Merle, Yet again Edgar misinterprets and misrepresents what I have consistently said. His count is only 1 off this time, but it's an important 1...
I do NOT believe only I exist, and you and Edgar and everyone else are delusions. I believe I and you and Edgar and everyone else are delusions. I hope you appreciate the difference... ...Bill! --- In [email protected], Edgar Owen <edgarowen@...> wrote: > > Merle, > > You don't get the depths of Bill's delusions. > > Bill truly believes only HE exists and you and I are delusions, figments of > HIS imagination. This solipsistic delusion is the height of arrogance and > megalomania.. > > Edgar > > > > On Jul 14, 2013, at 10:58 PM, Merle Lester 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: > >> > > > >> > > > >> > > > >> > > 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.6ÃâàOther 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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