Roslyn
Guy is a senior writer at The Age newspaper, Melbourne, Australia. Her
article was first published 29 March 2004
You'll
find them everywhere, in your local paper, on television, even in doctors'
waiting rooms - there's no shortage of advertisements suggesting that you
can be healthier and live longer if you learn to change your thinking, take
up meditation, do yoga or Tai Chi, learn to love yourself or, at least,
buy a juicer.
The accompanying images
are usually seductively calming, but the message they carry is at the
heart of a quarrel that is far from gentle. It's a battle between the
medical establishment, who say doctors should apply only the lessons of
science when treating their patients, and a growing number of their colleagues
who are using ancient therapies as part of their repertoire.
The belief that the mind can affect
our physical well-being is nothing new. In the 5th century BC, Hippocrates,
considered the father of Western medicine, summed up this philosophy when
he said: "The human being can only be understood as a whole."
But for most of the 20th century
this idea was out of favour, and science that separated the body from
the mind dominated medicine. Now, community interest in holistic treatment
is growing.
Meditation, hypnosis and aromatherapy
are no longer dismissed as New Age - a term that for many is synonymous
with "suspicious" - and titles such as You
Can Heal Your Life and Boosting
Your Immune System walk off bookshop shelves.
Increasing acceptance has brought
with it qualms about regulation - exactly what are the qualifications
of the person advertising massage therapy and counselling services in
the local press? And what if people with serious illnesses are persuaded
to forgo conventional treatment in favour of alternatives that are unproven
and, some doctors believe, potentially dangerous - there is disquiet about
herbal medicine and homeopathy, especially as these can interfere with
the effects of chemotherapy.
Other alternatives that cause concern
are the consumption of high doses of vitamin C in the belief that this
will kill cancer cells, or reliance on faith healers to effect miraculous
cures.
Cancer Council Australia cautions
that many alternative therapies that are promoted as cures have not been
scientifically tested, or when tested were found to be ineffective. Its
official view is: "If used instead of evidence-based treatment, the
patient may suffer, either from lack of helpful treatment or because the
alternative treatment is actually harmful."
Most doctors would agree that alternative
medicine should be approached cautiously. But there is less consensus
about "complementary medicine" which the Australian Medical
Association (AMA) describes as embracing acupuncture, chiropractic, osteopathy,
naturopathy and meditation - or even less mainstream treatments such as
aromatherapy, reflexology, crystal therapy and iridology - used in conjunction
with conventional medical treatment.
Strong
Emotions
Given that research cited by the
AMA shows that almost 50 per cent of GPs surveyed were interested in training
in areas such as meditation, hypnosis and acupuncture, and more than 80
per cent had referred patients for some form of complementary therapy,
it is hardly surprising that the professional body representing doctors
is being circumspect in its response to these developments.
In a position paper posted on its
website, the AMA neither endorses nor rejects the developments. However,
it does stress that it "is essential that scientific research is
carried out in such a way as to permit complementary medicines and therapies
to be assessed on an evidence basis".
Dr Craig Hassed, an advocate of mind-body
medicine and a senior lecturer in the department of general practice at
Monash University, has no quarrel with this.
"There is a healthy note of
caution," he says. "But sometimes there's a very high level of reluctance
to embrace different ways of thinking, even when evidence starts to mount
- and there is a great readiness to accept things that come from a more
biomedical model (such as hormone replacement therapy) that often prove
not to be well-grounded."
This is a topic that arouses strong
emotions. Hassed has no doubt that meditation, for example, can aid good
health. Other doctors, such as Raymond Snyder, an oncologist at St Vincent's
Hospital, see this as the 21st century equivalent of believing the earth
is flat simply because that's the way it appears when you look out the
window.
Snyder wants to see evidence based
on properly conducted scientific research rather than individual experiences.
He dismisses claims such as patients, by using their minds, have boosted
their immune system and hastened the regeneration of white blood cells
temporarily destroyed by chemotherapy.
These claims most often centre on
the use of techniques such as "creative visualisation", a form
of self-hypnosis pioneered in the 1970s by American oncologist Carl Simonton.
Reduce
Stress
Simonton has found a global audience
for his programs based on the belief that "our emotions significantly
influence health and recovery from disease (and) are a strong driving
force in the immune system and other healing systems".
Snyder doesn't mince words. "There
is no end to these claims and at the end of the day the only test is 'Where
is the evidence?'"
