Positive Expectation – A Medical Miracle?

Research Reveals the Healing Power of the Mind

One Study Invalidates Much of Medical Science

My lifelong assertion that much of medical science is literally wishful thinking has now been confirmed by new, groundbreaking scientific research involving the, so far, underestimated healing power behind patient expectation. The study, entitled “The Effect of Treatment Expectation on Drug Efficacy: the Analgesic Benefit of the Opioid Remifentanil” may completely crush the principles upon which medical science has built its case, to date. Yet, this finding may also open the door to an entirely new way of treating disease.

Prominent researchers from the University of Oxford, University Medical Center Hamburg-Eppendorf, Cambridge University, and Technical University, Munich found that the ultimate and most influential determining factor of whether a drug treatment is, or isn’t, effective is nothing less than the patient’s own mind. Their research, published in February 16, 2011 in the medical journal, Science Translational Medicine. [Sci Transl Med 16 February 2011: Vol. 3, Issue 70, p. 70ra14, DOI: 10.1126/scitranslmed.3001244], removes any doubt that the placebo effect is responsible for healing, not a drug treatment or even a surgical procedure.

In the study’s abstract, the researchers state: “Evidence from behavioral and self-reported data suggests that the patients’ beliefs and expectations can shape both therapeutic and adverse effects of any given drug.” They discovered how divergent expectancies in patients alter the analgesic efficacy of a potent opioid (painkilling drug) in healthy volunteers by using brain imaging.”

In this study, when test subjects were told that they were not receiving painkiller medications – even though they were – the medication proved to be completely ineffective. In fact, the research showed the benefits of painkillers could be boosted or completely wiped out by manipulating the subjects’ expectations, which basically means it’s entirely up to the patient whether he gets relief, or not.

This particular research also identified the regions of the brain that are affected by patient expectation. “On the basis of subjective and objective evidence, we contend that an individual’s expectation of a drug’s effect critically influences its therapeutic efficacy and that regulatory brain mechanisms differ as a function of expectancy,” according to the study’s findings. Now try telling that to your doctor the next time he hands you prescription medication!

Obviously, this should have important consequences for patient care and for testing new drugs, but I doubt that it ever will. There is no money to be made from telling patients they can heal themselves. Still, alternative and complementary forms of medicine may greatly benefit from incorporating these principles into their approaches.

Your Mind Does Count – More Than You May Think

Now let’s look at some of the specifics of this fascinating research.
A group of healthy test patients who experienced the same intensity of continuous pain caused by heat application to their feet were asked to rate their pain levels on a scale of 1 to 100. All patients were attached to an intravenous drip so drugs could be administered to them without their knowledge. The patients experienced pain at an average of level of 66.

The first phase of the experiment involved giving the patients one of the most effective and potent medications, remifentanil, without their knowledge. Their rate of pain dropped to 55.

In the second phase, the patients were told that they were receiving an intravenously administered painkiller. With no doubt in the patients’ mind that this was true, the pain score dropped to 39.

Then, without actually altering the dose of the drug, the patients were told the painkiller had been discontinued altogether and to, therefore, expect pain to return; consequently, the pain score went back up to 64. Even though the patients still received remifentanil, they now experienced the same level of pain as they did at the beginning of the experiment, when no drug was given to them.

Professor Irene Tracey, from Oxford University, told the BBC: "It's phenomenal, it's really cool. It's one of the best analgesics we have and the brain's influence can either vastly increase its effect, or completely remove it." She further pointed out that the study was conducted on healthy people who were subjected to pain for just a short period of time.

People with chronic conditions who have unsuccessfully tried many drugs would not be as responsive because their expectations were likely dampened too many times before. Consequently, they may readily turn their own doubts (negative expectations) into a self-fulfilling prophesy of non-recovery. In other words, recovery or cure doesn’t depend on the treatment, but rather on what the patient believes it will, or will not, do for him.

"Doctors need more time for consultation and to investigate the cognitive side of illness; the focus is on physiology not the mind, which can be a real roadblock to treatment,” claimed Professor Tracey.

George Lewith, a professor of health research at the University of Southampton, poignantly stated that these findings call into question the scientific validity of many randomized clinical trials: "It completely blows cold randomized clinical trials, which don't take into account expectation."

George Lewith is a person to take very seriously, given his impressive and impeccable record of achievements and contributions to the world of medical science. The University of Southampton awarded a personal chair to Dr. Lewith as Professor of Health Research. He has published over 200 peer review papers and 17 books. The Times, in an article on September 6, 2008, included George Lewith in The Lifestyle 50, the newspaper’s listing of the “top 50 people who influence the way we eat, exercise and think about ourselves.”

