One of the most intriguing studies I have read in the past several years is titled ‘Altered Placebo and Drug Labeling Changes the Outcome of Episodic Migraine Attacks’ published in the January 2014 issue of Science Translational Medicine 

 Here is an excerpt from the Harvard Medical School’s website that discusses this article and interviews its main chief researcher, Dr. Ted J. Kaptchuk:

“Placebos are often considered ‘fake’ treatments… To complicate matters, there is a documented ‘placebo effect,’ which means that [in double-blind studies] some people actually respond to a placebo [a ‘sugar pill’ that contains no medicine at all] even though it shouldn’t have an effect on the body. This has been thought to be largely due to the patient’s belief or expectation that he or she is getting the real treatment and not the fake one.”

So far you are likely not surprised. It has long been documented that people can respond to treatment for reasons of the mind.

But then comes this: “But what if people were told up front that they were getting a placebo and not an active medication? It stands to reason the placebo would have no effect. Right? Wrong.”

Wrong? How could that be?

The article continues, “Dr. Ted J. Kaptchuk, a professor of medicine at Harvard Medical School and director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, has been studying placebos for more than 20 years.

“In one study, Kaptchuk looked at people with irritable bowel syndrome (IBS), a common condition that causes abdominal cramping and one that can be debilitating for many. Half of the study volunteers were told they were getting an ‘open-label’ placebo, and the others got nothing at all. He found that there was a dramatic and significant improvement in the placebo group’s IBS symptoms, even though they were explicitly told they were getting a ‘sugar pill’ without any active medication.

“Kaptchuk says placebos won’t work for every medical situation—for example, they can’t lower cholesterol or cure cancer. But they can work for conditions that are defined by ‘self-observation’ symptoms like pain, nausea, or fatigue.

“‘Our hope is that in conditions where the open-label placebo might be valuable, instead of putting people on drugs immediately—for depression, chronic pain, fatigue—people would be put on placebo,’ says Kaptchuk. ‘If it works, great. If not, then go on to drugs.’”

How shocking!

The word ‘placebo’ is derived at least partially from Tanach. This has been documented in the Journal of the Royal Academy of Medicine (October 1999, pp. 511-515, and Issue 93, 2000).

One of the Psalms most frequently recited by Catholics at funerals, going back at least a thousand years, is “Es’halech lifnei Hashem b’eretz chaim, I will walk before Hashem in the land of the living” (Tehillim 116:9). While the literal translation of the first word is “I will walk” or “I will walk in step with,” the Septuagint uses a Greek word that means “I shall be pleasing.” (See Megillah 9 and Rishonim and Acharonim for whether the Septuagint is actually the original translation of the seventy Sages, although initially they only translated the Chamishah Chumshei Torah.)

Later, when the Greek was translated into Latin, this verse read: “Placebo D-omino in regione vivorum, I shall be pleasing to G-d in the land of the living.”

In time, people would come to funerals and cry this verse out even when most of the others present knew they had not been very close to the deceased. The term “the singer of the placebo” thus came about to describe people or things that pretend to be what they are not!

One of the issues that comes up from time to time is what type of medicine or treatment is given credence in halachah. As seen from the matter of the placebo, defining the term “medicine” is a difficult task.

For example, the Shulchan Aruch (328:17) rules that a non-Jew may be asked to assist a sick person whose condition is not life-threatening even by performing a melachah that is assur d’Oraisa.In light of the placebo study, would one be able to ask his non-Jewish neighbor to go to the store for him on Shabbos to pick up his placebo medication?

While that question may be academic in nature, many others are not.

How does halachah view alternative treatments such as acupuncture, chiropractic, and hypnotherapy? And what about segulos? Can one rely on them? Can their use supersede the halachos of Shabbos?

These sh’eilos become very real when people are seeking help for serious, ongoing, and sometimes terminal issues.

And even if one can prove that a certain alternative medical treatment is not helpful, would halachah recognize a well-documented placebo effect? (I would like to note here that I am not focused on any particular alternative treatment, and I am not offering my personal view of their efficacy.)

Medication on Pesach is an area where these issues are highly relevant. Many poskim posit that even when pills contain chametz, they may be swallowed whole on Pesach. (See, e.g., Ksav Sofer 118, Igros Moshe 2:92 and 3:62, Chazon Ish116:8,and Minchas Shlomo 1:17. Even those who differ would at least agree that it is at worst only a d’Rabbanan of “achshivei,” and even then, only according to the daas yachid opinion of the Rosh.)

But what if it’s an herbal medication? What about vitamins? May one take these on Pesach if they contain chametz?

Further, what about a choleh who is in a life-threatening situation, lo aleinu? Would halachah allow him to ride in a car on Shabbos in order to receive a brachah from a tzaddik? Is such a measure deemed curative in the eyes of halachah?

