The Placebo Effect and Holistic Care

ChiropracticAdjustment

In scientific research, there is a black horse known as the placebo effect.  It’s a (generally positive) change in a research subject that occurs in the absence of being given the active treatment.  In the research setting, it’s seen as the subjects falsely-reporting improvement because no “real change” has occurred.  Some call it “mind over matter” or “hope,” but researchers look at it as something discountable.  In their studies, the actual treatment must produce a result greater than in the non-treatment group to prove the treatment itself provides any benefit.  In a clinical setting, this view on placebo effect can have seriously negative consequences on the afflicted patient.  If a patient receives a “dummy treatment” (aka placebo) and shows marked improvement, then the patient may be deemed a malingerer – this means they believe the patient was faking the problem in the first place.  If the patient wasn’t consciously faking or exaggerating their problems, perhaps they were hallucinating, psychotic, anxious, hypochondriac or hysterical.  These diagnoses aren’t only given when patients respond positively to unconventional treatments, but also when doctors are unable to find a physical or chemical justification for their ailments.

To lessen the “placebo” effect in research studies, researchers may employ a “double-blind” approach.  In this method, neither the patient nor clinician administering the treatments knows whether it is the actual versus dummy treatment.  Of course, there are many limitations to this kind of study.  It can be done with identical looking (and tasting) pills or injections, but not with any physical forms of treatment, including surgery, electro-shock therapy, acupuncture, exercise, chiropractic, and massage.

In a clinical setting, there are moral and ethical barriers to the non-treatment of a patient seeking help, especially if this is not disclosed to the patient in advance.  There is also a different focus of activities.  In a research study, the goal is to test the effect of one treatment.  In doing so, the researchers attempt to eliminate (or account for) as many variables as possible, like other illnesses, other medications or treatments.  To this end, subjects should be similar, preferably healthy, young males (age 20-35). The study is conducted just long enough to see a statistically significant (though not necessarily noticeable to the subject) positive change which can be attributed directly to that particular treatment.  In a clinical setting, patients come in all varieties, with messy histories, multiple issues going on, variable lifestyles and all kinds of expectations.  They may or may not follow through with recommendations and they may not be loyal to the care of only one health professional.  Their prerogative is to get better, and quickly, often regardless of which treatment protocol(s) get them to that desired result.

From a holistic point of view, the placebo effect is mis-identified.  It is not merely an unintended positive effect of an easily-manipulated subject.  The placebo effect, in fact, is the effect of real factors not accounted for in the research design.  In addition to hope, this can include a warm bedside manner, the clinician having confidence the subject can and will improve, the subject feeling heard and their pains legitimate, and that someone cares about their wellbeing.  In listening to the patient, the clinician may discover that the current problem, depression for example, is not the main issue, but a side effect of having chronic pain and losing hope. The physical act of touching a patient can also change outcomes.  Think of the impact of a hug calming someone down or a creepy touch stirring up anxiety.  A mother kissing a boo-boo and “making it better” doesn’t mean the injury and pain were imaginary in the first place.

In a truly holistic office, the goal is to do whatever it takes (within the skills and scope of practice of the practitioner) to bring about maximum healing in the patient.   In the chiropractic office, this means performing spinal adjustments to remove interferences to nerve flow.  This may also include tonal adjustments to affect the fascia, plus soft tissue work (both passive and active) to release abnormal tension and restore proper muscle tone.  As this process can take time, often requiring many visits, and out-of-pocket costs, patients do require a lot of encouragement along the way, and reassurance they’re on the right path.  The clinician taking the time to learn the complexity of the patient’s condition and performing a thorough evaluation is key for the patient to know the recommendations are tailored to their particular needs.  When the patient feels at ease and cooperates with the practitioner, a synergy is formed that can magnify the positive effects of any interaction, whether it involves treatment or not.  The flipside is also true.  If there is a deep distrust, dislike, disconnect or disharmony between patient and practitioner, positive effects are harder to achieve and more difficult to recognize even when they do occur.

Holistic-type clinics are called that because they look at each person as a whole.  Regardless, if you’re coming in for help with acute back pain or metastatic disease, the practitioner will want to know about your history, life experiences, past and current physical, emotional, mental and chemical stresses.  The holistic practitioner will want to know how all parts of your body are functioning (or mal-functioning), not just the one that is bothering you most.  You are more than the sum of your body parts and the underlying issue may be more severe than the problems you are conscious about.  Similarly, the physical exam is not limited to the area of concern.  It is common that when one body part malfunctions, other parts will need to compensate for it.  Treatment protocols here tend to be more related to restoring balance, function and alignment rather than directly reducing perception of pain or objective measures.  For example, there is a difference between losing weight for the sake of weighing less, versus being fitter, healthier and eating nutritiously.   Similarly, there is a difference between taking ever-increasing doses of pain medication for migraines versus being more resilient so that you don’t get migraines in the first place.

Are you unsatisfied with your (or your child’s) current state of health?  Do you want the whole package of care, even if that includes a “placebo effect” mixed in with a unique blend of chiropractic techniques honed over 20 years of practice?  If so, let’s start a conversation.  Fill out a Baseline Health Questionnaire and our caring staff will set you up with a free consultation with Dr. Sabrina Chen-See.