[Zen] Re: Worried Sick..illusions

Sun, 14 Jul 2013 22:11:07 -0700 

Merle,

I don't really disagree with much of what you say, but many times I don't see 
the connection with zen.

For example the idea that "we need a consensus so we can function as a society" 
has nothing to do with zen practice.  It certainly might be a goal in a 
religion like Buddhism, but not zen.

...Bill!

--- In [email protected], Merle Lester <merlewiitpom@...> wrote:
>
> 
> 
>  
>  i must agree with edgar here..
> i was only thinking this ...this very morning... 
> we all  perceive things differently...
> the reality is out there as reality surely bill... 
>  we need a consensus so we can function as a society ... 
> merle
> 
> 
>   
> Bill,
> 
> Yes, you experience what you experience whatever. But it isn't reality 
> because it's different between observers...
> 
> There is an actual external reality that each observer experiences it 
> differently...
> 
> But why O why am I wasting my time trying to teach you the obvious, a 
> teaching that every Zen master from Buddha onward agrees with me on?
> 
> Edgar
> 
> 
> 
> 
> On Jul 14, 2013, at 8:14 PM, Bill! wrote:
> 
>   
> >Merle,
> >
> >If you are color-blind or totally blind it makes no difference.  You 
> >experience what you experience.  That which you experience is real. That 
> >which you perceive (think about, intellectualize) is not.
> >
> >We do interpret our experiences with our mind.  That's called perceiving.  
> >And just as you say we interpret them to make sense out of them, but it's 
> >WE, our human intellect, that 'makes the sense'.  It's not as many believe 
> >that our intellect 'discovers' the sense which is inherent in experience.  
> >We create it and we superimpose it, force-fit it, onto our experience.
> >
> >And yes, you're correct again that we perceive (apply our intellect)in order 
> >to survive.  That doesn't make our perceptions real, it only makes them 
> >useful.
> >
> >Our intellect does not make things real.  Our intellect takes our experience 
> >of reality and forces it into a little logical box so we can understand it.  
> >Our intellect distorts reality.  That's called perception and is a delusion 
> >(or illusion).
> >
> >I'm not sure what you mean by 'and then there is a consensus' so I cannot 
> >comment on that.
> >
> >...Bill!
> >
> >--- In [email protected], Merle Lester <merlewiitpom@> wrote:
> >>
> >> 
> >> 
> >>  so if one was colour blind...how would that fit into the scheme of 
> >> things?
> >> ..it would not be the correct interpretation of the world..for instance 
> >> traffic lights.. 
> >> 
> >> i do not believe one can totally trust our senses as being the only real 
> >> experience...what ever you mean by real...we see  we hear we touch we 
> >> smell we taste... 
> >>  one interpret this with our mind...
> >> otherwise this world would make no sense what so ever... 
> >>  one must in order to survive make meaning out of what we see, hear, 
> >> touch, smell and taste...
> >> what other experiences are there apart from the sensory?... 
> >> i'd say they are the starting point not the all end to understanding the 
> >> world...
> >> we need our minds to make sense of the world surely?...and hence an 
> >> intellect...
> >>  then it becomes real real real... and one is able to communicate that 
> >> reality to others
> >>  and then there is a consensus
> >> 
> >> merle
> >> 
> >>   
> >> 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:
> >> > >
> >> > > 
> >> > > 
> >> > > ÃÆ'‚ i 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.
