[Zen] Re: Worried Sick..illusions

[Bill!]

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 Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@...> wrote:
>
> 
> 
>  bill..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
> 
> 
>   
> 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:
> >
> > 
> > 
> >  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 Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@> wrote:
> > >
> > > 
> > > 
> > >  bill..thank you for your clarification...so what is NOT an 
> > > illusion bill?...and what is real in your world?...merle
> > > 
> > > 
> > >   
> > > 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:
> > > >
> > > > 
> > > > 
> > > > ÃÆ'‚ 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'‚ Megan ScudellariÃÆ'‚ 
> > > > >|ÃÆ'‚ July 1, 2013
> > > > >ÃÆ'‚© 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'¢â‚¬"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'¢â‚¬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 
> > > > >drugÃÆ'¢â‚¬â„¢s inert qualities, including 
> > > > >the tabletsÃÆ'¢â‚¬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.
> > > > >ÃÆ'¢â‚¬Å"NoceboÃÆ'¢â‚¬ (meaning 
> > > > >ÃÆ'¢â‚¬Å"I shall harmÃÆ'¢â‚¬) is 
> > > > >the dastardly sibling of placebo (ÃÆ'¢â‚¬Å"I shall 
> > > > >pleaseÃÆ'¢â‚¬).
> > > > >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'¢â‚¬â„¢s 
> > > > >pharmacological properties. The patients were victims of the nocebo 
> > > > >effect.
> > > > >ÃÆ'¢â‚¬Å"NoceboÃÆ'¢â‚¬ (meaning 
> > > > >ÃÆ'¢â‚¬Å"I shall harmÃÆ'¢â‚¬) is 
> > > > >the dastardly sibling of placebo (ÃÆ'¢â‚¬Å"I shall 
> > > > >pleaseÃÆ'¢â‚¬). In a placebo response, a sham 
> > > > >medication or procedure has a beneficial health effect as a result of 
> > > > >a patientÃÆ'¢â‚¬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 ParkinsonÃÆ'¢â‚¬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.2ÃÆ'‚ 
> > > > >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'‚ And men treated for an 
> > > > >enlarged prostate with a commonly prescribed drug and told that the 
> > > > >drug ÃÆ'¢â‚¬Å"may cause erectile dysfunction, 
> > > > >decreased libido, [and] problems of 
> > > > >ejaculation,ÃÆ'¢â‚¬ but that these effects were 
> > > > >ÃÆ'¢â‚¬Å"uncommon,ÃÆ'¢â‚¬ were 
> > > > >more than twice as likely to experience impotence as those who were 
> > > > >not so informed.4
> > > > >On paper, it sounds like psychobabbleÃÆ'¢â‚¬"a 
> > > > >negative effect caused by a sham treatment based on a 
> > > > >patientÃÆ'¢â‚¬â„¢s 
> > > > >expectationsÃÆ'¢â‚¬"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'¢â‚¬Å"Nocebo is at least as important as the 
> > > > >placebo effect and may be more widespread,ÃÆ'¢â‚¬ says 
> > > > >Ted Kaptchuk, director of 
> > > > >HarvardÃÆ'¢â‚¬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
> > > > >ÃÆ'‚© 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'¢â‚¬Å"More knowledge about nocebo effects on 
> > > > >itch can give us some targets to reduce [those 
> > > > >effects].ÃÆ'¢â‚¬
> > > > >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'¢â‚¬"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'¢â‚¬Å"We could show that a nocebo effect may be 
> > > > >induced even by mere information,ÃÆ'¢â‚¬ 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'¢â‚¬Å"ItÃÆ'¢â‚¬â„¢s 
> > > > >certainly possible,ÃÆ'¢â‚¬ says Manfred Schedlowski, 
> > > > >who studies placebo and the immune system at University Hospital 
> > > > >Essen. ÃÆ'¢â‚¬Å"From experimental data, we know an 
> > > > >allergic reaction can be conditioned.ÃÆ'¢â‚¬
> > > > >In an oft-cited case from 1886, John Mackenzie, a surgeon in 
> > > > >Baltimore, described how heÃÆ'¢â‚¬â„¢d 
> > > > >ÃÆ'¢â‚¬Å"obtained an artificial rose of such 
> > > > >exquisite workmanship that it presented a perfect counterfeit of the 
> > > > >original,ÃÆ'¢â‚¬ 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'¢â‚¬Å"WeÃÆ'¢â‚¬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,ÃÆ'¢â‚¬ 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'¢â‚¬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 
> > > > >increaseÃÆ'¢â‚¬"the nocebo effect was 
> > > > >absent.5ÃÆ'‚ 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'¢â‚¬â„¢s work that 
> > > > >finally convinced physician-bioethicist Howard Brody that the nocebo 
> > > > >effectÃÆ'¢â‚¬"allegedly first mentioned in the 
> > > > >scientific literature in 1961 by physician Walter Kennedy, who called 
> > > > >the phenomenon a ÃÆ'¢â‚¬Å"quality inherent in the 
> > > > >patient rather than in the 
> > > > >remedyÃÆ'¢â‚¬ÃÆ'¢â‚¬"was real.
