Placebo Effect Studies, Sham Surgery, and More: Our Interview with Dr. Wayne Jonas

Dr. Wayne Jonas has been a family physician for over 40 years, and spent a quarter century working as a doctor in the army. Given that, it might seem surprising that he’s also a prominent pioneer of integrative medicine, Executive Director of the Samueli Integrative Health Programs, and one of the foremost experts on the mind’s role in healing. But in our interview with Dr. Jonas, he explained why holistic health and the military are actually perfectly suited for one another. He also shared eye-opening insights on sham surgery, placebo effect studies, the economic drivers of medicine, and more.
*The above is a short clip from our interview with Dr. Jonas. Click here to watch the whole thing.*

The Role of Integrative Medicine in the Military and Veterans Affairs

Dr. Jonas always knew he would go into the military. After all, his dad, grandfather, and great grandfather had all enlisted. However, what he didn’t expect was that he would spend so much time —more than two decades — working as a Lieutenant Colonel in the Medical Corps of the U.S. Army. He’d always assumed he would serve his time and then leave. 
What kept Dr. Jonas around for so long was the fact that, in the army, he saw medical approaches he’d never seen before. Specifically, he encountered integrative medicine, things like health promotion (rather than disease treatment), research into acupuncture, mind-body practices, electromagnetic devices, and non-drug approaches.  “I realized it was a very rich environment, so I stayed for 24 years,” he says.
Dr. Jonas acknowledges that it might seem strange that holistic care and the military would go together, that there might, at first glance, be no connection there. But in his experience, this couldn’t be further from the truth. “The military is a great opportunity to take care of the whole person, because they’re interested in their mission, in prevention, in keeping people healthy,” he says. “Also, they don’t have to worry about health insurance and whether they can cover it.”
All of these factors meant that Dr. Jonas was free to truly focus on the patient, to pay attention to what each one needed. He was able to broaden the lens of his medical approach, taking into account mind, body, and spirit to help them achieve optimal health. “The military was very open to that, so it allowed me to explore this area,” he says. 
The importance of a holistic approach to medicine was brought to the forefront when the endless Iraq and Afghanistan wars were launched. People started coming back from deployment with PTSD, traumatic brain injuries, and chronic pain issues, and it quickly became clear that the conventional approach was not sufficient. “Simply throwing pills and procedures at this was not going to solve the problem,” says Dr. Jonas. “These were much more complex issues, and they needed a more holistic view.”
At that point, the Veterans Administration (where people with these afflictions were treated) got involved, and began trying to figure out what worked and what didn’t. They did research into things like acupuncture, mind-body practices, and yoga for pain, PTSD, trauma, and even brain injuries. And when they found evidence that these practices were effective, they would adopt programs that utilized them. “They said, ‘you know, if it works, we want it,’” says Dr. Jonas.
Today, there’s a new program in the VA called Whole Health, which goes even one step further, focusing on preventative self-care rather than treating health issues. “Self-care is such an important element if we’re going to turn the tide of chronic diseases, if we’re going to lower costs and improve outcomes,” says Dr. Jonas. This means focusing on things like nutrition, sleep, stress, exercise, and other lifestyle factors.
As more evidence mounts pointing to the importance of these things, they’re becoming routine in the daily care veterans receive — a major change from the way Dr. Jonas was trained. He notes that acute care is still essential for saving a life, but that people are finally realizing that more is necessary for preventing and reversing chronic disease. “It took over a hundred years to figure that out, and now here we go,” Dr. Jonas says. 

Placebo Effect Studies and the “Meaning Response”

In the research and practice Dr. Jonas has done over the years, he encountered a variety of different health care practices with very different approaches and modalities, that all seemed to be having significant benefits. Some were science-based, some weren’t science-based, but all claimed to have healing powers. “I was thinking, ‘Well, how could that be?’” he says. 
So he looked deeper into the science of the various practices, and realized that they all had one thing in common. They were all optimizing various mechanisms — belief, ritual, conditioning, and more — to tap into the body’s innate power to heal. He also realized that, up to this point, all of that had been glossed over by the term “placebo effect.” 
Dr. Jonas explains that while the placebo effect is generally dismissed as not being “real,” it was where 50-80% of the healing was coming from in these different modalities. This dissonance compelled him to dive into placebo effect studies to figure out what was really going on. Maybe it wasn’t a placebo — maybe it was, as he describes it, “the very core of what most of these systems use to induce healing, including our conventional system.”
To help combat the dismissive response the term “placebo effect” often evokes, Dr. Jonas came up with his own term: the meaning response. He calls it that because what this approach does is arrange the context and meaning of care in such a way that it taps into our own inherent healing capacity. By tapping into that powerful resource, people experience tremendous benefits regardless of what actual modality is being used, whether it’s a drug, surgery, an herb, a practice, or something else.
“The placebo effect is the sleeping elephant in healthcare,” says Dr. Jonas. “When we wake up to it and begin to use it, rather than discard it, it’s going to enhance our ability to address chronic illness in health care.”

