Story transcripts

Mind over Medicine

Thursday, November 29, 2012

Reporter: Allison Langdon
Producers: Jo Townsend, Phil Goyen

We've all heard about placebos, those phoney sugar pills that doctors sometimes hand out to trick people into thinking they've been medicated.

It's all about using the extraordinary healing power of positive thinking. Well, now researchers are making revolutionary advances in the science of placebos.

So much so, it's gone way beyond swallowing fake tablets to cure minor ailments.

They've now got patients undergoing pretend operations to fight disease and chronic pain, and the results are nothing short of remarkable.

Story contacts:

Further information about Professor Irving Kirsch's research into the placebo effect can be found here.

Dr Damien Finniss can be contacted at the Pain Management Research Institute at Sydney University.

Further Information about Tor Wager’s work is available here.

Dr Bruce Moseley's work into surgery and the placebo effect was co-authored by Drs Wray and Brody, and the journal article can be found here.

Full transcript:

IRVING: We have in our minds, in our brains, the capacity to change the way we experience pain, to affect some of the illnesses that bring us in to see physicians. What we need to do is learn how to unlock those capacities and make use of them.

STORY – ALLISON LANGDON: Perception, it’s often said, is everything. We believe what we want to believe. We see what our mind wants us to see, even when we know perfectly well we’re being tricked. It’s a curious ability of the brain, and one that holds extraordinary untapped power. But what if we could harness that power – the power of our minds – to heal our bodies – to cure ourselves of the most serious illnesses and diseases? Well, that’s what science is doing right now – taking the power of the mind and applying it to the world of modern medicine. And the results are breathtaking.

IRVING: People will have within them the ability to recover and heal from many conditions.

ALLISON LANGDON: This could really change medicine.

IRVING: I hope so.

ALLISON LANGDON: It’s called the placebo effect. And this groundbreaking research is being pioneered by Dr Irving Kirsch with his team at Harvard University. They’re leading research into using the power of the mind to heal the body. I’m surprised to see a “placebo lab” that’s full of real equipment.

IRVING: Well, you know, this really isn’t a placebo lab, it’s a real lab. This is where we do our genetics work. We’re looking to see if we can identify genetic markers, of who might respond best to placebo treatment.

ALLISON LANGDON: This world-renowned professor of psychology is proving what’s long been dismissed as a nonsense remedy for the gullible, or at best, a sugar pill used in clinical trials.

IRVING: Sometimes the ritual of medical care is more important than what you give to the patient.

ALLISON LANGDON: But fake pills, fake surgery – it’s not real medicine, is it?

IRVING: Well, it should be. You know, when you have something that works, that in some cases works almost as well as the best medications we have but is safer than those medications, shouldn’t that be part of our medical practice? Shouldn’t we want to learn how it works, and figure out how we can make use of it?

ALLISON LANGDON: It’s a great time in your life, isn’t it, when you’ve got grandkids running around.

GARY: It is, yep.

ALLISON LANGDON: Gary Wade certainly wants to figure it out. The 53-year-old loves nothing more than kicking a soccer ball with his two grandkids.

GARY: I love sport. Always played sport. Loved cricket, played soccer. Yeah, did a bit of everything, even played table tennis – if it was there as a sport I’d play it and I’d watch it.

ALLISON LANGDON: But his life-long passion for sport has taken a terrible toll – Gary regularly gets struck down with paralysing back pain. Surgery’s too risky, and powerful painkillers provide his only relief.

GARY: When it’s bad pain, it’s just hellishly debilitating. It’s very acute. Sometimes I just hit the floor and stay there.

ALLISON LANGDON: Is it crippling?

GARY: It’s horrendous. It’s not something you’d wish on anyone.

DAMIAN: Alright Gary, just let me know how this feels.

ALLISON LANGDON: So, with nothing to lose, Gary took part in an unprecedented trial led by Dr Damian Finniss at Sydney’s Royal North Shore Hospital. He gave Gary two injections, at different times. One was a powerful local anaesthetic, the other a harmless saltwater solution. But neither doctor nor patient knew which needle was which. Were you told that one of the injections you would receive would be the placebo?

GARY: Yes, indeed I was.

ALLISON LANGDON: So were you worried about picking which one was which?

GARY: Yes I was. Yes, you don’t want to look silly.

DAMIAN: Got the envelope here which tells us the actual formal drug that was given.

ALLISON LANGDON: It turns out that Gary is the perfect placebo patient: his chronic back pain reduced by up to 50% with the simple saltwater solution.

DAMIAN: On the first occasion you had local anaesthetic, and when you came back several weeks later it was actually the placebo that you received.

ALLISON LANGDON: Almost three quarters of participants in the trial had similar results, and even more incredible for Gary is that his mind-power actually provided greater pain relief than being injected with the anaesthetic. You actually felt you got a better response to the placebo?

GARY: With the second one, that’s right, and making that relative back to the first test.

ALLISON LANGDON: Tells you a bit about the power of placebo, doesn’t it?

GARY: It does, yes.

