Wednesday, August 24, 2011

Meditations on Placebo (Marin IJ)

I’ve had placebo on the mind recently. This preoccupation started at the gym after a discussion with a self-described “Zennie,” who tried to convince me of the benefits of meditation - particularly for priming athletes for peak performance. This woman, herself a practitioner of “muga-mushin,” (Japanese for “no mind, no self”), asserted that an athlete could benefit more from careful visualization than from actual practice. I was skeptical; I have to believe Kobe Bryant’s jumper is better served by physical practice than mental repetition. And this is when I started thinking about the placebo effect - the well-described sugar pill phenomenon in which patients experience significant improvement from sham treatments. It occurred to me that perhaps the mind-body benefits seen with placebos were not all that different than those achieved via meditation. And, I began to wonder, could meditation be used to consciously invoke the placebo effect?

Medical literature has, over and over again, demonstrated the power of placebo. Last year, for instance, a Newsweek cover story examined remarkable placebo treatments for depression – so remarkable that they are making it difficult for drug makers to prove the advantages of new anti-depressant medications. (The placebo response has become so robust in clinical trials that the drugs cannot outperform it.) Similarly, a recent Harvard study of asthmatics found 45% improvement in symptoms with a fake inhaler and 46% improvement with impostor acupuncture – compared to 50% with an actual treatment (albuterol).  Beyond just "tricking the brain to feel better," placebo treatments seem capable of causing actual neurological and physiological (bodily response) changes.

Even more startling was a recent study of patients with irritable bowel syndrome (IBS – a chronic gut condition characterized by pain and bowel irregularities). This study utilized an “open-label” placebo – in other words a placebo treatment without deception. In the investigation, led by Ted J. Kaptchuk and colleagues and published in December of 2010, eighty IBS patients were given either 1] no additional therapy or 2] treatment with what they described to the patients as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes." Self-reported symptom scores were assessed at 0, 11 and 21 days after the initiation of treatment. The results demonstrated significant improvements in symptom severity and relief in the placebo group.

Now, this study was a small one, with possible confounders (such as unreliability in patient symptom reporting) but certainly is provocative and promising. For years, physicians have struggled with placebo treatments – because they assumed that trickery was necessary for them to work. Trickery puts doctors in an uncomfortable position – having to choose between two ethical principles – beneficence (helping the patient) and autonomy (helping them make informed decisions). To freely prescribe placebo without the troublesome concealment component opens up a clear pathway for placebo treatments for many conditions - depression, asthma, chronic pain, IBS, addiction, hypertension, and more.  Now, I should be clear, there are limits to the physiologic possibilities for placebo. We can’t expect mind-over-matter to work with a bleeding limb or widely metastatic cancer.

Nonetheless, the ramifications of the IBS study, if borne out in subsequent studies, are huge - the placebo effect may not require deception at all. Perhaps it’s been mischaracterized for decades and perhaps conscious attempts at self-healing should
be carefully examined and mainstreamed. And this brings me back to meditation. Could meditation function like a placebo treatment for some conditions? I do not see why not. I’m no expert in Buddhism or meditation and I do not meditate (small children in the home would seem to make that nearly impossible). Still, I know there are a lot of different types of medication from a number of religious and spiritual traditions. And for the sake of this topic, I think we can agree that each shares an emphasis on channeling attention and achieving a still, rather than muddied and churning, mind. With that context, here’s some substantiation for meditation. First, and anecdotally, from my gymnasium Zennie…

- She successfully used meditation to limit sweating on a very hot day, reporting that she “was able to not sweat, save for a light sweat film on the face (nothing under the arms or chest.)” This, by the way, is not a recommended approach to dealing with the heat.

-She successfully used meditation to prepare for extreme 24-hour straight sessions on the rowing machine achieving “no pain, total relaxation in the moment and no tension.” This by the way, is not a recommended fitness regimen.

Not sold? Here’s what the medical literature has to say…

-Functional MRI studies by Richard Davidson at University of Wisconsin demonstrate that meditation can have measurable effects on certain regions of the brain (such as in the process of consciously cultivating empathy).

-Other studies suggest that meditation can help young adults cope with stress and can improve information-processing in adults.

-Studies of flu vaccine efficacy suggest that meditation can help boost the body’s immune response.

There is still much research to be done and I suspect that meditation is just one of a number of means of achieving better health through mind-body synching. Exercise, healthy relationships and optimism, for instance, may benefit the body through similar mechanisms. While the methods may vary, the physiologic mechanisms are likely similar. But, more on this another time. For now, I need to get back to the couch for some six-pack abs training - visualizing crunches is so much more comfortable than the real thing!