Yoga and the Placebo Effect

Recent studies are calling into question what we really know about a wide range of health conditions.  Placebo is often found to be as effective as conventional treatments.  And the tendency to gloss over these findings with merely a warning against "fake medicine" overlooks more important implications.

You wouldn't know it from watching the coercive commercials for spinal surgery but it has been shown that when you give MRI's to people without pain, they have the same percentage of disc herniation as those with pain.  In another bombshell study, they found that pretending to give someone knee surgery produces the same results as actually doing meniscus repairs.  And when they ran a similar trial to test a procedure for treating chest pain associated with angina, the fictitiously treated patients showed an 80% improvement while those actually operated upon only 40%.  In other words, placebo acted better than surgery.

The placebo effect is nothing new.  The only way a drug can be considered effective is to perform better than a placebo, commonly a sugar pill or some other inert substance.  The placebo itself has no intrinsic medicinal property. Yet, placebos have consistently shown in clinical studies to produce a 35-45 percent improvement in whatever medical condition is being treated.

More remarkable is that it appears the power of placebo is getting stronger.  The failure rate for new drugs compared to placebo in Phase III trials between 2001 and 2006 increased by 11%.  The FDA approved only 19 of "first-of-a-kind drugs" in 2007, which is the fewest approvals since 1983.  Even more startling are studies showing that antidepressants like Prozac, which have been on the market since the late 90s, might not be approved now were they to be tested again.

And it’s not that the drugs are getting any weaker, the perfunctory list of horrifying potential side effects can attest to that.  But the efficacy of placebo is definitely getting stronger.  Comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s.  One estimated that the "effect size" in placebo groups had nearly doubled over that time.

So what are we to make of the fact that established medical protocols are proving little more effective than a strong belief?

From a purely empirical standpoint, the placebo effect points to the importance of perception and the brain's role in physical health.  But implicit in the placebo effect are some inconvenient realities, to which, the usual response amounts to knee-jerk warnings of fantastical thinking.  Understandably so, because there are those who irresponsibly exploit the notion of positive thinking as both a cure for cancer and key to a million dollars.

While the mind over matter trope is easily reduced to subjective whims and quackery, an alarmist response is equally counterproductive in that it induces fear and creates pathology of its own.  The opposite of placebo, referred to as nocebo, has also been proven to be true.  If you think that a sugar pill is going to have negative side effects then a sugar pill will likely end up causing negative side effects.  Making people feel afraid and asserting protocols that can barely beat a placebo, is definitely not working.

Which is precisely why so many people are turning to yoga practice.  When applied appropriately, yoga is the most eloquent of all placebos.  It provides experiences and ideas that encourage a healing response.  The benefits cannot readily be measured by scientific means and yet the subjective and anecdotal evidence of its effectiveness is more than can be stifled.  Of course, yoga practice is quite diverse and, depending on which class you go to (see When Yoga Empowers), it can just as easily become another culturally-induced nocebo that further disables us.

Are you forty and starting to feel like you’re slowing down?  You must have “Low T.”  Didn’t you know?  It’s just a number.  Or do you have back pain?  Well, some laser spinal surgery can fix that up overnight.  Maybe you’re just depressed.  No worries.  We have a pill that can turn that depression into a cute cartoon character that follows you around.  Or perhaps, you are not into western medicine.  You do yoga.  If so, did you hear? You better not roll up from standing forward bend because its definitely going to destroy your spine.

What cannot be denied is the underlying fact that, given a set of favorable conditions and beliefs, people can heal themselves from within.

The problem is that, too often, whether we are in a doctors office or a yoga class, we are being made to feel that we are somehow damaged and in need of repairs.  As though our bodies are not actually governed by the same profound intelligence that moves the oceans and conceives us into existence.  This does not rule out times where medical interventions are warranted, even miraculous.  But if, in intervening, we disempower the very mechanism that we require to heal then our efforts are going to be for naught.

In addressing well-being, a deeper wisdom is necessary.  Each person has an individual story that needs to be honored.  And there must be a willingness to let people make their own informed determinations.  We are not broken.  Healing is possible.