Episode 4 – Empathy and the Placebo Effect with Dr. David Hamiltion

Dr. David Hamilton holds a PhD in organic chemistry and has been designing and developing drugs for many years with large pharmaceutical companies. What is the Placebo Effect? How do our emotions physically change our bodies? And how does empathy from a doctor to a patient affect that patient’s response to them? When someone believes or expects something, a chemical change in the brain occurs which brings about that which they are expecting to happen.

Watch the Video

Transcript

Jan Bonhoeffer:
Welcome to heart-based medicine Inspirations. Today we have a very special guest, Dr. David Hamilton. He’s holding a PhD in organic chemistry and has been designing and developing drugs for many years with large pharmaceutical companies. Oh, what a joy to meet you.

David:
You too. I’ve heard so many nice things about you.

Jan Bonhoeffer:
Thank you for taking the time. I know you’re very busy.

David:
It’s my pleasure. It’s good just to be able to chat with you.

Jan Bonhoeffer:
Yeah, it’s wonderful. So, David, you’re a scientist, you’re a PhD in organic chemistry. And you’ve been working the pharmaceutical industry and drug design and development. And one of the things that struck me a lot about the messages that you’re sending out is that the more you were into development of small molecules, at some point you realize, “What about that other part, and why is it so hard to get these trials … to get the human effect out of the equation? And to really get kind of crystallized the molecular effect. And then to see what the impact is on the non- intervention side of the arm.”

Jan Bonhoeffer:
So I was really intrigued in this, as this is something I’ve been struggling with [metalogically 00:02:46] a lot. In observational studies and in clinical trials. And only much later it hit me like God, if this is do difficult to get rid of this effect, why are we not embracing it more actively? And why did I never hear anything in medical school?

David:
I know. I often wondered about why we’re not embracing it. And I think people are not traditionally taught … I play tennis. I live in a small town that’s very famous for tennis. It’s the town that Andy Murray, the former world number one tennis player grew up in, so tennis is a big thing here. And I play tennis with a couple of doctors, and I also have a lot of my family working in National Health Service in the UK.

David:
And you start to realize that no one’s ever really been trained in harnessing the understanding of the placebo effect. My former family member, who used to be married to someone in my family, in a consultant in a big hospital, and having gone through five years of medical school and another five years to be a consultant, “I’d only ever got 30 minutes of an elective class in the placebo effect. And it wasn’t how to understand it and use it for the benefit. It was the ethical considerations around prescribing it.”

David:
And I thought, “Ten years of education and you get 30 minutes, which you don’t even have to attend?” And I thought, “I think it’s time for a shift.” And I think the shift’s happening because there’s so much good reception that shows that when you believe or you expect something … for example, you get a placebo for pain, and you expect it to work. Or you believe that this is a pain killer. And you brain produces its own morphine. Endogenous opiates in the brain’s natural versions.

David:
So when I worked in the pharmaceutical industry it was a company called AstraZeneca. And my colleagues at the time would often dismiss the placebo effect with one of two things. “It’s just the placebo effect,” with a sweeping movement of the hand. Or, “They’re not really getting better. They just think they’re getting better.” But now we know from neuroscience research that that isn’t true at all.

David:
In actual fact, when someone believes or expects something, that there’s a chemical change in the brain which brings about that which they’re expecting to happen. It’s a real physical effect in the brain that’s causing the physical change in the person’s symptoms. So there is something. So that quality of research, I think, is beginning to waking up the mainstream to the whole idea of the mind, body connection.

Jan Bonhoeffer:
Yeah. It’s just amazing. When I hear you talk about this … and now again it just resonates so well. It seems to me this is one of the key pieces that really need to change in, if you like, in the next generation of health care providers and their education. Is how can we actually bring the effect of the health care provider back into the equation.

David:
Yeah. One of the things I’ve talked a lot about, and I gave this lecture actually to a big hospital, an NHS hospital in the UK, and it was about we know so much about stress. And if you think of when a person feels stressed, it’s the feelings of stress that generate the stress hormones, the cortisol and the adrenaline. It’s not the situation itself. Outside of real, severe difficult situations, most of the time it’s not the situation itself, it’s how you feel about it. It’s your response to it.

David:
But that feeling of stress then generates stress hormones. And what people don’t realize is if you think, “What is the opposite of stress?” Most people will say, “Oh, it’s peace. Or it’s calm. Or it’s relaxation” That’s not the opposite of stress, that’s the absence of stress. The opposite of stress, physiologically speaking, is actually if stress is the feeling we’re talking about, then it’s the feeling associated with being kind. When you be kind, and psychologists now refer to that feeling as elevation. And it’s a broad term that roughly describes that feeling of warmth or connection that you get from being kind, or maybe satisfaction or inspiration.

