release of endorphins in the brain; opioid drugs like morphine and heroine bind to the same receptors as endorphins. Placebo response is working through the same biochemical pathway that a painkiller would work through, right? It’s the same thing except generated by the brain," she says.
Dopamine and prostaglandins are other drugs made by the brain that can also be popped as pills, though Marchant is clear that placebos obviously have limitations. Placebos aren't going to be effective for health issues where your brain can't make its own medicine. However, there's evidence that immune responses can be ramped up or relaxed. This is needed in the case of someone who received an organ donation and is on immune-suppressants, for example.
In many of Marchant's examples, she shows how studies have proven that a placebo in combination with a drug-as-pill can mean that less of the drug is needed, which is important for reducing the sometimes-problematic side effects of many drugs. It can also mean better quality of life for those taking the drugs and it's less expensive. The best part? Placebos can work even when the people taking them know they are placebos.
Placebos also work for other reasons — especially when you consider the cues around you. "There are good evolutionary reasons that we experience pain, nausea and fatigue," says Marchant. "These things are warning signs to get us to seek help, rest, to stop eating bad food, and psychological signals from our perception of a situation feed into how we feel, too."
Think about it: If people around you are throwing up, doesn't it make you nauseous too? After all, you might have eaten what they have, and it's probably safest if you don't keep potentially bad food in your stomach. You can know, intellectually, that you didn't eat the same food, yet you feel sick anyway. Our bodies are very attuned to our minds, and those signals about pain or exhaustion are ramped up if we are stressed. That fight-or-flight response makes us more aware of even small changes in our bodies — and that can keep us safe.
How virtual reality can be effective
Marchant also takes a look at virtual reality and the exciting work that's being done with patients using VR technology to fight chronic and severe pain. It can be effective by distracting people during painful procedures when they're already maxed out on painkillers. As she outlines in the book, significant pain reductions were found among burn victims who were completely immersed in a beautiful VR ice world (see above) while they were receiving needed treatments. It works because the brain can only focus on so many things at once, and pain response is dampened when patients can explore a virtual world.
Virtual reality does have its limitations. Right now, this kind of treatment is "... more useful for acute pain or procedures because you can be in the VR session for that period of time," says Marchant. For chronic pain, you obviously can't be in VR all the time, but there's still something to be learned. "What this research is telling us about is the power of distraction and if we are engaged in other activities, that helps to reduce the pain," says Marchant.
All in your head?
For anyone who has exhausted themselves after a long day of hiking, a marathon or an epic swim, Marchant's chapter on fatigue is enlightening — and kind of embarrassing. It has long been assumed that physical exhaustion comes when the body runs of out of "oxygen or fuel, or becomes damaged by the accumulation of toxic byproducts such as lactic acid," Marchant writes.
But looking at physical data sets including muscle use in long-distance cyclists and oxygen use in runners doesn't back up that premise. In reality, our feelings of tiredness are likely more mental than physical. "Obviously, there is a physical limit to what the body can achieve. But rather than responding directly to tired muscles, [Timothy David] Noakes and [Alan] St. Clair Gibson proposed that the brain acts in advance of this limit, making us feel tired and forcing us to stop exercising well before any peripheral signs of damage occur. In other words, fatigue is not a physical event, but a sensation or emotion invented by the brain to prevent catastrophic harm."
This margin of error means that we can't push ourselves too far very easily. It makes sense in an evolutionary context, but it also means that when we feel drained after a long day on the slopes, that's mostly mental, not physical.
The power of pain control
Marchant also looks at biofeedback, presenting various studies that have tested the effectiveness of regulating heart rates: There's convincing evidence that patients can lower blood pressure, and "Trials have also found benefits for pain, anxiety, and depression," using a simple program to regulate heartbeats, she writes. Part of the reason is that specific breathing exercises — some of which might be familiar to those who have practiced meditation — induce what's called a "relaxation response," the opposite of fight-or-flight. She gets into the physiology of how that works, focusing on the vagus nerve, which brings information from the body to the brain and vice versa. It's a great technical reminder of how these systems work in tandem.
There are quite a few other chapters in Marchant's book (the causes for longevity among some communities was fascinating), but the sense I got in reading it was one of empowerment. Whether you're looking to use the placebo effect to amp up the effectiveness of medication you're taking, using distraction or relaxation to lessen symptoms of pain or other discomfort, or questioning whether you can push your body a little harder, the consistent theme in "Cure" is about each person working within themselves to deal with their particular issues — along with a medical professional, of course.
I pointed out to Marchant that each of the areas she looks at involves people becoming more involved in their own health care and getting to know their bodies better.
"It’s definitely about treating patients as individuals. We've moved away from that with randomized controlled trials. And that has been an important advance and has led to great developments in medicine and being able to tell if drugs work," she responded. "At same time it has led us to discard other elements of care and everything aside from biochemical effects of a drug. All of those other individual things are ruled out, so we don’t have a way to measure/value those other things. I hope this research brings that balance back so we can have an evidence-based way to include human elements into conventional care."