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A QUESTION OF PROOF
By Roslyn Guy
Posted June 2004
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.
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.
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.
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."