> > > > >ÃÆ'¢â‚¬Å"For many years, I dismissed the value of 
> > > > >the term ÃÆ'¢â‚¬ËÅ
> > > > >"nocebo,ÃÆ'¢â‚¬â„¢ÃÆ'¢â‚¬â€°ÃÆ'¢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 effectsÃÆ'¢â‚¬"one was just manifested as a 
> > > > >positive outcome, while the other caused harm. But after reading 
> > > > >BenedettiÃÆ'¢â‚¬â„¢s work, Brody changed 
> > > > >his tune: ÃÆ'¢â‚¬Å"I received my 
> > > > >comeuppance,ÃÆ'¢â‚¬ 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'¢â‚¬Å"placeboÃÆ'¢â‚¬ and fewer 
> > > > >than 200 on 
> > > > >ÃÆ'¢â‚¬Å"nocebo.ÃÆ'¢â‚¬ Of those, 
> > > > >only a few dozen are empirical studies; most are reviews. 
> > > > >ÃÆ'¢â‚¬Å"The placebo phenomenon has a tremendous 
> > > > >fascination for the publicÃÆ'¢â‚¬"a gee-whiz thing 
> > > > >with a positive spin, a way to be healthy without taking 
> > > > >drugs,ÃÆ'¢â‚¬ says Frank Miller, a bioethicist at the 
> > > > >National Institutes of Health. ÃÆ'¢â‚¬Å"But nobody 
> > > > >is very enthusiastic about the nocebo 
> > > > >phenomenon.ÃÆ'¢â‚¬
> > > > >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'¢â‚¬Å"My ethics 
> > > > >committee will not allow me to do it,ÃÆ'¢â‚¬ says Paul 
> > > > >Enck, a psychologist at the University of TÃÆ'Æ'¼bingen in 
> > > > >Germany, ÃÆ'¢â‚¬Å"unless I tell the subjects that 
> > > > >I am deceiving themÃÆ'¢â‚¬ÃÆ'¢â‚¬"a 
> > > > >requirement that obviously defeats the purpose of the deception. 
> > > > >ÃÆ'¢â‚¬Å"It makes life really miserable as a 
> > > > >[nocebo] researcher,ÃÆ'¢â‚¬ 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'¢â‚¬â„¢s 
> > > > >insidious effects on medicine and research. 
> > > > >ÃÆ'¢â‚¬Å"In clinical drug trials, the placebo 
> > > > >effectÃÆ'¢â‚¬"and now we know the nocebo 
> > > > >effectÃÆ'¢â‚¬"can be really, really 
> > > > >large,ÃÆ'¢â‚¬ says Manfred Schedlowski, a clinical 
> > > > >researcher at the University Hospital Essen in Germany. 
> > > > >ÃÆ'¢â‚¬Å"This hinders the development of new 
> > > > >drugs.ÃÆ'¢â‚¬
> > > > >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'¢â‚¬"meaning they were receiving a completely 
> > > > >inert substanceÃÆ'¢â‚¬"dropped out of the study 
> > > > >because of side effects including dizziness and 
> > > > >nausea.6ÃÆ'‚ 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'¢â‚¬â„¢t cause symptoms of the 
> > > > >disease. The nocebo effect has ÃÆ'¢â‚¬Å"great 
> > > > >potentialÃÆ'¢â‚¬ 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'¢â‚¬Å"In places like primary care, people are 
> > > > >swimming in placebo and nocebo effects,ÃÆ'¢â‚¬ says 
> > > > >Kaptchuk.
> > > > >Thomas DÃÆ'¢â‚¬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. 
