x Abu Dhabi, UAEWednesday 24 January 2018

Case for alternative medicine in the mind

As millions of people resort to unorthodox treatments, a professor argues that they will only work for a while and only when the patient really believes in their worth.

In former times: Arabic physicians believed illnesses were often caused by an imbalance of bodily fluids.
In former times: Arabic physicians believed illnesses were often caused by an imbalance of bodily fluids.

My aunt has been going to see a bloodletting specialist for her anaemia and general weakness; she says it works quite well - sometimes. How would a procedure like bloodletting, known in our Arab culture as hijamah, which involves incisions to let out "bad" blood, work to treat anaemia, a deficiency in blood? We'll get to that later. My uncle deals with his chronic migraine by resorting to roqya, special prayers and verses recited by an expert sheikh. He too says this treatment works well.

More than in the past, millions people everywhere resort to "alternative" medical treatments, which range from drinking special infusions to acupuncture, bloodletting, homeopathy, yoga, Zen meditation and of course chicken and other flavours of soup. Most people who use these treatments swear that they work. And they do. What? A hard-core scientist who says that "alternative" treatments like bloodletting, homeopathy and chicken soup work for curing illnesses ranging from anaemia and migraines to ulcers and high blood pressure? That is going to get me cited in many places. But before I explain my views, I should add an important caveat: these treatments work for a while and only when one really believes they will work.

In recent years, there have been a number of serious scientific investigations of these alternative treatments and now we have a much better understanding of what is going on. One excellent recent book on the subject is R Barker Bausell's Snake Oil Science: the truth about complementary and alternative medicine, published at the end of 2007 by Oxford University Press. It is a very well-written book, very witty and funny in many instances, clear, informative and enjoyable to read. In it, the author presents his wide experience and knowledge on the subject.

Dr Bausell, a professor at the University of Maryland, served for several years as the director of research at the university's Center for Integrative Medicine. He has rigorously reviewed hundreds of experiments and reports on various alternative and "complementary" treatments, some of them published in international journals. He has looked at all kinds of factors influencing the results of treatments, from "trial size" and "statistical bias" (non-random trials) to therapist "induction" (influence). During the course of his study, Dr Bausell used brain scans and measured immune system responses, among other methodologies.

These treatments have been used for practically every existing illness: asthma, depression, smoking and drug addictions, high cholesterol and heart disease, strokes, epilepsy, back, elbow, and shoulder pain, and many more. As Dr Bausell meticulously shows, researchers are now confident that what is at work is the placebo effect. A placebo is a substance with no pharmacological effect but which is given to a patient either to make him or her think some real medicine is being administered or as a control substance in testing the efficacy of some drug (one group is given the real medicine and another one is given a fake one, the placebo, for comparative purposes). Clinicians have observed a surprising rate of self-healing by placebo. There is about a 30 per cent success rate for general pathologies, including 20 per cent to 50 per cent for migraines, about 50 per cent in metastatic bone pain, and 45 per cent to 75 per cent for headaches of various sorts. What is most interesting is that this effect only works if the patient genuinely believes that it is a real medicine that it is going to work.

Indeed, how could a fake treatment end up working so well in many cases and for various illnesses? The short answer is that we do not fully understand the process. The longer answer is that it seems the patient unconsciously musters a number of chemical substances already available in the body (eg, adrenaline, cortisol, endorphins, etc), which are known to have a dampening effect on pain. The body has also been found capable of producing its own opioids (opium-like substances, such as methadone). But these body processes work only for a while, which is why "alternative" treatments work but only temporarily.

But someone will say: "Who cares whether the medicine is real or not if it works?" Absolutely, I agree. Whatever works to relieve a patient's suffering should be used. But we must remember that placebos do not last very long. And that explains the advice to use one alternative treatment while it works and then switch to another ... and then another. But remember, you must believe in each one with your heart and mind - which I cannot do.

Nidhal Guessoum is an associate professor of physics at the American University of Sharjah