Weighing the Evidence on Mind-Body Medicine

IRA FLATOW: This is Science Friday. I’m Ira Flatow.

Most of us have a sense that what goes on in our minds affects our bodies. Like you feel a little bit nauseous before a presentation, right? Then you know how fear can go straight to your gut. Or try this. Think about a drop of sour lemon juice splashing over your tongue. You can feel that tingle.

But if you start talking about how these powerful thoughts might help us heal or ward off disease, expect some raised eyebrows. In Western medicine, the idea of healing thoughts can give off the distinct whiff of woo, conjuring religious gurus laying on hands and Reiki masters harnessing undetectable energy fields. It’s sort of just a no no to talk about this stuff.

Well, brave science writer Jo Marchant is having none of your energy fields or your auras. She has her PhD in genetics and medical microbiology, after all. But she did get curious– in our rush to avoid medical quackery, have we sidelined the mind’s role in medicine? Can thoughts help us heal?

In a new book, Cure– A Journey Into the Science of Mind Over Body, she reviews the evidence for and against mind-body medicine. Jo joins me now from London. Welcome to Science Friday.

JO MARCHANT: Hi. Thanks for having me on.

IRA FLATOW: Were you a little bit wary about taking on this topic?

JO MARCHANT: Probably not as wary as I should have been. I was just interested. And I’ve kind of came to realize as I continued just how divisive a topic this can be and how strong feelings can be on it.

IRA FLATOW: Did your friends say you were a little bit nutty when you were working on this book?

JO MARCHANT: My scientist and science journalist friends just would roll their eyes, mostly. But my friends outside of science– my mom friends at the primary school actually sounded really interested. They wouldn’t have been interested in any of the other books that I’ve written, but there’s something about this topic that fascinated them. So it was kind of a reversal from what I usually get.

IRA FLATOW: So what is the main takeaway from all that you’ve learned here?

JO MARCHANT: It is that we should be taking seriously the role of the mind in health, and particularly in our medical system. I think we need to take seriously and research, in an evidence-based way, how we deliver care– so not just the drugs we’re prescribing, but how those drugs are delivered. It’s not as simple as saying, oh, the mind can cure, obviously. But equally, it’s not right to say that the mind plays no role in health. So sometimes, the mind can have very dramatic, immediate effects, particularly when it comes to symptoms such as pain, for example.

Sometimes, the mind has no effect at all. A diabetic is never going to replace insulin their body needs using the mind. Sometimes, the mind can be a subtle factor among many that influences our disease risk over long periods of time, a bit like diet or exercise. So I think we need to take a scientific approach to studying this and working out when and where and who does the mind help.

IRA FLATOW: But you never really many research. You talk about taking a scientific approach. Who would study this? No one is going to spend a lot of money, right? Because it doesn’t involve a product that can be sold or treatments that would make money for people.

JO MARCHANT: Yeah. There were a lot of obstacles. So absolutely, money is one. You don’t have a product to sell with a psychological approach like this, so who’s going to fund those trials?

There’s also a kind of prejudice against even studying this stuff. Several of the researchers that I interviewed for the book had– they felt that this had had a real effect on their reputation. They had had real misgivings before going into studying something like hypnosis or mindfulness. So you have to be pretty brave to even get into this in the first place. And then there are just issues with trial design, for example. Because in medicine, we test our treatments against placebo in randomized controlled trials, and that’s a great thing that we do that. That’s extremely important so that we can tell that the drugs and treatments that we’re testing actually work.

But it means that anything else about how a treatment works, any way that it might be influencing or harnessing a patient’s psychological resources in terms of expectation or reducing stress or providing social support– all of those components of care get canceled out in the trial, because they’re present in the placebo arm as well as in the drug arm. So we don’t have any way of measuring or valuing these other aspects of care. So that’s a big problem as well, I think.

IRA FLATOW: Speaking of placebos, you point out in the book quite often that the placebo effect is real, and it really does work.

