Merle, IMO only experience is real, and by that 'experience' I mean sensory experience (sight, sound, touch, smell, taste).
That's it. That's all. ...Bill! --- In [email protected], Merle Lester <merlewiitpom@...> wrote: > > > >  bill..thank you for your clarification...so what is NOT an illusion > bill?...and what is real in your world?...merle > > >  > Merle, > > Sure...as long as you tie it back to zen it's fair game as far as I'm > concerned. What this article is talking about is what Buddhism calls > 'suffering'. > > Western medicine tries to alleviate it by prescribing medications. > > Most religions try to alleviate it by prescribing faith in God. > > Art, music, work, activities of all sorts, etc.. help alleviate it by having > you concentrate on something else. > > Zen IMO tries to alleviate it by helping you experience these are delusive. > > ...Bill! > > --- In [email protected], Merle Lester <merlewiitpom@> wrote: > > > > > > > > ài thought this was a good article as to what bill talks > > about..illusions... hence zen appropriate..correct me if i am > > incorrect...bill... > > merle > > > > > > > > > > > > > > >Worried Sick > > >Expectations can make you ill. Fear can make you fragile. Understanding > > >the nocebo effect may help prevent this painful phenomenon. > > >ByàMegan Scudellarià|àJuly 1, 2013 > > >é BRYAN SATALINO > > >Something strange was happening in New Zealand. In the fall of 2007, > > >pharmacies across the country had begun dispensing a new formulation of > > >Eltroxinââ¬"the only thyroid hormone replacement drug approved and paid > > >for by the government and used by tens of thousands of New Zealanders > > >since 1973. Within months, reports of side effects began trickling in to > > >the governmentââ¬â¢s health-care monitoring agency. These included > > >known side effects of the drug, such as lethargy, joint pain, and > > >depression, as well as symptoms not normally associated with the drug or > > >disease, including eye pain, itching, and nausea. Then, the following > > >summer, the floodgates opened: in the 18 months following the release of > > >the new tablets, the rate of Eltroxin adverse event reporting rose nearly > > >2,000-fold.1 > > >The strange thing was, the active ingredient in the drug, thyroxine, was > > >exactly the same. Laboratory testing proved that the new formulation was > > >bioequivalent to the old one. The only change was that the drugmaker, > > >GlaxoSmithKline, had moved its manufacturing process from Canada to > > >Germany, and in the process altered the drugââ¬â¢s inert qualities, > > >including the tabletsââ¬â¢ size, color, and markings. > > >So why were people getting sick? In June, it turned out, newspapers and TV > > >stations around the country had begun to directly attribute the reported > > >adverse effects to the changes in the drug. Following widespread coverage > > >of the issue, more and more patients reported adverse events to the > > >government. And the areas of the country with the most intense media > > >coverage had the highest rates of reported ill effects, suggesting that > > >perhaps a little social persuasion was at play. > > >ââ¬Å"Noceboâ⬠(meaning ââ¬Å"I shall harmââ¬) is the dastardly > > >sibling of placebo (ââ¬Å"I shall pleaseââ¬). > > >But Eltroxin takers were not making up their symptoms. The feelings were > > >real, but in the vast majority of cases they could not be attributed to > > >the drugââ¬â¢s pharmacological properties. The patients were victims of > > >the nocebo effect. > > >ââ¬Å"Noceboâ⬠(meaning ââ¬Å"I shall harmââ¬) is the dastardly > > >sibling of placebo (ââ¬Å"I shall pleaseââ¬). In a placebo response, a > > >sham medication or procedure has a beneficial health effect as a result of > > >a patientââ¬â¢s expectation. Sugar pills, for example, can powerfully > > >improve depression when the patient believes them to be antidepressants. > > >But, researchers are learning, the reverse phenomenon is also common: > > >negative expectations can actually cause harm. > > >When Parkinsonââ¬â¢s patients undergoing deep brain stimulation were > > >told that their brain pacemaker was going to be turned off, symptoms of > > >their illness became more pronounced, even when the pacemaker was left > > >on.2àWhen people with and without lactose intolerance