You Are in Charge of Your Brain

What made this new study so fascinating and important is that objective brain scans taken during the experiment also showed which regions of the brain were affected by the patients’ subjective expectations.

The researchers found significant changes in the neural activity in brain regions involved with the coding of pain intensity. Positive expectancy effects of pain relief were associated with activity in the endogenous pain modulatory system, whereas negative expectancy effects linked with activity in the hippocampus and the medial frontal cortex. Having either a positive or a negative expectation of outcome from a particular treatment, therefore, alters brain chemistry and determines your body’s ability to heal.

This is a quote taken from the first edition of my book, Timeless Secrets of Health and Rejuvenation (1995), which now makes more sense than ever: “The mechanism of placebo healing is centered in the belief of the patient that a drug, an operation, or a different kind of treatment is going to relieve his pain or cure his illness. Deep trust or a sure feeling of recovery is all that the patient has at his disposal to initiate a healing response. Utilizing the previously described powerful mind/body connection, the patient may release natural opioids (morphine-type painkillers) from areas of the brain that are activated by certain thought processes. The corresponding neurotransmitters for pain relief are known as endorphins. Endorphins are about forty thousand times more powerful than the strongest heroin.”

Professor Anthony Jones, Salford Royal Hospitals NHS Foundation Trust, has stated: "Work from our own lab and those of others indicates that expectations are a key driver to pain perception and to placebo analgesic effects. So this provides further confirmation of that idea in relation to drug effects. This has been demonstrated previously in relation to nitrous oxide analgesic effects, but the current study provides good evidence that this phenomenon is not due to the subject saying what they think the investigator wants to hear."

Drug Studies Are Fraud

The implications of this study are profound and science-shattering. It seriously undermines the validity of all drug studies ever conducted because they did not include this crucial factor – the subjective expectation of the patient or test subject who takes the actual drug. To reiterate Dr. Lewith’s words, “It blows them cold.”

Simply having a placebo group for comparison can neither make a drug trial trustworthy and scientific, nor can it ascertain the effectiveness of the drug. Those subjects who receive the actual drug have similar subjective, unpredictable expectations as the members of the placebo group. Drug companies like to give the impression that the placebo effect can only occur in the placebo group, not in the test subject group. But since members of neither group initially know whether they are getting the real drug or a ‘dummy’ drug, the study results are ultimately determined by each person’s expectation of beneficial outcome, regardless of the group to which he is assigned.

Even if a tested drug shows greater benefit than the placebo, this still doesn’t prove that the drug is effective. To the contrary, it may merely show the placebo effect is stronger in the drug group than in the placebo group – which is a big finding, in and of itself.

Principal Flaws in Drug Trials

Why would the placebo be stronger that the dummy drug in those participants that receive the actual drug? Well, since all trial participants hope they will receive the real medicine, not just a placebo pill, they will experience a significantly increased positive expectation the moment they notice the side-effects they were told the drug might produce, such as constipation, diarrhea, headache, dizziness, nausea, headaches, dryness of mouth, etc. Realizing they are among the actual drug recipients because of this self-observation, their expectation of possible recovery boosts the drug’s success score. Researchers claim that this is proof of effectiveness of the tested drug, and they give zero credit to the now-elevated expectancy on the part of the participants.

While some of the tested subjects may be very hopeful and enthusiastic about receiving a new medicine, others who have tried many similar medications before, without reaping much, if any, benefit, may have a more reserved or even negative expectation about its benefits. Since patient expectancy is highly relevant, according to this new research, all previously conducted scientific studies that didn’t account for patient expectancy are misleading and must be thrown out as invalid. This practically applies to all double-blind control studies ever done.

Another reason why clinical drug trials are so unscientific and fraudulent is that they are not conducted in a truly double-blind setting. All participants, regardless whether of they receive the real drug or the placebo pill, are told that the study is for a specific condition. For example, a clinical trial may test a new drug to combat hypertension, lower blood sugar, or decrease cholesterol. This simple information, which is advertised during the trial recruitment campaign, already generates an expectation in the participants that, perhaps, the new experimental drug might help them improve their health. This hopeful expectation may, in fact, be the primary reason they enroll in the trial.

There has never been a clinical trial where participants were not told what drug treatment they could expect to receive. On the one hand, the researchers claim their study is fool-proof because participants won’t know whether they receive the drug or a placebo. On the other hand, they tell all the participants upfront that at least half of them can expect to receive a pharmaceutical drug to improve the specific condition they are suffering from.