JO MARCHANT: Yeah. This really surprised me, actually. We tend to think of the placebo effect as a bit of an illusion, I suppose. So obviously, a lot of people get better anyway with time, regardless of what you give them. But what neuroscientists are finding is that there is also a specific effect in some cases where the response to receiving treatment, perceived or real, creates biochemical effects in the brain and body that are very similar to those caused by drugs. So a placebo painkiller can trigger the release of endorphins, natural pain relieving chemicals, in the brain. And these are exactly the chemicals that opioid drugs– morphine and heroin– are designed to mimic.

So if you take a placebo and your pain is eased, you haven’t just imagined that. You haven’t just changed your perception of the pain. It’s actually been eased through exactly the same biochemical pathway as would have occurred if you had taken a real pain killer.

But then in Parkinson’s, for example, when patients take a placebo, they get a flood of dopamine, the neurotransmitter dopamine in their brains exactly as they would when they take their real Parkinson’s drug. Or even with altitude sickness, you can give people fake oxygen, and you get a reduction in prostaglandins in the brain. And these dilate blood vessels, and they cause many of the symptoms of altitude sickness.

So there isn’t just one placebo effect. There are many depending on the condition, and they each need to be studied separately. But the principle is that you are getting these measurable biological changes triggered in response to these placebos that are very similar to those changes that are caused by drugs.

IRA FLATOW: Yeah. There was one amazing one that you talked about. We need Bonnie, who gets placebo back surgery. I didn’t think there was such a thing. How does a doctor do placebo surgery?

JO MARCHANT: Well, this is a technique called vertebroplasty, which involves injecting cement into a fractured vertebra to strengthen it. And it was a few years ago having great results, becoming very popular, patients recovering dramatically. Until a few trials were done comparing it against the sham surgery, where the patient goes into the room, and they’re given an injection of local anesthetic, and only then does the surgeon open the envelope to find out whether they’re getting the real injection or not. And then if they’re in the placebo group, the teams go through exactly the same steps. So they open the cap of cement so the smell spreads through the room. They have a script where they say all exactly the same words as they would do if they were injecting the real cement.

So even though patients know they might be receiving placebo, it’s a very convincing theatrical performance that they’re in the active group. And I met Bonnie, who was in this particular trial. She slipped on wet tiles and fractured her spine. And she loved playing golf. She wasn’t able to play golf. She couldn’t stand and do the dishes. She couldn’t sleep at night.

And then after the vertebroplasty, she said it was like a miracle. The pain was gone. Except she was in the sham surgery group. And overall, what several of these trials have shown is that there is no difference between the sham surgery and the real surgery. But both groups do significantly better.

That trial can’t say for sure how many of them would have felt better anyway. That’s why you need these other studies to look at the mechanisms. But the researchers were convinced that this wasn’t just patients happened to feel better by chance. They really felt that there was something else going on here.

IRA FLATOW: And in Bonnie’s case, she even felt well when she learned that the surgery was fake. It didn’t affect how she was feeling.

JO MARCHANT: Absolutely. There are some other studies– for example, in Parkinson’s– where people have benefits, but then when they found out it was placebo, those benefits receded. But in Bonnie’s case, she was still fine. She had no problems with that.

IRA FLATOW: And you mentioned patients who were receiving hypnosis for irritable bowel syndrome. Describe what one of these hypnosis sessions is like.

JO MARCHANT: Yeah. So perhaps when people think of hypnosis, they either think of those embarrassing state shows where people impersonate Elvis.

IRA FLATOW: Eat an onion, and it will taste like orange, that sort of thing.

JO MARCHANT: Exactly. Or else this going back into past lives, or early abuse, or whatever. But this is nothing like that. This is very down to earth. It’s called gut-focused hypnosis. So it’s about helping patients with irritable bowel syndrome to regain control over their gut using a lot of visual imagery. So a common one is to imagine your gut is a river. So somebody with diarrhea might want to imagine a slow-moving canal, whereas somebody with constipation may prefer a fast-moving river.

And trials show that while hypnotized, the patients can actually influence the rate of gut contractions, which is not something that’s supposed to be under conscious control. A cause of this hypnosis also reduces the sensitivity of the gut to pain. Because that’s a common thing in irritable bowl syndrome, that patients– they got very hypersensitive to pain. And in trials as well, the hypnosis has been shown to help 70% to 80% of patients for whom all other treatments have failed. So that is an example of a psychological approach allowing patients to influence physiological function in a way that you wouldn’t be able to otherwise, which is actually helping them to recover from that condition.