were asked to > > >ingest lactose, but were actually given glucose, 44 percent of those with > > >lactose intolerance and 26 percent of those without it still complained of > > >stomach pain.3àAnd men treated for an enlarged prostate with a commonly > > >prescribed drug and told that the drug ââ¬Å"may cause erectile > > >dysfunction, decreased libido, [and] problems of ejaculation,â⬠but > > >that these effects were ââ¬Å"uncommon,â⬠were more than twice as > > >likely to experience impotence as those who were not so informed.4 > > >On paper, it sounds like psychobabbleââ¬"a negative effect caused by a > > >sham treatment based on a patientââ¬â¢s expectationsââ¬"but it is a > > >real biochemical and physiological process, involving pain and stress > > >pathways in the brain. And mounting evidence suggests that the nocebo > > >effect is having a substantial negative impact on clinical research, > > >medicine, and health. > > >ââ¬Å"Nocebo is at least as important as the placebo effect and may be > > >more widespread,â⬠says Ted Kaptchuk, director of Harvardââ¬â¢s > > >Program in Placebo Studies at Beth Israel Deaconess Medical Center in > > >Boston, Massachusetts. > > >Now that this pernicious phenomenon is starting to receive the recognition > > >it deserves, the question is: What exactly can be done about it? > > >Evil effects > > >ALLERGIC TO NOCEBO > > >é BRYAN SATALINO > > >According to several recent studies, pain and itch appear to be especially > > >susceptible to verbal suggestion. Recently, researchers in the Netherlands > > >demonstrated that people who are told that a stimulus will cause itch feel > > >the itch more intensely than those told that the stimulus is unlikely to > > >cause itch. The finding could have implications for chronic itch > > >conditions, says first author Antoinette van Laarhoven of Radboud > > >University Nijmegen Medical Center. ââ¬Å"More knowledge about nocebo > > >effects on itch can give us some targets to reduce [those effects].â⬠> > >Also last year, in a curious study of nocebo and rectal pain, a team at > > >University Hospital Essen in Germany managed to recruit healthy volunteers > > >to undergo multiple rectal balloon distensions, a procedure in which a > > >balloon is inserted into the rectum and slowly inflatedââ¬"in this case, > > >until the moment it becomes painful. The procedures were exactly the same > > >in control and nocebo groups, but there was a 20 percent increase in pain > > >ratings among patients who had been told that doctors had observed an > > >increase in pain sensitivity in response to repeated distensions. Those > > >individuals who experienced more pain also had elevated levels of > > >cortisol, again linking nocebo to anxiety. ââ¬Å"We could show that a > > >nocebo effect may be induced even by mere information,â⬠says Sven > > >Benson, an author on the paper. > > >Another area of health that researchers suspect may be affected by nocebo > > >is the increased incidence of asthma and allergies. ââ¬Å"Itââ¬â¢s > > >certainly possible,â⬠says Manfred Schedlowski, who studies placebo and > > >the immune system at University Hospital Essen. ââ¬Å"From experimental > > >data, we know an allergic reaction can be conditioned.â⬠> > >In an oft-cited case from 1886, John Mackenzie, a surgeon in Baltimore, > > >described how heââ¬â¢d ââ¬Å"obtained an artificial rose of such > > >exquisite workmanship that it presented a perfect counterfeit of the > > >original,â⬠then exposed a woman with severe rose allergy to the fake > > >flower. The woman, not knowing it was fake, had a full-blown allergic > > >reaction, including a running nose, swollen nostrils, and a tight chest.12 > > >Similarly, people allergic to dogs may begin sneezing when they simply see > > >a dog across the way. Researchers have even shown that guinea pigs can be > > >conditioned to release histamine, causing a local immune response, when > > >presented with just an odor stimulus. > > >But the link between nocebo and allergy is far from concrete. > > >ââ¬Å"Weââ¬â¢re in such a primitive state of understanding this > > >phenomenon, particularly in a clinically oriented way, that we just need > > >to do more research,â⬠says bioethicist Frank Miller of the National > > >Institutes of Health. > > >In 1997, Fabrizio Benedetti, a neurophysiologist