David:
But there’s a heart-centered, a heart-based feeling, that you get that’s associated with being kind. Now that feeling generates the hormone oxytocin, which as well as being a trust hormone in the brain is also a very potent cardiovascular hormone. And one of the things it does is it lowers blood pressure. So it produces nitric oxide, it dilates the arteries, and it reduces blood pressure.

David:
So it’s called cardioprotective. So therefore any mechanism, any way of producing it, is a cardioprotective behavior. So here you have now, we can say that being kind, because of how that makes you feel, because it makes you feel elevated, being kind, because of how it makes you feel, is cardioprotective. And it’s a real mechanism, there’s a real physical process that occurs, that’s physically affecting the body just through being kind. And I think … I love seeing that kind of research coming in now.

Jan Bonhoeffer:
Yeah. That is … you’re making such an important point, in that I saw quite often, similar to the sweeping placebo dismissal, there is this, “Yeah, yeah, this is psychosomatic.” And so this is a very similar phenomenon. And so I was wondering, there’s such an increasing bulk of evidence around actual direct effects on the body, so not just, “I had a childhood trauma and therefore now I have an issue with some organ.” But because of how my consciousness, how I’m directing consciousness, because of the intentions, because of the way that I’m visualizing, or intending on some level, on the process towards that state of health, rather than a state of disease, how that is not a psychosomatic phenomenon of yeah you need to heal your childhood trauma, but there’s actually a way how the mind can directly govern-

David:
Absolutely.

Jan Bonhoeffer:
… body functions. Down the genetic level.

David:
Yeah, absolutely. And I think when people use that term psychosomatic, it’s often used in a dismissal. It’s just psychosomatic, meaning there’s nothing really there. And I think now that we’re understanding the mind, body connection, we mentioned visualization there. One of my favorite scientific studies was done by a professor at Harvard called Alvaro Pascual-Leone. Very famous neuroscientist. And he got a group of volunteers to play a sequence of five notes on a piano.

David:
So basically with each of the fingers, plunk, plunk, plunk, plunk, plunk, plunk, plunk. But up and down a scale for two hours on and off on five consecutive days. So like on a Monday, Tuesday, Wednesday, Thursday, Friday. And he scanned the brain each day, and he found that the region of the brain connected to the finger muscles grew like a muscle. So by the Friday, it was about 30 to 40 times bigger than it was on the Monday. We now know that overall phenomena, broadly speaking, is called neuroplasticity.

David:
But a separate group of people, instead of playing the psychosocial notes with the fingers, they played them in the mind. So they closed their eyes, put their hands flat on the table, and just imagined that they were playing the notes. And it’s called kinaesthetic imagery. So you imagine what it would feel like to play the notes. So your hands are flat, but you imagine the feelings and the sensations as if you really were playing the notes with your fingers. So as best as you can, you’re imaging how that feels.

David:
They did that for two hours in their imagination, visualizing, on the five days as well. They also had the brain scan done on the Friday, on the fifth day. The same region of their brain connected to the finger muscles had also changed by a factor of 30 to 40 times. And if you put the brain scans side by side, you actually can’t tell the difference between who played the notes with the fingers, and who played the notes with the mind.

Jan Bonhoeffer:
This underpins a lot of what we know from high performance sports, right?

David:
Yeah, yeah. Absolutely. Yeah, yeah. Many sports people use visualization. Do you know, I’m a big tennis fan, as I mentioned, and a few nights ago I watched the Indian Wells final. It’s the Indian Wells Masters 1,200. One of the biggest of the year. And an 18 year old girl called Bianca Andreescu, Canadian girl, won. She’s 18 years old and she beat the best in the world and won this tournament.

David:
And one of the things that everyone was talking about, as she moved from the first round to the second round and third and fourth and the quarter semis and won it, they were all talking about how she opened about the amount of visualization she does. She has a daily practice of at least 15 minutes a day visualizing hitting the ball with perfect strokes. And there’s the testimony to the power of visualization. She’s an 18 year old, came from nowhere in the world, and won one of the biggest tournaments of the year.

Jan Bonhoeffer:
Amazing.

