In a lecture on diagnostics, a professor of mine told the story of a physician during a war who ran out of medicines. This was pre-antibiotics, but the doctor had none of his usual “arsenal” available to him. All he could do was bandage wounds and sit with his wounded and dying soldiers. And the doctor noticed that there was no change in the number of people who recovered from their wounds. In other words, his medicines hadn’t been increasing his success at all.

I think about this story a lot. I have no idea who this doctor was, or what war he was a part of, so I have never been able to fact-check it. But as a parable, it is humbling. How do we ever know whether something is working? Whether what we do is actually making a difference in someone’s health? Placebo supposedly accounts for 30-50% of recoveries, which is how we developed the set up of a randomized control trial and have developed statistical models to account for the large percentage of people who get better with nothing (spontaneous recovery) or through suggestion (meaning our brain is the most potent medicine anyone has ever discovered).

As a patient, how do we know if the medicine is working, or if our phenomenal body has just done all the work on its own? In a medical practice, how do we ever really know if our patients get better because of the medicine you gave? We can never do a randomized trial on ourselves, so in our own personal healing journeys, it’s rare to know if what we are taking/doing has a definite effect. And if you are getting side effects, that does not mean that the medicine is behind it. There is a phenomenon called the "nocebo" where people get side effects from medicines (even if the medicine is a placebo). The power of thinking. If you think you will get better, you might (placebo). If you think you will get side effects, you might (nocebo).

There are some cases where it’s clear what’s going on. If you start taking a medicine and you get better much faster than expected, then you have a clue that the medicine may be to blame. For example, if you break your arm, then take something and the pain gets 50-75% better in a few hours, you can be pretty sure that the medicine you took did something. However, placebo also works quickly so this is not fool-proof. You can stop taking the medicine, see if the symptoms come back, and then start again and see if they go away, but this still does not eliminate placebo. In conventional medicine, and now in some alternative medicine, the randomized controlled trials tell us whether or not a medicine has a certain effect on most people. But these trials never tell us if the person we just gave that medicine to is in the group of people who get better because of the medicine, or whether they got better on their own (remember that in a trial, some people will receive the medication but still only get better because of the placebo effect or spontaneous remission).

As a homeopath, my favorite way of knowing whether what I prescribed is truly creating change, is if something happens that the patient didn’t expect, but that I could predict. For example, if I tell someone I prescribed something for their heartburn, but I know that it also matches their bloating and anxiety pretty well, and all three things get better to the surprise of the patient, then I am sure that the remedy is what created the improvement. But we don’t get this scenario often. And I think that all medical professionals, conventional doctors, naturopaths, homeopaths, herbalists, everyone, can benefit from remembering that we rarely know for sure that our medicines are creating the effect we want.

But to answer the question – how do we know if the medicine we are taking is working: it’s very hard to ever know. You can always try stopping your medication and restarting to see if the improvement disappears without the medication and begins again after you start again (with the ok from your health practitioner of course!). However, check how long the medicine may stay in your system! If you REALLLY want to know, set up a randomized trial on yourself. Have a family member or friend replace your medicine with something that looks and tastes the same. For a few weeks, have them give you the placebo, and then they will switch to the medicine (or the other way around). But the key is that you should not know which week the active medicine is being given (this is called "single blinded". If your family/friend has no idea which medicine they are giving each week, then it's called "double blinded"). There are a lot of practical issues with this, not to mention ethical issues. But this is the closest you will get to doing a randomized trial on yourself and knowing for sure. For most of us though, we will just have to find some way of making peace with the unknowable.