> >> > > >ByÃÆ'‚ Megan ScudellariÃÆ'‚ 
> >> > > >|ÃÆ'‚ July 1, 2013
> >> > > >ÃÆ'‚© 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 EltroxinÃÆ'¢â‚¬"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 
> >> > > >governmentÃÆ'¢â‚¬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 
> >> > > >drugÃÆ'¢â‚¬â„¢s inert qualities, 
> >> > > >including the tabletsÃÆ'¢â‚¬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.
> >> > > >ÃÆ'¢â‚¬Å"NoceboÃÆ'¢â‚¬ (meaning 
> >> > > >ÃÆ'¢â‚¬Å"I shall harmÃÆ'¢â‚¬) is 
> >> > > >the dastardly sibling of placebo (ÃÆ'¢â‚¬Å"I 
> >> > > >shall pleaseÃÆ'¢â‚¬).
> >> > > >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 drugÃÆ'¢â‚¬â„¢s 
> >> > > >pharmacological properties. The patients were victims of the nocebo 
> >> > > >effect.
> >> > > >ÃÆ'¢â‚¬Å"NoceboÃÆ'¢â‚¬ (meaning 
> >> > > >ÃÆ'¢â‚¬Å"I shall harmÃÆ'¢â‚¬) is 
> >> > > >the dastardly sibling of placebo (ÃÆ'¢â‚¬Å"I 
> >> > > >shall pleaseÃÆ'¢â‚¬). In a placebo response, a sham 
> >> > > >medication or procedure has a beneficial health effect as a result of 
> >> > > >a patientÃÆ'¢â‚¬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 ParkinsonÃÆ'¢â‚¬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.2ÃÆ'‚ When 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.3ÃÆ'‚ And men treated for an enlarged prostate 
> >> > > >with a commonly prescribed drug and told that the drug 
> >> > > >ÃÆ'¢â‚¬Å"may cause erectile dysfunction, 
> >> > > >decreased libido, [and] problems of 
> >> > > >ejaculation,ÃÆ'¢â‚¬ but that these effects were 
> >> > > >ÃÆ'¢â‚¬Å"uncommon,ÃÆ'¢â‚¬ were 
> >> > > >more than twice as likely to experience impotence as those who were 
> >> > > >not so informed.4
> >> > > >On paper, it sounds like psychobabbleÃÆ'¢â‚¬"a 
> >> > > >negative effect caused by a sham treatment based on a 
> >> > > >patientÃÆ'¢â‚¬â„¢s 
> >> > > >expectationsÃÆ'¢â‚¬"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.
> >> > > >ÃÆ'¢â‚¬Å"Nocebo is at least as important as the 
> >> > > >placebo effect and may be more widespread,ÃÆ'¢â‚¬ 
> >> > > >says Ted Kaptchuk, director of 
> >> > > >HarvardÃÆ'¢â‚¬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
> >> > > >ÃÆ'‚© 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. ÃÆ'¢â‚¬Å"More knowledge about nocebo 
> >> > > >effects on itch can give us some targets to reduce [those 
> >> > > >effects].ÃÆ'¢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 
> >> > > >inflatedÃÆ'¢â‚¬"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. 
> >> > > >ÃÆ'¢â‚¬Å"We could show that a nocebo effect may 
> >> > > >be induced even by mere information,ÃÆ'¢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. 
> >> > > >ÃÆ'¢â‚¬Å"ItÃÆ'¢â‚¬â„¢s
> >> > > > certainly possible,ÃÆ'¢â‚¬ says Manfred Schedlowski, 
> >> > > >who studies placebo and the immune system at University Hospital 
> >> > > >Essen. ÃÆ'¢â‚¬Å"From experimental data, we know 
> >> > > >an allergic reaction can be conditioned.ÃÆ'¢â‚¬
> >> > > >In an oft-cited case from 1886, John Mackenzie, a surgeon in 
> >> > > >Baltimore, described how heÃÆ'¢â‚¬â„¢d 
> >> > > >ÃÆ'¢â‚¬Å"obtained an artificial rose of such 
> >> > > >exquisite workmanship that it presented a perfect counterfeit of the 
> >> > > >original,ÃÆ'¢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. 
> >> > > >ÃÆ'¢â‚¬Å"WeÃÆ'¢â‚¬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,ÃÆ'¢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 
> >> > > >bodyÃÆ'¢â‚¬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 
> >> > > >increaseÃÆ'¢â‚¬"the nocebo effect was 
