Closely related to this semantic mechanism is the placebo effect. The placebo effect is a subjectively experienced, objectively measurable effect caused not by a medication that has been administered, but by the expectations that the patient has of medications. Jellinek points to a study in which the presence of an odorant was feigned, and the test subjects in three groups were breathing pure air. "The three groups judged their current state of health differently depending on what they thought they were smelling," says Jellinek.
Pamela Dalton of the Monell Chemical Senses Center of Philadelphia agrees that understanding a person's attitude toward a particular odor is key. "Aromatherapy may not function as a drug, but it still may be an effective therapy for some conditions and for some individuals," Dalton says. "I am not convinced yet of the various effects attributed to various oils and extracts in the absence of an awareness of how they are supposed to make one feel. I am amazed at the spontaneous attributions people make after being exposed to 'a natural extract' or 'an industrial solvent'-which are completely in line with the expected results. The mindset or expectation they are operating under, to a large extent, will determine how they interpret those low-level sensations."
Cultural differences further muddy the waters. Japanese women, for example, find little in odors that Europeans like, such as marzipan, Pernod, and perfume. And, surprisingly, Germans do not rate odors from peanuts, beer, and cheese as highly as do the Japanese, perhaps because Germans, who consume those products in larger quantities than the Japanese, know the scents better and are more discriminating. Given the evidence that aromatherapy's effects may be substantially psychological in nature, any company interested in marketing aromas globally must take cultural factors into account.
Does it matter if the oils used in aromatherapy are man-made or natural? Aromatherapists, who claim direct pharmacological benefits, passionately believe that nature knows best, and some studies support that contention. But, natural scents are more expensive. It takes a million rose petals to make one pound of rose attar. Also, even if a product is natural, it does not mean that it is pure. James Kalabak, director of Flora Research, a California-based firm that analyses essential oils, estimates that in recent years at least half of the oils on the market have been adulterated. "It is very hard for consumers to know the purity of the oil. They should ask if an independent laboratory has tested the oil and what kind of information they can provide on the purity of the oil," Kalabak says.
And then, there are the inevitable snake oil salesmen, peddling odors to combat everything from poor vision to poltergeists. Aromatherapist Scholes, who has had hundreds of students in his aromatherapy classes, shakes his head. "I have had 200 people go through my classes to teach and prescribe, and I would not hire 190 of them. There are 150 books on the subject, and eighty percent of them have probably been written by people who have smelled an essential oil." Although there is a nationally accepted core curriculum with accreditation procedures in the United Kingdom, no such standards exist in the United States.
Jane Buckle, a registered nurse and author of the forthcoming book Clinical Aromatherapy in Nursing, notes aromatherapy's potential, but worries about claims that it can stand alone as a therapy. "Personally, I am happier with the concept of aromatherapy being used to enhance orthodox or an accepted alternative medicine. It does not stand on its own. It should complement massage therapy, nursing, acupuncture, chiropractic, and orthodox medicine. The problem, as I see it, is that people think of alternative and complementary medicine as the same, and feel that aromatherapy is an alternative. The aromatherapy world needs to get its act together."
Indeed, poor aromatherapeutic practice, even with (and perhaps especially with) pure natural oils, is dangerous. Cheryl Grossman, an Aromatherapist in Toronto, notes the disaster that befell a neighbor who naïvely swathed her neck with frankincense. Direct contact of frankincense with the skin is at variance with standard practice, which calls for frankincense to be dissolved in a solvent so that it is not put on the skin pure, or, as aromatherapists would say, neat. "Being so concentrated, the essence is approximately seventy times the strength of the ordinary herb," Grossman says. "Suffice it to say that my friend's neck looked like the best cure would be cortisone. It broke out in hives. She had a rash that was not only painful, but also was very embarrassing to walk around with!"
The more you look into the therapeutic effects of certain odors, the less you can say for certain. Then again, the action of aspirin is not understood, but millions of aspirin tablets are consumed every day around the world, because aspirin works. The whole pharmacological versus physiological question may be somewhat of a false choice, too, since the two concepts are so inextricably linked.
What is the bottom line on aromatherapy? It works, though its mode of action is not well understood. The lack of consensus by researchers about how to properly use aromatherapy and what oils heal what maladies will inevitably be resolved through time, research, and trial-and-error. Aromatherapy is very likely to become yet one more age-old folk practice that slowly seeps into standard western medicine.
Recall acupuncture's debut in America. When acupuncture was first "discovered" by a reporter covering President Nixon's visit to China in the early 1970s, and was described in newspapers here at home, the original reaction by the medical establishment was knee-jerk dismissal. The little needles and talk of "chi" was disparaged as backward, superstitious technology. Now, acupuncture has been validated both in the laboratory and in doctors' offices throughout North America.
With the Massachusetts Board of Nursing endorsement of aromatherapy late last year, can aromatherapy be far behind?
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