Edgar,
I probably am much more proficient in math than you think, but I don't
understand the relevance of your example below.
For example I understand you can determine the shape of a space from inside
that space, but I fail to see how that could prove there is something outside
of that space.
Can you?
...Bill!
--- In Zen_Forum@yahoogroups.com, Edgar Owen <edgarowen@...> wrote:
>
> Bill,
>
> I understand what you are saying but you are wrong. For example it is
> possible to determine the shape of a space from inside that space by
> measuring what the angles of triangles add up to. You don't have to be
> outside of your experience to understand there is something else outside it.
> I don't know whether you know enough math for this to make sense to you.
> Maybe Joe or Mike can explain it...
>
> Edgar
>
>
>
> On Jul 14, 2013, at 10:09 PM, Bill! 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,ââ⬠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,âââ¬
> > > > > > > >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.ââ⬠Measuring the
> > > > > > > >effect of such detail on an individual patient is hard to
> > > > > > > >quantify, he says, but fear and distress before an operation has
> > > > > > > >been associated with slow postoperative recovery and delayed
> > > > > > > >wound healing.
> > > > > > > >Nuts and bolts
> > > > > > > >̩̉ 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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