ALLISON LANGDON: You’re convinced the placebo effect is real?

DAMIAN: Absolutely real. Placebo acts on certain chemicals in the brain and certain brain regions, and even the spinal cord and into the body. No longer is it just this thing that happens, people walking away feeling better because they’ve seen a doctor or had a sham treatment or a sugar pill. Something real changes in their brains and in their bodies to modulate their symptoms.

ALLISON LANGDON: The placebo effect’s not only revolutionising how we perceive and manage pain. Mind power is transforming the body’s ability to heal itself. And some of the most sophisticated fields of medicine are being challenged, including treatments of migraines and depression – even major forms of surgery.

BRUCE: They would go to sleep and get three holes and a pretend surgery, but not real surgery.

ALLISON LANGDON: Fake surgery?

BRUCE: Fake surgery, that’s right.

ALLISON LANGDON: Perhaps the most extraordinary example of the placebo effect took place here in Houston, Texas. Right now, orthopaedic surgeon Doctor Bruce Moseley is performing a real knee arthroscopy. But in an incredibly controversial trial, he performed fake surgery on 60 patients. He knocked them out, opened them up, and did no procedure whatsoever, before stitching them up and sending them home. To his great surprise, those who received the “sham” surgery reported exactly the same improvements as those who were given the real deal.

BRUCE: They all had reported they were better after the surgery. Their arthritic symptoms had improved, they were pleased with the surgery, they were all equally the same, meaning the pretend surgery group did just as well as the real surgery group.

ALLISON LANGDON: Do you find that extraordinary?

BRUCE: I do – I mean, it really speaks to the power of the placebo effect.

ALLISON LANGDON: Remember: Dr Moseley has devoted his entire career to surgical intervention, only to undergo what is the most extraordinary of professional conversions – he’s now convinced that in some cases, the mind can heal just as effectively as the scalpel. See, I understand with fake pills and fake cream, but to actually give someone surgery – that’s taking it to a whole new level.

BRUCE: It is, no doubt. The bigger the treatment the patient thinks they’re going to have, the bigger the placebo effect, and in general small pills don’t have as big of a placebo effect as bigger pills, and pills don’t have as big of an effect as shots, and shots don’t have as big of an effect as procedures, and there’s hardly a bigger procedure than surgery.

ALLISON LANGDON: How often would you walk up here?

TOR: All the time.

ALLISON LANGDON: The next big step in this bold new field of medicine is unlocking and understanding how the mind commands such control over the body.

TOR: It probably also combines with lifestyle.

ALLISON LANGDON: So, in the foothills of the Rocky Mountains, neuroscientist Dr Tor Wager and his team at the University of Colorado are mapping the exact changes in our brain when we trick ourselves into feeling better. The results offer the very first illustration of ‘mind-over-matter’.

TOR: How can a dummy pill, how can a sugar pill make you feel better? And the answer is it doesn’t make you feel better, you make you feel better, I think. It’s your brain processes that respond to that. It’s your response to that that makes you feel better. I’ll just put a little dab on your arm.

ALLISON LANGDON: Dr Wager’s volunteers receive a minor burn to the arm, and then a fake cream that they’re told will relieve their pain.

TOR: We’ll slide you back in, and we’ll do the next test.

ALLISON LANGDON: The MRI scan shows how our brain generates its own pain relief – a cocktail of feel-good chemicals is released simply because we’ve been told that the medication will work.

TOR: And then what we’ll do is we’ll look for places in the brain in which the signal goes up and down when she experiences pain. And that way we can find what essentially the neural signature of pain is.

ALLISON LANGDON: But at the moment she thinks that that cream is stopping the pain.

TOR: Right. Now, so at the moment, yeah, she thinks that the cream is reducing the pain, and so we expect those regions of the brain to respond less. What’s happening to your brain is you are releasing opioids and dopamine, and that’s turning down, to some degree, the brain response to the painful event itself.

ALLISON LANGDON: Observing the placebo effect, and clinically proving its existence, is a major medical milestone. Now the next frontier is knowing exactly how and when to apply it – the limits as well as limitations.

IRVING: I don’t think we’re going to learn how to mentally heal fractured bones. But I do think that we can learn how to overcome depression, how to overcome anxiety, how to deal with migraines and other kinds of clinical pain, how to manage asthma better.

ALLISON LANGDON: But a lot of it relies on deception.

IRVING: I don’t think we should be deceiving patients. I think we need to be honest with them, but what that means is that we need to find ways of making use of the placebo effect, harnessing its power without deception and that’s ethical.

ALLISON LANGDON: For Gary, any early doubts he had about the placebo effect as a therapy have long since disappeared. He’s now telling everyone to keep an open mind about the proven healing power of the brain.

GARY: I can only put it down to mind over matter, that if you think something is going to happen that’s going to make you feel better, then I think that’s the reasoning behind it.

ALLISON LANGDON: So are you a placebo believer?

GARY: Yeah, well I think I am a placebo believer.

ALLISON LANGDON: You’ve come round.

GARY: Yes.

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