> >> > > >absent.5ÃÆ'‚ In one fell swoop, Benedetti identified a 
> >> > > >biochemical reaction responsible for the nocebo response, and he 
> >> > > >showed that it could be blocked.
> >> > > >It was BenedettiÃÆ'¢â‚¬â„¢s work that 
> >> > > >finally convinced physician-bioethicist Howard Brody that the nocebo 
> >> > > >effectÃÆ'¢â‚¬"allegedly first mentioned in the 
> >> > > >scientific literature in 1961 by physician Walter Kennedy, who called 
> >> > > >the phenomenon a ÃÆ'¢â‚¬Å"quality inherent in the 
> >> > > >patient rather than in the 
> >> > > >remedyÃÆ'¢â‚¬ÃÆ'¢â‚¬"was real.
> >> > > >ÃÆ'¢â‚¬Å"For many years, I dismissed the value of 
> >> > > >the term ÃÆ'¢â‚¬ËÅ
> >> > > >"nocebo,ÃÆ'¢â‚¬â„¢ÃÆ'¢â‚¬â€°ÃÆ'¢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 effectsÃÆ'¢â‚¬"one was just manifested 
> >> > > >as a positive outcome, while the other caused harm. But after reading 
> >> > > >BenedettiÃÆ'¢â‚¬â„¢s work, Brody changed 
> >> > > >his tune: ÃÆ'¢â‚¬Å"I received my 
> >> > > >comeuppance,ÃÆ'¢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 
> >> > > >ÃÆ'¢â‚¬Å"placeboÃÆ'¢â‚¬ and fewer 
> >> > > >than 200 on 
> >> > > >ÃÆ'¢â‚¬Å"nocebo.ÃÆ'¢â‚¬ Of those, 
> >> > > >only a few dozen are empirical studies; most are reviews. 
> >> > > >ÃÆ'¢â‚¬Å"The placebo phenomenon has a tremendous 
> >> > > >fascination for the publicÃÆ'¢â‚¬"a gee-whiz thing 
> >> > > >with a positive spin, a way to be healthy without taking 
> >> > > >drugs,ÃÆ'¢â‚¬ says Frank Miller, a bioethicist at the 
> >> > > >National Institutes of Health. ÃÆ'¢â‚¬Å"But 
> >> > > >nobody is very enthusiastic about the nocebo 
> >> > > >phenomenon.ÃÆ'¢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. ÃÆ'¢â‚¬Å"My 
> >> > > >ethics committee will not allow me to do it,ÃÆ'¢â‚¬ 
> >> > > >says Paul Enck, a psychologist at the University of 
> >> > > >TÃÆ'Æ'¼bingen in Germany, 
> >> > > >ÃÆ'¢â‚¬Å"unless I tell the subjects that I am 
> >> > > >deceiving themÃÆ'¢â‚¬ÃÆ'¢â‚¬"a 
> >> > > >requirement that obviously defeats the purpose of the deception. 
> >> > > >ÃÆ'¢â‚¬Å"It makes life really miserable as a 
> >> > > >[nocebo] researcher,ÃÆ'¢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 noceboÃÆ'¢â‚¬â„¢s 
> >> > > >insidious effects on medicine and research. 
> >> > > >ÃÆ'¢â‚¬Å"In clinical drug trials, the placebo 
> >> > > >effectÃÆ'¢â‚¬"and now we know the nocebo 
> >> > > >effectÃÆ'¢â‚¬"can be really, really 
> >> > > >large,ÃÆ'¢â‚¬ says Manfred Schedlowski, a clinical 
> >> > > >researcher at the University Hospital Essen in Germany. 
> >> > > >ÃÆ'¢â‚¬Å"This hinders the development of new 
> >> > > >drugs.ÃÆ'¢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 armÃÆ'¢â‚¬"meaning they were receiving a 
> >> > > >completely inert substanceÃÆ'¢â‚¬"dropped out of the 
> >> > > >study because of side effects including dizziness and 
> >> > > >nausea.6ÃÆ'‚ Other 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 
> >> > > >wonÃÆ'¢â‚¬â„¢t cause symptoms of the 
> >> > > >disease. The nocebo effect has ÃÆ'¢â‚¬Å"great 
> >> > > >potentialÃÆ'¢â‚¬ 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. 
> >> > > >ÃÆ'¢â‚¬Å"In places like primary care, people are 
> >> > > >swimming in placebo and nocebo effects,ÃÆ'¢â‚¬ says 
> >> > > >Kaptchuk.
> >> > > >Thomas DÃÆ'¢â‚¬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. 
> >> > > >ÃÆ'¢â‚¬Å"IÃÆ'¢â‚¬â„¢ve
> >> > > > listened to some well-respected colleagues give information [to a 
> >> > > >patient], and I thought, ÃÆ'¢â‚¬ËÅ"Gosh, I know 
> >> > > >the operation and even I 
> >> > > >wouldnÃÆ'¢â‚¬â„¢t want 
> >> > > >it,ÃÆ'¢â‚¬â„¢ÃÆ'¢â‚¬ he 