I was actually once asked if someone could take a cab on Shabbos to the late Lubavitcher Rebbe’s Ohel in order to daven for a terminally ill relative who was in surgery on Shabbos!

The Minchas Shabbos (d. 1917) discusses sending a telegram to a tzaddik on Shabbos to ask him to daven for a person who is deathly ill.He rules that it is forbidden (Minchas Shabbos, siman 84, se’if 19, os 65).

Rav Shlomo Kluger (d. 1869) records a fascinating story about a rav in the nearby town of Zalutchov who allowed non-Jews to write a kvittel on Shabbos for a person who was very ill and then travel to deliver it to a rav so the choleh could be davened for (Shu”t U’bacharta B’chaim, siman 87; see this same event recorded in Shu”t Maharsham 3:225). In Rav Kluger’s response, one can sense his anger at this psak; he even forbade that rav to pasken in the future!

But why? Don’t we believe in tefillah? Why should it be viewed differently from natural cures?

The Gemara states that in certain dangerous situations, we allow certain measures on Shabbos (Taanis 14). Rav Yosi points out, however, that general tefillah and crying out would not be allowed in these dangerous situations. Rashi explains that we cannot be certain that our tefillos will be accepted.

The Tzitz Eliezer takes this further, stating that, especially in our generation, “even a d’Rabbanan may not be desecrated for the sake of tefillah for a sick person. Even regarding [sending his name] to a tzaddik who is known to have his tefillos answered, like Rav Chanina ben Dosa, it would still be forbidden.”

As we will see, all of this is due to the fact that halachah only sanctions as medicine things that work al pi teva,through nature, encouraging us to seek only proven scientific interventions.

We will discuss in detail just how this is defined, and what types of scientific experiments would be accepted in halachah as proof of the efficacy of a treatment; we will also discuss how these guidelines relate to popular alternative treatments. (For instance, the Tzemach Tzedek [siman 38] discusses the mysterious ‘segula’ of pouring hot lead while reciting certain teffilos and whether it may be done on Shabbos. A note to the reader: any divination or practice not found in chazal should not be embraced before speaking with competent morah horah, and a medical professional)

 But, what about the ‘placebo effect’? Could there not be cases that the emotional calm of, say, a beracha alone could bring better health, and maybe extend a life?

 These questions are not academic. On the few occasions that I was with congregants as hatzala took them away the patient requested that I somehow contact their relatives on Shabbos. 

 The Shulchan Aruch rules (siman 306:9), for example, that certain cholim would be allowed to send non-Jews outside of the techum so as to get relatives to come after Shabbos. The Mishna Berura (ad loc. siif 41) explains that this is a psychological concern for which certain violations are indeed made permissible, and even required at times. 

 While this is an allowance for rabbinical violations, the Aruch Hashulchan allows for even biblical ones to be bypassed if a doctor confirms that it could have a significant impact. 

 This view can be proven from what the Shulchan Aruch later writes (siman 328:4) that we perform for a choleh on Shabbos all that was performed during the week. 

 As we can see issues of Shabbos and emotional desires versus real treatment are vast and complex – a rav must be consulted at all times. (The reader is also directed to Piskei Teshuvos mehadura kamma 328:4, and second edition, volume two, 238 footnote 114). 

 There is also an extra value in consulting a rav, doctor, therapist, etc. in the above cases and those similar: Objectivity.

 To explain this, let us for a moment look at another halacha. The Shulchan Aruch rules (328:14) that if a choleh does not have access to kosher food one may violate Shabbos and slaughter an animal so that he has food. This means that if there is a choice between eating treif and driving to the hospital to bring him food we take the latter option.

 Why is this so? One would think that a choleh should himself eat the treif rather than have another(s) violate Shabbos on his behalf. 

 The poskim (see Aruch Hashulchan and Shulchan Aruch Harav) give a number of reasons for this. One of the most prominent of these is that while true that non-kosher food seems to be the right option to take in terms of halachic compartmentalization, however we must be concerned that the emotional reaction to violating the isuur(im) of treif food will scar the choleh to the point of harming his health!

 I have been witness to cholim being greatly agitated at relatives who find heterim to come to the hospital during a Shabbos emergency, and visa versa.

 In other words, while there are indeed times that emotions play a role in halacha, it is sometimes hard for family members to see what is best for one’s emotional well being. And, the rav as well should be aware that he may not know what is best, and therefore must listen carefully to the words of the family members and loved ones who know the patient best. Both objective voices and and those that are noggea b’davar voices are critical in these cases. Amazingly, all of the above relates to Purim. Its connection to the story of Mordechai and Esther will be discussed next week iy’H.