View your area of interest
Science and Mind/Body Healing
The institution of medicine bases much of it’s authority on the claim that it is a scientific discipline, and it rightly looks for scientific proof underlying clams of therapeutic effectiveness. While this is a noble goal, the fact is that he day-to-day practice of medicine includes very little that is scientifically well proven and a good deal that is not proven at all. The “gold standard” of scientific proof is the double-blind randomized controlled study. In such a study, neither patients receiving treatments nor the doctors administrating treatments know what the patient is getting. The outcome is assessed by independent analysts who don’t know whether patients received real or placebo treatments. These extreme measures to maintain secrecy are taken because if either the patient or the physicians knows whether they are getting active treatment, this will influence the results. When you think about it, this is the strongest eveidence there is for the power of belief and expectation in healing.
While double-blind studies are the most definitive type of study, very few clinical studies are of this design. In fact, as recently as 1976, fewer than 5 percent of original research articles published in the New England Journal of Medicine, the Journal of the American Medical Association, and the Lancet were based on controlled matched studies of any kind. Only a fraction of that small percentage were double blind. In 2003 I reviewed articles over the previous 4 years in those same journals and found that about 10% of all the clinical studies published there were double-blinded. All three journals refused to publish my article, saying that they didn't see whay that was important. In case it's not obvious, I think it's important because we often hear criticism of mind/body approaches based on the lack of double-blind studies and we should know to what this "lack" is being compared.
The fact is, if doctors were to limit themselves to using only treatments that have been conclusively proven worthwhile through double-blind studies, they would prescribe very little treatment at all. Yet because our patients are suffering, we must often use our best judgment in suggesting other less rigorously proven treatment. Ideally, we choose from remedies that have a long history of effectiveness and safety in clinical experience or, if no such option is available, from newer methods whose potential benefits outweigh their potential risks by a large enough margin. This conflict between necessity and certainty in treatment is so fundamental to medical practice that it is addressed on page one of Harrison’s Textbook of Internal Medicine, one of the most widely used medical textbooks in print. Harrison says:
"In the practice of medicine the physician employs a discipline which seeks to utilize scientific methods and principles in the solution of its problems, but is one which, in the end, remains an art…in the sense that the practicing physician can never be content with the sole aim and clarifying the laws of nature; he cannot proceed in his labors with the cool detachment of the scientist whose aim is the winning of truth, and who, theoretically, is uninterested in the practical outcome of his work. The practicing physician must never forget that his primary and traditional objectives are utilitarian — the prevention and cure of disease and the relief of suffering, whether of body or mind."
Faced with illness, distress, and uncertainty, the informed patient and the practicing physician must often consider options that may not be rigorously proven as they attempt to formulate a sensible plan for treatment and self-care. Even simple clinical research on human beings is difficult because of the many influences on outcome that cannot be controlled. Add to this the difficulty of trying to determine what an individual is really thinking, and we are faced with the very real possibility that it may never be possible to conclusively prove or disprove the theory that thoughts can ameliorate or cure disease. That doesn't mean we shouldn't use them.
Posted in Blog