Better late than never is a good thing, even if the delay is measured in many thousands of years. Western medical science is just now discovering that the mind is powerful and placebo works.
Shamans have implicitly known this since they began ritually treating patients perhaps 40,000 years ago, during the Upper Paleolithic transition. In fact, one of the better hypotheses regarding the adaptiveness of invisible agent-agency ideas (improperly called “religion”) revolves around shamanic placebo healing. In Wondrous Healing: Shamanism, Human Evolution, and the Origin of Religion (2001), James McClenon contends that what we today call “religion” evolved because ancestral humans who believed in spiritual healing powers had a much greater chance of actually being healed. These differential healing effects, even if statistically minor at any given time or place, become enormous over evolutionary time.
This may account for the fact that placebo is the most powerful non-medicine known to science. Any drug that had the proven clinical efficacy of placebo would be a billion dollar blockbuster. I suppose this is why placebo treatments, which come in all shapes and woo-sizes outside of standard medicine, is in fact a several billion dollar per year industry.
This makes Harvard Magazine’s recent profile of placebo researcher Ted Kaptchuk all the more interesting. Placebo is finally getting the scientific scrutiny it deserves. At my own university, Tor Wager does similar research that was profiled in 2010 by the New York Times. The Harvard profile is particularly poignant because the researchers are using some curious language:
“What we placebo neuroscientists have learned is that therapeutic rituals move a lot of molecules in the patients’ brain, and these molecules are the very same as those activated by the drugs we give in routine clinical practice. In other words, rituals and drugs use the very same biochemical pathways to influence the patient’s brain,” said Fabrizio Benedetti at the University of Turin.
“Doctors give subtle cues to their patients that neither may be aware of. They are a key ingredient in the ritual of medicine,” Ted Kaptchuk explained.
“There was simply no way to quantify the [doctor-patient interaction] ritual of medicine. And the ritual is the one finding from placebo research that doctors can apply to their practice immediately,” said professor of medicine Russell Phillips.
Although placebo therapies are often considered to be “alternative,” the fact of the matter is they are better conceived as supplemental. The two should go hand in hand, even in cases where the cause (e.g., bacterial infection) is unequivocally responsive to treatment (e.g., antibiotics). If the immune response can be boosted even slightly with placebo, why not provide the assist? It makes sense to me.
This also made sense to Dr. James R. Walker, a Civil War veteran and government physician assigned to the Lakota Pine Ridge Reservation in 1896. When he arrived, a tuberculosis epidemic was raging. The disease was being treated by shamans, a fact which frustrated the skeptical scientist Walker:
In my first relations with the medicine men [Oglala shamans] I considered them arrant humbugs whose practices should be suppressed by every means. I then studied their methods of treating the sick, and the results. I found that they have little knowledge of disease, that most of their medicines are inert, and that their practices consist mostly of mysticism and trickery.
But I also learned that the Indians have faith in the power of the medicine men to relieve suffering, and that most of the medicine men have a sincere confidence in their power to do so; that the sick believe the mystical forms and ceremonies of the medicine men to be solemn rites that propitiate malignant powers; that these ceremonies beget an expectation of relief so that when the medicine man suggests that there is relief the patient declares that he feels it; that in minor ailments, this relief is real and permanent; that in serious illness it sooths the patient and consoles the friends; that because of these results the medicine men maintain a powerful influence among the Indians in all matters pertaining to the sick. (Lakota Belief and Ritual, Walker at p. 10).
If there is a better description of placebo therapy than this, I’m not aware of it. Walker kept meticulous records and discovered that standard medical treatments nearly always worked better in conjunction with traditional shamanic rituals. This was true even when the ailment (such as tuberculosis) was clearly amenable to drug intervention. It’s nice to see modern neuroscience finally catching up.