> >> > > >says. 
> >> > > >ÃÆ'¢â‚¬Å"ThereÃÆ'¢â‚¬â„¢s
> >> > > > too much detail and too much emphasis about things that could go 
> >> > > >wrong.ÃÆ'¢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
> >> > > >ÃÆ'‚© BRYAN SATALINODespite the disproportionate 
> >> > > >amount of effort put into placebo research, since 
> >> > > >BenedettiÃÆ'¢â‚¬â„¢s 1997 discovery 
> >> > > >thereÃÆ'¢â‚¬â„¢s been an uptick in the 
> >> > > >funding and time devoted to investigating the mechanisms behind 
> >> > > >nocebo, with impressive results. ÃÆ'¢â‚¬Å"Without 
> >> > > >a doubt, thereÃÆ'¢â‚¬â„¢s been a level of 
> >> > > >research and a sophistication of research that has made a quantum 
> >> > > >jump in the last decade or so,ÃÆ'¢â‚¬ says Brody.
> >> > > >In 2007, for example, Benedetti discovered that the 
> >> > > >hypothalamic-pituitary-adrenal axis in the brain, an important part 
> >> > > >of the bodyÃÆ'¢â‚¬â„¢s 
> >> > > >ÃÆ'¢â‚¬Å"stress system,ÃÆ'¢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 BenedettiÃÆ'¢â‚¬â„¢s and 
> >> > > >KaptchukÃÆ'¢â‚¬â„¢s work, it is now clear 
> >> > > >that a personÃÆ'¢â‚¬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 effectÃÆ'¢â‚¬"which seems to be at least 
> >> > > >partly regulated by opioid releaseÃÆ'¢â‚¬"suggesting 
> >> > > >the two phenomena have distinct mechanisms.
> >> > > >ÃÆ'¢â‚¬Å"Even if placebo and nocebo are on a 
> >> > > >continuum of expectation, different mechanisms kick in at different 
> >> > > >points along that continuum,ÃÆ'¢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.9ÃÆ'‚ 
> >> > > >ÃÆ'¢â‚¬Å"It was a really risky 
> >> > > >experiment,ÃÆ'¢â‚¬ says Kaptchuk. 
> >> > > >ÃÆ'¢â‚¬Å"We were really surprised. We 
> >> > > >couldnÃÆ'¢â‚¬â„¢t believe it, 
> >> > > >actually.ÃÆ'¢â‚¬
> >> > > >The biochemical and physiological discoveries about nocebo have made 
> >> > > >the phenomenon more credible in the medical community. 
> >> > > >ÃÆ'¢â‚¬Å"These brain measures provide objective 
> >> > > >evidence on the physical system implementing these squishy, fuzzy 
> >> > > >changes in emotion and expectation,ÃÆ'¢â‚¬ says Wager.
> >> > > >Most nocebo research to date, however, focuses on basic mechanisms, 
> >> > > >not on how to deal with the phenomenon in the clinic. 
> >> > > >ÃÆ'¢â‚¬Å"Translational research has been a 
> >> > > >stepchild in scientific investigations of this 
> >> > > >phenomenon,ÃÆ'¢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 
> >> > > >ÃÆ'¢â‚¬Å"side effects are not anticipated beyond 
> >> > > >occasional gastrointestinal irritation and, rarely, skin 
> >> > > >rash.ÃÆ'¢â‚¬ At the third center, 
> >> > > >patientsÃÆ'¢â‚¬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, 
> >> > > >ÃÆ'¢â‚¬Å"First, do no 
> >> > > >harm,ÃÆ'¢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 
> >> > > >theÃÆ'‚ American 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 effectsÃÆ'¢â‚¬"those that are not a 
> >> > > >direct result of the pharmacological action of the 
> >> > > >drugÃÆ'¢â‚¬"including headache, nausea, and fatigue.
> >> > > >Nocebo is at least as important as the placebo effect and may be more 
> >> > > >widespread.ÃÆ'¢â‚¬"ÃÆ'‚­ Ted 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. ÃÆ'¢â‚¬Å"I 
> >> > > >certainly donÃÆ'¢â‚¬â„¢t think that we 
> >> > > >should be rethinking whether informed consent should be a basic norm 
> >> > > >in clinical practice,ÃÆ'¢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
> >> >
> >>
> >
> >
>



------------------------------------

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