Do You Believe in Magic? Topol, Offit on Alternative Medicine

Meditation and the Placebo Response

Dr. Topol: I am not sure that the whole world knows about that whole Wakefield story, but it is nicely reviewed in the book. Now I want to ask your opinion.

We here in San Diego are very close to the Chopra Center. Deepak Chopra, MD, is up in Carlsbad, just a few miles away. He wanted us to use our digital medical tools to understand the physiologic response to meditation, and so we are going to do a study with various sensors (not only EEG but also vital signs and autonomic nervous system metrics, such as galvanic skin response and heart rate variability -- the whole shooting match) to see what happens with meditation. I kind of like that, because we are going to get some objective data, and that is what this field is missing. Do you think that it's OK that we are going to embark on that kind of study?

Dr. Offit: I think it is important. The one thing that changed my mind in writing this book was that when it was originally conceived and written, it had a different title. It was called "Quacks: How They Hurt Us and Why We Let Them." I changed it, and you have seen the last chapter of the book. I talk a lot about the placebo response and the physiology of the placebo response. And because it is real, I think in many ways it is physiologically based.

Can we learn to relieve symptoms with our own endorphins? Can we learn to upregulate and downregulate our own immune system, release our own dopamine, and affect our own mediators of stress, which can have broad negative effects? Yes, I think that is all true, and it is all studyable, and that is why I think that what you are saying is so important. I think Mehmet Oz, for example, will go on his show and will talk wondrously about acupuncture, which no doubt benefits people, and it may be because they are learning how to release their own endorphins.

We don't have to look to the gods to explain these things. We can look into ourselves and try and figure out the physiology so that we can then learn to evoke these behaviors at lowest risk, lowest burden, and lowest cost. I think that is important.

Dr. Topol: The last thing I wanted to ask you about was indeed the placebo effect, because that story is just so rich, and obviously it is not just endorphins and dopamine squirts. You can tell a patient, "I am giving you a placebo," and people get better even when knowing that it's a placebo, so there seems to be a whole science of placebos. Why aren't we actually just calling it placebo and giving placebos in our medical practice and studying it more?

Dr. Offit: First of all, we used to. I am old enough to remember my pediatrician coming to my house -- Dr. Milton Markowitz, who eventually became dean of Connecticut's medical schools and is a very smart man. I remember looking through his big black bag, and he had a bottle in there of these small pills. I asked him what they were, and he said that they were sugar pills for people who were going to get better anyway who just needed to feel that they were taking something. And I thought this was great, because in my little doctor's kit at age 5 I also had sugar pills, so I thought, I am well on my way.

You are right. I think the question is, is it ethical to deceive, and at some level I think the answer is yes. I think we do it all the time. At Children's Hospital of Philadelphia, when we give medicines, we often will say, "We really think this is going to work for you." I think that is part of it. We wear white coats with red lettering. We have big fancy equipment that makes interesting noises. I think people come in with an expectation of therapy, and that goes a long way toward being therapeutic.

I wish we had a word that was different from "placebo," because when people hear that word, they think it is dismissive -- that it is just all in their heads. But in fact it can very much be in their bodies, and so I think it is all worthy of study.

Dr. Topol: This has been so much fun to talk to you about your book. Thanks for all the hard work and research you did to put that together. I give you a lot of credit. I think the whole medical community should be indebted because you have taken on vaccines, the antivaccine movement, and now with this project you have taken on a tough, tough area. Hopefully this will somehow spark some improvement; there is a lot of improvement that could be had here. Thanks a lot, Paul. I really enjoyed the discussion with you.

Dr. Offit: Thank you, Eric. I appreciate you having me on.

Dr. Topol: Well, that is it for Medscape One-on-One today. We're really indebted to have Paul Offit with us, and we will be back with more hopefully interesting looks into various topics that will be pertinent to medical practice and the health of our population in the times ahead. Thank you.

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