My two-year-old son was screaming. Lemon juice had gotten into a tiny cut on his finger and the sting in conjunction with a missed daytime nap meant he was feeling especially emotional and vulnerable. As far as he was concerned the pain in his finger signified the end of the world.
Luckily I’d just been reading about the power of placebo and I had an idea. I would ‘placebo’ my son. Before I tell you about what I did, let me explain a little about the placebo response. In the last decade there has been an explosion of new research exploring the phenomena where people are administered an inert treatment and as a result, experience psychological benefits and sometimes physiological healing. There are different ways this may happen, for example a person may have improved cardio vascular health after being given highly elaborate, but fake heart surgery, or a person may simply perceive to have improved asthma symptoms after being given fake treatment.
With the development of modern technology scientists have started to view the placebo response as far more than just saline treatments and sugar pills that get in the way of the development of new drugs. Recently they’ve been exploring what happens in a person’s brain when they start responding to a placebo and although in its infancy, they’ve also started identifying the genetic programing of people who are more likely to benefit from being given a placebo.
I’m fascinated by the work of Professor Ted Kaptchuk from Harvard who recently performed a study that found the placebo response is dose dependent - the more care and attention people get, the stronger their physical response even if the treatment isn’t real.
In Kaptchuk’s study 262 people suffering from irritable bowel syndrome were split into three groups. The first group received no treatment. The second group received fake acupuncture without much attention from the practitioner. In fact when the practitioners treating the second group introduced themselves, they stated they had reviewed the patient’s questionnaire and “knew what to do,” then proceeded to say little else. The third group also received fake acupuncture but had great attention lavished upon them. The practitioners purposely adopted a warm, friendly manner and expressed empathy by saying things like “I can understand how difficult IBS must be for you.” They communicated an air of confidence and positive expectation and at times spent 20 seconds in thoughtful silence while feeling the pulse of their patient or pondering the treatment plan.
After six weeks of receiving the placebo acupuncture the results weren’t surprising. The patients who experienced the greatest relief were those who received the most care.It’s no wonder that the therapeutic benefits of the ‘ritual of medicine’ are capturing the attention of placebo researchers around the world.
So when faced with a highly distressed toddler, with Kaptchuk’s study fresh in my mind, I paid a great deal of attention to my son’s painful experience with his lemon juice infused wound. I first gave him a big cuddle to sooth his tears and when the sobbing became calmer, I took his finger and contemplated the cut very thoughtfully (I considered getting out a magnifying glass so that I could actually see the cut, but thought this may be taking it a little too far).
I acknowledged that the juice from the lemon must have caused a painful stinging sensation and soon the tears fizzled to a sob. I made a great show of the ‘ritual of medicine’ as I carefully selected the appropriate band-aid to administer. By this time my son had stopped crying and was looking on with interest but for good measure, I offered to ‘kiss it better’ and sealed the experience with a special kiss on his finger.
I can’t say for sure that my performance (exceptional as it was) triggered any neurological effects on my son’s sense of pain, nor may it have cued his immune system to expedite the healing of his wound. But I can say for certain that my son felt a lot better. His mood improved and we made it through bath time and into bed without further incident that evening.
Coming back to the science, this research on placebo highlights for me the great responsibility that comes with being the carer of a sick person. In an age of jam packed waiting rooms and carefully allotted 10 or 15-minute windows with doctors we barely know, what potential for healing is being missed because doctors don’t have the time or inclination to perform the ‘ritual of medicine’?
I think back to the many interactions I had with health care providers over the years when I was unwell with my autoimmune disease and feel some sadness. One specialist rheumatologist never looked up from the screen in front of him. To him, I was just a bunch of results on a page.
My conclusion with all of this is to spend a lot of time finding the right doctors and any other health care providers you’re handing money over to. If you’re not well and you’re not feeling the love from your carer, find someone else immediately. It may make all the difference to your health outcomes.
One final note:
A few days after the great lemon juice incident of 2015, I was putting my son to bed. He wanted the fun of our bedtime stories and songs to continue and when I went to leave the room he began to cry. Offhandedly I said to him that I needed some Mum time and was going to have a hot shower to try and fix the ache in my back from sitting down too much and he stopped crying and became thoughtful. After I’d had my lovely warm shower, I found my son still awake.
‘How’s your back Mum?’ he asked in his sweet toddler voice.
“Want me to kiss it bedda?’
A rush of warmth and love went through my body and after he kissed my back ‘bedda’ the ache definitely went away. I may well have just been placeboed right back by my kind hearted, empathetic two-year-old, but I don’t mind one bit.