Merle, No, I have not read that book. I'll Bing it to find out what it's about...Bill!
--- In [email protected], siska_cen@... wrote: > > Hi Bill, > > Have you read Albom's The Time Keeper? I find it interesting, though not very > 'Zen' (whatever that means :-p), but the idea is just interesting. > > And of course, this writer is very gifted in story-telling... > > Siska > -----Original Message----- > From: "Bill!" <BillSmart@...> > Sender: [email protected] > Date: Mon, 15 Jul 2013 02:18:46 > To: <[email protected]> > Reply-To: [email protected] > Subject: [Zen] Re: Worried Sick..illusions > > Edgar, > > I forgot to address your 'wasting time' comment which IMO is much more > important that the other part. > > IMO you feel you're 'wasting time' because you have an attachment to > accomplishment. When you don't accomplish what your self has defined as > important then you feel like you've 'wasted time'. > > Of course I'm sure it comes as no surprise to you that I would also remind > you that there is no time to waste. Time is delusive. There is only Now, > and what you do with it is entirely up to you - but nothing you do is a > waste. It's just life. > > Just THIS! > > ...Bill! > > > --- In [email protected], "Bill!" <BillSmart@> wrote: > > > > Edgar, > > > > I experience what I experience. You experience what you experience. That > > is the only reality that either of us have available to us. > > > > All the rest that you claim to exist is speculation, intellectualizations; > > in other words delusions. > > > > ...Bill! > > > > --- In [email protected], Edgar Owen <edgarowen@> wrote: > > > > > > 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: > > > > > > > > > > > > > > > > > > > > > > > > àbill..thank you for your clarification...so what is NOT an > > > > > > illusion bill?...and what is real in your world?...merle > > > > > > > > > > > > > > > > > > à> > > > > > 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: > > > > > > > > > > > > > > > > > > > > > > > > > > > > Ãâài 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. > > > > > > > >ByÃâàMegan ScudellariÃâà|ÃâàJuly 1, 2013 > > > > > > > >Ãâé 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 Eltroxinâââ¬"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 > > > > > > > >governmentâââ‰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 drugâââ‰â¢s inert qualities, including > > > > > > > >the tabletsâââ‰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∠"Noceboââ⬠(meaning ââ∠"I shall > > > > > > > >harmâââ¬) is the dastardly sibling of placebo > > > > > > > >(ââ∠"I shall pleaseâââ¬). > > > > > > > >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 drugâââ‰â¢s pharmacological > > > > > > > >properties. The patients were victims of the nocebo effect. > > > > > > > >ââ∠"Noceboââ⬠(meaning ââ∠"I shall > > > > > > > >harmâââ¬) is the dastardly sibling of placebo > > > > > > > >(ââ∠"I shall pleaseâââ¬). In a placebo > > > > > > > >response, a sham medication or procedure has a beneficial health > > > > > > > >effect as a result of a patientâââ‰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 Parkinsonâââ‰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.2ÃâàWhen 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.3ÃâàAnd men treated for an > > > > > > > >enlarged prostate with a commonly prescribed drug and told that > > > > > > > >the drug ââ∠"may cause erectile dysfunction, decreased > > > > > > > >libido, [and] problems of ejaculation,ââ⬠but that these > > > > > > > >effects were ââ∠"uncommon,ââ⬠were more than > > > > > > > >twice as likely to experience impotence as those who were not so > > > > > > > >informed.4 > > > > > > > >On paper, it sounds like psychobabbleâââ¬"a negative > > > > > > > >effect caused by a sham treatment based on a > > > > > > > >patientâââ‰â¢s expectationsâââ¬"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∠"Nocebo is at least as important as the placebo > > > > > > > >effect and may be more widespread,ââ⬠says Ted Kaptchuk, > > > > > > > >director of Harvardâââ‰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 > > > > > > > >Ãâé 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∠"More > > > > > > > >knowledge about nocebo effects on itch can give us some targets > > > > > > > >to reduce [those effects].