Jo Marchent: (2016) , Edinburgh, Canongate Books
The obvious thing about the NHS is that it is in a mess. Underfunding has driven it to crisis point. Part of the crisis is the way that the administrators have come up with thousands of ways of solving the problems on a shoestring. Reorganisations, restructurings and reconfigurations seem to flow in a continuous stream.
Meanwhile we all still need to solve our health problems. In ordinary times, we apply a mix of common sense, medical science and mysticism. Common sense has guided us around thousands of decisions. It has also long told us that our minds affect our physical health. However, our author has set out to test this proposition systematically. She is well qualified to do so. In the biomedical sphere she has a BSc in genetics and a PhD in microbiology.
A problem is that on one side of the argument are airy fairy alternative people who will create a cure out of mind alone and on the other are many medics who will focus on bodies and symptoms as if they were vets with clients who have no language.
Vital to Marchant’s exploration is the placebo effect. This is the positive impact of a treatment with no known curative properties. It has long been known to exist. Modern drugs trials use a control group receiving either a placebo or the current treatment while another group are given the new drug. Those running the trial should be “blinded”, that is neither they nor the subjects know who is getting the real thing and who gets the phoney. Thus the placebo effect can be eliminated in assessing the new treatment. But the author points out science is missing a trick here. If the placebo effect works it can be beneficial in itself.
The placebo effect is not just a con trick. For example, patients with Parkinson’s disease were seen to receive a flow of dopamine to the brain and to improve accordingly after a placebo was given.
There are a couple of problems with this simple story. The first is that there is also a “nocebo effect”. If we think something will damage us it may well even if it doesn’t have the physical properties to do so. Another is that the placebo is inconsistent. The same placebo helped 60% of ulcer suffers in Denmark but only 7% in Brazil.
The arguments about alternative/complementary medicines rage on. Most such therapies do not seem to work as the practitioners say they do. However, plenty of people swear by them. Again the placebo effect may be important here. Linked with this is time and concern. The typical GP appointment of about 10 minutes is pushed into a brief transaction, ending with a prescription. Against that an hour with somebody taking an interest in real problems may do more good, even if the benefits do not stem from the therapy itself. Homeopathy comes under particular criticism here as a treatment based on implausible explanations. Yet many people find that it works for them.
We all know about Ivan Pavlov and his dogs. But even the conditioned response he understood can be used in health care. An example is a group of children diagnosed with ADHD. They were given their normal drug plus a pill they knew was inert. Later the inert pill was given alongside half the normal drug dose. It worked! The drug regime had been halved with no ill effect – the placebo did the rest.
The placebo is not the only way that the mind alters physical change. A simple change in childbirth was to ensure that the woman had a single person caring for her instead of people coming and going. This reduces the need for pain killers and cut the number of complications.
Meditation has had its followers. They tell us, often with missionary zeal, how good it is. This book confirms that it can lower blood pressure and improve health generally without drugs. There is a detailed discussion of quite how this works.
I often think of Shakespeare’s phrase in Richard II “I wasted time, and now doth time waste me;” It reminds us of the inevitability of growing frailty and decline as our age advances. However, Marchant shows that exercise, mental activity a sense of usefulness will stave off the impact of the years racing by.
One of the more interesting features is a discussion of religion and health. It seems that if you can believe it will keep disease at bay. This probably works by reducing stress.
Where does this all leave socialists campaigning to protect the NHS?
Firstly, this book helps us to avoid the narrow mindedness that an excessive faith in the current level of medical science can bring. All sorts of unlikely things can help. However, that is not a reason to go off to any whacky set of beliefs. As the author shows, beliefs need testing for their impact.
Secondly, some aspects of these mind over matter treatments are being used by the NHS. The term is social prescribing. Thus, the practice I use has walking groups. Others prescribe time in the gym., etc. All of this has to be better than drugs. However, it runs up against the entrenched habits of GPs. They may find it easier to prescribe a drug rather than a preferred activity. Patients also often feel that their problem has been properly acknowledge by a prescription for a chemical of some kind. If the avoidance of pharmaceuticals catches on the drug companies will almost certainly respond.
To return to where we came in, we need two things. We can ask how a work like this relates to health policy. Firstly, to recognise that the integration of social care and health is essential and with it the capacity to use non-medical services. Secondly, we need to develop a more sophisticated understanding of the relationship between mind and body in developing the services needed.