Belief and healing relationships in healthcare
Healthcare is a rigorous discipline grounded in hard science. Over the course of my 36 years as a physician, I have also come to understand the power of belief in healing relationships. Today, as a healthcare CEO, I have the opportunity to lead an organization that recognizes and celebrates the importance of belief in healing relationships.
That was not the case in 1975, however, when I was a fourth year medical student. I was at the old Hennepin County Medical Center when an experience prepared me to later understand the positive powers of believing.
Bare knuckle belief
My pager summoned me to the “stab room,” the area in the Emergency Center dedicated to stabilizing critically ill patients. As I arrived breathless from running, the team huddled around a muscular young male in a coma. I started the IV with one try — a first for me at the time — and began drawing blood. My resident inserted a breathing tube into the patient as another resident barked orders for the coma cocktail: “push Amp of D50!” (concentrated sugar water for possible insulin reaction). No response from the patient. “Push amp of Narcan!” (an antagonist to heroin and other opiod drugs).
I barely had time to exclaim “It worked!” before I ducked to avoid a flying fist. As the patient snapped out of his coma, he reared up punching at anything near him and cursing at everyone around him. I avoided his right hook as I witnessed the power of Narcan (naloxone) to temporarily negate the effects of heroin overdoses.
Heroin, morphine, codeine, Demerol and other potent narcotic pain killing substances exert their analgesic effect by activating the body’s own “opiod receptors” (the part of the brain where narcotics take effect to relieve pain). Narcan works by preventing these drugs from interacting with “opiod receptors.” A few years after witnessing the power of Narcan I learned that “placebos” (inactive substances with no medication) activate these same receptors — if the person believes the placebo is a pain killer. And Narcan, the same drug that reversed the heroin coma, blocks the analgesic placebo effect. In other words, placebos don’t reduce pain when subjects receive Narcan along with placebo- just like narcotics don’t work when they are administered along with Narcan.
So belief activates the same internal receptors for pain relief as narcotics. This fact fills me with wonder. Why did humans evolve “opiod receptors” that block pain? I don’t think it was in anticipation of the pharmaceutical industry. Humans and other animals developed opiod receptors to support resilient self healing.
Placebos and platitudes: the power of believing
We tend to disparage and minimize the placebo effect with comments like “Placebos aren’t real medicine, they just show how gullible and suggestive people are,” and “Real medicine doesn’t use the placebo effect.” But Herbert Benson, MD, a researcher at Harvard Medical School, provides a contrasting view in his book Timeless Healing- The Power and Biology of Belief.Benson substitutes the term “remembered wellness” for the pejorative word “placebo.” He marshals evidence for the potent potential of remembered wellness. He also provides evidence about its opposite: the “nocebo” effect (you will experience problems if you expect to have problems).
Interesting examples cited by Benson include:
Ø Sham treatments with disconnected ultrasound probes that reduced swelling by 35% after wisdom tooth extraction.
Ø Women with persistent nausea and vomiting of pregnancy swallowed balloon tipped tubes that allowed researchers to record stomach contractions associated with waves of nausea. The women were given a drug they were told would cure the problem. In fact, they were given the opposite, syrup of ipecac, a substance that causes vomiting. Remarkably, the patients’ nausea and vomiting ceased entirely and their stomach contractions as measured by the balloons returned to normal. Because they believed they received antinausea medicine, the women reversed the proven action of a powerful drug. With beliefs alone, they cured themselves. (Note: this study was performed in 1950, before the advent of Institutional Review Boards that likely would have disallowed it on ethical grounds).
Ø Individuals with asthma experienced deterioration in lung function after inhaling what they believed to be a chest constricting chemical (nocebo effect). But if the patients were treated with what they believed to be a powerful new chest expanding bronchodilating drug, they experienced no deterioration. In both instances they received a placebo of inert distilled water. Thus, bronchial constriction was caused by belief and prevented by belief.
Ø Boys who reported allergic reactions to lacquer trees were blindfolded. The researchers brushed one arm with leaves from a lacquer tree but told the boys it was a chestnut tree. They brushed leaves from a chestnut tree on the other arm and told the boys that the leaves were from a lacquer tree. The arm the boys believed was brushed with the poisonous lacquer leaves reacted with bumps, redness and itching (nocebo effect) while in most cases the arm brushed with the poison did not react.
Additionally, the Journal of the American Medical Association has a commentary that examines the clinical data behind the influence of belief and the placebo effect.
Mind and body inseparable
These studies demonstrate the potent physiological effects of belief. The catalyst in every incident of remembered wellness is belief. Such belief may be your own composite of life experiences. The belief may come from your clinician and the product of his or her professional and personal history. Finally, the belief can be instilled in you by the confident and trusting tone established in consultations between you and your clinicians.
Of course, none of this diminishes the important and effective use of modern medical therapies. We just need to remember to couple these therapies with the trusting, healing relationship between patients and their clinicians.
Park Nicollet’s culture of Head +Heart, Together positions us to embrace the inseparability of mind and body. Belief (mind) influences clinical outcomes via powerful physiological pathways. Ultimately, the patient and family experience is about healing relationships. Back in 400 B.C., Hippocrates, the father of Western medicine taught this: “some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” One thing that has changed since Hippocrates wrote this 2,500 years ago is that all roles and disciplines on the healthcare team- not just physicians- contribute to healing relationships. Otherwise, his statement is as true today as when he first uttered these words.