Cure review: Jo Marchant's fascinating exploration of evolving human science
This is a review that appeared recently in the Sydney Morning Herald about a book entitled Cure, by Jo Marchant PhD, who has examined the scientific evidence into the effect of the mind on health.
In particular there is an emphasis on the effectiveness of the placebo effect in healing physical and emotional problems, and the underlying biological mechanisms, as well as how social factors, such as poverty, impact on health.
It's a really fascinating description of the scientific evidence for the link between our feelings and thoughts in many areas of physical health.
It is essentially the book I intended to write a few years ago when I first wrote Heal Your Own Pain, to provide scientific evidence for the processes outlined in the book, but thankfully I no longer need to since Jo Marchant has done the job for me!
I recommend it if you would like to know more about the science of emotions and health.
Cure: A Journey into the Science of Mind over Body
The postie has dropped off the package you were waiting for. Inside is a small jar full of blue and white capsules you ordered online. But inside each capsule is ... nothing actually. No active ingredients, at least.
You can buy almost anything online, but who in their right mind would knowingly pay for a pill being marketed as a placebo? Any number of people apparently, and their efforts might not be as misguided as they sound. In fact, in the future, it could be just what your doctor ordered.
In Cure: A Journey into the Science of Mind over Body, British science journalist and author Jo Marchant – PhD in genetics and medical microbiology – delves into provocative, perplexing terrain. This is an important book, and one that will challenge those dismissive of efforts to investigate how our thoughts, emotions and beliefs might directly influence our physical wellbeing.
"We no longer need to abandon evidence and rational thinking in order to benefit from the curative properties of the mind. The science is there," Marchant enthuses. But she is a cautious inquirer, and rightly so. For every well-designed study on the potential potency of placebos or hypnosis, meditation or biofeedback – countless others make grand claims off the back of small trials or scant evidence. There's blatant quackery at work too, exploiting us when we're at our most vulnerable. Positive thinking and deep breathing will not cure cancer.
Part of the problem is, as Marchant reveals in her compelling sweep of the recent science, so much in medicine is now driven by the big business of Big Pharma. Modern drugs have saved millions of lives, yes, but researchers doing promising work in the so-called "mind-body" medicine arena struggle to get funding to pursue properly the clinical questions they think are worth asking. There's little money to be made in the relatively low-tech field of mind-led medicine, and the poorer are we for that, Marchant suggests.
"Despite their best intentions, medical professionals are working within a system that prioritises access to medical technology, and allows increasingly little space for the human aspects of care," she writes. "...This paradigm has been less successful at warding off complex problems such as pain and depression, or stemming the rise of chronic conditions such as heart disease, diabetes and dementia."
However, short of an explanation that belongs somewhere in the sixth dimension, how might our thoughts or even a "mere suggestion" materially influence our biology? Do they only affect our perception of the symptoms we experience or can they shift things at the cellular level too? And, how much is attributable to the power of the therapeutic relationship – the influence of receiving good care from a good doctor?
The evolving science explored in Cure is intriguing and trailblazing, and Marchant's account of its pursuit is often gripping.
We now know that our nervous system and our immune system talk to each other. Previously they were thought to function entirely separately in the body and any suggestion otherwise was shunned as pseudoscience.
Today the work of people such as neuroendocrinologist Bruce McEwen proves to us that chronic stress, through the action of the hormone cortisol, produces inflammation in the body, which in turn can trigger disease. Australian Nobel laureate Elizabeth Blackburn's work on the parts of our chromosomes called telomeres is also showing that life stress in its many guises ages us prematurely.
Marchant's pursuit takes her far and wide – from volunteering at Lourdes to meditating beachside in Santa Monica; scaling the Alps in Italy to floating through a virtual reality ice canyon. She meets people with chronic pain, Parkinson's Disease, fractured spines, altitude sickness, chronic fatigue syndrome, parents of children with autism, and beyond – along with the doctors and scientists who are studying and treating them.
And she casts an even wider net across the course of all our lives, investigating the long-term physical impacts of poverty and stress in childhood; the biology of social connection, the visceral role of empathetic, comforting conversation on our physical recovery or during palliative care; the models of care we receive during childbirth and why they matter for health outcomes (her account of the very different births of her own two children is striking).
One of the most exciting areas of investigation is the role of placebo treatments – fake pills and sham surgeries – in improving our health when we're sick. Extraordinarily, it appears that here the active ingredient could be "meaning". And no one placebo fits all – we all respond differently.
Beyond placebo treatments changing our subjective experience of illness, scientists such as pioneering placebo researcher and neuroscientist Fabrizio Benedetti, are revealing more. Benedetti has "chased a belief right down to an individual cell – demonstrating that in Parkinson's patients, motor neurons fire more slowly after injection of a placebo, exactly as they do in response to a real drug".
Traditionally, placebo treatments have been used in randomised clinical trials to help eliminate any biases in the interpretation of results and to test that a drug is working better than a placebo or control intervention. The idea is to eliminate the placebo effect, not foster it.
Controversially, though, there are medicines that make it to market today that work no better than placebo alternatives. Some mainstream antidepressants are an example, a fact only revealed after freedom of information requests for raw drug-company data.
Even more mind-boggling is that some mainstream medicines appear to function solely through the placebo effect themselves. Benedetti's earlier work demonstrated this with certain painkillers. If we expect pain to ease, that can be enough to trigger the release of endorphins, the body's natural painkillers.
One of the ethical barriers to studying the placebo effect has been that patients have had to be told the treatment they are taking is real – a lie. But now "honest" or "open label" placebos are being tested too, and patients (like "Linda" with a miserable, intractable case of irritable bowel syndrome) are experiencing surprising benefits through the work of Harvard's Ted Kaptchuk. "You know I'm a deviant," says Kaptchuk playfully when Marchant visits him at his home in Massachusetts.
The conclusion that often gets drawn from work such as this is that if mind-body interventions work then the conditions themselves must be made up, or the person malingering. The physical has cachet over the psychological. But Marchant's exploration of the latest science of stress shows us this disconnect is now misguided.
"What is psychological is physical, and what is physical has a psychological perception to it," says British scientist Peter White, who works on one of the most complex conditions of all, chronic fatigue syndrome.
Part of the problem is we're drawn to dichotomies. We take comfort in their siloed simplicity. Binaries such as Nature versus Nurture; Art versus Science; Rational versus Emotional; Good versus Evil form the frontiers of the most fractious and enduring knowledge wars.
Likewise, the historical separation of the mind and body is another we're struggling to let go of. The French philosopher René Descartes famously cleaved the two apart, and centuries later, modern medicine is still reluctant to reconcile them as one despite mounting evidence to the contrary.
Cure could engage more deeply and rigorously with the arguments made by prominent sceptics of mind-body medicine. At times Marchant skates over critiques of specific research too hastily. As with everything, the devil is in the detail. That said, the same claim could be applied to many doubters, who often look at this field with their blinkers firmly on.
There's a lot to this impressive book, and it has the potential to have the same dramatic impact on our understanding of our self as Norman Doidge's blockbuster, The Brain that Changes Itself.
February 5, 2016