In other words, at least 1 in every 2 participants may already experience a placebo effect before the trial has even started.
Every clinical scientist knows that the mind’s belief in a drug or treatment can produce a healing response. This is the very reason there is a placebo group in every clinical trial. Why, then, do scientists and doctors insist that only drugs can cure conditions?

There is a clear double standard in medical research. If they are correct in that only drugs can cure and treat diseases, then why do they need to include a placebo group in their research?

Telling the participants that one-half of them will receive the experimental drug and the other half will just get a placebo creates a major uncertainty factor of varied, unpredictable expectations in the subjects, one that the research doesn’t account for. This is pseudo-science at its best, and outright fraud at worst.

The only other way to do an objective study would be to tell every participant that he/she will receive the real drug, but nobody actually will. Instead, all participants will get a placebo. Then start a second phase with the same subjects at a different time, and now give them the real drug while telling them so. If findings from the above pain study are correct, then the subjects are most likely going to get the same results at both phases. If the findings are incorrect, then it will show that the researched medication has true benefits. This would be honest, scientific research.

Dishonest Practices

To prevent getting a poor success score for the tested drug, pharmaceutical companies typically instruct researchers to choose the youngest and healthiest subjects to test it against a targeted disease. However, this practice is both unrealistic and deceptive. In real life, most drugs are being prescribed to the more sick, weaker and older patients who are already less likely to muster positive expectations than younger, stronger and healthier patients can. When you are really sick, you are also much more likely to feel disheartened or depressed.

Drug companies know about this dirty little secret and, therefore, refuse really sick or depressed people from participating in drug trials. Think of a time in your life when you suffered from influenza or another type of illness. You likely felt weak and lost interest in almost everything that normally excited you. As we now know, you will need to be excited about a treatment (positive expectation) to reap genuine benefits from it, or rather, from the placebo response it can trigger in you.

Even with the drug companies succeeding in manipulating the outcome of the so-called research in favor of a new drug, there always are a relatively large number of trials that show outright ineffectiveness of the same drug.

If a drug were truly effective, it would work for every person tested. But since patient expectancy is a highly variable and unpredictable factor, some of these trials show that there are drug benefits, whereas others show there aren’t any. Drug companies are legally permitted by the Federal Drug Administration (FDA) to cherry-pick the ‘good’ trials and throw out the ‘bad’ ones.

When the research is finally presented to the FDA and the medical journals for peer-review and publication, it will look like a valid scientific study. The research paper carries the stamp of ‘proof’ of drug efficacy.

In truth though, all of the studies conducted in this way are fabricated, worthless, and potentially risky for the patient population, leading to the often serious consequences of side-effects, including death. No wonder the FDA is compelled to pull numerous drugs off the market each year because they are just too toxic and dangerous. Hundreds of thousands of Americans die each year, poisoned by these Frankenstein pharmaceuticals.

Bottom line, it is impossible to directly prove whether a patient improves his condition because he is taking a medical drug, or because he believes the treatment will make him better. However, this new pain research clearly indicates the latter to be the case.

Danger of Medical Diagnosis

There is another aspect to the new findings. If someone goes to the doctor and receives a diagnosis for a serious or terminal illness, such as cancer or congestive heart failure, this ‘negative diagnosis’ may turn into the same self-fulfilling prophesy that the test subjects in the aforementioned study experienced when they were told the painkiller was discontinued, even though this wasn’t the case. A diagnosis of such an illness can practically shut down any remaining healing abilities the body may still have, including intrinsic hope.

The uncertainty of not knowing “what I have” is based on fear of the unknown, where I may expect the worst case scenario, such as dying from it. This negative expectation, which is usually confirmed by the doctor’s diagnosis, can shatter all hope. Hope is just another word for ‘positive expectation.’ Why is it so necessary for a doctor to take this proven healing opportunity away from someone, simply because "we don't want to give him 'false' hope"'? There is no false hope. If hope is there, it's a good thing. Hope can never be false. Telling the patient that there is no hope can just be as disappointing at the point of a doctor’s diagnosis and prognosis as it can be when a cure eventually does not come about.

Taking away hope is a crime committed against the patient. Hope can make the difference between dying from a terminal illness and recovering from it.