David:
Daily visualization. And she built upon the fact that many sports people use that. The brain scans I showed you really just demonstrate how it works. That when you imagine something the brain processes it as if
you … in other words, brain processes it, it stimulates the same brain circuits as if you really were doing the movement. And because of that that then impacts the actual physical muscles that you’re imagining. So therefore there’s a physical change in muscle performance in the body. So something you’re doing in your mind is having a physical effect on the body. And that’s why it’s so useful for high performance sports.

Jan Bonhoeffer:
It’s just so amazing. And it’s wonderful to see that now this has been in high performance sports for years, but now this has been kind of a trial and error, and it’s been kind of a pursuit that has proven to work well. And now with more technology becoming available, we can actually demonstrate this. This is amazing.

David:
Absolutely. Yeah, yeah.

Jan Bonhoeffer:
[crosstalk 00:14:20] substantiated. One of the things that I struggle with is that … you know this. And you’re teaching meditation classes. And you practice yourself. And when we’re not looking at the brain from the outside, as scientists, but we’re kind of looking at brain activity from the inside, everybody practicing this for just a very short time, very soon, within minutes, everybody, nothing dramatic, nothing extraordinary, everybody will come to the point where there’s nobody there. Kind of there’s nobody … there’s no one there. There’s no point in the brain that kind of says, “I. This is me.”

Jan Bonhoeffer:
So in our … I wonder what you think about this. In our Cartesian way of looking at the brain where we’re saying, “If we cut a monkey’s piece of brain out, and then it doesn’t speak anymore, therefore this is where speech is generated.” So the localized, hierarchical view of the brain. And we know that there’s no kind of coordination central. Or at least no MRI, no brain scan, nobody was able to pinpoint, “This is me. This is the I. This is the master of ceremonies at the integration point.”

Jan Bonhoeffer:
Given that that’s not there, and given that that’s at least a subjective experience as I was looking at the mind from the inside, what does this mean for a healing process?

David:
I thought about this a lot. Because like yourself, I don’t really believe that consciousness, or that which you had originate, is inside the head. So for example, when we look at brain activity when a person is having an experience, what that tells you is what the brain is doing at that time. It doesn’t tell you that that part of the brain produces the conscious subjective experience. It only tells you that that’s what the brain is doing right now.

David:
And I think this is where the impasse is between science and philosophy. And there’s an overlap here. And philosophers are saying that … some philosophers are suggesting perhaps consciousness isn’t inside the head at all. It just feels that way because you’ve had a lifetime of experience saying, “If it do this, I can feel it here.” So therefore we begin to identify with the physical body, so much so that it literally feels like we’re here.

David:
But maybe that’s just because we’ve had a lifetime of experience of identifying with that. Maybe, just maybe, as some philosophers are entertaining, and as many meditation teachers have talked about for millennia really, that perhaps if you take that to it’s logical conclusion, if consciousness is not inside the head then where is it? Well the next logical assumption is everywhere. It just feels like it’s here.

David:
But what does that mean for healing? Well I think that that maybe suggests that we’re capable of far more than we think we are. And perhaps many of the limitations that we experience are not the same limitations that we think they are, but in part, to a degree, related to what our perception of them is. And whether we think such and such a thing is possible. And I say that because as our beliefs shift over time and we begin to believe more and more things are possible, we seem to be able to achieve more and more things.

David:
Now I’m not, for a moment, suggesting that a person can just get rid of a condition, maybe a genetic condition. Maybe in hundreds of years time. I don’t know how far our understanding of consciousness might go. And I’m not trying to suggest that people right now, if they’re not doing that then there’s something wrong. I’m just making an observation that I think there’s something in that. And I think that which we are is more than what we see when we look in the mirror.

David:
And I think our capabilities, whether we have the ability or knowledge or know how of tapping into them, whether we have that ability or not, I do feel that we do have much more ability than we would ordinarily think we have. And I think we’re capable of more what you might call miracles of healing. And perhaps some of the, what we might regard as, extreme spontaneous remissions, perhaps they that have been documented for many, many different conditions, perhaps they have something to do with profound shifts in a person’s consciousness. That somehow demonstrate that we do have that capacity somewhere inside of us. If that makes sense.

Jan Bonhoeffer:
Yeah. Totally. It totally makes sense. So if there was a … in a way, medicine … it seems to me the way that I was trained in medicine, I came into medical school with a lot of enthusiasm, right? To help and to alleviate suffering and whatever it might be. And very soon this was replaced by business. Learning all the organic chemistry formulas. Oh dear. Oh dear. All that. And until that time, because that’s when the exam was. And so it was very brainy, memory, kind of heavy. I would say very kind of better activity in the brain. And the human being that actually was enthused in the beginning of the training was pushed into the background more and more. And from a philosophy of science perspective, was dismissed as not wanted actually. As a potential interference with the pure, objective, reproducible observer.

