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 Zen_Forum@yahoogroups.com, "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 Zen_Forum@yahoogroups.com, 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 Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@> wrote:
> > > >
> > > >
> > > >
> > > > Â 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..Â
> > > >
> > > > 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...Â
> > > > Â one interpret this with our mind...
> > > > otherwise this world would make no sense what so ever...Â
> > > > Â 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?...Â
> > > > 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...
> > > > Â then it becomes real real real... and one is able to communicate that
> > > > reality to others
> > > > Â and then there is a consensus
> > > >
> > > > merle
> > > >
> > > > Â
> > > > 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 Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@> wrote:
> > > > >
> > > > >
> > > > >
> > > > > ÃÂ bill..thank you for your clarification...so what is NOT an
> > > > > illusion bill?...and what is real in your world?...merle
> > > > >
> > > > >
> > > > > ÃÂ
> > > > > 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 Zen_Forum@yahoogroups.com, 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
> > > > > > >̩̉ 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.
> > > > > > >âââ¬Ã
"Noceboââ⬠(meaning âââ¬Ã
"I shall
> > > > > > >harmâââ¬) is the dastardly sibling of placebo (âââ¬Ã
> > > > > > >"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.
> > > > > > >âââ¬Ã
"Noceboââ⬠(meaning âââ¬Ã
"I shall
> > > > > > >harmâââ¬) is the dastardly sibling of placebo (âââ¬Ã
> > > > > > >"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
> > > > > > >âââ¬Ã
"may cause erectile dysfunction, decreased libido,
> > > > > > >[and] problems of ejaculation,ââ⬠but that these effects
> > > > > > >were âââ¬Ã
"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.
> > > > > > >âââ¬Ã
"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
> > > > > > >̩̉ 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. âââ¬Ã
"More knowledge about nocebo effects
> > > > > > >on itch can give us some targets to reduce [those
> > > > > > >effects].âââ¬
> > > > > > >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.
> > > > > > >âââ¬Ã
"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.
> > > > > > >âââ¬Ã
"Itâââ‰â¢s certainly possible,âââ¬
> > > > > > >says Manfred Schedlowski, who studies placebo and the immune
> > > > > > >system at University Hospital Essen. âââ¬Ã
"From
> > > > > > >experimental data, we know an allergic reaction can be
> > > > > > >conditioned.âââ¬
> > > > > > >In an oft-cited case from 1886, John Mackenzie, a surgeon in
> > > > > > >Baltimore, described how heâââ‰â¢d âââ¬Ã
> > > > > > >"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.
> > > > > > >âââ¬Ã
"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,âââ¬
> > > > > > >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 âââ¬Ã
"quality inherent in the patient rather
> > > > > > >than in the remedyâââ¬Ã¢ââ¬"was real.
> > > > > > >âââ¬Ã
"For many years, I dismissed the value of the term
> > > > > > >âââ¬ÃÅ"nocebo,âââ‰â¢Ã¢ââ‰â¬Â°Ã¢ââ¬
> > > > > > > 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: âââ¬Ã
"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 âââ¬Ã
> > > > > > >"placeboââ⬠and fewer than 200 on âââ¬Ã
> > > > > > >"nocebo.ââ⬠Of those, only a few dozen are empirical
> > > > > > >studies; most are reviews. âââ¬Ã
"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. âââ¬Ã
"But nobody is very
> > > > > > >enthusiastic about the nocebo phenomenon.âââ¬
> > > > > > >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. âââ¬Ã
"My ethics
> > > > > > >committee will not allow me to do it,ââ⬠says Paul Enck, a
> > > > > > >psychologist at the University of TÃÆ'übingen in Germany,
> > > > > > >âââ¬Ã
"unless I tell the subjects that I am deceiving
> > > > > > >themâââ¬Ã¢ââ¬"a requirement that obviously defeats
> > > > > > >the purpose of the deception. âââ¬Ã
"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. âââ¬Ã
"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. âââ¬Ã
"This hinders the
> > > > > > >development of new drugs.âââ¬
> > > > > > >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.6ÃâÃÂ
> > > > > > >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 âââ¬Ã
"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.
> > > > > > >âââ¬Ã
"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. âââ¬Ã
"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. âââ¬Ã
"Thereâââ‰â¢s too much detail and
> > > > > > >too much emphasis about things that could go wrong.âââ¬
> > > > > > >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
> > > > > > >̩̉ 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. âââ¬Ã
"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 âââ¬Ã
"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.
> > > > > > >âââ¬Ã
"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.9Ãâàâââ¬Ã
"It was a really risky
> > > > > > >experiment,ââ⬠says Kaptchuk. âââ¬Ã
"We were really
> > > > > > >surprised. We couldnâââ‰â¢t believe it,
> > > > > > >actually.âââ¬
> > > > > > >The biochemical and physiological discoveries about nocebo have
> > > > > > >made the phenomenon more credible in the medical community.
> > > > > > >âââ¬Ã
"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.
> > > > > > >âââ¬Ã
"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 âââ¬Ã
"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, âââ¬Ã
> > > > > > >"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. âââ¬Ã
"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
> > > > >
> > > >
> > >
> > >
> >
>
------------------------------------
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