As can be expected, the mechanism to heal from pain, cancer, or a heart condition is practically destroyed by instilling some kind of panic or death fright in a patient. A person of authority, which a medical doctor undoubtedly is, can pass on to the patient his own misguided conviction that he (or she) suffers from a terminal cancer, even though there are many examples of patients who have recovered from it.
Yet, even if the doctor knew of an alternative method that could be helpful and save the patient’s life, he is legally prohibited from making such a recommendation.

If the patient is already very vulnerable because of a preexisting condition, financial hardship, social isolation, depression, anxiety, emotional stress, etc., then it is relatively easy to convince this person that he is caught in a trap from which he cannot escape. The fearful expectation of death can have dire consequences and, as implied by this research, actually prevent the patient from recovering and surviving. In other words, the certainty of a diagnosis can turn out to be far worse than the uncertainty of an undiagnosed disease.

There are numerous examples that support this. It has been a medical mystery for many decades why people can comfortably live with a large malignant lung tumor for many years, but then die within a few days after receiving the diagnosis. While the death certificates will blame cancer for their death, in reality it’s the diagnosis of cancer that kills them. Death fright is about the strongest fight or flight situation one can experience. It shuts down the body’s digestive functions and waste removal, prevents sleep, causes wasting and rapid weight loss, and triggers many other serious physical imbalances. Modern medicine is still so far removed from understanding and applying the intricate relationship that exists between mind, body and spirit, that it cannot make any sense of these ‘unexplainable’ phenomena where patients die from the diagnosis, not the disease – or survive a ‘terminal’ diagnosis because their positive expectations are profoundly strong, stable and effective.

“Miracle” of Spontaneous Remission

The mind/body/spirit triad connection is clearly demonstrated in the now thousands of cancer patients who experience spontaneous remissions of their cancers. Research has shown that the size of a tumor can be reduced dramatically within a few hours of holistic health treatment, when the patient is highly motivated by personal development. Perceiving a spiritual purpose in the disease that affects them, can also be enough to achieve remission.

This usually happens when the disease is no longer perceived as a threat, but as a blessing in disguise. In other words, instead of being helpless victims of a senseless disease, they become active participants in the process of becoming whole again. The expectation of being blessed by something they might have previously seen as a dreadful curse evokes some of the most powerful healing responses the body has at its disposal.

The mechanism of expecting, and subsequently experiencing, pain relief from a saline solution placebo is no different than the mechanism that turns a big tumor to powder in less than a minute.

I once saw a live ultrasound image where a cancerous bladder tumor, the size of a grapefruit, completely disintegrated and vanished during a 15-second sound-energy-healing session by a group of Chinese Qigong masters. Of course, without the patient’s hopeful and receptive expectation that healing would occur, nothing would happen. Nobody can enter your home as long as you keep the door closed.

Instead of instilling death fright in a patient, a doctor ought to help the patient to develop hope-filled expectations that can then translate into the necessary biochemical responses in the brain and heart that are required for the patient’s body to actually and fully heal itself. On the other hand, telling the patient that he (or she) is suffering from a terminal illness introduces a factor of expectancy that is undeniably capable of executing the doctor’s unintended death sentence.

If the doctor or, even worse, a diagnostic machine like a CT scanner (machines don’t lie) passes a death sentence on a patient, it is the natural expectation of the patient that the sentence will be carried out that actually kills him, not the disease.

When feeling this vulnerable, patients often see their doctor as their savior, their God. If God tells me I am dying, then it must be true. Relinquishing one’s power to someone who plays God makes one a slave, where the expectation is one of worthlessness and dependency. Letting a diagnosis, or rather the negative interpretation of it, rule one’s life, lies at the core of today’s health crisis.

Just the title of my book, Cancer is Not a Disease – It’s a Survival Mechanism, has helped thousands of people restore their confidence in themselves and their bodies. Transforming a negative expectation into a positive one is what practicing medicine ought to be about. The aforementioned research should be studied by every doctor and applied to every field of modern medicine, but this would most certainly make most of modern medicine obsolete.

Still, thanks to these brilliant researchers, we now have the model to scientifically explain that healing is largely up to the expectation, state of mind, and attitude of the patient, not necessarily to the doctor and his pharmaceutical treatments.
So far, most medical dogma has turned everything upside down. I sincerely hope, for the sake of the survival of humankind, that modern medicine undergoes a revolution that will turn it all upside down again. I am encouraged to see there is some light at the end of the tunnel.

Expectations Shape Reality

Both negative and positive expectations can lead to very unusual events. Many people have heard about the studies that showed heart attacks occurring more often on Mondays, usually at 9AM, to be more exact. It is presumed this is due to the expected difficulties and stress that may occur during the work week. Also, fewer people die during the days before Christmas, and more people die right after Christmas.