And if people believe they have kept
their white blood cell count up, he says, they should be able to produce
records of treatment that compare the cell count before meditation with
that immediately after meditation, not days after a low reading when the
count would have improved anyway.
Nor is he persuaded by the AMA's
position. "The medical oncology community as a professional group
is a bit more sceptical than that because the major players in this are
cancer patients. For most diseases it's not critical, but for cancer patients
it can be critical, and that produces anxiety."
A study presented to the British
Psychological Society in 2000 tested the effects of guided imagery - visualising
white blood cells attacking their cancer cells - on 96 breast cancer patients.
It found that those using the technique survived no longer than the patients
who didn't use it. Further randomised clinical trials are underway at
Britain's Hull University to test whether relaxation therapy and guided
imagery can help fight bowel cancer, and at Duke University in the United
States to assess the effect of meditation on blood pressure, prostate
cancer and osteoarthritis. Results won't be available for at least two
years.
Even die-hard opponents of the use
of therapies - such as meditation and hypnosis - instead of drugs concede
that they can help reduce stress and add to a patient's quality of life.
Snyder acknowledges "meditation
in itself isn't generally harmful unless it occupies extraordinary amounts
of time". But he says many things will work to reduce anxiety but
"to get rid of disease, that's where the line needs to be strongly
based on evidence".
The question of evidence is a thorny
one. Hassed cites a study on long-term HIV infection that showed that
the rate of progression to AIDS was twice as fast for men with significantly
higher levels of stress and social isolation. Similar results can be found
for MS, he says.
He has no doubt that the mind is
a potent instrument in healing. "What you think, and your emotions,
can have a powerful effect on your immune system. If you're getting angry
or tense all the time it can suppress immunity." And, he says, there
is plenty of data to support this view.
For Snyder, it is vital to distinguish
between validated scientific research, reported in peer-review medical
journals, and what are essentially consumer reports. His own search for
details of research into the impact that meditation can make on the immune
system turned up more than 600 of the latter but not a single reference
in the medical scientific literature, he says.
Long-term
Study
One of the benefits claimed for
meditation is that it can result in a sense of well-being and this translates
into a more positive attitude to life, which in turn helps healing.
As a research fellow at Peter MacCallum
Cancer Centre, Dr Penny Schofield was part of a team that did a long-term
study of the impact of positive thinking on survival rates in lung-cancer
patients. While the study found no causal link between optimism and survival,
it did give Schofield the opportunity to reflect on mind-body medicine.
She observes that a belief that people
control their own destiny through "correct thought" or being
positive or optimistic often underpins complementary therapies. But this
can have less desirable effects.
"People need to be allowed to
feel down in the dumps some days, to feel frightened about the future.
If people are pressured to be positive, there is an underlying assumption
that the person themselves is at least partly responsible for the outcome
of their disease."
And while Schofield does not believe
that visualisation is "a terribly plausible mechanism for increasing
immunity", she thinks it should be tested.
Guided imagery or creative visualisation
is close relatives of self-hypnosis, a therapy practised by doctors and
psychologists and accepted by Medicare as a legitimate medical practice.
Dr Angela Mackenzie, a paediatrician
at the Royal Children's Hospital, teaches children self-hypnosis as a
means of helping them cope with their treatment.
She has worked with claustrophobic
children who needed anaesthetics before they could have MRIs, those who
are terrified of needles and can't have intravenous drips inserted, or
who can't swallow vital medication, like the boy who would vomit up his
oral chemotherapy until Mackenzie taught him to imagine the pill as a
slice of pizza.
Mackenzie believes that there is
a double standard when it comes to assessing the complementary and alternative
medicines. "Doctors are so judgmental about most of these treatments.
They are ready to damn them without knowing anything about them, and lump
them together as if they are just one therapy instead of more than 200.
"There are more randomised controlled
trials, the gold standard in medicine, showing the effectiveness of behavioural
techniques for migraine, including hypnotherapy, than there are drug trials,
and yet most children would be put on drugs first and only referred for
other therapies in desperation." But it may be a long wait for those
wanting general acceptance by the medical community of mind-body medicine.
Hassed says: "History will tell whether a lot of these therapies
and approaches were really by snake oil salesmen, or whether the best
of the researchers doing work in this area will one day be seen as Galileo
figures being held before the Inquisition." |