Chris, I do agree with you but take no offense. I don't think Edgar is purposely misquoting what I say. I think he really believes that's what I say.
To borrow some lyrics from THE BOXER, an old Simon and Garfunkle song, I think sometimes Edgar "hears what he wants to hear and disregards the rest". ...Bill! --- In [email protected], Chris Austin-Lane <chris@...> wrote: > > I could quote some old story about the red bearded one, but I'll wager he > partially agrees with me when it's his day again. > > Anyway, aside from my whining about your writing, do you actually believe > Bill is a solopsist? I have never read him say that reality isn't, merely > that it's chaos, with no internal order outside of Just This. > > Thanks, > --Chris > 301-270-6524 > On Jul 15, 2013 9:28 AM, "Edgar Owen" <edgarowen@...> wrote: > > > > > > > Chris, > > > > Yes, almost as bad as you speaking for him! > > :-) > > > > Edgar > > > > > > > > On Jul 15, 2013, at 11:43 AM, Chris Austin-Lane wrote: > > > > > > > > Bill's never said this, and I personally find falsely attributing things > > to people to be about par socially with calling them names. > > > > He says no one exists, there is no Bill and no Chris, just experiencing. > > All supppsedly separate beings are incorrect perceptions, there is no > > separation possible. > > > > Thanks, > > --Chris > > 301-270-6524 > > On Jul 15, 2013 6:16 AM, "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: > >> > > >> > > >> > > >> > à 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..à > >> > > >> > i do not believe one can totally trust our senses as being the only > >> real experience...what ever you mean by real...we see à we hear we touch > >> we > >> smell we taste...à > >> > à one interpret this with our mind... > >> > otherwise this world would make no sense what so ever...à > >> > à 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?...à > >> > 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... > >> > à then it becomes real real real... and one is able to communicate that > >> reality to others > >> > à and then there is a consensus > >> > > >> > merle > >> > > >> > à > >> > 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: > >> > > > >> > > > >> > > > >> > > Ãâà bill..thank you for your clarification...so what is NOT an > >> illusion bill?...and what is real in your world?...merle > >> > > > >> > > > >> > > 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'ââ¬Å¡Ãâà 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'ââ¬Å¡Ãâà Megan ScudellariÃÆ'ââ¬Å¡Ãâà > >> > > > >|ÃÆ'ââ¬Å¡Ãâà July 1, 2013 > >> > > > >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'ââââ¬Å¡Ã¬"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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s inert > >> qualities, including the tabletsÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢ > >> 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'ââââ¬Å¡Ã¬Ãâ¦"NoceboÃÆ'ââââ¬Å¡Ã¬ (meaning > >> > > > >ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"I shall > >> harmÃÆ'ââââ¬Å¡Ã¬) is the dastardly sibling of placebo > >> (ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"I shall > >> pleaseÃÆ'ââââ¬Å¡Ã¬). > >> > > > >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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s > >> pharmacological properties. The > >> patients were victims of the nocebo effect. > >> > > > >ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"NoceboÃÆ'ââââ¬Å¡Ã¬ (meaning > >> > > > >ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"I shall > >> harmÃÆ'ââââ¬Å¡Ã¬) is the dastardly sibling of placebo > >> (ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"I shall > >> pleaseÃÆ'ââââ¬Å¡Ã¬). In a placebo response, a sham medication > >> or procedure > >> has a beneficial health effect as a result of a > >> patientÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââ¬Å¡Ãâà 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'ââ¬Å¡Ãâà And men > >> treated for > >> an enlarged prostate with a commonly prescribed drug and told that the drug > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"may cause erectile dysfunction, decreased > >> libido, [and] > >> problems of ejaculation,ÃÆ'ââââ¬Å¡Ã¬ but that these effects were > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"uncommon,ÃÆ'ââââ¬Å¡Ã¬ were more > >> than twice as likely to > >> experience impotence as those who were not so informed.4 > >> > > > >On paper, it sounds like psychobabbleÃÆ'ââââ¬Å¡Ã¬"a > >> > > > >negative effect > >> caused by a sham treatment based on a > >> patientÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s > >> expectationsÃÆ'ââââ¬Å¡Ã¬"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'ââââ¬Å¡Ã¬Ãâ¦"Nocebo is at least as important as the > >> > > > >placebo > >> effect and may be more widespread,ÃÆ'ââââ¬Å¡Ã¬ says Ted > >> Kaptchuk, director > >> of HarvardÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'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'ââââ¬Å¡Ã¬Ãâ¦"More > >> knowledge about > >> nocebo effects on itch can give us some targets to reduce [those > >> effects].