IRA FLATOW: What would need to change about our medical system for some of these mind-body approaches to gain some traction?

JO MARCHANT: Quite a lot.

IRA FLATOW: Long pause.

JO MARCHANT: Yeah.

IRA FLATOW: Too many things well.

JO MARCHANT: Yeah, a lot of things. We talked about some of them already. So there’s where is the money coming from for trials. We really need to have trials that can look at these other components of care, and not just purely the drugs, but look at how that care is delivered and what difference that makes. And there are some trials going on into this already.

So Harvard, for example, there was a trial showing that patients with irritable bowel syndrome who have a warm, empathic practitioner have much better relief from their symptoms than when the practitioner is cold and polite. Or another one in acid reflux disease showing that patients do dramatically better if the consultation with the physician is longer– 44 minutes long compared to the standard 18 minutes.

So if we have more research like that, I think it would give more justification, if you like, for taking those elements more seriously rather than what we do at the moment, which is cutting appointment times and cutting medical staff to try to be as efficient as possible. But also, just in terms of scientists taking this stuff more seriously, maybe, rather than just dismissing it all as woo and flaky claims– and obviously, there’s an awful lot of that out there, but that doesn’t mean that the mind doesn’t have any role to play.

And I think some of these neuroscience studies, whether it’s in placebo research or a lot of the mindfulness research that’s showing changes in the physical structure of the brain, for example– I think that’s helping people to take this more seriously.

IRA FLATOW: I was about to say that. I’ve been around a long time covering this as a journalist. And mindfulness now, of all these new, mind control things, seems to me to be taken more seriously than the other things in the past. Did you find that also?

JO MARCHANT: Yeah. There’s a lot of resistance to it as well, but yeah. It’s just been this incredible surge in popularity, both in people wanting to try mindfulness, but also in the scientific studies as well. I think there’s often an element of fashion with these things. So hypnosis, for example, is completely unfashionable. You will not any money to study that. And mindless has taken its place, and that’s on the up now.

And there are very good trials now showing that training in mindfulness can reduce symptoms such as pain, fatigue, anxiety. It protects against relapse in depression. Where the trials aren’t as good so far is then looking at does that affect physiology. So does reducing stress reduce inflammation, for example, and how does that affect the progression of autoimmune diseases and our susceptibility to infection? And there is some evidence that’s quite intriguing suggesting that there might be an effect there, but we need more research on that.

IRA FLATOW: Talking with Jo Marchant, author of the book Cure– A Journey into the Science of Mind Over Body, on Science Friday from PRI, Public Radio International.

One thing that used to be popular that you heard about a lot, and it’s sort of still being practiced, is acupuncture. Do you come across cases of acupuncture there?

JO MARCHANT: Yes, mainly demonstrating the usefulness of placebo responses, I think. Because acupuncture is– you’ve got the physical needles. It’s not really a psychological therapy, so I didn’t look at it from that sense.

But it’s very interesting case. Because in trials, generally, there is no difference between real acupuncture and sham acupuncture. So this is where you put the needles in the wrong places and they don’t penetrate the skin. So that’s telling us fairly clearly that all these meridians and energy lines and needles isn’t really doing anything.

But often, both of those groups, again, improve significantly. So there’s a very interesting trial done in over 1,000 patients with chronic back pain. And there were two groups. One group had real acupuncture. One had the fake acupuncture, and there was no difference between the two. But in this trial, there was a third group, and that third group received conventional care. So this was a combination of pain killing drugs, physiotherapy, and exercise. And that conventional care group did barely half as well as both of the acupuncture groups, even the fake acupuncture group.

So what that shows you is that just because something isn’t any better than placebo, that doesn’t mean it can’t benefit patients. There are cases, particularly for conditions where drugs aren’t particularly effective and where they have significant downsides, such as side effects and addiction, and where placebo response is strong– and pain is a good example of this– where even something that’s working purely through these placebo responses, these social and psychological aspects of care, that can actually be better for patients than receiving the conventional drugs. And I think that shows that we’re doing something wrong in conventional medicine if something with no active direct effect is better than conventional care.

