The Other Medicine: Programme Three

LEWITH
There are two aspects to any therapy. If we take depression as an example, if we look at the overall effectiveness of antidepressants they work. But if when we do the placebo controlled trials we find that probably only 15 or 20% of their effect is because of the actual chemical we’re prescribing. So perhaps 70 or 85% of the effect may be due to caring for the patient, putting them into a clinical trial, saying I recognise you have a problem, oh dear you have a very low mood for whatever reason or maybe this is a chemical imbalance. And so a lot of the effect that the GP will gain from the prescription is because of the process of consulting and prescribing. Now the same is very possibly true of complementary medicine - that a lot of the effect that we gain is because of the process of receiving treatment.

FORD
George Lewith, former GP and now a CAM practitioner and researcher in Southampton. He’s trying to separate out these two aspects of treatment - the specific effect of the therapy (the needle, the herb, or the drug) and the non-specific effect of talking and being listened to.

LEWITH
We have some trials currently underway that separate the process of consultation from giving of the therapy, because we can give some therapies without consultation or we can make some consultations involving a lot of chat and discussion and very caring consultations and we can actually also consent people to have acupuncture consultations where apriori - at the beginning they’ll consent to just have somebody come in, define the tender points and put the needles in and not have much conversation, deliberately and specifically just the process. So we can begin to separate out time and caring.

REILLY
When I first saw homeopathy I was quite confident that that was the total explanation and that the bottles and so on and that the rituals surrounding that would prove to be placebo.

FORD
Dr David Reilly runs the Glasgow Homeopathic Hospital. It’s the only in-patient homeopathic unit in the country, which despite its name, treats patients with a range of different therapies. Reilly’s ground-breaking studies surprised everyone, including himself.

REILLY
I was profoundly sceptical before conducting these studies. I was respectful of homeopathy and of the care of patients and the results it was getting but I was really quite sceptical that the medicines would show any activity. After all by current orthodox models it’s an absurdity, would be the only logical way to approach that.

FORD
The therapeutic relationship isn’t an interesting aside in the story of healing says Reilly, it’s central. And studies are starting to show this.

REILLY
What the research is showing is if you engage with a patient in a discourteous way, in a way which that isn’t effective - let’s call it join up, actual blocking together, deep effective communication in a safe emotional environment, conscious of the depth that the words are penetrating to in such a charged situation, one, you’re doing damage without knowing it and two, you’re missing opportunity. And I again would say what complementary medicine has been screaming out over this last two decades is the fact that these holistic factors of engagement are critically important, are of central importance.

LEWITH
I believe that the homeopathic process works because I’ve used homeopathy and been amazed by its effects. I’m not actually certain that it’s the remedy that’s working.

FORD
But you still use it, you’re happy to give it to your patients?

LEWITH
I’m happy to give homeopathy to my patients, yes because I think the process of coming to see me and having a homeopathic remedy prescribed is really beneficial.

FORD
But you might as well give them a cup of tea.

LEWITH
No I don’t think so because that’s where the thinking model comes in. Because when I see a person and I want to prescribe a homeopathic remedy for them I want to take a very careful homeopathic history, I want to find out what the whole process is that’s going on with them and it may be the process of taking the history which is effective.

FORD
So why go through the process - you could still ask them all those questions and give them a cup of tea at the end, why do you have to give them the homeopathic medicine?

LEWITH
My personal view is that I like to prescribe, I feel it’s important to prescribe, I think it’s perhaps a symbolic act that’s part of the process.

FORD
So when you’re treating people as a homeopath you don’t believe that it’s working according to the principles of homeopathy, you just believe in the process - you with the patient?

LEWITH
Well that’s not quite true, I believe that homeopathy is effective. And effective contains a specific effect and a non-specific effect that you might call placebo. And I don’t know how much of that effect is specific. Very often in medicine, even in conventional medicine, we use very powerful treatments, the effect of which we don’t understand completely - like general anaesthesia - yet we’re very happy to use them because they have positive effects in certain specific situations.

FORD
You can call it ’the process’, you can call it ’the non-specific effect’ but some might also called it ’placebo’.

Dylan Evans is a Senior Researcher from the University of the West of England and author of Placebo: the Belief Effect. Placebos, says Evans, can act powerfully - the effect on pain can be as powerful an analgesic as morphine. Relatively little research exists on how placebos might work, but the growing interest in so-called mind-body medicine points to our innate immune system being activated or deactivated in some way.

EVANS
We have two arms, if you like, of our immune system - the innate immune system and the acquired immune system. The acquired immune system is the part of the immune system that is most complex and which we’ve probably all heard about, which involves things like antibodies, B cells and T cells. The innate immune system is much simpler, it’s much more primitive, it’s evolutionarily much older than the acquired immune system. A lot of attention has been refocused on the importance of the innate immune system since it seems that it does play a very important role in the initial phases of fighting infection and dealing with injury. So the innate system - what the innate immune system does is to provide a very rough and ready first line of defence against infection and it does that through a number of mechanisms, such as making the site of infection or injury more painful so that we tend to guard it and protect it against further damage, it does it by raising our body temperature in the form of fever. The innate immune system also causes local inflammation - swelling, redness, heat and local pain. And so it has a wide range of systemic effects - local effects - and they all - all of those signs, the typical signs of infection, having a cold for example, all of those symptoms are in fact not the direct result of the infectious agent, if you like, but rather defences that are produced by the body itself to fight the infection. Now my theory is that sometimes this period of acute response to infection produced by the innate immune system can get out of hand, it can become chronic, and then it’s a very good idea to be able to suppress it and that’s exactly what placebos do - placebos work by suppressing some of the body’s own natural defences to infection and sometimes that’s a bad thing and sometimes it’s a good thing.

FORD
The body healing itself? When put like that, it doesn’t sound too far off the notion trumpeted by many CAM practitioners. David Reilly confirms this revaluation of the role of the placebo which is now being seen in the lab, though he’s still not keen on the word.

REILLY
What had been buried in the placebo literature was not as irrelevant as we thought. That actually all along it had been desperately trying to tell us that these drugs were interacting with the innate healing systems of the body. Medicine hasn’t even woken up to this, that the individual that sits down in front of us in pain and distress and sadness can be helped to begin to spark these changes within themselves without medicalising them and making them dependent on orthodox or complementary therapies.

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