> > > > >ÃÆ'¢â‚¬Å"IÃÆ'¢â‚¬â„¢ve 
> > > > >listened to some well-respected colleagues give information [to a 
> > > > >patient], and I thought, ÃÆ'¢â‚¬ËÅ"Gosh, I know 
> > > > >the operation and even I wouldnÃÆ'¢â‚¬â„¢t 
> > > > >want it,ÃÆ'¢â‚¬â„¢ÃÆ'¢â‚¬ 
> > > > >he says. 
> > > > >ÃÆ'¢â‚¬Å"ThereÃÆ'¢â‚¬â„¢s
> > > > > too much detail and too much emphasis about things that could go 
> > > > >wrong.ÃÆ'¢â‚¬ 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'‚© BRYAN SATALINODespite the disproportionate amount 
> > > > >of effort put into placebo research, since 
> > > > >BenedettiÃÆ'¢â‚¬â„¢s 1997 discovery 
> > > > >thereÃÆ'¢â‚¬â„¢s been an uptick in the 
> > > > >funding and time devoted to investigating the mechanisms behind 
> > > > >nocebo, with impressive results. ÃÆ'¢â‚¬Å"Without 
> > > > >a doubt, thereÃÆ'¢â‚¬â„¢s been a level of 
> > > > >research and a sophistication of research that has made a quantum jump 
> > > > >in the last decade or so,ÃÆ'¢â‚¬ says Brody.
> > > > >In 2007, for example, Benedetti discovered that the 
> > > > >hypothalamic-pituitary-adrenal axis in the brain, an important part of 
> > > > >the bodyÃÆ'¢â‚¬â„¢s 
> > > > >ÃÆ'¢â‚¬Å"stress system,ÃÆ'¢â‚¬ 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'¢â‚¬â„¢s and 
> > > > >KaptchukÃÆ'¢â‚¬â„¢s work, it is now clear 
> > > > >that a personÃÆ'¢â‚¬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 effectÃÆ'¢â‚¬"which seems to be at least 
> > > > >partly regulated by opioid releaseÃÆ'¢â‚¬"suggesting 
> > > > >the two phenomena have distinct mechanisms.
> > > > >ÃÆ'¢â‚¬Å"Even if placebo and nocebo are on a 
> > > > >continuum of expectation, different mechanisms kick in at different 
> > > > >points along that continuum,ÃÆ'¢â‚¬ 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'‚ 
> > > > >ÃÆ'¢â‚¬Å"It was a really risky 
> > > > >experiment,ÃÆ'¢â‚¬ says Kaptchuk. 
> > > > >ÃÆ'¢â‚¬Å"We were really surprised. We 
> > > > >couldnÃÆ'¢â‚¬â„¢t believe it, 
> > > > >actually.ÃÆ'¢â‚¬
> > > > >The biochemical and physiological discoveries about nocebo have made 
> > > > >the phenomenon more credible in the medical community. 
> > > > >ÃÆ'¢â‚¬Å"These brain measures provide objective 
> > > > >evidence on the physical system implementing these squishy, fuzzy 
> > > > >changes in emotion and expectation,ÃÆ'¢â‚¬ says Wager.
> > > > >Most nocebo research to date, however, focuses on basic mechanisms, 
> > > > >not on how to deal with the phenomenon in the clinic. 
> > > > >ÃÆ'¢â‚¬Å"Translational research has been a 
> > > > >stepchild in scientific investigations of this 
> > > > >phenomenon,ÃÆ'¢â‚¬ 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'¢â‚¬Å"side effects are not anticipated beyond 
> > > > >occasional gastrointestinal irritation and, rarely, skin 
> > > > >rash.ÃÆ'¢â‚¬ At the third center, 
> > > > >patientsÃÆ'¢â‚¬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, 
> > > > >ÃÆ'¢â‚¬Å"First, do no harm,ÃÆ'¢â‚¬ 
> > > > >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'‚ 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'¢â‚¬"those that are not a 
> > > > >direct result of the pharmacological action of the 
> > > > >drugÃÆ'¢â‚¬"including headache, nausea, and fatigue.
> > > > >Nocebo is at least as important as the placebo effect and may be more 
> > > > >widespread.ÃÆ'¢â‚¬"ÃÆ'‚­ Ted 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'¢â‚¬Å"I certainly 
> > > > >donÃÆ'¢â‚¬â„¢t think that we should be 
> > > > >rethinking whether informed consent should be a basic norm in clinical 
> > > > >practice,ÃÆ'¢â‚¬ 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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