This is an incredible subject. It is one where there will be no conclusive
answer or philosophy that every one can get a handle on.

Recent postings have alluded to practitioners attempting to make use of
belief as a basis for treatment. This is a technique as old as man kind.
Some respondents have rubbished this type of approach and stated that the
practitioner should be basing their approach on evidence (best available).
Others advocate the 'if it works use it (as long as it is not dangerous) and
wait for evidence base confirmation'. I could go on.

However surely whether the approach works or not is subject to so many
variables it makes one's head hurt. As a physiotherapist trained in the
90's in England, I have a very evidence based approach to treatment. I am
also very skeptical and challenge both myself and others. It is hard for me
to accept other ways of treating because it does not feel right in my head
when I think about how they could possibly work. For example I listened to
a Cranial-Sacral talk several years ago. I think part of my doubt was based
on the very defensive style of presentation by the lecturer but she really
lost me when she described some treatments which involved no hands on
mobilisation of the cranial bones (indeed if such a thing is possible) but
that the therapist channeled her thoughts to treat the patient.

As some of you may also think, 'what a con, what nonsense!' However this
lady had a thriving practice of many years and must have (I do not actually
know) a reasonable reputation to be able to survive.

Ah ha! I hear some of you shout, she is an excellent sales woman and is very
convincing. I wonder what her long term results were and did people have
less pain and/or more function. It is possible that they did. May be that
is worth the cash? Personally I would not opt for that approach either as a
therapist or a patient, because I do not believe in it.

I have begun training in acupuncture for pain relief. The best evidence
available would suggest that it may be a useful treatment type. It has been
used over Millennia and I believe in it. However I have also listened to
overviews on the entire scope of Traditional Chinese Medicine. I understand
(or think I do)/believe in some aspects but the concepts behind acupuncture
and other modalities (the energy lines, 'trapped wind', tongue diagnosis)
return me to a non-believer (kill the heretic!). However are millions of
people in countries who utilise such methods suffering because they have no
evidence to back these approaches up? Different living conditions,
education, affluence, diet, environmental pollutants and culture differences
make it difficult to compare one countries long term health to anothers, but
they obviously believe in the treatments available.

Which approach is right or wrong? I can't answer that. However it is
significant that the overall placebo effect (a physical response to a non
intervention based on belief) in trials is 43% (Information provided by
Nigel Lawes at Queens Square, London). An interesting trial on Cimetidine,
a histamine antagonist, for duodenal ulcer treatment sheds some light on the
complex belief process. This drug has been found to be 75% effective in
reducing the lesion, on endoscopic measurement, without other advice, such
as stress reduction. The trials were carried out in many countries on
thousands of patients. The studies were placebo matched double blinded with
randomised groups. The subjects received either the drug or a placebo. No
life style advice was given. The lesions were measured with endoscopy. In
the States the placebo effect, i.e.. a good result (partial or complete
resolution of the lesion) was 41%, in Germany it was 63% and in Denmark it
was 13%.

Does this mean German doctors are very convincing, Danes are non-believers,
Germans are more robust and heal quicker, Danes drink too much Elephant
beer? One thing it does show is that if the research was only carried out
in Germany then the drug may never have been developed.

If some one successfully treats a person using such belief then maybe they
are being evidence based! The evidence involving some techniques is less
obvious and convincing but as it fits in with the cultural and professional
milieu then it is acceptable (much more 'value for money'!?).

As I have stated I am (or like to think) evidence based and self/peer
analyse my practice. But I hope I keep an open mind even if I shall not be
signing up to take my Cranial -Sacral exams (I am not saying it does not
work but that I do not believe, a belief based on my nurture as a person and
as a practitioner no matter how open minded I feel I am).

Joining the Shaman's group sounds like a good idea, especially if they have
some of those hallucinogenic plants to chew, it did not seem to do john
Humphreys any harm.

Simon


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