Jan Bonhoeffer:
And similarly so, it seems that this has happened with the patients. And so what you’re describing really is a call to put the patient back into the driver’s seat. In saying, “It’s not that you as a patient have a problem, and good old doctor, or good old pharmacist, has the solution for you. And if you take the pills, you’re going to be happy again.” But it’s actually the way that your body is now manifesting. And that is now, by some people, by some learned people, called a disease. That is actually one form of expression that may, and I hear from you that’s kind of the hypothesis, it may actually be due to a way that the patient’s consciousness has influenced their setup.

Jan Bonhoeffer:
So if we’re saying that … say if our genetics, you’re talking about genetic defects, if our DNA is like the hardware as a computer, during our lifetime we load a lot of software, so there’s kind of a nature and nurture part of it. And depending on what we entertain, what we download, what we interact with, how we program our … how we utilize our hardware, the expression may shift. And so the patient actually has the ability to influence the way their body expresses or functions, and this is something that neither the patient or the physician is trained to support and promote.

David:
Yeah. I really agree. Yeah. And I don’t think we’re … I’ve not been to medical school, but I don’t see, from conversations I have with other doctors, I don’t see that kind of training taking place. There is a bit of a growing awareness of the fact that the good relationship matters. There’s studies now that show that if a doctor, for example, shows higher empathy, then the patient might have a higher immune response things that they’re called. There was a study of over 700 patients where the doctor’s empathy level was measured. It was like a care questionnaire consultation and relational empathy study.

David:
And the doctors that scored highest on empathy, in other words the relationship was strong because the patient felt listened to, they had almost 50% greater immune response to the cold or the flu. And I think that kind of study, even though it’s only going a small way to looking at the effects of consciousness itself, it showing us that the patient’s state of consciousness is influencing their health. There you have a significant difference in immune response due to a measurement of empathy, which ultimately is telling us about the relationship between the doctor and the patient. And the state of consciousness therefore of the patient.

David:
So we’re beginning to see that kind of evidence. And I think it’s only a matter of time before that kind of stuff is routinely taught. And we start asking bigger questions about what does this mean in the bigger scale? How can we really learn? How can we really reset to this? And I think it’s a quite an exciting time, really.

Jan Bonhoeffer:
Yeah. Totally exciting. So this is … let me ask you, as you were developing drugs, you were designing drugs, so you know a lot about molecules and how they attach to other molecules and cell surfaces and that interaction. And how you can actually construct something that really fits that part in the body’s signaling system to achieve a certain effect. If we combine this … and certainly a lot has been achieved through this kind of research. Antibiotics just probably … I still have a right hand, because thanks to antibiotics.

David:
Absolutely. Yeah. Yeah.

Jan Bonhoeffer:
So great. We have these molecules. There’s nothing wrong with that. And yet, you were just alluding to the effect of empathy. And before we talked about the placebo effect. So there’s a kind of difference between the placebo, hopefully there’s a difference, between the placebo arm and the intervention arm of the study. Where any kind of molecule or intervention is being used. Now, from a drug development point of view, from a molecule development point of view, do you see that the patient has the ability to change the drug effect?

David:
Yeah.

Jan Bonhoeffer:
Kind of creating … is there a way that, “Yes. Here’s the drug. And it does the job. And we may understand the mechanism of how it does the job.” The attitude that I take as a patient towards this effect changes the level of the effect. So I create like an enabling environment in my body through directing the consciousness in a way that you describe. So it’s not so much of, then I will be healthy. You said that beautifully with the 18 year old tennis player. She wasn’t imagining, if I heard you correctly, she wasn’t imagining to stand on the, what do you call it, on the podium-

David:
No. She was imagining-

Jan Bonhoeffer:
But she was imagining the perfect movement.

David:
Yes. Yeah.

Jan Bonhoeffer:
So that’s an important piece that you mentioned there. So what is it the patient could do to amplify the effect of the drug along the lines of what this high performance sport person did?

David:
Yeah, well there’s a number of different things. First of all, one of the main reasons that I write about and give lectures and talks on the mind, body connection, and I quote so much science, is I want to give people faith in themselves. That when a person understands that what they think about, what they imagine, has a psychosocial effect, a biological effect, a chemical effect, that therefore eventually a physical effect, then they start to expect more. And I think that can amplify that.

