Leaving health on the table

There is a saying that someone "left money on the table" -- they could have gotten more from their financial dealings.

Well, as a society I believe we are leaving health on the table, and doing it in some pretty concrete ways. Unfortunately the ways are pretty well entrenched, so I'm not sure how easy it is to go back and "renegotiate".

All of them revolve around the body's ability to heal itself. Perhaps they are just symptoms of the same thing. But there are three distinct things to think about.

We all know the anecdotes of phenomena like cancer patients who Western Medicine deems "untreatable" mysteriously go into remission. A simple example is the knee jerk reaction to take antibiotics to fend off a sinus infection while the body in the vast majority of cases could do this on its own. (In fact, medical best practice now recommends that antibiotics not be prescribed for routine sinus infections.)

So that brings us to the topic of ways of encouraging the body to heal itself faster or better. There is an aspect to medical research that is so routine that nearly everyone has forgotten its importance. Medical tests can consist of three groups: control (no treatment -- what can the body do on its own), placebo (a treatment with no "therapeutic" value), and the treatment in question.

As already discussed, some percentage of a control group will handle a condition, so when looking for the efficacy of a treatment, we want to show that patients with the treatment do better than without. However there is a phrase "more effective than placebo" used in reporting results. There is an interesting truth in that construct: placebos are effective in treating conditions.

Placebos are sugar pills, so there is little likelihood that there is some complex biochemical chain of reactions leading to the outcome. The outcome is psychological -- we have triggered our internal mending system to better results.

So the first way in which we leave health on the table is by having structured the system such that we cannot leverage the simple truth that people can heal themselves better if someone simply tells them they are helping. (Which is all prescribing a placebo is.)

How to overcome that? It's tough. In the age of reason, we have developed the culture of doubt and an expectation of everyone needing to be an expert. Since everyone is encouraged to read about drugs themselves, it is impractical to prescribe a placebo -- a large percentage of patients would discover that is what they have. To conceal the fact would legally constitute fraud. For that matter, simply prescribing a placebo may break laws or codes of ethics.

We also insist on proof of anything in medicine. If something seems to work, we must prove it works. Preferably we must also understand how it works. That leads to questioning means of treatment older than Western Medicine.

Acupuncture, shamanism, rural apothecaries. Western science has scoffed at these. Interestingly, acupuncture is now accepted at least in some circles.

Do they work? If the receiver of care believes they will help, then they will help. Looking at placebos confirms this. Of course that still runs into our societal constraints on medicine.

For some reason if someone says they will help someone heal and the effect of healing is only to help the person believe they can heal, that is a fraud. We refute the psychological effect as valid treatment, and by doing so, we all suffer. There are probably practitioners in bad faith -- who are looking for a buck and don't really care about the patients. Most are caring people, looking to help, who offer treatments that they don't know how work, but sincerely believe do work.

So if we know placebos help, why prohibit these claims to help? Partly to protect people from the true shams. Partly because we don't believe it is valid to claim to have done something that you didn't mechanically cause. And partly because those that profit from specialized treatment have an interest, conscious or unconscious, to prevent competition from simple sources.

So we have made it impossible to use placebos. We throw roadblocks to treatments that may be just the effect mechanism of a placebo.

The question also remains of "if we don't understand how something works, could it be working?" Obviously the answer is yes, but it triggers our skepticism.

We are capable of many things we don't really understand. Recent books like "Blink" note that we can process huge amounts of information, very, very quickly.

What got me thinking are questions like "how did anyone think to try _____?" In particular this applies to having found medicinal herbs. Is it possible that when we quiet our overactive intellects that our bodies can sense things in their environment that will help them?

I know of an anecdote that could be random, or could be enlightening. It involves the patient of a chiropractor.

Chiropractors are an interesting lot. They perform services that are clearly efficacious. Through physical manipulation you leave the office feeling better than when you walked in. At a minimum we're talking a benefit similar to massage. But there are chiropractors that believe chiropractic medicine can help treat illness. Some are also interested in other forms of alternative medicine. But all of them have a skill so few are probably outright shams on the other fronts -- it is probably always out of a sincere desire to help rather than just to make a buck. But I digress.

The anecdote involves a patient that was having recurring issues that the chiropractor didn't think skeletal manipulation was going to correct. They had a notion that there could be a mineral deficiency. That much isn't interesting -- what is interesting is how they went about determining what the deficiency was.

The patient stood with an arm held out in front of them. The chiropractor then held up a series of bottles of multi-vitamins in front of the chest of the patient, label away from the patient. As each was held up, they would press down on the arm to see how much resistance was provided to having the arm pushed down. While one of the middle bottles in the series was held up, the resistance was much higher -- the body/mind were creating a positive reinforcement from having those vitamins nearby.

I've seen the arm resistance measurement used in a pop psych experiment before. If before testing resistance you state something you believe (I want to live), it is much stronger than if you first say something you don't (I want to be broke).

So two questions come to mind looking at the anecdote. Was there a real effect observed? And if so, how did it work. I wasn't in the room, but I'm more inclined to believe the story than not. Perhaps just because it fits observations that we seem to be able to perceive things that there is no way currently to explain. Which brings us to the question of how might the patient have done that? My curiosity is interested in that question, a much more pragmatic voice says "who cares?"

The general sentiment in science and thus in Western society is that ancient humans must have spent lots of time experimenting to find the herbs and plants that help medicinally may be fundamentally flawed. It may be that they innately knew what would help. It certainly is a simpler answer even though we don't understand how people can do this.

So in addition to not letting others "coach" us into healing ourselves, we also refute and deny treatments that may be truly effective because they can't be confirmed nor explained within a scientific framework. Should you be able to show the efficacy of the above example of the body "sensing" what it needs? Perhaps, but it may be that simply participating in an experiment tends to key our mind to "thought" rather than "feel" and thus suppress the effect if it was ever there. I don't buy that science has proven these things don't work -- I think that by how they ask the questions they exclude a lot of truths.

Shamans that have spoken frankly have acknowledged that some of the ceremonial pomp and circumstance is solely to get the patient to believe that great magic is occurring which will cause them to be in the frame of mind for healing. That part is a placebo effect, and they'll admit it. However they believe they do more that is directly helpful. Scientific skepticism may say it is mystical gobbledygook. Some of it may be, but some of it may work via a mechanism that science will discover (and exploit for our good) in a hundred years, or three hundred, or a thousand.

Ultimately we have bought so thoroughly into the "Western Medical Expertise" model that we leave many opportunities for health on the table. There is the potential for abuse in the other direction, and for mutual self-deception (sometimes to good effect, sometimes to simply an exchange of money). Might the good outweigh the bad? It may be a long time before we can tell.