I felt a light tap as the delicate needle went into my ankle. Within moments my racing thoughts settled and I felt my awareness shift to the present moment. My breath. My body. My baby.
I’m now 41 weeks pregnant, a week past the expected date of arrival for my second child. I’m hoping to go into labour naturally without needing to be medically induced, and with some evidence to show that acupuncture can be effective in encouraging a natural start to labour, I’ve had a series of appointments with Amrit Dean, a registered Traditional Chinese Medicine (TCM) practitioner who has trained in an integrative hospital in China. Amrit is also an experienced massage therapist and her treatments have been wonderful – soothing my heavy, pregnant body and settling my busy mind.
When I told my doctor that I was having acupuncture in hope of encouraging labour to start naturally he gave me a slightly quizzical look. He knows that I’m an investigative health journalist, and given that I’ve spent the last nine months discussing peer-reviewed scientific papers with him, I could tell he was wondering why I had been drawn towards alternative therapy. I explained that there’s actually a fascinating, ever-growing body of research emerging from some of the most respected institutions in the world, such as Harvard University and the University of Turin that is starting to explain why having a treatment with an alternative therapist can lead to health improvements.
At the forefront of this research is Ted Kaptchuk, whose background is not typical of someone holding the title of Professor of Medicine at Harvard Medical School. He’s the author of a seminal textbook about Traditional Chinese Medicine (TCM) called The Web That Has No Weaver: Understanding Chinese Medicine, which today sits on the bookshelves of acupuncture practitioners and TCM students around the world. In fact, he once ran a TCM clinic in Boston on a street commonly referred to as “Quack Row.” As Kaptchuk told Harvard Magazine he doesn’t doubt the value of TCM, but these days, his research focuses on finding out exactly what mechanisms encourage the health improvements he saw in his patients.
One of Kaptchuk’s breakthrough studies was published in 2008, when he demonstrated that the care and concern shown for patients during treatment can have a significant impact on their recovery. The study recruited 262 people suffering from irritable bowel syndrome, a chronic, gastrointestinal disorder that causes frequent abdominal pain and diarrhea or constipation. He divided the volunteers into three groups, the first receiving no treatment and the second two groups each receiving fake acupuncture involving the use of trick needles. People in one of the sham acupuncture groups were treated by practitioners who 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 their patient’s pulse or pondering the treatment plan. The other fake acupuncture group received little attention from their therapists, who merely introduced themselves and stated they had reviewed the patient’s questionnaire and knew what to do. After six weeks, the patients in the group who received the most personal care were the ones who reported experiencing the greatest symptom relief as well as the greatest improvements in disease severity and quality of life.
This study speaks volumes about the importance of the patient-provider relationship, which I’ve written about recently when I was facing a dilemma of whether or not to allow my doctor to induce me early in order to ensure he would be available during the birth. Through their words, attitudes, and behaviours, our healthcare providers can communicate critical information that can have a profound impact on our health – for better or for worse. It’s fascinating that in 2010, Kaptchuk’s research was taken to another level when he demonstrated that the patient-provider interaction could be effective even when the patient knew the treatment was fake. Patients with irritable bowel syndrome reported their symptoms improved after a caring and considerate doctor or nurse explained that placebos could be effective and powerful, then instructed them to take pills from a bottle clearly labeled “Placebo. Take 2 pills twice daily.”
Meanwhile, in another part of the world, a neurophysiologist named Fabrizio Benedetti from the University of Turin, is uncovering the physiological mechanisms that can help explain these improvements. Benedetti is a leading researcher on the placebo response and an expert on how our mind can influence our body. I’ve written previously about his research on the nocebo effect, which is when you have a negative response to a harmless substance you believe is harmful. With thanks to Benedetti’s research we now know that placebos can work in a way similar to morphine by using the endogenous opioid system, the body’s innate pain-relieving system. Another way placebos can work is by triggering dopamine, the chemical in your brain that makes you anticipate pleasure and reward.
The main point here is that although there is still much to discover, we now know of many different physiological pathways that can explain why you respond to a treatment – be it conventional or alterative. It may be that the active treatment takes effect, that pain-reliving chemicals are triggered in your brain, or that your health practitioner has reassured you enough to make you feel less anxious, which improves your mood and makes you feel better.
All this does come with a critical caveat. I don’t want to overstate the potential healing power of the patient-provider relationship. It’s not that we should start thinking that if experimental scientists using fake acupuncture needles can trigger a physiological response, then the same biological mechanisms can be triggered by any practitioner of conventional, complementary, or alternative medicine. The leading researchers all emphasize that the empathetic care-induced placebo response they’re studying is being shown to be effective in addressing people’s subjective feelings or perceptions of their illness such as reducing their pain, anxiety, nausea, dizziness, or fatigue. Kaptchuk himself takes great care to draw attention to this in a 2015 piece he wrote for the New England Journal of Medicine where he highlighted one of his own studies that found that while placebos can dramatically relieve asthma symptoms, they are no match for real drugs when it comes to objective measurements such as lung function. “Placebos may provide relief, but they rarely cure,” he wrote.
We must also be careful not to assume that alternative treatments won’t have any harmful effects. In most countries complementary therapies and products are not regulated in the same way that the conventional medical and pharmaceutical industry is. For my own part, if I see an alternative therapist, I take time to ensure they are trained and registered with a reputable professional body.
As for the series of treatments I’ve been having with Amrit, there is something powerful that happens in my mind and body when I see her. In stark contrast to the sterile white hallways of the hospital where I visit my doctor, Amrit’s treatment room glows with the soft flicker of candlelight. Instead of the dings and pings of machines that filled my ears during my last check up with a midwife, Amrit’s treatment room soothes with the sound of chimes and birdsong. I experience deep comfort from the warmth of the lamp she places over my body, the heated stones she uses to massage my tight muscles and the tap tap of her acupuncture needles. Her treatments draw me away from my swirling thoughts and bring me into the moment. When all is said and done, it does not matter to me whether it is a life force energy called ‘chi’, or whether her treatments are triggering other biological responses in my body. Indeed, it does not even matter whether her treatments are effective helping along the natural start of labour. What matters to me is that when she gives me her time, Amrit makes me feel amazing, the importance of which during a time of uncertainty when I have many health related decisions to make cannot be overstated.