ÃÆ'ââââ¬Å¡Ã¬ > >> > > > >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'ââââ¬Å¡Ã¬"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'ââââ¬Å¡Ã¬Ãâ¦"We could show that a nocebo effect may be > >> induced even by > >> mere information,ÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ãâ¦"ItÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s > >> certainly possible,ÃÆ'ââââ¬Å¡Ã¬ says > >> Manfred Schedlowski, who studies placebo and the immune system at > >> University Hospital Essen. ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"From experimental > >> data, we know an > >> allergic reaction can be conditioned.ÃÆ'ââââ¬Å¡Ã¬ > >> > > > >In an oft-cited case from 1886, John Mackenzie, a surgeon in > >> Baltimore, described how heÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢d > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"obtained an > >> artificial rose of such exquisite workmanship that it presented a perfect > >> counterfeit of the original,ÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ãâ¦"WeÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââââ¬Å¡Ã¬"the > >> nocebo effect was absent.5ÃÆ'ââ¬Å¡Ãâà 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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s work that > >> > > > >finally convinced > >> physician-bioethicist Howard Brody that the nocebo > >> effectÃÆ'ââââ¬Å¡Ã¬"allegedly first mentioned in the scientific > >> literature in > >> 1961 by physician Walter Kennedy, who called the phenomenon a > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"quality inherent in the patient rather than > >> in the > >> remedyÃÆ'ââââ¬Å¡Ã¬ÃÆ'ââââ¬Å¡Ã¬"was real. > >> > > > >ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"For many years, I dismissed the value > >> > > > >of the term > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¹Ã > >> "nocebo,ÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢ÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Ã°ÃÆ'ââââ¬Å¡Ã¬ > >> 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'ââââ¬Å¡Ã¬"one > >> was just manifested as a positive outcome, while the other caused harm. But > >> after reading BenedettiÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s work, Brody > >> changed his tune: > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"I received my > >> comeuppance,ÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ãâ¦"placeboÃÆ'ââââ¬Å¡Ã¬ and fewer than > >> 200 > >> on ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"nocebo.ÃÆ'ââââ¬Å¡Ã¬ Of those, > >> only a few dozen are > >> empirical studies; most are reviews. ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"The > >> placebo phenomenon > >> has a tremendous fascination for the publicÃÆ'ââââ¬Å¡Ã¬"a > >> gee-whiz thing > >> with a positive spin, a way to be healthy without taking > >> drugs,ÃÆ'ââââ¬Å¡Ã¬ > >> says Frank Miller, a bioethicist at the National Institutes of Health. > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"But nobody is very enthusiastic about the > >> nocebo > >> phenomenon.ÃÆ'ââââ¬Å¡Ã¬ > >> > > > >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'ââââ¬Å¡Ã¬Ãâ¦"My ethics committee will not > >> allow me to do > >> it,ÃÆ'ââââ¬Å¡Ã¬ says Paul Enck, a psychologist at the > >> University of > >> TÃÆ'Ã'Ãâübingen in Germany, ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"unless I > >> tell the subjects that I > >> am deceiving themÃÆ'ââââ¬Å¡Ã¬ÃÆ'ââââ¬Å¡Ã¬"a > >> requirement that obviously > >> defeats the purpose of the deception. ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"It > >> makes life really > >> miserable as a [nocebo] researcher,ÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s > >> insidious effects on > >> medicine and research. ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"In clinical drug > >> trials, the placebo > >> effectÃÆ'ââââ¬Å¡Ã¬"and now we know the nocebo > >> effectÃÆ'ââââ¬Å¡Ã¬"can be > >> really, really large,ÃÆ'ââââ¬Å¡Ã¬ says Manfred Schedlowski, a > >> clinical > >> researcher at the University Hospital Essen in Germany. > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"This > >> hinders the development of new drugs.