Wayne Jonas worked as a director of the Office of Alternative Medicine at the National Institutes of Health (NIH), and as a research scientist at the World Health Organization (WHO), Walter Reed Army Institute of Research, and Samueli Institute. In How Healing Works, he provides a simple, systematic approach to healing.
What does the scientific evidence point to?
• Only 20% of healing comes from the “treatment agent” that the doctor applies to you—whether that is surgery, drugs, acupuncture needles, herbs and supplements, diet, or anything else external to you.
• A full 80% of healing comes from constructing a meaningful treatment response, unique to you, which is internal and highly personal, using simple principles and components.
• You can activate your own inherent healing processes and get your physician and others on board to help accelerate your healing journey, making any approach more effective, safer, and less expensive. And these processes can prevent the majority of chronic diseases in the future.
Jones doesn’t argue that you can think yourself into healing. And, of course, he acknowledges that broken bones, cancer, and heart attacks aren’t easily fixed by the powers of the mind. But that isn’t his focus anyway. He cites the top ten reasons for seeing a doctor, according to a Mayo Clinic study, and these include pain (especially back pain), fatigue, cognitive dysfunction, hypertension, diabetes, obesity, chronic heart or lung problems, or brain diseases such as Alzheimer’s, Parkinson’s, or depression.
Almost all of these conditions accelerate and increase as we age, so even if you feel healthy now, chances are if you live long enough, you will get more than one of these conditions, unless you seek out ways to prevent them.
The book is filled with anecdotes about the placebo effect.
Norma had gotten remarkably better, perhaps 80% overall, as she took a completely inert pill. Niacinamide did work—a little. When we statistically analyzed the differences in response between those on the niacinamide and those on the placebo, the niacinamide did work better than the placebo, but by only a small amount. On average, those on the vitamin improved by 29%, compared to a 10% worsening in those on the placebo. While this was statistically significant in favor of the vitamin, the overall difference was small—and the placebo had fewer side effects.
Norma was a patient who had suffered from arthritis.
Using randomization, double-blinding, and placebo controls with adequate numbers of patients, most treatments for the most common chronic conditions either do not work or work only 20% to 30% of the time. Most of the drugs prescribed for pain, mental health, ulcers, hypertension, diabetes, Parkinson’s disease, and many other conditions show little benefit, with improvement in a minority of those studied. Even surgery, the king of modern medicine, works very little for chronic diseases (especially pain) when studied in a rigorous manner.
As an example, an analysis of over eighteen thousand patients, drawn from studies where half the patients got sham (fake) acupuncture (needles are put in the wrong points or not inserted into the skin at all) and the other half got real acupuncture, the groups getting the fake acupuncture had a healing rate of over 80% of that experienced by the those getting real acupuncture. This seems stunning, but it is actually a routine finding in medicine. It also occurs in treatments based on modern science.
For example, studies in which sham (fake) surgery (an imitation of surgery without the actual tissue manipulation) is “performed” on half of a patient test group with chronic pain, it produces 87% as much improvement as seen in those who receive the real surgery.
If that isn’t strange enough, he cites other studies that show that the fake surgery worked better than the real surgery and produced fewer side effects.
Systematic Reviews
If you’ve never been a victim of a shared article that “proves” the benefits of “treatment x” on “disease y” based on one study, then you’re either very lucky, or live in an alternate reality. The replication problem in science is old. From the 1960s to the 1990s, many scholars used rigorous scientific methods and showed repeatedly that many widely used treatments—even those considered “standard of care”—were not only ineffective but actually harmful.
They thought that medical opinion shouldn’t be trusted. Instead, “systematic reviews” should be used. Another worrying finding was that medical errors are the third leading cause of death in the United States.
Despite his disparaging views on modern scientific treatments, Jonas wasn’t fawning over alternative medicine practices either. As he concedes, acupuncture and herbal remedies, as well as more recent complementary and alternative treatments such as homeopathy, dietary supplements, and manual therapies, show disappointing results and only small effects when rigorously studied.
Likewise, data on most of our modern conventional treatments show the same thing. Most drugs for pain, mental health, ulcers, hypertension, and diabetes, for example, show little benefit—often only 20% to 30%.
And the more carefully the studies are done, the smaller the effects Even more startling, only about one-third of well-done studies—executed in the laboratory or in the clinic—can be independently replicated.
Back pain is expensive…
Back pain is the most common of those musculoskeletal conditions, affecting over 70% of all adults sometime during their life, and is the leading cause of limited activity in the world. It costs the United States over $100 billion per year.
Why do placebos work?