ââ⬠> > > > > > > >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 inflatedâââ¬"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∠"We could show that a nocebo effect may > > > > > > > >be induced even by mere information,ââ⬠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∠"Itâââ‰â¢s certainly > > > > > > > >possible,ââ⬠says Manfred Schedlowski, who studies > > > > > > > >placebo and the immune system at University Hospital Essen. > > > > > > > >ââ∠"From experimental data, we know an allergic > > > > > > > >reaction can be conditioned.ââ⬠> > > > > > > >In an oft-cited case from 1886, John Mackenzie, a surgeon in > > > > > > > >Baltimore, described how heâââ‰â¢d ââ∠> > > > > > > >"obtained an artificial rose of such exquisite workmanship that > > > > > > > >it presented a perfect counterfeit of the original,ââ⬠> > > > > > > >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∠"Weâââ‰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,ââ⬠> > > > > > > >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 bodyâââ‰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 > > > > > > > >increaseâââ¬"the nocebo effect was absent.5ÃâàIn > > > > > > > >one fell swoop, Benedetti identified a biochemical reaction > > > > > > > >responsible for the nocebo response, and he showed that it could > > > > > > > >be blocked. > > > > > > > >It was Benedettiâââ‰â¢s work that finally convinced > > > > > > > >physician-bioethicist Howard Brody that the nocebo > > > > > > > >effectâââ¬"allegedly first mentioned in the scientific > > > > > > > >literature in 1961 by physician Walter Kennedy, who called the > > > > > > > >phenomenon a ââ∠"quality inherent in the patient > > > > > > > >rather than in the remedyâââ¬Ã¢ââ¬"was real. > > > > > > > >ââ∠"For many years, I dismissed the value of the term > > > > > > > >âââ¬ÃÅ"nocebo,âââ‰â¢Ã¢ââ‰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 > > > > > > > >effectsâââ¬"one was just manifested as a positive > > > > > > > >outcome, while the other caused harm. But after reading > > > > > > > >Benedettiâââ‰â¢s work, Brody changed his tune: > > > > > > > >ââ∠"I received my comeuppance,ââ⬠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∠> > > > > > > >"placeboââ⬠and fewer than 200 on ââ∠> > > > > > > >"nocebo.ââ⬠Of those, only a few dozen are empirical > > > > > > > >studies; most are reviews. ââ∠"The placebo phenomenon > > > > > > > >has a tremendous fascination for the publicâââ¬"a > > > > > > > >gee-whiz thing with a positive spin, a way to be healthy without > > > > > > > >taking drugs,ââ⬠says Frank Miller, a bioethicist at the > > > > > > > >National Institutes of Health. ââ∠"But nobody is very > > > > > > > >enthusiastic about the nocebo phenomenon.ââ⬠> > > > > > > >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∠"My ethics > > > > > > > >committee will not allow me to do it,ââ⬠says Paul Enck, > > > > > > > >a psychologist at the University of TÃÆ'übingen in Germany, > > > > > > > >ââ∠"unless I tell the subjects that I am deceiving > > > > > > > >themâââ¬Ã¢ââ¬"a requirement that obviously defeats > > > > > > > >the purpose of the deception. ââ∠"It makes life really > > > > > > > >miserable as a [nocebo] researcher,ââ⬠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 noceboâââ‰â¢s > > > > > > > >insidious effects on medicine and research. ââ∠"In > > > > > > > >clinical drug trials, the placebo effectâââ¬"and now we > > > > > > > >know the nocebo effectâââ¬"can be really, really > > > > > > > >large,ââ⬠says Manfred Schedlowski, a clinical > > > > > > > >researcher at the University Hospital Essen in Germany. > > > > > > > >ââ∠"This hinders the development of new > > > > > > > >drugs.