GPs in Ireland used to give people a bottle of medicine. It was pink or it was blue, and if one didn’t work you tried the other one. Then, as now, most ailments got better with or without medication.
Many people in Ireland, until at least the mid 20th century, believed that their health and wellbeing, as well as that of their animals, were routinely threatened by envious and ill-intentioned neighbours, witches and fairies.
Biddy Early, the famous wise woman of Clare who is said to have died in 1874, reputedly had a magical power to cure illnesses and ailments.
Stories collected by Lady Gregory say Biddy Early had a magic bottle – in the same vein as a crystal ball – which she used to communicate with the fairies and to heal people. People came to her and told them her problems. She listened.
Along with another healer, Moll Anthony of Kildare – who was such an outcast the priest is said to refused her a Christian burial – both of these women gave out bottles containing some kind of unspecified liquid which people were told to drink. Exactly what was in these bottles, nobody is sure.
Today, the work of herbalists is subject to far more scrutiny, and their patients are less likely to be fobbed off with a vague promise they will get better. Now, they want to know what’s in the bottle.
"Ireland has a rich ethno-medical knowledge and a history of traditional healing, but it is not as culturally embedded as in other countries like France, Germany and Austria," says Helen Sheridan, professor of pharmacology at Trinity College.
Dr Ronnie Moore, a lecturer in sociology and a lecturer in public health medicine and epidemiology at UCD, is a critic of the power of modern biomedicine and takes a different perspective.
“The herbs or minerals are all props: this is about magic and to belief systems,” he said.
“Magic?” I ask incredulously. “That’s a loaded word.”
“I like to use the word because that is exactly what is at play here,” he says. “Talk of placebo and nocebo if you want, but you’re buying into medical discourse. I introduce my students to placebo by calling it witchcraft, because it does the same thing and has the same functions.”
What’s so wrong about medical discourse? I ask. Hasn’t it greatly expanded the human lifespan, saved hundreds of millions of lives and led to massive improvements in our quality of life?
“Biomedicine tends to see the body as a machine, but to use that approach ignores psychosocial responses – of which there are many – to healing,” says Moore.
"Which has done more harm: herbs or biomedicine? [The disgraced obstetrician] Michael Neary needlessly removed 129 women's wombs; the drug Thalidomide led to birth defects; and people have died on drug trials."
When Moore started to write a book on the topic, he realised that his ideas would be controversial and decided that he needed to work with other academics.
But there’s increasing evidence that this “magic”, to use Moore’s term, might actually work, and it seems to be due to one of the most misunderstood concepts in modern healthcare: the placebo effect.
Helen Sheridan, associate professor at the School of Pharmacy and Pharmaceutical Sciences in Trinity College Dublin and an advisor to the subcommitte on herbal medicines with the Health Products Regulatory Authority, says placebo applies to people when they may be some element of the immune system brought into play, that is controlled by the mind.
In her recent book Cure, the author Jo Marchant lays bare a catalogue of studies showing that the placebo effect is deeply complex and so much more than just a curious trick of the mind where we believe we are better.
Marchant tells of Ted Kaputchuk, who trained and worked as a traditional Chinese herbalist and acupuncturist for many years before becoming professor of medicine and professor of global health and social medicine at Harvard Medical School. While practicing as a herbalist, he watched people visibly improve before they had even left his office, but he became uncomfortable with the idea that it was the herbs at work.
Placebo effect
In a more recent experiment, Kaputchuk teamed up with his colleague, Dr Anthony Lembo, a gastroenterologist. In a trial of 80 patients with long-term irritable bowel syndrome, half were given a placebo and told it was a placebo but it might help with self-healing, and they still did better than those who got no treatment. A study of 20 women with depression showed up similar results, while a study on migraine patients found that those who knew they were taking a placebo still felt 30 per cent less pain than those receiving no treatment.
Evidence is mounting for the placebo effect. The mere belief we are being looked after, with medicine and care from nurses or loved ones, can help to ease symptoms, boost the immune system and even prevent us from getting sick in the first place.
Studies conducted by Jon Levine, a neuroscientist at the University of California in Los Angeles, have shown that our brains can release endorphins - "the happy drug" but also a natural painkiller – which is part of the opiate family of chemicals that includes heroin and morphine – when we take placebo. Our mind doesn't just influence our health, it is inextricably linked with it.
But Marchant also shows that the placebo effect – or call it “a belief in the infinite healing power of the universe” over modern medicine, or whatever else you want to – won’t cure many illnesses, including diabetes, asthma and cancer. Nor will it lower your blood pressure. So it’s not the panacea either.
Herbalists have tended to emphasise the importance of good digestion and gut health, exposing themselves to the claim that they’re similar to reflexologists who say that different parts of the hands or feet correspond to different parts of the body and that ailments can be cured by stimulating them.
Unlike reflexologists, however, there’s at least some solid evidence to support them.
Earlier this year, researchers at University College Cork found that the microbes in our gut influence how our nerves work.
We already know that bowel disorders, the immune system and obesity are influenced by the microbiome (the 1kg+ of bacteria and other organisms living in our gut) and now there is evidence that it can influence stress, anxiety and depression.
Professor John Cryan, head of the Department of Anatomy and Neuroscience at UCC, told this newspaper's science editor, Dick Ahlstrom, that our brains have developed with signals from the microbes all the time.
Irving Kirsch, a lecturer in medicine at Harvard University, has produced a body of research showing that the effect of pharmaceutical drugs used for depression had little more effect than placebo.
Kirsch put in a freedom of information request to the US Food and Drug Administration on clinical trials of antidepressants.
The response suggested what pharmaceutical firms had not been telling us: with the exception of severe cases, most antidepressants (such as Prozac) performed little or no better than an inert sugar pill placebo.
His research has been criticised on the basis of flaws in those trials and the difficulties in measuring improvements in depression.
But between the placebo effect and the influence of the microbiome on our body and mind, could the herbalists be onto something?
Research in the National Folklore Collection shows many herbal remedies were accompanied by some kind of ritual: usually a chant, prayer, incantation, or sometimes a symbolic rite such as passing a sick person three times around a bush or animal.
People get better, says anthropologist Dan Moerman of the University of Michigan, because of the meaning that is attached to the treatment, whether that's from a medical doctor or a traditional herbalist.
A range of researchers suggest that how we take our pills is important and they work better if there’s a little ritual around them: take them with a prayer or meditation, before bath time or get someone else to give them to you which will help you feel more cared for.
Bethann Roche is one of the founders of the Irish Medical Anthropology Network, and her own background is in anthropology and medicine.
She has spent most of her working life as a public health doctor in Ireland and many years examining the phenomenon of faith healing. She says anthropology has a contribution to make to health – and she emphasises the word health as distinct from medicine.
Regarding magic she say: “it is helpful to look at this in total context rather than blaming health professionals for being too narrow-minded or patients for being too superstitious”.
Isn’t placebo just a polite way of saying “it’s all in your head” I ask Dr Dilis Clare, a GP and practicing herbalist based in Galway.
She laughs heartily. “And isn’t that a wonderful place to be? Your healing is all in your head. That is fantastic.”
I grimace and prevaricate. Well, I say, the implication is that you were imagining it all along.
The smile falls from her face.
“So?” she asks. “If imagination is so powerful that it can stop coals burning feet, why would it not be strong enough to either give you IBS or be a part of it?”
If you have an abnormal microbiome it produces hormones which are like small protein molecules going straight to the brain, easily absorbed across the gut barrier and blood brain barrier.
“Which came first, the illness or the imagination, the chicken of the egg? Does it matter?”