IRA FLATOW: In the book, we meet a guy named Carl Heinz. And every time Carl takes his pills, he listens to the same song by Johnny Cash. What’s going on there?

JO MARCHANT: OK. So this is research into conditioning. So I don’t know if most listeners would know Pavlov’s dogs.

IRA FLATOW: I think they would. We’re pretty up on conditioning, yeah.

JO MARCHANT: So Pavlov conditioned his dogs to– every time he fed them, gave them their meat, he would flash a light or sound a buzzer, and they would salivate in response to the meat. But over time, they learned to associate the light or the buzzer with the meat, until eventually, they celebrated automatically just in response to that psychological cue. They didn’t need the meat anymore. So this is a learned association. A psychological cue triggers a physiological response automatically.

And this happens in people as well. That’s what happens when you salivate. When you think about biting into a lemon, you’ve been into a lemon before. Your body knows the appropriate physiological response.

IRA FLATOW: So Johnny Cash would allow this reaction to happen without the drugs, just by hearing the music?

JO MARCHANT: Well, I’m getting to Johnny Cash. So this also works not just for salivation and digestion, but for a lot of physiological functions in the body, including the immune system. So if you take a drug that suppresses the immune system a few times, your body learns that response. If you subsequently take a placebo, your body will automatically have that same immune response to that placebo even though there’s no drug there.

And so these are trials that are trying to get people to learn the association. So Carl Heinz is–

IRA FLATOW: I’m going to have you stop there, because we have to take a break.

JO MARCHANT: Sorry.

IRA FLATOW: It’s an interesting story. I want to give you full time to tell it. So we’ll take a break and come back and talk lots more with Jo Marchant, author of Cure– A Journey into the Science of Mind Over Body. And my mind and body are telling me we have to go. We’ll be right back after this break.

This is Science Friday. I’m Ira Flatow.

In case you’re just joining us, we’re talking with Jo Marchant, a science journalist, author of the book Cure– A Journey into the Science of Mind Over Body. And when I rudely interrupted her, she was telling us a story about Carl Heinz, every time he takes his pills, he listens to the same Johnny Cash song. And we got through the part about the bell and the light and the reaction. So what happened? What did he do?

JO MARCHANT: I’m so glad that you let me come back to this, because it’s one of my favorite pieces of research in the whole book. So the idea is that you can learn an association with a psychological cue, and then that can have an effect on your immune system. So he’s taking his immunosuppressant drug, because he has a kidney transplant, so he needs to take this.

And the idea is that alongside taking his drug, he listens to Johnny Cash, but also, he drinks– it’s this really bizarre drink the researchers have come up with. It’s strawberry milk mixed with green food coloring and lavender oil. And I tried it. It’s quite disgusting, actually. It hits all your senses at once. It’s a bizarre drink.

So he takes this with the drug for a few times, learns the association. And then the hope is that when he just has the drink, the placebo drink, and listens to the music and the rest of the environment, when he does that on its own, that will suppress his immune system. And the idea is that hopefully will allow kidney transplant patients to reduce their drug doses. So their immune system is still suppressed, but with a lower dose of drug. And that is important, because these immunosuppressant drugs are extremely toxic, not least the kidney, the very organ that you’re trying to save. So it would be very important if you could do this with lower drug doses.

And this has been shown to work in healthy volunteers. You can condition the suppressed immune response. There are also some small studies in autoimmune disease as well showing that you can get the clinical response with a lower drug dose if you use this kind of conditioning technique. And now this is a trial that’s happening in kidney transplant patients. And I just think that this has such fundamental implications if this can be shown to work. Because reducing drug doses in autoimmune disease, allergies, transplant patients, potentially even cancer– there are some animal work in cancer showing that this can work– that would have huge cost savings as well as improving the quality of life for patients.

IRA FLATOW: I’ve got a quick phone call in from McLean, Virginia, Mark in MacLean. Hi, Mark.

CALLER: Hi. How are you?

