A placebo is something that produces a positive or improving effect on a person’s health but having no relation or root on actual physical or medical treatement. The effect is also referred to as placebo effect and has been well documented in the past years. One notable study (Response expectancies in placebo analgesia and their clinical relevance) conducted in the University of Torino Medical School in Italy describes how verbal instructions can act as a placebo in relieving pain.
Thoracotomized patients were treated with buprenorphine [a powerful pain reliever] on request for 3 consecutive days, together with a basal intravenous infusion of saline solution. However, the symbolic meaning of this basal infusion was changed in three different groups of patients. The first group was told nothing about any analgesic effect (natural history). The second group was told that the basal infusion was either a powerful painkiller or a placebo (classic double-blind administration). The third group was told that the basal infusion was a potent painkiller (deceptive administration). Therefore, whereas the analgesic treatment was exactly the same in the three groups, the verbal instructions about the basal infusion differed. The placebo effect of the saline basal infusion was measured by recording the doses of buprenorphine requested over the three-days treatment.
We found that the double-blind group showed a reduction of buprenorphine requests compared to the natural history group. However, this reduction was even larger in the deceptive administration group. Overall, after 3 days of placebo infusion, the first group received 11.55 mg of buprenorphine, the second group 9.15 mg, and the third group 7.65 mg. Despite these dose differences, analgesia was the same in the three groups.
These results indicate that different verbal instructions about certain and uncertain expectations of analgesia produce different placebo analgesic effects, which in turn trigger a dramatic change of behaviour leading to a significant reduction of opioid intake.
There is an opposite phenomena to the placebo effect in which adverse or harmful symptoms are caused by something that should have no established effects. This is called the nocebo effect but is not as widely documented as placebos due primarily to ethical considerations (i.e. what scientist or doctor would intentionally administer something that can cause harmful symptoms or effects to a patient?). However some studies exist which may illustrate the effect:
“Japanese researchers tested 57 high school boys for their sensitivity to allergens. The boys filled out questionnaires about past experiences with plants, including lacquer trees, which can cause itchy rashes much as poison oak and poison ivy do. Boys who reported having severe reactions to the poisonous trees were blindfolded. Researchers brushed one arm with leaves from a lacquer tree but told the boys they were chestnut tree leaves. The scientists stroked the other arm with chestnut tree leaves but said the foliage came from a lacquer tree. Within minutes the arm the boys believed to have been exposed to the poisonous tree began to react, turning red and developing a bumpy, itchy rash. In most cases the arm that had contact with the actual poison did not react.” (Gardiner Morse, “The nocebo effect,” Hippocrates, November 1999, Hippocrates.com)
I briefly brought up the above discussions as a springboard to appreciate the interesting findings of a 2006 study funded by the John Templeton Foundation and published in the American Heart Journal. The study was to find any noticeable effects that prayer had on the recovery of some 1,800 heart bypass patients.
Medical News Today briefly shared the structure of the study:
Three groups of people were asked to pray for patients they did not know personally. The congregations came from:
— St. Paul’s Monastery, St. Paul
— The Community of Teresian Carmelites, Worcester, Massachussetts
— Silent Unity, which is a Missouri prayer ministry near Kansas City
Patients were divided into three groups:
1. Patients who were told people would pray for them
2. Patients who were not told people would pray for them, but people did pray for them
3. Patients who were not told anything, and nobody prayed for them.
One night before surgery, each patient who had people assigned to pray for him/her, would be prayed for. Then the worshippers would pray for him/her for a period of two weeks after surgery. The prayers would ask God to grant ‘a successful surgery with a quick, healthy recovery and no complications.’
We can consider this scientific inquiry as among those that are attempting to test or bridge the forever gap between religion and science. Prayer or praying for healing has long been a part of many religious beliefs and predates modern medical scientific advances as a treatment for illnesses and pain. Although medicine has all but taken over this role, there still persists a strong belief in the power of prayer among other things that could achieve healing outside of current medical science.