ââ⬠> > > > > > > >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 armâââ¬"meaning they were receiving a > > > > > > > >completely inert substanceâââ¬"dropped out of the study > > > > > > > >because of side effects including dizziness and nausea.6Ãâà> > > > > > > >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 > > > > > > > >wonâââ‰â¢t cause symptoms of the disease. The nocebo > > > > > > > >effect has ââ∠"great potentialââ⬠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∠"In places like primary care, people are swimming > > > > > > > >in placebo and nocebo effects,ââ⬠says Kaptchuk. > > > > > > > >Thomas Dâââ‰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∠"Iâââ‰â¢ve > > > > > > > >listened to some well-respected colleagues give information [to > > > > > > > >a patient], and I thought, âââ¬ÃÅ"Gosh, I know the > > > > > > > >operation and even I wouldnâââ‰â¢t want > > > > > > > >it,âââ‰â¢Ã¢â⬠he says. ââ∠> > > > > > > >"Thereâââ‰â¢s too much detail and too much emphasis > > > > > > > >about things that could go wrong.ââ⬠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 > > > > > > > >Ãâé BRYAN SATALINODespite the disproportionate amount of > > > > > > > >effort put into placebo research, since > > > > > > > >Benedettiâââ‰â¢s 1997 discovery > > > > > > > >thereâââ‰â¢s been an uptick in the funding and time > > > > > > > >devoted to investigating the mechanisms behind nocebo, with > > > > > > > >impressive results. ââ∠"Without a doubt, > > > > > > > >thereâââ‰â¢s been a level of research and a > > > > > > > >sophistication of research that has made a quantum jump in the > > > > > > > >last decade or so,ââ⬠says Brody. > > > > > > > >In 2007, for example, Benedetti discovered that the > > > > > > > >hypothalamic-pituitary-adrenal axis in the brain, an important > > > > > > > >part of the bodyâââ‰â¢s ââ∠"stress > > > > > > > >system,ââ⬠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 Benedettiâââ‰â¢s and > > > > > > > >Kaptchukâââ‰â¢s work, it is now clear that a > > > > > > > >personâââ‰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 effectâââ¬"which seems to be > > > > > > > >at least partly regulated by opioid > > > > > > > >releaseâââ¬"suggesting the two phenomena have distinct > > > > > > > >mechanisms. > > > > > > > >ââ∠"Even if placebo and nocebo are on a continuum of > > > > > > > >expectation, different mechanisms kick in at different points > > > > > > > >along that continuum,ââ⬠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.9Ãâàââ∠"It was a really risky > > > > > > > >experiment,ââ⬠says Kaptchuk. ââ∠"We were > > > > > > > >really surprised. We couldnâââ‰â¢t believe it, > > > > > > > >actually.ââ⬠> > > > > > > >The biochemical and physiological discoveries about nocebo have > > > > > > > >made the phenomenon more credible in the medical community. > > > > > > > >ââ∠"These brain measures provide objective evidence on > > > > > > > >the physical system implementing these squishy, fuzzy changes in > > > > > > > >emotion and expectation,ââ⬠says Wager. > > > > > > > >Most nocebo research to date, however, focuses on basic > > > > > > > >mechanisms, not on how to deal with the phenomenon in the > > > > > > > >clinic. ââ∠"Translational research has been a > > > > > > > >stepchild in scientific investigations of this > > > > > > > >phenomenon,ââ⬠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∠"side effects > > > > > > > >are not anticipated beyond occasional gastrointestinal > > > > > > > >irritation and, rarely, skin rash.ââ⬠At the third > > > > > > > >center, patientsâââ‰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∠"First, do no harm,ââ⬠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 > > > > > > > >theÃâàAmerican 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 > > > > > > > >effectsâââ¬"those that are not a direct result of the > > > > > > > >pharmacological action of the drugâââ¬"including > > > > > > > >headache, nausea, and fatigue. > > > > > > > >Nocebo is at least as important as the placebo effect and may be > > > > > > > >more widespread.âââ¬"ÃâàTed 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∠"I certainly > > > > > > > >donâââ‰â¢t think that we should be rethinking > > > > > > > >whether informed consent should be a basic norm in clinical > > > > > > > >practice,ââ⬠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! 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