IRA FLATOW: Hi there. Speak up, please.

CALLER: OK. Let me take you of Bluetooth. I think that will hopefully help.

IRA FLATOW: I hope we’re still there when we’re off. Go ahead.

CALLER: Let’s see. How’s this? Is this better?

IRA FLATOW: Yes. Go ahead.

CALLER: So it’s very apropos that Jo just mentioned cancer. I happen to be a cancer center director and a physician in a health system in suburban Maryland in Frederick. And we’re doing a couple of things. I don’t think we’re that terribly unique. One of our lead medical oncologists was a Senior Investigator at the NCI and spent a lot of his time researching complementary and alternative therapies. And we’re using that for our cancer patients to improve their experience and to improve their spiritual and psychological well being. And we’re also working with an organization, a not-for-profit foundation called the Samueli Institute that does evidence-based creation of healing environments for patients. So I do think that there’s a lot of value in mind-body connection, certainly for cancer patients and for folks in general. So I applaud the work that you’re doing.

IRA FLATOW: That’s very interesting, Mark. Thanks for calling. It looks like some people are listening and maybe reading your book. Let’s go to Fish Creek, Wisconsin. Gale, hi.

CALLER: Hi. Thanks for taking my call. This is a great show. I have so much– waiting for 25, 30 years for people to start talking about hypnosis and the real mind-body connection, to have that come in to the healing. When I was doing research with a chiropractor that I knew, we were actually pulling out the energy that was in the way. So we were working with the mind-body connection with energy with helping with adjustments. And working with him, we were finding that there was more clearing of the meninges out of the spine, which was helping people overall, because that will affect the vagus nerve, which affects everything in the body, and the immune system and the nervous system.

And I’m wondering– I did some interesting work with my dentist to get to not have to do any Novocaine if I had a filling or anything done. Have they done any work with people with– say, really with children or people with this kind of consciousness work with dentistry?

JO MARCHANT: Well, there is one chapter where I look in the book not at dentistry, but at people undergoing invasive medical procedures, such as breast biopsies or destruction of tumors. So I think having a dental procedure would probably fall into a similar category.

And just looking at the difference it makes when the medical staff change how they speak to patients– so stop using lots of negative language, like this is going to sting or burn. Try to speak to the patient in a way that makes them feel more in control, and also, encourage patients to use visualization techniques to relax, a little bit like self-hypnosis, I suppose, to imagine yourself in a nice faraway place where you’d rather be.

And that had actually quite dramatic effects in terms of the– first of all, the pain and the anxiety that the patients reported during these procedures. But then in turn, they required far less painkillers and sedatives. And whether it was because of that, I don’t know. But the level of complications, the rate of complications during those procedures, fell as well. So just through the patients being less anxious and not needing such high levels of painkillers and sedatives, you actually had better physical outcomes to those procedures.

IRA FLATOW: So doctors offer treatments like Reiki or acupuncture that don’t perform better than placebo but do provide relief for patients? What’s the right thing to do there?

JO MARCHANT: Now that is a controversial question. Ultimately, I think the answer is that rather than outsourcing this stuff to alternative therapies that often rely on explanatory frameworks that aren’t scientific, I think we should be trying to understand these elements of care and ritual, and how they help people, and incorporate those into conventional medicine in an evidence-based way.

The trouble is that’s probably quite a long way off. So for a cancer patient now who’s struggling with side effects of chemotherapy, for example, I would find it quite difficult to say to them, no, don’t use alternative medicine if you feel that it helps you.

IRA FLATOW: Well, I want to thank you for taking time to be with us today. I’m going to end with a tweet that came in from John Reese, who says, let mom kiss it and make it better is a good example of the placebo effect. I think mom’s kiss really does make it feel better. There you go. From a very early age.

JO MARCHANT: Yeah. I agree with that.

IRA FLATOW: Jo Marchant, the science journalist, author of the book Cure– A Journey into the Science of Mind Over Body. We thank you for your hard work and bravery in writing this, Jo.

JO MARCHANT: Thank you very much.

IRA FLATOW: And you can read an excerpt from Cure at our website. Go to sciencefriday.com/cure.

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