David:
Because what you mentioned about enabling, what research does show us is if a person has a drug, and they believe in it, then that belief in it, it creates enabling conditions. So you might find that that belief itself maybe amplifies the immune system or some other system in the body that creates an enabling environment that makes the drug work better. By the same token, through maybe a lack of empathy, and therefore because we don’t feel listened to or something, or we don’t believe something, then we can create a disabling environment. And take the same drug and suppress its effects. So one of the reasons why I talk about the science of things is to give people belief in themselves. But secondly, you mentioned antibiotics.

David:
A lot of people visualize, if they have to take medicines, so they visualize their medicine working. So people taking antibiotics they take the two tablets, say with a glass of water, and they visualize the drug molecules dissolving into little particles. Then they visualize them going to the site of the body. The drug has to work. So almost that they’re enabling it. Many people who get chemotherapy imagine the chemotherapy drugs in a very similar way. And they imagine the drugs arriving at the tumor site, like little piranha fish going, “[Biting sounds 00:28:50].” And they imagine the drugs, like piranha, nibbling. And the tumor getting smaller and smaller and smaller and smaller and smaller.

David:
And a lot of people do that. And I’ve even had consultants, oncologists, come along to some of my workshops, because some of their patients who had really amazing recoveries had done exactly that. And said, “I did this.” And a few of them have, in time, have handed a copy of my book to them. And have came along to workshops out of nothing other than curiosity. To say, “I’m curious about this whole mind, body connection thing. It’s not something I ever learned at medical school. I’m curious to see what the evidence says, and how this whole thing kind of works.”

David:
So in terms of enabling conditions, we can take what we’re doing … and I think when we visualize perhaps what we’re doing is we are creating conditions in the body that help the situation along. That was a conclusion from … there’s been a couple of randomized control clinical trials on women with locally advanced breast cancer, who are receiving chemotherapy or radiotherapy. But half of them were visualizing their immune systems working. So they would visualize their immune systems like, for example, piranha fish. And they’d visualize their immune systems swimming through the bloodstream, arriving at cancer cells and, “[Biting sounds 00:30:10],” and destroying the cancer cells.

David:
Now in these randomized controlled trials what they’ve found is they fare better than those who just got chemotherapy and radiotherapy. But in addition, instead of the cytotoxicity of the immune system dropping through chemotherapy, it didn’t drop much at all. And even after four cycles of chemotherapy, the immune system cytotoxicity of those who did the visualizations, was still very high. And in the paper, the published paper in the scientific journal called Breast, they said that something along the lines of, I forget the exact words, but it was something along the lines of that the visualization of the immune system seemed to be enhancing the immune system so the immune system was working in conjunction with the mainstream treatment. Not one or the other. The immune system is working in conjunction with, and that is why you are having a slightly better effect. I think that’s amazing. Really exciting.

Jan Bonhoeffer:
Absolutely amazing.

David:
So I’m a big advocate for teaching visualization techniques because they’re harmless. They’re not things you do instead of taking medical advice. You take the advice that you’re given by a doctor, but you can use your mind as well. You can use visualization techniques as well. Not necessarily instead of, but in addition to. And I think that’s like an integrated approach. We’re beginning to take the best of the West, if you like, and the best of the rest. And put it all together, and see if we can some up with something that’s a little bit better than what we’ve had forever. Well, for the last several decades anyway.

Jan Bonhoeffer:
Amazing. Thank you. This is an amazing … this is a very helpful piece of evidence here that really demonstrates how important it is, or let’s say how the patient actually may play a way more active role than to be a passive receiver of something that is saving their lives.

David:
Yeah. Absolutely.

Jan Bonhoeffer:
So they’re not sort of at the mercy of a drug working or not working at some degree of probability. But it’s something that they can actually invite to work. And they can actually create an environment that this medicine works better. You were talking about empathy, and I wonder as you speak about this, when we talk about placebo this typically comes in the form of something that looks like the drug, and it should look like, and be indistinguishable for the investigator and the patient. And hopefully nobody knows which one’s which. So at the end it’s something external. And you talk about empathy, and when you talk about a visualization, and that placebo isn’t really outside of us anymore. That’s something inside.

David:
Inside of us. Yeah.

Jan Bonhoeffer:
So there’s a … I don’t know if we should use the same term for this. But there’s something like the placebo effect. So the belief into something external that may help or not. There is a … I think you mentioned a confidence or trust in the body’s own self-regulatory mechanisms we want that kind of turns the patient into a placebo, if I may say so.

David:
Yeah. Yeah. Yeah. Totally.