ÃÆ'ââââ¬Å¡Ã¬ > >> > > > >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'ââââ¬Å¡Ã¬"meaning they were receiving a completely inert > >> substanceÃÆ'ââââ¬Å¡Ã¬"dropped out of the study because of side > >> effects > >> including dizziness and nausea.6ÃÆ'ââ¬Å¡Ãâà 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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢t cause symptoms of the disease. > >> The nocebo effect has > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"great potentialÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ãâ¦"In > >> places like primary care, people are swimming in placebo and nocebo > >> effects,ÃÆ'ââââ¬Å¡Ã¬ says Kaptchuk. > >> > > > >Thomas DÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââââ¬Å¡Ã¬Ãâ¦"IÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢ve > >> listened to some well-respected > >> colleagues give information [to a patient], and I thought, > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¹Ã "Gosh, I know the operation and even I > >> wouldnÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢t want > >> it,ÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢ÃÆ'ââââ¬Å¡Ã¬ he says. > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"ThereÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s > >> too much detail and too much > >> emphasis about things that could go wrong.ÃÆ'ââââ¬Å¡Ã¬ > >> 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'ââ¬Å¡Ãâé BRYAN SATALINODespite the disproportionate > >> > > > >amount of > >> effort put into placebo research, since > >> BenedettiÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s 1997 > >> discovery thereÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s been an uptick in > >> the funding and time > >> devoted to investigating the mechanisms behind nocebo, with impressive > >> results. ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"Without a doubt, > >> thereÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s been a > >> level of research and a sophistication of research that has made a quantum > >> jump in the last decade or so,ÃÆ'ââââ¬Å¡Ã¬ says Brody. > >> > > > >In 2007, for example, Benedetti discovered that the > >> hypothalamic-pituitary-adrenal axis in the brain, an important part of the > >> bodyÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"stress system,ÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s and > >> KaptchukÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢s work, it is now clear that > >> a > >> personÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢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'ââââ¬Å¡Ã¬"which seems to > >> be at least > >> partly regulated by opioid releaseÃÆ'ââââ¬Å¡Ã¬"suggesting the > >> two phenomena > >> have distinct mechanisms. > >> > > > >ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"Even if placebo and nocebo are on a > >> > > > >continuum of > >> expectation, different mechanisms kick in at different points along that > >> continuum,ÃÆ'ââââ¬Å¡Ã¬ 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'ââ¬Å¡Ãâà ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"It was a really > >> risky > >> experiment,ÃÆ'ââââ¬Å¡Ã¬ says Kaptchuk. > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"We were really > >> surprised. We couldnÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢t believe it, > >> actually.ÃÆ'ââââ¬Å¡Ã¬ > >> > > > >The biochemical and physiological discoveries about nocebo have > >> made the phenomenon more credible in the medical community. > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"These brain measures provide objective > >> evidence on the > >> physical system implementing these squishy, fuzzy changes in emotion and > >> expectation,ÃÆ'ââââ¬Å¡Ã¬ says Wager. > >> > > > >Most nocebo research to date, however, focuses on basic > >> mechanisms, not on how to deal with the phenomenon in the clinic. > >> ÃÆ'ââââ¬Å¡Ã¬Ãâ¦"Translational research has been a stepchild > >> in scientific > >> investigations of this phenomenon,ÃÆ'ââââ¬Å¡Ã¬ 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'ââââ¬Å¡Ã¬Ãâ¦"side effects are > >> not anticipated beyond occasional gastrointestinal irritation and, rarely, > >> skin rash.ÃÆ'ââââ¬Å¡Ã¬ At the third center, > >> patientsÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢ > >> 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'ââââ¬Å¡Ã¬Ãâ¦"First, > >> do no harm,ÃÆ'ââââ¬Å¡Ã¬ 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'ââ¬Å¡Ãâà 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'ââââ¬Å¡Ã¬"those that are not a direct result of the > >> pharmacological action of the drugÃÆ'ââââ¬Å¡Ã¬"including > >> headache, nausea, > >> and fatigue. > >> > > > >Nocebo is at least as important as the placebo effect and may be > >> more widespread.ÃÆ'ââââ¬Å¡Ã¬"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'ââââ¬Å¡Ã¬Ãâ¦"I > >> certainly > >> donÃÆ'ââââ¬Å¡Ã¬Ã¢ââ¬Å¾Ã¢t think that we should be > >> rethinking whether informed > >> consent should be a basic norm in clinical > >> practice,ÃÆ'ââââ¬Å¡Ã¬ 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/