Although to be clear, from the structure of the experiment, there was no attempt to qualify the effect of prayer if any was found, but merely to measure any noticeable effects. If there were, perhaps prayer might qualify as a placebo as it is currently understood by science.
However, the results of the study were interestingly counter-intuitive. Still from Medical News Today:
Among two groups of patients, one having people praying for them but not knowing, and the other receiving no prayers, there was no difference in their health and recoveries.
However, the group that was being prayed for and knew about it had more complications after surgery than the other two groups.
Here are the results presented in a different way:
Percentage of Patients Having Complications After Surgery
52% – Patients who were receiving prayers and did not know this.
52% – Patients receiving no prayers and not being told anything about prayers taking place anywhere for anyone.
59% – Patients knowing they were receiving prayers
Does this mean that knowing people are praying for you is bad for your health? Some say that the stress of thinking ‘I must be really ill if people are praying for my health’ may have contributed towards the health complications.
According to this study, we may conclude the following:
— Praying does not help the patient at all.
— Telling patients that people are going to pray for them does have an effect, but not a good one.
Prayers had no observable effect if the patient was not aware of them, but had an adverse effect if the patient did. Praying for health was no placebo but actually veers closer to the definition a nocebo. Further to this, the Seattle Times wrote:
Researchers were at a loss to explain the worsened outcomes in their study. An accompanying editorial in the journal criticized the study authors for taking “an almost casual approach toward any explanation, stating only that it ‘may have been a chance finding.’ ”
The editorial authors, led by Dr. Mitchell Krucoff of Duke University Medical Center, wrote that study leaders had not anticipated that prayer might be harmful and had “allowed cultural presumption to undermine scientific objectivity.”
To that last statement, objectively speaking, that the results were contrary to a hypothesis (even a culturally presumed one) is not a reason to dismiss the findings. In fact, it only serves to highlight that the hypothesis (i.e. prayers can help) should be challenged. However, some question the validity of subjecting religious belief to scientific inquiry. From the Times Online:
Dr Richard Sloan, a professor of behavioral medicine at Columbia and the author of a forthcoming book, Blind Faith: The Unholy Alliance of Religion and Medicine, told The New York Times: “The problem with studying religion scientifically is that you do violence to the phenomenon by reducing it to basic elements that can be quantified, and that makes for bad science and bad religion.”
Others also question the whole rationale of testing prayer as a form of medicine, when this should not really be the case. In the Washington Post:
Krucoff, a cardiologist, published a study last summer involving 748 heart patients at nine hospitals. That study failed overall to show any benefit. But Krucoff said he did find tantalizing hints that warrant follow-up: A subset of patients who had a second group of people praying that the prayers of the first group would be answered may have done better.
That underscores one of the many difficulties that critics and advocates say makes studying prayer problematic: There is no way to quantify thedose,and no way to know whether people outside the study may be praying for its subjects, diluting the effects.
Krucoff and others say it is also important to study prayer as an adjunct—not a replacement—to standard medical care, to make sure it is safe.
That prayer is not or should not be considered a replacement for medical attention is a valid and important assertion in the appreciation of this study. Early 2008 saw a case of a death which resulted from parents taking an opposite view. As Fox News reported:
WESTON, Wis. — The mother of an 11-year-old girl who died of untreated diabetes said Wednesday that she did not know her daughter was terminally ill as she prayed for her to get better.Madeline Neumann died Sunday from a treatable form of diabetes.
Her mother, Leilani Neumann, told The Associated Press that she never expected her daughter, whom she called Kara, to die. The family believes in the Bible, and it says healing comes from God, but they are not crazy, religious people, she said.
The age-old question of religion vs. science continues, but if there’s one insight to be had from this and the study of placebos and nocebos it’s that perhaps the whole question of pitting belief and science is absurd from the very beginning–because they address two completely different concerns in completely different ways.