at the University of > > >Turin Medical School in Italy, was busy mapping the biochemical pathways > > >involved in placebo responses when he performed a simple study that > > >revealed a distinct neural mechanism driving the bodyââ¬â¢s nocebo > > >response. He gave consenting postoperative patients reporting mild pain an > > >injection that they were told would increase their pain within 30 minutes. > > >The injection was either saline solution or proglumide, which blocks a > > >hormone implicated in pain hypersensitivity and associated with anxiety. > > >Neither substance actually causes any discomfort. > > >When saline was injected, patients experienced increased pain. When > > >proglumide was injected, they had no pain increaseââ¬"the nocebo effect > > >was absent.5àIn one fell swoop, Benedetti identified a biochemical > > >reaction responsible for the nocebo response, and he showed that it could > > >be blocked. > > >It was Benedettiââ¬â¢s work that finally convinced > > >physician-bioethicist Howard Brody that the nocebo effectââ¬"allegedly > > >first mentioned in the scientific literature in 1961 by physician Walter > > >Kennedy, who called the phenomenon a ââ¬Å"quality inherent in the > > >patient rather than in the remedyââ¬Ã¢â¬"was real. > > >ââ¬Å"For many years, I dismissed the value of the term > > >ââ¬Ënocebo,ââ¬â¢Ã¢â¬â°Ã¢â¬ says Brody, chair of family medicine > > >and director of the Institute for the Medical Humanities at the University > > >of Texas Medical Branch in Galveston, who first began studying the placebo > > >effect in the 1970s. He and others had long assumed that nocebo and > > >placebo were two sides of one coin, that the same process in the brain > > >supported both illusory effectsââ¬"one was just manifested as a positive > > >outcome, while the other caused harm. But after reading Benedettiââ¬â¢s > > >work, Brody changed his tune: ââ¬Å"I received my comeuppance,â⬠he > > >laughs. > > >With that first biochemical evidence, others also began recognizing the > > >importance of nocebo, and a few inquiring minds began to study it. > > >Nevertheless, compared to placebo, the nocebo effect remains vastly > > >understudied: a PubMed database search will turn up more than 163,000 > > >publications on ââ¬Å"placeboâ⬠and fewer than 200 on > > >ââ¬Å"nocebo.â⬠Of those, only a few dozen are empirical studies; most > > >are reviews. ââ¬Å"The placebo phenomenon has a tremendous fascination > > >for the publicââ¬"a gee-whiz thing with a positive spin, a way to be > > >healthy without taking drugs,â⬠says Frank Miller, a bioethicist at the > > >National Institutes of Health. ââ¬Å"But nobody is very enthusiastic > > >about the nocebo phenomenon.â⬠> > >In addition, the nocebo effect has become notoriously difficult to study. > > >Few institutional review boards will allow scientists to induce pain in > > >their subjects, and some even refuse to let researchers mislead their > > >volunteers. ââ¬Å"My ethics committee will not allow me to do it,â⬠> > >says Paul Enck, a psychologist at the University of Tübingen in > > >Germany, ââ¬Å"unless I tell the subjects that I am deceiving > > >themââ¬Ã¢â¬"a requirement that obviously defeats the purpose of the > > >deception. ââ¬Å"It makes life really miserable as a [nocebo] > > >researcher,â⬠says Enck. > > >The tragedy of this lack of investigation, researchers assert, is that > > >controlled trials about the nocebo effect are needed to further understand > > >and prevent noceboââ¬â¢s insidious effects on medicine and research. > > >ââ¬Å"In clinical drug trials, the placebo effectââ¬"and now we know > > >the nocebo effectââ¬"can be really, really large,â⬠says Manfred > > >Schedlowski, a clinical researcher at the University Hospital Essen in > > >Germany. ââ¬Å"This hinders the development of new drugs.