Merle,
Thanks for correcting my perception.
And I have now looked at a synopsis of The Time Keeper. It sounds mildly
interesting but I don't think I'll be reading it any time soon.
...Bill!
--- In Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@...> wrote:
>
>
>
> Â bill...pay attention...it's siska who is asking you not merle..... and you
> are reckoning you have all your senses  in tact .. merle
>
>
> Â
> Merle,
>
> No, I have not read that book. I'll Bing it to find out what it's
> about...Bill!
>
> --- In Zen_Forum@yahoogroups.com, siska_cen@ wrote:
> >
> > Hi Bill,
> >
> > Have you read Albom's The Time Keeper? I find it interesting, though not
> > very 'Zen' (whatever that means :-p), but the idea is just interesting.
> >
> > And of course, this writer is very gifted in story-telling...
> >
> > Siska
> > -----Original Message-----
> > From: "Bill!" <BillSmart@>
> > Sender: Zen_Forum@yahoogroups.com
> > Date: Mon, 15 Jul 2013 02:18:46
> > To: <Zen_Forum@yahoogroups.com>
> > Reply-To: Zen_Forum@yahoogroups.com
> > Subject: [Zen] Re: Worried Sick..illusions
> >
> > 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:
> > > > > >
> > > > > >
> > > > > >
> > > > > > Ã 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..Ã
> > > > > >
> > > > > > 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...Ã
> > > > > > Ã one interpret this with our mind...
> > > > > > otherwise this world would make no sense what so ever...Ã
> > > > > > Ã 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?...Ã
> > > > > > 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...
> > > > > > Ã then it becomes real real real... and one is able to communicate
> > > > > > that reality to others
> > > > > > Ã and then there is a consensus
> > > > > >
> > > > > > merle
> > > > > >
> > > > > > Ã
> > > > > > 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:
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > > Ãâà bill..thank you for your clarification...so what is NOT
> > > > > > > an illusion bill?...and what is real in your world?...merle
> > > > > > >
> > > > > > >
> > > > > > > ÃâÃ
> > > > > > > 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'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¡ÃâÃ
> > > > > > > > >|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¡ÃâÃ
> > > > > > > > >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
> > > > > > >
> > > > > >
> > > > >
> > > > >
> > > >
> > >
> >
>
------------------------------------
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