Jan Bonhoeffer:
And the other way around, if the physician is able to invite this, or the healthcare provider, the nurse or the therapist, whoever he’s working with, or the friend or the husband or the beloved, somebody’s able to invite this confidence, trust, the inner placebo effect. Whatever we want to call this. How does this work? What is the mechanism between the physician, or the health care provider, and the patient? Does it require the physician to take an attitude and take a certain degree of intention, and then invite the patient into that space? Is it the healthcare provider is creating an enabling environment for the patient to create an enabling environment for a drug to work better, for example. Or even without a drug.

David:
I love that. I love that. I think that one of the enabling environments, we talked about empathy, is listening. And just giving someone the time to speak, to communicate. Now that doesn’t necessarily fit in a classical healthcare environment when a doctor might only have five minutes for a patient. And a patient really needs maybe a quarter of an hour to get something off their chest. And that listening to totally helps.

David:
But then add to that the intention of the doctor. And the doctor now communicates, let’s say, in a way that the doctor profoundly understands that if they speak with assurance and authority, and explain to the patient that you will be okay, perhaps it might even give them some techniques, some self-empowerment techniques, visualizations they can do, for example. Or even reassures them about a form of medication. [inaudible 00:36:07] medication.

David:
But if the doctor shows empathy and authority, and shows that I really believe this will help you. But really has the authority and the empathy, I think that creates a beautiful condition. And certainly some research in placebo effect would suggest that that’s how you amplify the placebo effect in a patient, is to show empathy and assurity and reassurance. I think we add to that education, where the patient is educated in some way that they understand that some of the psychological techniques they can use, like visualization for example, can and do have an effect.

David:
So I think we add these together, the empathy, the reassuring, the intention, the confidence, if you will, of the doctor. And then add that to the patient understanding, that something they can do with their mind can have an effect. And that empowers the patient. They start to believe that yes, this is not something being done to me. There’s a relationship here. And I’m now being shown that I’m a participator in my healing.
Jan Bonhoeffer: Exactly.

David:
And here is a technique I can use myself. And I think, put those three things together, and I think we’ve got something really exciting. Perhaps as the next stage. Maybe. Or part of the next stage.

Jan Bonhoeffer:
Wonderful. This is so good. What a joy to talk. (37:32) I’m so grateful for Andrea to connect us. This is what heart-based medicine is about. When I had this call to completely change my career and focus on this, this was exactly the point. And this was the calling, is how can we bring in the patient’s self-healing capacity? How can we bring in the healthcare providers’ healing capacity back into the equation? So how can they be a participant rather than kind of the healthcare provider being almost like a salesperson for the pharmaceutical industry. Or a broker. A drug broker.

David:
Yeah, yeah, yeah. In some things, yeah.

Jan Bonhoeffer:
So yeah. This is an instrument that is helpful, just as practices are helpful. Just as intention is helpful. And one of the elements that you touched on … in a way you touched on visualization. You touched on neuroplasticity. So as we go into repeated visualizations and we practice, you know three days a week, we practice … so what might be the practices for healthcare providers and patients together to create this resonance? And let me try and go a little bit into very close to woo woo land here.

Jan Bonhoeffer:
But it seems to me that if we come back to meditation, and if we realize that there isn’t anybody in there, and if we just assume that that’s the same for the other person, so there’s actually nobody in there on either side, then we’re kind of stepping out of the paradigm of, “I am the patient and I have a problem.” “I am the doctor and I have the solution.” “Okay, I will do what you say.” “That’s a good idea.” “Let’s hope nothing happens.” “Yes, let’s hope nothing happens.”

Jan Bonhoeffer:
So if we step out of this game into realizing that there’s actually nobody home here, there’s actually nobody home here, but we can create a therapeutic alliance where we go in a shared space with the intention on a healing process, rather than of a disease, a version process. What might this look like?

David:
Yeah, that’s really beautiful. It’s like both parties recognizing the important role that both play in the healing process. It’s not something being done to someone else, or received by someone else. It’s a joint process. Who knows? Maybe that even involves … is part of each consultation. A little sit down shared meditation and visualization, as a bond is really created. As the [affirmer 00:40:55] bond, we are in this together. We are participating together in this … the doctor’s saying, “I am part of this healing journey with you. Let’s sit down.”

David:
And you mentioned meditation. Who knows? Perhaps that’s part of it. We sit down together, we meditate. Maybe we visualize. But we’re doing something that makes it feel like the patient is not alone and not being done to, but as an empowered participant in understanding that this is a very important part of the process. And I think that’s the key. Is the patient has to understand that this relationship is an important part of the process. The doctor, physician, must understand that too. I’ve never thought about this until this conversation. This is great.

