Biology 202
2002 First Paper
On Serendip

When I was seven years old my family and I took my grandmother on a trip around northern India. It was her desire to make pilgrimages to the temples that were considered to be the holiest by the Swaminaryans, an orthodox sect of Hindus. At that time in my life, I couldn't even pretend to be interested in the activities occurring within the temples. Instead, I was mesmerized by my proximity to the wildlife that was lounging just outside of the actual walls of temples. In a two-week span of time I must have seen more than twenty temples, and by the end they all blurred together except for one.

Although the temple itself was not magnificent, what was occurring inside has remained with me to this day. A male priest, who was sitting at the main alter, was pulling on elderly woman's hair causing her to scream hysterically. I discovered that the woman was suffering from a headache and was having it cured by the priest. More accurately, she was having the "ghosts" removed from her brain. For the individuals who were directly involved in the ceremony and for many of the people with whom I was traveling, exorcism was a perfectly legitimate way of curing an illness of the body. The cure had no pharmaceutical basis, but it was based in the people's belief system. The belief system for the circumstance that I witnessed was a ritualistic aspect of Hinduism. In the case of the exorcism, the individuals involved expected that the treatment would work, and as a result the treatment did work. The idea that people benefit from expectation alone is called the placebo effect, and it is not unique to India or to the east.

Placebos are medications or treatments that are benign and have no pharmacological properties 1)The Placebo Effect Real of Imagined. The category of placebo includes everything from the hair pulling I witnessed in India to the starch pills that millions of American women take along with their birth control. Until recently, placebos were considered important to Western medicine, in so far as they were part of a rigorous scientific method of testing and approving new medicine. In particular, a standard part of clinical trials is the division of patients into two categories. One category is given the medication being tested and the other is given placebo pills. The trials are such that neither the patients nor the researchers know who is in what category (double blind trials). The purpose of these types of trials is to control for the influence of attitude both on the part of researchers and patients 1)The Placebo Effect Real of Imagined. However, the accumulation of clinical studies that seem to suggest that placebos themselves promote positive health outcomes has caused an explosion in the research of the placebo effect. The placebo effect is "the measurable, observable, or felt improvement in health not attributable" to conventional medical treatment. More importantly, the improvement is believed to be due to the placebo itself 6)The Placebo Effect, good source of general information about the placebo effect.

In the past decade, the most premiere scientific journals have published articles that look at the placebos themselves, outside of their primary role in new drug approval. Last year, a Canadian study suggesting the effectiveness of placebo treatment was published in Science. The study concerned Parkinson's disease, a neurodegenerative disorder that causes impaired coordination and tremors. Parkinson's causes the destruction of brain cells that produce the chemical messenger dopamine. The study demonstrated that similar levels of dopamine are released after injection of a drug or a placebo 3)Great Expectations, summary of a study done on placebo effect in Parkinson's patients. Although dopamine is primarily found in the movement control circuits that degenerate in Parkinson's, the researchers surmised that dopamine is also released by expectation of a therapeutic reward 3)Great Expectations, summary of a study done on placebo effect in Parkinson's patients. According to the researchers, one possible explanation for the phenomena of dopamine release with placebo in take, lies in the connections between the regions of the cerebral cortex and those involved in memory with the substania nigra (the region of the brain affected in Parkinson's) 2)Scientists Show How the Placebo Effect Works. More specifically, memory of earlier benefits from Parkinson's drug could cause dopamine release 2)Scientists Show How the Placebo Effect Works.

There are several recent other studies suggesting that placebos themselves are beneficial. According to a paper presented to the American Psychological Association's (APA) 104th annual convention, the placebo effect accounts for fifty percent of improvements in depressed patients taking antidepressants 4)Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication, a controversial study done on the effectiveness of using pharmaceuticals in treatment of depression. According to another study, when placebos are given for pain management, the course of pain relief follows that of an active drug 9)The Placebo Prescription, comprehensive non-scientific article on the placebo effect. For both the placebo and the active medicine, peak relief comes about an hour after administration. The placebo effect seems to be acknowledged, perhaps unwittingly, by most medical doctors when one considers that until recently prescribing antibiotics for viral colds and flus was a common practice 5)Understanding It Can Help Avoid Flawed Study Designs.