â⬠> > >In December 2012, for example, a meta-analysis revealed the shockingly > > >large impact of the nocebo effect in clinical trials: in 18 fibromyalgia > > >drug studies, 11 percent of 3,546 patients in the placebo armââ¬"meaning > > >they were receiving a completely inert substanceââ¬"dropped out of the > > >study because of side effects including dizziness and nausea.6àOther > > >studies have calculated that nocebo effects cause between 4 and 26 percent > > >of patients taking placebo to leave a clinical trial because of side > > >effects from an inert treatment. > > >The nocebo effect may also have a worrisome effect on vaccine use. In > > >2011, researchers at the French vaccine manufacturer Sanofi Pasteur > > >analyzed 33,275 vaccine side-effect reports and found that doctors and > > >patients preferentially report disease-specific side effects, such as > > >measles-like rash following measles immunization, even when the vaccine > > >contains only proteins, sugars, or killed organisms that wonââ¬â¢t > > >cause symptoms of the disease. The nocebo effect has ââ¬Å"great > > >potentialâ⬠to exacerbate rumors and fears, and to cause a vaccine > > >crisis similar to the Eltroxin events in New Zealand, the authors write.7 > > >But the most common place where the nocebo effect makes an appearance is > > >in everyday visits to clinics and hospitals. ââ¬Å"In places like primary > > >care, people are swimming in placebo and nocebo effects,â⬠says > > >Kaptchuk. > > >Thomas Dââ¬â¢Amico, chief of thoracic surgery at Duke University > > >Medical Center in Durham, North Carolina, says that even before he heard > > >the term nocebo effect, he was aware of it in the clinic. > > >ââ¬Å"Iââ¬â¢ve listened to some well-respected colleagues give > > >information [to a patient], and I thought, ââ¬ËGosh, I know the > > >operation and even I wouldnââ¬â¢t want it,ââ¬â¢Ã¢â¬ he says. > > >ââ¬Å"Thereââ¬â¢s too much detail and too much emphasis about things > > >that could go wrong.â⬠Measuring the effect of such detail on an > > >individual patient is hard to quantify, he says, but fear and distress > > >before an operation has been associated with slow postoperative recovery > > >and delayed wound healing. > > >Nuts and bolts > > >é BRYAN SATALINODespite the disproportionate amount of effort put into > > >placebo research, since Benedettiââ¬â¢s 1997 discovery thereââ¬â¢s > > >been an uptick in the funding and time devoted to investigating the > > >mechanisms behind nocebo, with impressive results. ââ¬Å"Without a doubt, > > >thereââ¬â¢s been a level of research and a sophistication of research > > >that has made a quantum jump in the last decade or so,â⬠says Brody. > > >In 2007, for example, Benedetti discovered that the > > >hypothalamic-pituitary-adrenal axis in the brain, an important part of the > > >bodyââ¬â¢s ââ¬Å"stress system,â⬠is activated during a nocebo > > >response, as detected by an increase in the secretion of the hormones > > >ACTH, from the pituitary gland, and cortisol, from the adrenal gland, both > > >markers of anxiety.8 > > >Then, in 2008, Kaptchuk and colleagues at Harvard performed the first > > >brain-imaging study of the nocebo effect. After conditioning healthy > > >volunteers to expect pain on their right forearm, they watched as the > > >hippocampus lit up when people experienced pain from a sham acupuncture > > >device. > > >Through Benedettiââ¬â¢s and Kaptchukââ¬â¢s work, it is now clear > > >that a personââ¬â¢s expectation of pain can induce anticipatory > > >anxiety, triggering the activation of cholecystokinin, the hormone that > > >Benedetti blocked with proglumide. Cholecystokinin-mediated pathways in > > >turn facilitate pain transmission, which occurs in specific areas of the > > >brain. The finding does not coincide with what is know about the > > >biochemistry of the placebo effectââ¬"which seems to be at least partly > > >regulated by opioid releaseââ¬"suggesting the two phenomena have > > >distinct mechanisms. > > >ââ¬Å"Even if placebo and nocebo are on a continuum of expectation, > > >different mechanisms kick in at different points along that > > >continuum,â⬠says Tor Wager, director of the Cognitive and Affective > > >Control Laboratory at the University of Colorado, Boulder, who studies the > > >brain pathways underlying pain. > > >Last year, Kaptchuk and colleagues added a surprising twist when they > > >discovered nocebo can occur without conscious awareness. His team applied > > >either high or low heat pain to the arms of 20 volunteers while showing > > >them an image of one of two faces. The researchers then showed the > > >volunteers the faces again, but with identical, moderate heat applied to > > >their arms each time and the faces displayed at a much faster pace, > > >preventing conscious recognition. When exposed to the faces associated > > >with high pain levels, even without conscious awareness, the volunteers > > >felt more pain.9àââ¬Å"It was a really risky experiment,â⬠says > > >Kaptchuk. ââ¬Å"We were really surprised. We couldnââ¬â¢t believe it, > > >actually.