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The ecology unit in the diagnosis and treatment of allergies: the placebo effect THE ECOLOGY UNIT IN THE DIAGNOSIS AND TREATMENT OF ALLERGIES: THE PLACEBO EFFECT
This is all well and good, says the conventional skeptic, but the so-called results of the Ecology Unit, and of clinical ecology, are actually based on suggestion. This is the so-called placebo effect (from the Latin "I will please") in which a totally inert "sugar pill" sometimes has curative properties. In the case of clinical ecology the patient wants to get well to such an extent, we are told, that he accepts the physician's idea that wheat, pork, or some other substance is the source of his illness.
Such arguments are sometimes heard from critics of this new approach, although never yet from a physician who has closely observed our methods nor from a patient who has been treated in the unit. The door of the Ecology Unit is always open to qualified professionals who wish to investigate our methods first-hand.
The impression of those who have studied the response of patients in our clinic is usually the opposite of those who speculate about the "placebo effect": patients are in fact more likely to respond negatively to suggestions that their illness is caused by some common food. Remember, these are not only frequently eaten foods we are talking about, staples in the diet, but more often than not favorite foods, which may be eaten in an addictive manner. Patients do not ordinarily encourage doctors to tell them to give up cherished pleasures. Nor do they usually enjoy a new interpretation of their illness which may impinge on their freedom.
The discovery of a food addiction can be unpleasant, for it may mean preparing unaccustomed meals, as well as the chance of social awkwardness. Anyone who thinks patients are easily persuaded to give up their favorite food addictants should try to separate a wheat-a-holic from his bowl of pasta or daily portion of bread.
Similarly, a diagnosis of chemical susceptibility is rarely greeted with enthusiasm by patients. It entails serious changes in lifestyle. Few patients look forward to the opportunity of changing or moving their heating systems, for instance. Their tendency is to deny the problem, not to embrace it as one does a placebo. Once a correct diagnosis is made, however, and the patient sees some improvement in his life, he will then often enthusiastically—and rationally—embrace the new regimen.
There is additional evidence that the reactions which patients have to food and chemicals during our testing program are not based on suggestion: blind tests have been performed sufficiently often to prove that such reactions are not dependent on foreknowledge on the part of the patient. Some of the most dramatic of these tests have been recorded on film and shown repeatedly at medical conferences.
Patients have also been given sham feedings through a tube of foods to which they were not allergic or of no food at all, while being told that they were receiving a food to which they were allergic. I have never elicited what appeared to be a psychological reaction from such patients. Invariably, they do not react under such circumstances, no matter how they have been primed with suggestion. In one case, discussed at length earlier, I let a beet-sensitive patient glimpse some red juice on a dish after she was given a tube feeding. The dish was then quickly whisked out of her sight and hidden. She failed to react to the feeding, however. When asked if she thought that the feeding had been beets she admitted that she had seen the red juice left in the pan. The juice was actually from a pomegranate and had been deliberately placed in the bowl in an attempt to trigger a psychological reaction.
Other patients have accidentally and unknowingly eaten food to which they were known to be allergic. In these cases, they suffered the same kind of reaction as during a deliberate feeding, although they would have to retrace their steps to discover the cause. Joan Kowan, the student nurse with the headache problem, suffered such an attack after accidentally eating some butter.
Another case was a physician who suffered from diarrhea whenever he ate milk or milk products. One day he went into a diner and ordered a hamburger and then suffered a reaction. He returned to the diner when he was better, sat himself at the counter, and watched the chef prepare another hamburger. The burger itself contained no milk products, but it was cooked on a griddle still sizzling with butter from the previous order. Even this small amount of a milk product was enough to cause a reaction in him.
Many patients have had similar reactions to coffee, pork, corn, or other foods. Environmental pollutants can unknowingly create symptoms in the same way. Ellen Sanders suffered irregular heartbeats (cardiac arrhythmia) after pesticide was drawn into her apartment by an air conditioner. She became deathly ill, but it was not until she was taken to the hospital that it was discovered that these pesticides had been released, in massive quantities, in her vicinity.
It is easy to theorize about psychological effects and placebo reactions. In the Ecology Unit our primary responsibility is in healing the patient, not in performing double blind tests, for which we have neither the facilities nor the funding. It is possible that psychological factors play some unknown role in all healing processes. Innumerable facts, however, show that the chronic ailments of patients usually have real causes in the material world, many of which can be unmasked through the methods of clinical ecology.
To summarize, it may be said that the technique of comprehensive environmental control in an isolated hospital unit set up for this task has filled a useful purpose. It is especially helpful for advanced complicated cases in which efforts at outpatient management have failed.
There tends to be a deteriorating continuum in advanced and complicated instances of environmentally related illness which sometimes is difficult to change on the basis of office or outpatient management. This downhill course may often, but not always, be reversed by the application of more detailed observations favored by this approach. It is especially useful in instances where home and work exposures are suspected of maintaining chronic illnesses. Once such chronic manifestations have been reversed, the clinical effects of trial reexposures— either in the hospital or upon returning to home or work conditions—often induce acute convincing test effects.
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