Health: a three-legged stool

The best way to understand health and well-being is to use a metaphor. We equate it to a three-legged stool -- one leg of drugs, or pharmaceuticals, a second leg of surgery and procedure, and a third leg of self-care. Unfortunately most of our medicine, health and well-being are viewed today as needing only the first two legs - drugs, surgery and procedures. However, 60 to 90 percent are in the mind/body stress-related realm where the drugs and surgery don't work. We need a self-care leg. In that self-care leg we have the relaxation response, nutrition, exercise, stress management and the patient's belief system. When we bring that third leg in, we have truly balanced our approach. It's a much more healthy, complete and effective medicine.

This seems like such common sense, the three-legged stool. So why is it just being recognized? About 150 years ago all we had was a belief system. Then it was the placebo effect -- we had no medicine, no surgery. Then we had spectacular success over the last 150 years with anti-tetanus toxin, the vitamins, insulin, antibiotics, surgeries that are miraculous by biblical standards, etc. Our surgeons are curing blindness on an assembly line basis with cataract operations. This awesome medicine led to arrogance -- we don't need mind/body. We don't need self-care. We can take care of it all. As awesome as these medicines and surgery are, they only treat 10 to 40 percent of cases. We need to balance the self-care aspect of things and weave it into medicine. What prevented that from happening sooner was a lack of scientific base to this self-care. Over the last 30 years or so scientists have brought in a scientific basis for mind/body interactions, the relaxation response, for a belief system. Now it can be on an equal basis woven together with pharmaceuticals and surgery.

There is a very rich legacy of research on how powerful belief is in healing processes. We've ignored it, however. We have tested new medicine against placebos, sugar pills and inert substances. If the new medicine was no better than the placebo, both were thrown out -- never asking the question, "Why is it that the placebo works at all?" So when you go back into the medical literature for studies studying drugs for a number of disorders -- angina pectoris, asthma, duodenal ulcers, skin rashes, all forms of pain, rheumatoid arthritis -- the placebos were used. They were effective in 50 to 90 percent of cases. We never asked the question, "What's going on here?" We simply threw them both out because the new drug was no better than placebo. So you see we have a very rich literature in terms of showing us that the placebo effect works in a number of diseases. We just didn't pay attention. What's happening now is we're getting to a point where we can begin to explain how belief in a drug, how belief in self can work. That gets us into a whole host of new neurobiological research.