â⬠> > >The biochemical and physiological discoveries about nocebo have made the > > >phenomenon more credible in the medical community. ââ¬Å"These brain > > >measures provide objective evidence on the physical system implementing > > >these squishy, fuzzy changes in emotion and expectation,â⬠says Wager. > > >Most nocebo research to date, however, focuses on basic mechanisms, not on > > >how to deal with the phenomenon in the clinic. ââ¬Å"Translational > > >research has been a stepchild in scientific investigations of this > > >phenomenon,â⬠says Miller. Understanding the mechanism is important, > > >but at the end of the day, he says, the medical community needs a solution > > >to the problem. > > >Controlling for nocebo > > >In 1987, a team of doctors in Ontario, Canada, suspected that medical > > >consent forms might actually cause harm. Using the chance occurrence of > > >two different consent forms being used for the same drug trial, they > > >compared patient reactions to the wording of the forms. The trial pitted > > >aspirin against sulfinpyrazone, a medicine already approved to treat gout, > > >as a treatment for chest pain. Patients at two of the three centers > > >hosting the trial were informed that ââ¬Å"side effects are not > > >anticipated beyond occasional gastrointestinal irritation and, rarely, > > >skin rash.â⬠At the third center, patientsââ¬â¢ consent forms did > > >not mention gastrointestinal effects. Seventy-six patients out of 399 (19 > > >percent) given the first consent form that mentioned GI irritation > > >withdrew from the study, citing GI issues, compared to just 5 out of 156 > > >(3 percent) who received the second form.10 > > >With the nocebo effect, doctors are caught between a rock and a hard > > >place: their medical duty to primum non nocere, ââ¬Å"First, do no > > >harm,â⬠and the ethical and regulatory obligation of informed consent. > > >What do you do when informed consent leads to harm? > > >Last year, Kaptchuk and colleague Rebecca Wells, also at Harvard Medical > > >School, sparked a debate on this topic in the pages of theàAmerican > > >Journal of Bioethics. They proposed a middle ground called contextualized > > >informed consent. Doctors, they suggested, might choose not to tell > > >patients every last side effect of a treatment in great detail, but > > >instead provide information to a patient tailored to his or her level of > > >anxiety, such as leaving out nonspecific side effectsââ¬"those that are > > >not a direct result of the pharmacological action of the > > >drugââ¬"including headache, nausea, and fatigue. > > >Nocebo is at least as important as the placebo effect and may be more > > >widespread.ââ¬"àTed Kaptchuk, Program in Placebo Studies, > > >>Beth Israel Deaconess Medical Center, Harvard University > > >But the idea of not informing patients of all possible side effects is > > >anathema to some ethicists. ââ¬Å"I certainly donââ¬â¢t think that we > > >should be rethinking whether informed consent should be a basic norm in > > >clinical practice,â⬠says Miller. Such a practice could promote > > >mistrust in the health-care system and defeat recent efforts towards > > >increased transparency. It may not be possible to have valid informed > > >consent with no chance of the nocebo phenomenon, Miller admits, but he > > >proposes two alterative techniques. > > >One is to frame information about treatments positively rather than > > >negatively. A 1996 study from the University of Ottawa in Canada, for > > >example, described the benefits and risks of a vaccine to 292 people, who > > >had never been previously immunized, using tw > ------------------------------------ Current Book Discussion: any Zen book that you recently have read or are reading! Talk about it today!Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/Zen_Forum/ <*> Your email settings: Individual Email | Traditional <*> To change settings online go to: http://groups.yahoo.com/group/Zen_Forum/join (Yahoo! 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