In 1995, I brought together a small group of investigators at the NIH who were studying why placebo seemed to work in some people and not in others. We were interested in understanding why an inert or inactive substance, such as a sugar or salt solution or distilled water with no known pharmacological value, could be effective and how often this happened. This question was popularized in a 1955 article on placebo by Henry Beecher, MD, in the Journal of the American Medical Association. Beecher reported that about one-third of all effects seen in medicine were due to the placebo response.
Counterintuitively, they found that cultural context influenced the meaning, which in turn influenced the biology, the pathology, and the outcome. The effects were very specific. For example, in Germany, the placebo healing rates of patients with high blood pressure were low, not high as for ulcers. The meaning and context surrounding how a treatment was delivered had a much greater impact on healing than the treatment modalities themselves.
Acupuncture was more effective when the study was conducted closer to China, where acupuncture was developed and is widespread.
Professor Kaptchuk has done two studies exploring to what extent the effect of treatment depends on collective belief verses individual belief. One study had all patients with a painful abdominal condition (irritable bowel syndrome, or IBS) take a fake treatment—sham acupuncture. But each group went through a different social ritual.
In one group, the practitioner delivered the treatment without saying much. In the second group, the practitioner explained the treatment mechanism and created the expectation that the treatment would work. In the third group, a prominent doctor from a top medical school delivered the treatment with a full explanation and even added in a story about the benefits others had experienced as a result of this treatment.
All patients had similar beliefs about acupuncture at the start of the study. But it turns out, the greater the social meaning created by the ritual, the more powerful the effect. All the patients held about the same amount of individual belief in acupuncture at the beginning of the study.
In the third group, the benefit the patients experience is greater than that achieved by the best drugs approved for treatment of IBS.
Kaptchuk conducted a second study where patients were actually told ahead of time that the treatment was fake. One group was given placebo pills with this description: “Placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body, self-healing processes.” This statement created an expectation that even these placebos have an effect. A second group of IBS patients was given no treatment but with the same quality of interaction with providers.
The group given the placebo (and who knew it was placebo) had significantly better pain reduction and improved quality of life. The suggestion, then, is that it is not simply being treated well that is effective, but the combination of a social ritual of taking or ingesting something and being treated well produced a profound effect. But the twist here is that the patients knew that they were taking a placebo, so it was not as if they were misled by the practitioner.
A top researcher of placebo effects is Fabrizio Benedetti of the University of Turin, Italy. He demonstrated that if you link a placebo treatment ritual to a painkiller, you can continue to get pain relief with the placebo after withdrawing the painkiller.
Other treatments that work? Apparently, journaling.
Research by social psychologist Professor James Pennebaker and others has documented psychological, physiological, and immunological changes from such episodes in well-conducted randomized controlled trials—the gold standard of science
And perhaps unsurprisingly, yoga.
There happens to be good research evidence that yoga is effective for easing back pain. The year before, my organization had conducted a comprehensive systematic review of nondrug approaches to pain. Yoga had emerged as one of the best. Recently, the American College of Physicians, the top group of internal medicine doctors in the United States, added yoga and massage to their guidelines for managing back pai
What is the “decline effect”?
It is a repeated phenomenon in clinical research. The more rigorous and larger a study, the smaller the actual contribution of the active treatment. Early studies, especially smaller pilot studies, frequently show large effects, which encourage physicians and patients to use the treatment. It seems that not only the social sciences suffer from a replication crisis as many claim.
Usually, those smaller studies are not enough for FDA approval or to be accepted by the mainstream community as standard of care; therefore, additional and larger studies follow. As those larger and more rigorous studies are done, the effects diminish. When you combine the results of those studies in a method called meta-analysis, frequently the effects became so small as to become irrelevant for use in practice.
In a notable analysis of clinical research published in the Journal of the American Medical Association in 2012, Ioannidis showed that merely about one-third of proven results can be replicated.
Jonas interviewed an Ayurveda practitioner who was well versed in the western science. He told Jonas that “do no harm” should always take precedent over anything else, reiterating the wisdom of Hippocrates. He thought that contrary to Western medicine which focuses on isolated body parts and organs, the whole systems perspective takes into consideration a person’s whole lifestyle, their social life, stress, etc…
Building on this perspective, Jonas thinks that disease is a distortion in the shape or in the web of pathways. When an outside disturbance like a stress or trauma occurs, symptoms are produced as the person attempts to rebound, repair itself, and restore order and harmony again.
If the disturbance is from a single cause/event, such as an acute trauma or infection, removing that cause will allow the person to come back to harmony quickly.
He uses t