Merle, Buddha Nature and Human Nature working hand-in-hand is the purpose of zen practice.
...Bill! --- In [email protected], Merle Lester <merlewiitpom@...> wrote: > > bill >  would not human nature and buddha nature work hand in hand... buddha after > all was human..merle >  > Merle, > > We don't "have to make sense of our experiences". We could just sit in deep > samadhi until we died. > > We choose to intellectualize our experiences and use these perceptions as the > basis for making decisions about what actions to take and what not to take. > Although I admit that for most of us it's really not a choice since we aren't > aware there is an alternative. Anyway, all that's our Human Nature at work, > not Buddha Nature. > > ...Bill! > > --- In [email protected], Merle Lester <merlewiitpom@> wrote: > > > > > > > > àbill..we have to make sense of our experiences... and if you say the > > intellect distorts reality..how else pray are you going to operate?..there > > is no other system...merle > > > > > > à> > 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: > > > > > > > > > > > > Ãâàso 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..Ãâà> > > > > > i do not believe one can totally trust our senses as being the only real > > > experience...what ever you mean by real...we see Ãâàwe hear we > > > touch we smell we taste...Ãâà> > > Ãâàone interpret this with our mind... > > > otherwise this world would make no sense what so ever...Ãâà> > > Ãâàone 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?...Ãâà> > > 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... > > > Ãâàthen it becomes real real real... and one is able to communicate > > > that reality to others > > > Ãâàand then there is a consensus > > > > > > merle > > > > > > Ãâà> > > 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: > > > > > > > > > > > > > > > > ÃÆ'ââ¬Å¡Ãâàbill..thank you for your clarification...so what is > > > > NOT an illusion bill?...and what is real in your world?...merle > > > > > > > > > > > > ÃÆ'ââ¬Å¡Ãâà> > > > 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'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡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. > > > > > >ByÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡ÃâàMegan > > > > > >ScudellariÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡Ãâà> > > > > >|ÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡ÃâàJuly 1, 2013 > > > > > >ÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡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 EltroxinÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs inert qualities, > > > > > >including the tabletsÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââ 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"NoceboÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì (meaning ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"I shall > > > > > >harmÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì) is the > > > > > >dastardly sibling of placebo (ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"I shall > > > > > >pleaseÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì). > > > > > >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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs pharmacological > > > > > >properties. The patients were victims of the nocebo effect. > > > > > >ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"NoceboÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì (meaning ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"I shall > > > > > >harmÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì) is the > > > > > >dastardly sibling of placebo (ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"I shall > > > > > >pleaseÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì). In a > > > > > >placebo response, a sham medication or procedure has a beneficial > > > > > >health effect as a result of a > > > > > >patientÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 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'Ã'ââ∠> > > > > >¡ÃÆ'ââ¬Å¡ÃâàWhen 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'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡ÃâàAnd men treated for > > > > > >an enlarged prostate with a commonly prescribed drug and told that > > > > > >the drug ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"may cause erectile dysfunction, decreased > > > > > >libido, [and] problems of > > > > > >ejaculation,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì but > > > > > >that these effects were > ÃÆ'Ã'ÃââÃÆ'âââ∠> ¡ÃâìÃÆ'ââ¬Â¦"uncommon,ÃÆ'Ã'ÃââÃÆ'âââ∠> ¡Ãâì were more than twice as likely to experience impotence as those > who were not so informed.4 > > > > > >On paper, it sounds like > > > > > >psychobabbleÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"a > > > > > >negative effect caused by a sham treatment based on a > > > > > >patientÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs > > > > > >expectationsÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"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'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"Nocebo > > > > > >is at least as important as the placebo effect and may be more > > > > > >widespread,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì says Ted > > > > > >Kaptchuk, director of HarvardÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 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'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡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. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"More knowledge about nocebo effects on itch > > > > > >can give us some targets to reduce [those > > > > > >effects].ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì > > > > > >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'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"We could show that a nocebo effect may be > > > > > >induced even by mere > > > > > >information,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"ItÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs certainly > > > > > >possible,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì says > > > > > >Manfred Schedlowski, who studies placebo and the immune system at > > > > > >University Hospital Essen. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"From experimental data, we know an allergic > > > > > >reaction can be conditioned.ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì > > > > > >In an oft-cited case from 1886, John Mackenzie, a surgeon in > > > > > >Baltimore, described how heÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââd > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"obtained > > > > > >an artificial rose of such exquisite workmanship that it presented a > > > > > >perfect counterfeit of the > > > > > >original,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"WeÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââre in such a primitive > > > > > >state of understanding this phenomenon, particularly in a clinically > > > > > >oriented way, that we just need to do more > > > > > >research,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 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'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"the nocebo > > > > > >effect was absent.5ÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡ÃâàIn one > > > > > >fell swoop, Benedetti identified a biochemical reaction responsible > > > > > >for the nocebo response, and he showed that it could be blocked. > > > > > >It was BenedettiÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs work that finally > > > > > >convinced physician-bioethicist Howard Brody that the nocebo > > > > > >effectÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"allegedly > > > > > >first mentioned in the scientific literature in 1961 by physician > > > > > >Walter Kennedy, who called the phenomenon a > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"quality > > > > > >inherent in the patient rather than in the > > > > > >remedyÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"was real. > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"For many > > > > > >years, I dismissed the value of the term > > > > > >ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¹Ãâ¦"nocebo,ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > > ¡ÃâìÃÆ'âââ∠> > > > > >¾ÃââÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬Å¡Ã¬ÃâðÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > > ¡Ãâì 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'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"one was just > > > > > >manifested as a positive outcome, while the other caused harm. But > > > > > >after reading > BenedettiÃÆ'Ã'ÃââÃÆ'âââ∠> ¡ÃâìÃÆ'ââââ¬à ¾Ãââs work, Brody changed his tune: > ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"I received my > comeuppance,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"placeboÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì and fewer than 200 on > > > > > >ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"nocebo.ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì Of those, only a few dozen are empirical studies; most > > > > > >are reviews. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"The placebo phenomenon has a tremendous > > > > > >fascination for the publicÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì"a gee-whiz thing with a positive spin, a way to be > > > > > >healthy without taking drugs,ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì says Frank Miller, a bioethicist at the > National Institutes of Health. ÃÆ'Ã'ÃââÃÆ'âââ∠> ¡ÃâìÃÆ'ââ¬Â¦"But nobody is very enthusiastic about the nocebo > phenomenon.ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì > > > > > >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'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"My > > > > > >ethics committee will not allow me to do > > > > > >it,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì says Paul Enck, > > > > > >a psychologist at the University of TÃÆ'Ã'Ãâ > > > > > >'ÃÆ'ââ¬Å¡Ãâübingen in Germany, > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"unless I > > > > > >tell the subjects that I am deceiving > > > > > >themÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"a > > > > > >requirement that obviously defeats the purpose of the deception. > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"It makes > > > > > >life really miserable as a [nocebo] > > > > > >researcher,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs insidious effects on > > > > > >medicine and research. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"In clinical drug trials, the placebo > > > > > >effectÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"and now we > > > > > >know the nocebo effectÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì"can be really, really > > > > > >large,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì says Manfred > > > > > >Schedlowski, a clinical researcher at the University Hospital Essen > > > > > >in Germany. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"This hinders the development of new > > > > > >drugs.ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì > > > > > >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'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"meaning > > > > > >they were receiving a completely inert > > > > > >substanceÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"dropped > > > > > >out of the study because of side effects including dizziness and > > > > > >nausea.6ÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡ÃâàOther 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãâât cause symptoms of the > > > > > >disease. The nocebo effect has ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"great > > > > > >potentialÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"In > > > > > >places like primary care, people are swimming in placebo and nocebo > > > > > >effects,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì says > > > > > >Kaptchuk. > > > > > >Thomas DÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾ÃââAmico, 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"IÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââve listened to some > > > > > >well-respected colleagues give information [to a patient], and I > > > > > >thought, ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¹Ãâ¦"Gosh, I know the operation and even I > > > > > >wouldnÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãâât want > > > > > >it,ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'âââ∠> > > > > >¾ÃââÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì he says. > ÃÆ'Ã'ÃââÃÆ'âââ∠> ¡ÃâìÃÆ'ââ¬Â¦"ThereÃÆ'Ã'ÃââÃÆ'âââ∠> ¡ÃâìÃÆ'ââââ¬à ¾Ãââs too much detail and too much > emphasis about things that could go > wrong.ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡Ãâé BRYAN SATALINODespite the > > > > > >disproportionate amount of effort put into placebo research, since > > > > > >BenedettiÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 1997 discovery > > > > > >thereÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs been an uptick in the > > > > > >funding and time devoted to investigating the mechanisms behind > > > > > >nocebo, with impressive results. > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"Without > > > > > >a doubt, thereÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs been a level of > > > > > >research and a sophistication of research that has made a quantum > > > > > >jump in the last decade or so,ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì says Brody. > > > > > >In 2007, for example, Benedetti discovered that the > > > > > >hypothalamic-pituitary-adrenal axis in the brain, an important part > > > > > >of the bodyÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"stress > > > > > >system,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs and > > > > > >KaptchukÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs work, it is now clear > > > > > >that a personÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââs 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì"which seems to be at least partly regulated by opioid > > > > > >releaseÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"suggesting > > > > > >the two phenomena have distinct mechanisms. > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"Even if > > > > > >placebo and nocebo are on a continuum of expectation, different > > > > > >mechanisms kick in at different points along that > > > > > >continuum,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡Ãâà> > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"It was a > > > > > >really risky experiment,ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì says Kaptchuk. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"We were really surprised. We > > > > > >couldnÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãâât > believe it, actually.ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì > > > > > >The biochemical and physiological discoveries about nocebo have made > > > > > >the phenomenon more credible in the medical community. > > > > > >ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"These > > > > > >brain measures provide objective evidence on the physical system > > > > > >implementing these squishy, fuzzy changes in emotion and > > > > > >expectation,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì says > > > > > >Wager. > > > > > >Most nocebo research to date, however, focuses on basic mechanisms, > > > > > >not on how to deal with the phenomenon in the clinic. > > > > > >ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"Translational research has been a stepchild > > > > > >in scientific investigations of this > > > > > >phenomenon,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"side effects are not anticipated beyond > > > > > >occasional gastrointestinal irritation and, rarely, skin > > > > > >rash.ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì At the third > > > > > >center, patientsÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãââ 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'Ã'ÃââÃÆ'ââââ¬à ¡ÃâìÃÆ'ââ¬Â¦"First, > > > > > >do no harm,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì 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'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡ÃâàAmerican 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'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"those that > > > > > >are not a direct result of the pharmacological action of the > > > > > >drugÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì"including > > > > > >headache, nausea, and fatigue. > > > > > >Nocebo is at least as important as the placebo effect and may be > > > > > >more widespread.ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡Ãâì"ÃÆ'Ã'âââ¬à ¡ÃÆ'ââ¬Å¡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. ÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââ¬Â¦"I certainly > > > > > >donÃÆ'Ã'ÃââÃÆ'âââ∠> > > > > >¡ÃâìÃÆ'ââââ¬à ¾Ãâât think that we should be > > > > > >rethinking whether informed consent should be a basic norm in > > > > > >clinical practice,ÃÆ'Ã'ÃââÃÆ'ââââ¬à ¡Ãâì > > > > > >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! ID required) <*> To change settings via email: [email protected] [email protected] <*> To unsubscribe from this group, send an email to: [email protected] <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
