Mind over Matter
In 1994, many middle-aged men responded to a call to be guinea pigs for a surgical study. Ten of them were chosen. They all had the same condition, a debilitating arthritic infliction of the knee. What they did not know was they were going to unknowing participants in a sham of sorts. One by one, they were wheeled into the operating room of the Houston Veterans Hospital. The surgeon was Dr. J. Bruce Moseley. Each patient appeared poised before his scalpel, all covered up except for the knee. He picked up an envelope, containing a directive, and proceeded as instructed. Two of the patients got a standard surgical procedure (arthroscopic surgery for osteoarthritis). Three had the knee joint incised and rinsed. Five of them received no treatment, but incisions were made to simulate surgery. Then they were sent for recovery, discharged and followed up. This event has been reported over and over again, especially in a well-known article in the New York Times Magazine (“The Placebo Prescription” by Margaret Talbot, January 9, 2000)
The surgeon never saw the faces when he performed the procedure, so he did not know who had what done to them. Later, as the doctor followed the prognosis of the 10 men, a startling result emanated: they all felt better. Six months later, all 10 reported significantly less pain. The results were so dramatic that in 2001 Dr. Moseley did it again, with 180 men. Almost all of them reported to be cured of the arthritis.
Dr. Moseley’s sham surgeries are just two of a large number of studies showing the stark realities of what is known as the “Placebo Effect”. The word placebo comes from Latin meaning “to please, give pleasure, be pleasing, be agreeable, to suit, satisfy”. The placebo effect is the result of the power of suggestion. If you believe a white pill will cure you it probably will. Medical research shows that depending upon the condition, 35% to 75% of patients receiving dummy pills get cured.
Patients with skin lesions were told to rub brightly dyed water on the warts and told they would be healed when the color wore off. They did. Asthmatics were given fake inhalers and they not only got relief but their airways measurably dilated. The documented studies of placebos curing even complicated medical conditions are overwhelming.
The placebo effect rears its ugly head when new drugs are tested. Suppose a company invents a new medicine that shows promise in curing headaches. Before such a drug is approved for use, it has to pass rigorous testing of side effects, safety and adverse reactions. More important is the test of efficacy. To do this, a double-blind test is utilized. The subjects are divided into two groups—the experimental group and the control group. Care must be taken that both groups contain close to identical subjects (or should we say, victims). The experimental group gets the medication; the control group gets dummy pills. No one involved in the study knows who gets what; people with no contact with the participating doctors, nurses or victims, make the decisions.
The results are predictable. The control group does rather well, and many of them get cured of the condition even without any medication. Only if the medication garners significantly better results on the experimental group than the placebo fares with the control group, it passes the test. In reality, an astoundingly large number of medications fail this test—even though in preliminary testing a drug is found to be highly effective, they end up performing barely as well as the placebo in the double-blind tests.
After all, if you take a pill that is supposed to get rid of your headache, after some time, your head will ache less. Of course, the power of suggestion does not extrapolate very well. If you really believe that you are immune from poison, and consume some to prove your case, the result would be a funeral.
While headaches are often a simple condition, many major problems react favorably to placebos. The explanation is rather simplistic—the mind is a very powerful controller of the body. If a person genuinely believes a particular treatment will positively benefit him or her, then quite often such treatment works wonders.
While evidence of efficacy many forms of alternative medicine is sparse, the popularity of such treatments have always been high. We all know of many a technique for curing routine ailments. For centuries acupuncture has been used in China with baffling successes. In India the use of mantras coupled with inexplicable diets and questionable practices such as vomiting, enemas, purging seem to give positive results. In France, use of leeches, blood letting, freezing, heating and other forms of oddities were common in the 17th century, leading Voltaire to remark “the art of medicine is to amuse the patient while the nature cures the illness”.
Close to the heels of the well-established placebo effect is the not-so-well-known, “Nocebo Effect”. The placebo is positive reinforcement, the nocebo is negative reinforcement. If you believe a white pill will cure your aches, it will, even if its just sugar. Similarly, if you are convinced that no silly pill will cure your headache, then nothing will, even if it is the highly effective drug, Aspirin. In a study 34 college students were told that an electrical current passing was being passed through their heads (lie) and it could produce a headache. More than two thirds of the subjects did develop headaches.
Suppose one day you eat a banana and later you have a bad allergic reaction. It is possible the banana did not cause it, the reaction could be due to many other causes, or even a spontaneous reaction without a particular cause. Yet, suddenly this event engraves your brain. From thence, every time you eat a banana you will get a reaction, leading you to become intolerant of bananas.
Quite likely the difference between a good doctor and a bad doctor is his or her demeanor. If your doctor is upbeat, happy, friendly and optimistic, you would get better. If your doctor is apathetic, pessimistic, unfriendly, very likely the prescribed medication will not work.
Since the placebo is such a demonstrably effective treatment, should the medicine man, not try the placebo fist before he starts you on the strong and nasty drugs? This idea is one of the hottest subjects of debate in the medical community. The widely held opinion is that using the placebo effect is simply, fraud. It is unethical for a doctor to give you a useless pill; in the hope your mind will cure your condition. But is it unethical, if the placebo cures you?
How do you get charged for a placebo? We know from the nocebo effect that the cheap placebo will not work, because you would realize you are being fed something cheap. So the medical store has to charge you a high price for useless pills. Anyone would call that fraud. If it cures, it is it still fraud?
The correlation between the price of things and its quality is ingrained. If you go to a store to buy a radio, and you see one for $10 and one for $15. Which one would you buy? If you are price conscious you may buy the cheaper one, but you will be left with a nagging feeling that you got something inferior. If you buy the more expensive one, you will definitely be happy when it lasts you many years, and you would be confident that if you bought the cheap one it would sound worse and would break sooner (largely untrue). Manufacturers routinely use this dilemma heavily, they make the same thing and label them differently and charge different prices—just to capture both ends of the market (price conscious and quality conscious).
We are what our minds make us. The mind controls everything. It is conditioned from the time we were young. It gives us our abilities, our perceptions, our character and the way we think. From science to religion, from politics to economics, everything is controlled by the human mind. We perceive, we believe and we react. Things that matter are what we think they are. The quest for truth is bafflingly elusive, after all what is the truth? We have to come to the realization that if I believe it is true, it indeed is true for me, regardless how incredible you may think it is. Experiments do not matter, arguments do not matter, reality does not matter, in fact, matter does not matter—it is all in the mind. As a wag succinctly put it, “It is a case of mind over matter—I do not mind, and you do not matter”.
Americans are convinced that millions of people living in the Middle East, the “radicals”, are the cause of significant problems in the world today. Nothing will ever convince the American public that these people are anything other than grossly misguided, wrong minded, immoral miscreants, bent on bringing hatred, death and the pursuit of debauchery to the world. Similarly, the “radicals” are convinced that Americans are nothing but evil, arrogant, overbearing, “imperialists”, out to torture, rob, exploit, conspire and control to make the world bow to their will. Nothing would convince them that on the contrary, the American public is just a bunch of well-intentioned people, who love freedom and earthly pleasures and want the rest of the world join them in the search for Utopia.
Perception is reality.
Partha Dasgupta is on the faculty of the Computer Science and Engineering Department at Arizona State University in Tempe. His specializations are in the areas of Operating Systems, Cryptography and Networking. His homepage is at http://cactus.eas.asu.edu/partha