Though it's rarely treated as a religious issue, the alternative medicine debate has a lot in common with the God versus science wrangle. Just as religious belief is scoffed at by atheists, so "traditional healer" services, while providing comfort and relief for many, are prone to come into collision with rationalist claims that they're based on fantastical faith-based premises, that they prey on the delusions of the vulnerable, and do no meaningful good.
We saw the latest round of this ding-dong last week, in the wake of a study that claimed to have found a plausible mechanism for a pain relief mechanism in acupuncture. Experimenting on mice, researchers found that rotating needles just below the knee resulted in a two-thirds reduction in pain levels and a 24-fold rise in the production of adenosine, an anti-inflammatory molecule. For the pro-acupuncture camp, this was proof that the therapy works, while critics pointed out that mice are not humans, that other studies have shown you get an analgesic effect when you stick the needles at non-acupuncture points, that sham needles which don't pierce the skin have the same effect, and that any pain relief obtained is so small as to be of little clinical benefit.
Of course this study – and the rest – shed no light on the issue that makes acupuncture so loved and despised – the proposition that it promotes healing by unblocking qi energy in the body, restoring an internal balance between yin and yang. Just as scientists have so far failed to find evidence for God, so qi has proved a property elusive to mice-prodding (and other) investigators. And yet it is this belief which forms the basis for most acupuncture practice, for the trust that patients tend to have in the method, and for much of the ire heaped on it by critics.
While both sides bicker, perhaps each is missing a trick – the importance of the placebo effect and what it tells us about the power of the mind. Placebo is sometimes a dirty word in medical discussions – we often hear procedures dismissed as "just placebo", while drug companies do their utmost to demonstrate that their remedies outperform dummy pills. But perhaps we might do better to more actively harness placebo, which actually represents the healing ability of our own minds and the environments we place them in.
Research on the placebo effect has show that a treatment's effectiveness is significantly impacted by a whole range of factors that seem to have nothing to do with the treatment itself. How well it works can depend on the "warmth, attention and confidence" of the person administering it, by how much the patient believes it'll work and by how much they want to get well. Placebo injections often work better than placebo pills (at least in the US, where "shots" are often seen as a stronger treatment – in Europe placebo pills are slightly more effective), while stopping a placebo treatment often creates withdrawal symptoms. Blue sedatives are more than twice as effective as pink ones (although not among Italian men – one explanation being that they associate blue with the national football team, which gets them excited rather than sleepy).
Researcher Daniel Moerman describes the placebo effect as a "meaning response" – the mind consciously or unconsciously makes positive associations with a treatment that then creates healing. It is an issue of faith – and thanks to acupuncture's reputation as a "holistic" treatment, the time, care and attention that practitioners bestow on their patients, and the patients' trust in and desire for an acupuncture-assisted cure, the treatment appears to work for lots of people. These may not be the only reasons it works – the latest study would suggest there's something else going on (the mouse mind is unlikely to attach much meaning to the needles in their knees).
But even if treatments like acupuncture were "just" placebo, does this make them all bad? Critics would say yes, as the treatment is then based on false premises, and therefore unethical. Others might shrug that if it helps, it helps – even if the belief that creates the positive response is questionable. But wouldn't it be more interesting to use what we know about our brain's power to heal to develop an integrated mind-body medicine where information about the "placebo" response is celebrated. This would mean working to ensure that each medical procedure is offered in an ambience of care and attention, and where patients learn (honestly, rather than through any elaborate smokescreens) that adopting particular states of mind can have an impact on the course of illness and are given practical methods to help cultivate those states. This is already beginning to happen with the spread of evidence-based treatments based on meditation, visualisation or cognitive therapy.
We don't need to know whether qi exists to learn from people's responses to acupuncture, just as we don't need to know whether God exists to appreciate the magic of everyday existence. In either case, wouldn't it be more helpful to make the most of what we do know? That learning how to work more consciously with our mind states can help us live a happier life, in healthier bodies.
