At present, our medical community is at a critical impasse that demands the attention of parties across the board. Our current state of health care cannot meet the growing costs and concerns associated with a lengthening list of chronic pathologies, which require a more extensive treatment regime than presently available. Complications with chronic diseases cost a multitude of insurance and consumer’s dollars, yet management and prevention of our plaguing diseases are far from ideal. Despite such a large investment of time and monetary values, the effectiveness of health care is proving to be an inadequate treatment plan without curative effects. In essence, our population’s health concerns are reaching a decisive point, one that requires a paradigm shift. Perhaps a different approach to the management and treatment of patients is in order. One that could provide an answer to these goals, and at the same time, one that keeps our patient’s best interests at heart, focusing on compassionate encounters between doctor and patient.
All physicians take the Hippocratic oath stating, “never do harm to anyone,” yet our acceptance of side effects directly violates this aspect of our doctoral creed.
As practitioners of healing, we swore to protect the health and rights of our patients. Accruing side effects from any treatment methodology should not be considered normal.
Accepting any additional suffrage for our patients caused by our current methods of treatment is negligent.
As doctors, we have a responsibility to uphold the high level of trust that our patients place upon us. It is appropriate to both question and challenge methods that have a higher likelihood of causing our patient harm.
Perhaps a proactive approach is in order: let us actively seek out alternative methodology that better serves those in sickness and in health, and most importantly those devoid of side effects. Less conventional methods are widely available, but I would like to focus upon the conventionally misunderstood term of placebo. Researching the effects and characteristics of the illusive placebo can illuminate treatment modalities resulting in fewer, if any, side effects. Moreover, learning more about the phenomenon of placebo may give a greater understanding of how to approach a treatment plan, allowing the practitioner to treat the patient in a unique and compassionate manner.
The concept of placebo is multi-faceted and should not be generalized under a blanketed approach solely with the intention of controlling its unknown features. In actuality, the modalities fit nicely under an umbrella of misunderstood and ill-defined actions. Commonly these actions are described as miracles in a broad layman’s sense, and within the research based communities as the infamous placebo effect. Regardless of its title, these accounts are roughly sketched details in the areas of healing that are not fully understood by many scientists and practitioners of medicine. It is incorrect to refute the growing evidence for the positive effects of placebo, especially those that contain curative methods for treatment without side effects. More often than not, these methods are much more sustainable to the economic, environmental, social, and physical wellbeing of every individual on the planet.
It would behoove everyone to reassess the importance of studying the unique effects of placebo. Currently, placebo is approached in research models with counteractive measures, in an attempt to limit and control its effects. Rather, let us shift importance. What if: importance was placed on methods or interactions between patient and practitioner that are able to create a causative effect with without side effects? Moving placebo research into this direction would require a multi-pronged and holistic approach because the actions of placebo contain both immaterial and material components; therefore it is crucial that research concentrates on both ends of the spectrum in order to satisfactorily include all the relevant characteristics of placebo effects.
Within the last century, the advent of chemical and physical manipulations through herbal and synthetic compounds has taken precedent over our understanding of treatment methodology. This has lead to the dominating paradigm of medicine: a one-sided view primarily centered on the physical aspects of what practitioners are capable of achieving. The Neuropsychiatric Institute at UCLA houses several MDs and PhDs who, as a collective, delve deeply into the inter-relationships between placebos and its effectiveness in reducing symptoms of disease, albeit their focus in primarily on the neurochemical pathways in the brain. This analytical approach to understanding placebo is necessary, yet remains embedded in the physical aspects of medicine. Biochemistry is an important aspect of understanding the relationships between the brain and the body, but this level of comprehension is only the tip of the iceberg, a mere sliver of the full picture of placebo. And, more importantly, this level of understanding is devoid of the compassionate interactions between practitioner and patient.
An alternative approach is currently underway with Tom Janisse, MD, Editor-in-Chief at the Kaiser Permanente Journal, although he may not label his research as placebo-related at all. Janisse devotes a good bit of his time describing the doctor-patient relationship, attempting to configure the dialogue within interactions that remains unsaid; in short, he attempts to describe the delicate non-verbal interactions of personal characteristics. Non-verbal interactions are part of the picture of placebo, and this is evident with all of the constraints set by double-blind placebo measures, taking “human intention/bias” out of the scientific equation. Perhaps within these subtle interactions, true healers are better able to listen and understand the context and 
nature of suffering for the patient, and in turn, provide the best tools for patient recovery. To expand upon this concept, Janisse articulates the importance of the Power of Relationship in Medicine in an interview with Consciousness and Healing channel host, Marilyn Schlitz. Moreover, a Kaiser Permanente publication, Soul of the Healer, adds the compassionate integrity back into the medical profession, capturing artistic expressions of healing through the eyes of health practitioners, adding artistic and creative depth to the healing process on both sides of the equation. These examples are the sorts of strides in our profession that go beyond conventional medicine, that take the experience of healing to a level that is both pleasurable for the physician and the patient. In essence, this form of focus on interactions between people is a highlight of the hidden nature of placebo, and not an attempt to control and or discount placebo’s effects.
Donivan Bessinger, a retired surgeon and a mainstay in the medical field, writes primarily on the spiritual and ethical aspects of healing, suggesting that same concept in an article entitled, “Reflections on ‘soul’ and medical art,” by stating that:
“A medical philosophy which is germane to our current problems, would foster integration of bioethics, humanities, general knowledge, depth psychology, and spirituality as they relate to patient experience. By being sensitive to the ‘soul’ issues of patients, we improve our ability to ‘evoke the placebo response’ and to reduce patient interest in unconventional therapies”(Bessinger, 1993).
Ideally doctors could learn to use the placebo effect to advantage!
An attempt to accentuate and duplicate these more reasonable and sustainable effects of placebo in less conventional methodology is in order. Too readily our current research plays a heavy-handed approach based on the physical methods of healing. This approach ignores less understood immaterial aspects of placebo, resulting in treatment plans that lack compassion and causing unnecessary harm to our patients. New research into placebo that takes into account the compassionate and artistic qualities of humanities experiences could prove a noteworthy expedition, obtaining a greater understanding of how the human body is capable of healing itself. It would be unwise and costly to any discount research attempting to make sense of the black box of placebo, with a flippant disregard for the unknown, labeling these methods as debunked ideas. The curiosity that drives researchers into this ill-defined field of medicine is a noteworthy exploration. Without fully evaluating less conventional methods, as a medical community, we are causing great disservice to our patients, especially at a time when an overwhelming number of side effects are the norm.
Sincerely,
C. Biscuit