Jan Bonhoeffer:
So wouldn’t it be interesting if the patient is able to create an enabling environment for healing, with or without molecules. And if the physician is able to create an enabling environment for the patient’s self-healing processes, could we see that these effects actually amplify each other? So it’s like when we take the image of resonance … so here’s kind of a … whether this will translate … I’m not sure if this translates to brainwaves or what kind of modality of energy this is. I don’t really have a … I don’t really know what that might be. But we all know that sometimes we relate to people very easily. Chemistries, right?

David:
And we use the term we resonate with them.

Jan Bonhoeffer:
We resonate with them. So there is some form of … there’s some modality that it is recognizable, intuitively recognizable to everybody.

David:
Yeah. Yeah. I totally agree.

Jan Bonhoeffer:
If we use the acoustic wave paradigm or whatever. Let’s just take a wave pattern. And kind of here’s a wave, and here’s a wave, and they might be asynchronous. Or they may actually turn into a coherent pattern. If we see disease as a non-coherence, as somehow our body, whether its molecules or cells or organs, at whatever level that might happen, if we see disease as a non-coherence, and health as a coherent state of being, as a harmonious functional state of being, could we extrapolate from the placebo research that if both go into this shared placebo experience, that is not taking external looks like a drug thing, but it’s taking an internal perspective … does that make sense?

David:
Totally. Because basic physics tells us if you take two waves that size, and you add … they resonate. You add them, the amplitude doubles.

Jan Bonhoeffer:
[inaudible 00:44:14].

David:
So what you’re … I think this is an amazing thing. If two people do resonate together, then maybe that shared experience, we intuitively understand that resonance. Regardless of whether we know what the waves are, but we, in truth, if we understand the thing. So maybe it works the same way. And when that resonance means there’s an amplification of the consciousness, the state of consciousness, the belief may be an amplification of the placebo mechanism. That is the production of biochemicals in the brain that enable the increased healing. Maybe that is amplified. Yeah. Probably. I think that’s a good, I feel, extrapolation to make. It’d be an interesting scientific study to do.

Jan Bonhoeffer:
Let’s say at least why not? Let’s say we can accept it as a hypothesis. It might be a little bit far out, but at least, as you say, it might be a hypothesis worth testing.

David:
Not that far out, really. It seems pretty logical given the wealth of information we have so far. It seems pretty logical that some kind of amplified effect would occur.

Jan Bonhoeffer:
Wow, that’s very encouraging. If you’re saying there’s looking so much into placebo research, that’s encouraging. That’s really intriguing. When we’re … it takes me a little bit in a different direction. Let’s explore a little side alley. Let’s go and kind of circle around this a little bit. I believe you were talking about the signs of self-healing. That’s something that is very … that’s a topic geared to you.

Jan Bonhoeffer:
And that is certainly relevant to the patient. So if I do have a condition that I regard as disease, are there ways for me to activate self-healing mechanisms through empathy and compassion with myself? It we talk about the healthcare provider, are you aware of research into this? Is basically what I wondered in way … let’s phrase the question maybe differently. Sorry. Just say if we accept that the healthcare provider does have an effect on the healing process of the patient, then I would like to see the training of a healthcare provider to be such that they are masters of health, rather than brokers of molecules. Or surgical interventions.

Jan Bonhoeffer:
So do you see an argument for training healthcare providers to actually learn self-healing capacities for themselves?

David:
Yes. Absolutely. Absolutely. And find more … I guess, maybe you could say the more wholeness that you feel in yourself, the more healed you feel yourself. I think that increases your capacity for empathy and compassion in other people. And compassion itself, you may be aware of this research already, but research into compassion has an anti-inflammatory effect in the body. Typically you can get volunteers doing a Tibetan Buddhist practice called the loving kindness meditation. Or Metta-Bhavana. Which is really a cultivation of kindness and compassion.

David:
But that brings about an anti-inflammatory effect, because it stimulates the vagus nerve. And the vagus nerve is known as the care taking nerve. So as well as being the rest and relax mode, so you breath in your heart rate increases, you breath out your heart rate decreases because the vagus nerve pulls it down, as well as that the vagus nerve also controls the inflammatory reflex, which is one of the primary ways that the body, the nervous system, controls inflammation. And so copious amounts of research have found an increase in vagus nerve activity, or vagal tone as it’s called, akin to muscle tone. As a person practices Metta-Bhavana, the loving kindness meditation, and simultaneously an anti-inflammatory effect.

