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Hidden Treasures

#crohns #ibdvisible #inflammatory bowel disease Jun 24, 2021

One of my favorite pacific northwest summer activities is beachcombing with my children.  We collect treasures- sea glass, heart-shaped rocks, unique shells.  Yesterday on the beach, my 6 year old was frustrated that his treasures were not accumulating as quickly as mine.  “What is your trick?” he asked me.  I explained to him that I practiced scanning with my eyes for the shiny objects.  I noticed how much focus it required, but how rewarding it was to find my tiny treasures.

Beachcombing reminded me of another skill that I have been cultivating in my life- scanning for the positives, the small wins in my days.  Sometimes it can be so easy for our brains to see only the grays of the sand and the rocks- the areas where we still struggle, the obstacles, the what ifs -- that it can be hard to track our progress or bask in the glory of what is truly working well.  I am training myself to spend more time showing my brain the treasures in my life, even during times when they take extra effort to find. 

 

What treasures in your life can you notice today?

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The Power of Belief in IBD

In my medical specialty treating inflammatory bowel disease, the placebo effect has been a thorn in the side of doctors.  I have called it the placebo “problem.”

In a clinical trial, when we are testing a new medication to see if it will be effective, we compare it to a “placebo” or fake medication (sometimes referred to as a “sugar pill”).    The placebo effect occurs when patients receiving the placebo experience a benefit.   

My colleagues and I look at the data published in clinical trials and see the clear improvement in patients getting both real drug and placebo as a problem.  It makes it hard to interpret their results  if many patients are getting better when they are not receiving the real drug.  In trials for inflammatory bowel disease, placebo rates for symptom response have historically been between 20-40%.  While accounting for the placebo effect is critical to know whether a drug is truly effective, I was ignoring an equally exciting and important part of what these studies show.  

Over the past few years, I have begun to look at the placebo response with curiosity and excitement.  If patients with Crohn’s disease and ulcerative colitis can objectively feel better by just believing that this is possible, than why are we not harnessing the power of the mind more and learning to do it better?  We may not even have to “trick” ourselves into believing we are getting a real medication.  Studies have shown that even when people know they are getting a placebo, they may still experience improvement in symptoms. 

While there is clearly a very strong mind-body connection in IBD, I think we have to be careful when we recommend harnessing the power of the mind to manage disease.  The placebo response as it relates to symptoms is high, but is much lower when we look at more objective markers of inflammation such as blood inflammatory markers (CRP, ESR), stool inflammatory markers (calprotectin) and healing of the tissues seen on colonoscopy.  Doctors, including myself, become concerned that patients will take this to mean that they should work on mindset instead of taking traditional medications.  We worry that our patients might then suffer long-term complications of undertreating their disease.  A better approach is to capture as much benefit as possible using the right medications and the right mindset tools.  

In medicine, we often tell patients that they are likely to have a 10-15% response rate to a certain drug.  That is what we call the delta- or difference- between the response of the patients who received drug and those who received placebo in a clinical trial.  So, for instance, if 20% of subjects receiving placebo responded to a medication and 35% responded to a drug, the drug’s overall efficacy (the difference) is 15%.  When I quote these rates of response with medications, my patients often become discouraged at the low likelihood that they will get better.  They may not even want to take a chance on a medication that might really work for them.  However, when we combine the medication and placebo response, things look much better. The full effect is 35%, not 15%.

So what if I told you that there was something you could do that would make your current medicines twice as effective at reducing your symptoms?  What if I also told you it had no traditional medication side effects (unless you count better relationships, increased productivity and less pain)? 

I think of the addition of the placebo response to traditional therapy as a starting place.  There are then ways that we can train the brain to be even more efficient.   Coaching and mindset tools are designed to help us work on believing that getting better is not only possible but inevitable.  Then out of that place of determination, we take the actions we need to help the body heal.

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