A Twist to the Conventional Wisdom of Placebo Effect Studies

In Dr. Jonas’s work, he helped launch the Society for Interdisciplinary Placebo Studies, which conducts placebo effect studies and research to learn more about this phenomenon. In one particular area of research, they discovered something that turned the mainstream understanding of the placebo effect on its head.
Traditionally, people in placebo effect studies can’t know they’re in the placebo group. The thinking goes that they must believe they’re taking “real” medicine, that if they knew they were in the placebo group it would interfere with their belief, which would block the ability of the placebo effect to heal. “We know now that’s completely wrong,” says Dr. Jonas. 
He explains that there have been extensive placebo effect studies that use an “open placebo” approach. This means they tell the patient that they will be getting an inert substance. But they also tell the patient that if they go through the healing ritual and engage in the therapy (no matter what it is, and even though it’s not “real”), evidence shows that they will get better. 
In these open placebo effect studies, patients experienced just as many benefits as patients in traditional blind placebo effect studies. Bonus? Doctors don’t have to navigate the ethically murky ground of misleading patients. 
“You can say, ‘This is what I’m doing. Let’s go on this healing journey together and let’s go through it and you’ll get better,’ because a lot of what happens is unconscious,” says Dr. Jonas. “A lot is actually social and emotional changes, the belief of the provider, the practitioner, the culture that you live in.” 

How Sham Surgery Creates Real Healing

In the conventional medical system, aggressive approaches like surgery and medication are the norm, even though 50-60% of people who benefit from them experience side effects. The reason for the prevalence of these approaches, despite their downsides, is a simple and disheartening one: insurance covers them, because they’ve been proven to have some sort of benefit, even if that benefit doesn’t apply to everyone and comes with some serious side effects.
But according to Dr. Jonas, in many cases, even in some cases where surgery appeared to help, surgery isn’t necessary. He cites back surgery as an example: over $40 billion worth of surgery is done for back pain, and yet 80-85% of people whose pain is improved by these surgeries have conditions that wouldn’t benefit from surgery. Though this might seem contradictory, Dr. Jonas says that something called “sham surgery” explains how this is possible. 
Sham surgery is, as the name suggests, a fake surgical procedure. In other words, somebody undergoes all the other elements associated with the surgery (anesthesia, operating room, recovery, etc), but the actual surgical intervention isn’t performed. Using sham surgery as a tool, researchers are able to determine how much of the benefit that people get from surgery is due to the procedure itself, and how much simply comes from the ritual of care associated with it.  
Dr. Jonas looked at various studies on sham surgery for back pain, and found that there was no difference in benefits between those who had undergone real surgery and those who’d had sham surgery. People in both groups improved at about the same rate. The only variation? Those in the real surgery group had more side effects. 
“So that’s an example of having something that actually hurts people more than it helps them,” Dr. Jonas explains. “Yet, there’s a huge industry doing back surgery and so, the economics drives it rather than the evidence.”

Conclusion: Takeaways from Dr. Jonas on Holistic Healing

After 40 years as a practicing family physician and prolific researcher into holistic and integrative approaches to health, Dr. Jonas has incredible insights into not only how healing works, which he detailed in his book by the same title, but also the drivers behind our healthcare system. Here are the main takeaways to remember:
  • Surprisingly, the U.S. Military is actually a perfect environment for exploring holistic and integrative health practices. This is because they have a vested interest in not just treating disease but also keeping people healthy, and because insurance coverage isn’t an issue.
  • Many different, effective approaches to healing have been all lumped together under the umbrella term “placebo effect” and dismissed. Dr. Jonas suggests that we adopt the term “meaning response” instead, which gives more credit to this powerful phenomenon.
  • What the placebo effect does is create a treatment environment that taps into our body’s innate power to heal. This, in many cases, is more powerful than a “real” intervention.
  • Placebo effect studies show, surprisingly, that people can know they’re receiving a placebo and still experience the benefits of the placebo effect. This is because the important part is the ritual, context, and overall healing environment — this is what triggers our inherent healing response, not a false belief.
  • Surgeries are massively overprescribed in our conventional medicine system. Studies on sham surgery show that, even when people appeared to benefit from surgery, it wasn’t the surgical intervention that actually caused their healing. Just going through the ritual of surgery, without the actual procedure, triggered the same benefits.
  • We can tap into our own inherent healing abilities by prioritizing self-care and creating health-promoting environments in our own lives. This means not only good nutrition, exercise, and proper sleep, but also strong social support and a sense of purpose. 
  • If you’re looking for a practitioner like Dr. Jonas who can help you find a holistic health solution to an issue, schedule a 1:1 call with Adrienne. She can serve as your patient advocate and do the heavy lifting on finding the right person.
Watch our full interview with Dr. Jonas to learn about a promising new approach to medical science called “Whole Systems Research,” the fundamental things every human needs in order to be healthy, the first question he asks every patient he sees, how you can tap into your inherent healing capacity, the three common aspects of all healing, and much more. 
Have you had an experience with the placebo effect? Share it with us in the comments below!

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