In western society, the schools of thought regarding the explanation for the placebo effect divide along lines similar to those that divide the schools of thought regarding the mind-body relationship. One explanation for the placebo effect is that it is psychological, "due to a belief in the treatment or to a subjective feeling of improvement" 6)The Placebo Effect, good source of general information about the placebo effect. In other words, "a person's beliefs and hopes about a treatment, combined with their suggestibility, may have a significant biochemical effect" 6)The Placebo Effect, good source of general information about the placebo effect. This type of belief that faith heals can most closely be aligned with dualists who believe that the mind is an "immaterial substance, capable of existence as a conscious, perceiving entity independent of the physical body" 8)Mind, good source of general information on mind body dilemma. As such, the mind can both influence and overcome the body.

Other theories regarding the placebo effect are more biological in nature. For example, according to one theory, the placebo effect is merely an illness or injury taking its natural course. In other words, humans can spontaneously heal with time. In addition, illnesses themselves wax and wane 6)The Placebo Effect, good source of general information about the placebo effect. This argument, with its more biological basis, seems to indicate that the body is a distinct entity with the biological potential to heal itself. Another argument that also focuses on the body itself, suggests that the placebo effect "is an organic effect that occurs in patients due to Pavlovian conditioning on the level of abstract and symbolic stimuli" 7)Placebo Effect: The Power of the Sugar Pill, provides a more scientific perspective on the placebo effect. In other words, the placebo effect is a product of an involuntary conditioned reflex of the patient's body 7)Placebo Effect: The Power of the Sugar Pill, provides a more scientific perspective on the placebo effect. Another scientific theory, suggests that the actual process of treatment-touching, showing attention, interpersonal communication-may trigger physical reactions in the body while promoting healing 7)Placebo Effect: The Power of the Sugar Pill, provides a more scientific perspective on the placebo effect. In terms of the mind body debate, the individuals who believe in these more biological explanations of the placebo effect can most likely be grouped together in the camp with metaphysical materialists. According to this school of thought, the mind is the brain itself or an emergent reality of the brain
8)Mind, good source of general information on mind body dilemma. From this perspective, the "mind" refers to all the "processes or activities which can be reduced to cerebral, neurological, and physiological processes" 8)Mind, good source of general information on mind body dilemma.

Throughout India, people rely on ayurvedic and homeopathic medicine. Although many of these treatments may promote health in some way or another, the belief, and therefore the reality, that these methods actually cure specific physiological illnesses are rooted in the idea that the mind and body are the same thing. Within both eastern and western medicine there are treatments that may be labeled as placebos according to current definitions of the word. Traditional medicine, in all of its varied forms, is no less valuable as a form of treatment when compared to pharmaceutical and non-pharmaceutical placebos that are routinely administered by medical doctors in the west.

The difference between eastern and western medicine is that western philosophy makes distinctions between the mind and body. This results in the unwillingness of western medical practitioners to accept and utilize what they know to be fundamentally true. For example, the very inclusion of a placebo group in clinical studies seems to be an admission that the mind influences the body, yet the placebo effect has until recently been ignored by most scientists. This stands in stark contrast to traditional medicine, which maintains a legitimate place for placebo treatment. The very fact that placebos are not considered to be merely placebos, but actual treatments for specific ailments makes these treatments effective in the circumstance in which they are used. Their effectiveness is not based on the actual pharmaceutical value of specific molecules being inserted into the body, but rather on the belief in getting better.

The placebo effect seems to be proof of the fact that the mind and body are fundamentally connected. The conclusion is not that illnesses and injuries can be healed simply by a belief in the cure being applied. However, the placebo effect suggests that physiological health outcomes are without a doubt influenced by the mind. All of this brings to the forefront the question of what the mind actually is. Although this is a topic for another paper, what can be said is that the placebo effect is essentially a result of beliefs, and beliefs seem to fall partly in the category of non-physiological.

References

(1) The Placebo Effect Real or Imagined
www.studysonline.com

(2) Scientists Show How the Placebo Effect Works
www.healthy.net

(3) Great Expectations
www.nature.com

(4) Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication
http://journals.apa.org

(5) Understanding It Can Help Avoid Flawed Study Designs
www.pubs.acs.org

(6) The Placebo Effect
http://skepdic.com

(7) Placebo Effect: The Power of the Sugar Pill
www.epub.org.br

(8) Mind
http://skepdic.com/mind.html

(9) The Placebo Prescription
www.nytimes.com

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