David:
So even the experience of self-compassion or compassion for others, we know from research has an anti-inflammatory effect. So now inflammation plays a role. And I don’t know every medical condition, but I think without exception every serious disease we know about in the Western world, I don’t think there’s any disease that I’m aware of, serious disease, that doesn’t have an inflammatory component. So you can reduce inflammation through empathy and compassion. There’s an argument already for making that part of the relationship. Part of the clinical experience between a doctor and a patient. There’s an argument for having that, regardless of anything else, as part of the relationship.

David:
So yeah, I think the next generation of medical practitioners should be taught in how to heal themselves, and to be able to understand the relationship and the importance of empathy and compassion. And therefore working self-healing on ourselves … certainly my experiences, the more I’ve worked on healing myself, the more able I am to access a space inside myself when I can feel empathy or compassion for someone else. The less broken I feel, the more I can feel for someone else. In a way that I can feel and watch them, free them from from their suffering.

Jan Bonhoeffer:
Beautiful. Thank you. Beautiful. You’re just expanding on a … I work as a pediatrician and as an infectious disease physician. And I was always asked, “What’s your bug? What’s your bug?”

David:
What’s your bug?

Jan Bonhoeffer:
I never had a bug. I’m interested in methods and prevention. I don’t have a bug.

David:
That is compassion. The bug’s compassion.

Jan Bonhoeffer:
And then I thought at some point, “Maybe it’s the love bug.”

David:
Yeah. Yeah. It’s love. Yeah.

Jan Bonhoeffer:
And I realized that maybe one of the … maybe the most … the disease that is the most transmissible disease, or the most frequently transmitted disease from human to human, is maybe non-love. Or non-compassion. So this is what we’re infecting us all the time. And now we actually bring … you connect this with inflammatory response. So it’s interesting. Now there’s actually non-compassion … stress is associated with inflammatory processes. And we see an incredible increase in inflammatory disease, auto-immune diseases where we might wonder to what degree a compassionate flow, access to compassion, is part of the paradigm.

David:
Yeah. Massively. I do think you’re on … I love the work that you’re doing. Even that sign behind you, heart-based medicine. I think that is beautiful, because that’s what we need now. Not replacing medicine, bringing heart into existing practices. And making the relationship and the empathy and the compassion and the love and the kindness, bring that into the healing equation. Because I think it’s missing a lot of the time. Or it has been missing a lot of the time. In the sense that it’s not been educated as something that matters. We’ve made things over-clinical, and forgot that heart, in the sense of love and compassion and kindness, are part of the healing experience. They’re not separate from it. They are a vital, necessary part of it.

David:
And when we bring these in, surely it makes things better. And surely if the world is so focused on we need the financial returns, then surely this will save the healthcare industry millions of dollars, if we can bring that into it. And perhaps be able to put some of the money saved to other ways that we can expand on healthcare. More comfortable ways. Other fantastic research that was not even conceived of, perhaps. Or put it to use for other things. Like other programs, other types of development of the human species. Of human society, I should say. I think we absolutely have to understand that heart is a absolutely vital part of the healing equation. We’ve just forgotten about it, typically, until now.

Jan Bonhoeffer:
Wow. Thank you for such a strong plea. And I see that you’re … in a way you have moved from being a drug designer for specific disease indications, to a designer or molecules of kindness, I think.

David:
I like that.

Jan Bonhoeffer:
So you’re actually still … you’re kind of, let’s say, what do you call it, faithful to your trade, in developing molecules to serve healing.

David:
That’s a great way to look at it. That’s quite clever.

Jan Bonhoeffer:
So that’s beautiful. So thank you so much. Thank you, David, for serving health so beautifully, and through such a heartful and loving approach that you’re taking. And kind of having the courage to speak up while staying very close to heart science, and see what we can derive from it. And to really make that bridge that is hard to make, and is so unreasonably dismissed by so many. So you’re really … I believe you’re one of the key pioneers of this field. And then I’m just trying to bring together and give a voice … like heart-based medicine to me is a platform where I would love to see people like you interact, create a platform, where we bring these different voices together. And work like a lens, where all these different lights that are out there, where we can focus them and create a laser beam to-

David:
Yeah. Yeah. Love it.

Jan Bonhoeffer:
That would be wonderful. So thank you for sharing so much of your experience. So much insight and so much of your heart and love, that is so very tangible. Even through all the technology of a Zoom call. You’re very present here. Thank you.

David:
Well thank you. I’ve had a really enjoyable conversation.

Download the Episode Transcript