Another phenomenon, discovered by the Yale School of Public Health and the National Institute of Aging, is that young people who have positive expectations about aging are less likely to have a heart attack or stroke when they grow older.

In a study on aging conducted at Yale and also Miami University, middle aged and elderly people lived seven years longer when they had a positive attitude about aging.
In a classical study, 100 individuals over 80 years of age were placed in an environment that put them back 30 years in time – from old time music playing on the radio, to era-appropriate clothing. Within a few weeks all their physiological and biochemical markers of aging had dropped by an average of 15 years. When they returned to their current homes and living environments, however, they ‘aged forward’ by 15 years in just one day.

In a piece posted on CNN.com, Elizabeth Cohen, CNN Senior Medical Correspondent, wrote about the self-induced, spontaneous remission of cancer in David Seidler, who won an Oscar this year for best original screenplay for “The King's Speech.” Mr. Seidler, age 73, suffered from bladder cancer and used a simple method of visualization to completely disintegrate his large tumor in less than two weeks, just in time before his scheduled operation, much to his physician’s shock.

There are literally thousands of examples where imagination, expectation, visualization, perception, attitude, etc., have shown to manifest whatever is being seriously entertained by the mind. Mind-body medicine is not some kind of woo-woo or wishful thinking, it is true science, as the following research further confirms.

Would you believe that just looking at the photograph of a romantic partner is enough to significantly dull pain, in the same way that paracetamol or narcotics, such as cocaine, can? Well, a research study by Stanford University published discovered just that.

In the study, which was published in the journal PLoS ONE in October 13, 2010, (doi:10.1371), researchers took MRI scans of the brains of love-struck students who were asked to focus on photographs of partners while varying levels of heat pain were applied to their skin. On average, the pain reduction was reduced between 36 and 44 percent, according to neuroscientist Jarred Younger. Pain drugs don’t perform much better than that.

According to a report in the September 2006 issue of the Hospitalist, “many patients will only experience a 30%-50% reduction in pain relief.” Besides, pharmaceutical painkillers can have side-effects, including nausea, dizziness, somnolence, constipation, dry mouth, increased sweating, liver failure and death. In other words, you don’t have to rely on drugs to get good pain relief.

In yet another study, published in the journal Psychological Science in November 2009, psychologists from the University of California Los Angeles studied 25 women and their boyfriends for a period of six months, subjecting them to different levels of pain.

While experiencing the pain, the women were told to either hold their boyfriend's hand or the hand of a male stranger, both of whom were hidden behind a curtain. The women experienced significantly less pain while holding their partner's or a stranger’s hand.

When asked to view a photograph of their boyfriend, or a picture of a male stranger while being subjected to discomfort, the women experienced at least the same pain reduction. In fact, the relief was even greater when a stranger was involved. This means that pain relief doesn’t necessarily involve love-induced analgesia. The feeling of closeness or security that the women expected to receive from looking at their lover’s picture, or touching someone’s hand, is all that’s needed for the brain to send out the necessary opiates that bring on the relief.

These studies are invaluable in that they show how healing is closely connected to how we feel. We are not robots. To heal from a cancer, we require the support, encouragement, and assurance from the world around us, so that we can generate the kind of (positive) expectations necessary for the healing to occur. A negative diagnosis or prognosis, threatening a person with “if you don’t take this medicine you will die,” or making him feel that he is a helpless victim of a terrible disease, won’t help but may actually be responsible for his declining health or ultimate demise.

Many pharmaceuticals only work because people expect them to work, not because they have any significant biochemical effect on the body. Without the belief of receiving a substantive benefit, the brain will simply block the medication from doing its job.
As we have seen in the first study, giving a person a painkiller while telling him it’s not a painkiller, proved to be completely worthless. Mind power either overrides the potential benefit of the drug, or it triggers the same biochemical responses the drug is designed to produce. In other words, the mind tells the brain whether or not to initiate the biochemical responses necessary for healing to take place.

We know from brain research that all healing in the body is regulated by the brain. This has repeatedly been confirmed by many studies, including those on antidepressant drugs, which have consistently failed to outperform the placebo. What’s so encouraging about all this is that we are in charge of our brain. The brain carries out our instructions in the form of beliefs and expectations, positive and negative, conscious and subconscious. In one expression, we are what we believe. So, perhaps, it’s now time to change the way we think about the power we have over our own healing ability.