Edgar,
Thanks for the confirmation about my reasoning considering the space.
You are absolutely correct in your first sentence saying it is 100%
self-evident that my statement that your existence as something separate and
completely apart from Merle or Mike or Chris or me. But the key word in that
statement is SELF. It is SELF-evident. It is evident to YOUR SELF (your
delusion of self and your delusion of Merle's self and my self) that we are
all separate. It is SELF-evident, yes. It is not however evident, and in fact
when you realize Buddha Nature you experience that this is not indeed the case.
So, in your next statement: "Why? Because here I am sitting here on the other
side of the world whether you or anyone else is alive or dead doing things you
have no idea whether I'm doing or not" the only think you can really say from
experience is "Why? Because I am sitting here". Everything else in that
statement is at best speculation and in reality is delusive.
Yes, you can say that I am only a 'figment of your imagination'. I would leave
out the prejudicial word "only" and change 'figment of imagination' to
'perception' or even 'delusion' - but yes, I agree.
'We' (our mutual but individual delusion of a separate self) do perceive many
thing the same way. That's our Human Nature at work. It doesn't point to any
logical structure 'out there', but point to a commonality of logic which is big
part of Human Nature, and the common human predilection to project that logic
into our experiences to create perceptions.
Reality is indeed incontrovertible because it is entirely experiential and not
something subject to logic or emotions or other whims of Human Nature.
...Bill!
--- In Zen_Forum@yahoogroups.com, Edgar Owen <edgarowen@...> wrote:
>
> Bill,
>
> Yes, you are correct that my example does NOT establish anything external to
> the space.
>
> However it is 100% self-evident that your view that I am a figment of your
> imagination is 100% wrong.
>
> Why? Because here I am sitting here on the other side of the world whether
> you or anyone else is alive or dead doing things you have no idea whether I'm
> doing or not.
>
> So if anything it's YOU that is figment of MY imagination.
>
> So because we can both say this about the other it is clear that there is an
> external reality common to both our experience, and it is clear that external
> reality has a logical structure that accommodates both our experiences...
>
> This is incontrovertible reality and thus it is Zen...
>
> Edgar
>
>
>
> On Jul 16, 2013, at 3:15 AM, Bill! wrote:
>
> > --J0Wn7g-Kgwnbh53pQHyl91Q8Xzhg-mgC2a929rM
> > Content-Type: text/plain; charset=ISO-8859-1
> > Content-Transfer-Encoding: quoted-printable
> >
> > Edgar,
> >
> > I probably am much more proficient in math than you think, but I don't unde=
> > rstand 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 outs=
> > ide of that space.
> >
> > Can you?
> >
> > ...Bill!
> >
> > --- In Zen_Forum@yahoogroups.com, Edgar Owen <edgarowen@> wrote:
> >>
> >> Bill,
> >> =20
> >> I understand what you are saying but you are wrong. For example it is pos=
> > sible 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 yo=
> > ur experience to understand there is something else outside it. I don't kno=
> > w whether you know enough math for this to make sense to you. Maybe Joe or =
> > Mike can explain it...
> >> =20
> >> Edgar
> >> =20
> >> =20
> >> =20
> >> On Jul 14, 2013, at 10:09 PM, Bill! wrote:
> >> =20
> >>> Edgar,
> >>> =20
> >>> I experience what I experience. You experience what you experience. Tha=
> > t is the only reality that either of us have available to us.
> >>> =20
> >>> All the rest that you claim to exist is speculation, intellectualizatio=
> > ns; in other words delusions.
> >>> =20
> >>> ...Bill!
> >>> =20
> >>> --- In Zen_Forum@yahoogroups.com, Edgar Owen <edgarowen@> wrote:
> >>>>
> >>>> Bill,
> >>>> =20
> >>>> Yes, you experience what you experience whatever. But it isn't realit=
> > y because it's different between observers...
> >>>> =20
> >>>> There is an actual external reality that each observer experiences it=
> > differently...
> >>>> =20
> >>>> 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?
> >>>> =20
> >>>> Edgar
> >>>> =20
> >>>> =20
> >>>> =20
> >>>> On Jul 14, 2013, at 8:14 PM, Bill! wrote:
> >>>> =20
> >>>>> Merle,
> >>>>> =20
> >>>>> If you are color-blind or totally blind it makes no difference. You=
> > experience what you experience. That which you experience is real. That wh=
> > ich you perceive (think about, intellectualize) is not.
> >>>>> =20
> >>>>> We do interpret our experiences with our mind. That's called percei=
> > ving. 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 beli=
> > eve that our intellect 'discovers' the sense which is inherent in experienc=
> > e. We create it and we superimpose it, force-fit it, onto our experience.
> >>>>> =20
> >>>>> 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.
> >>>>> =20
> >>>>> Our intellect does not make things real. Our intellect takes our ex=
> > perience of reality and forces it into a little logical box so we can under=
> > stand it. Our intellect distorts reality. That's called perception and is a=
> > delusion (or illusion).
> >>>>> =20
> >>>>> I'm not sure what you mean by 'and then there is a consensus' so I =
> > cannot comment on that.
> >>>>> =20
> >>>>> ...Bill!
> >>>>> =20
> >>>>> --- In Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@> wrot=
> > e:
> >>>>>>
> >>>>>> =20
> >>>>>> =20
> >>>>>> =C2 so if one was colour blind...how would that fit into the sche=
> > me of things?
> >>>>>> ..it would not be the correct interpretation of the world..for in=
> > stance traffic lights..=C2=20
> >>>>>> =20
> >>>>>> i do not believe one can totally trust our senses as being the on=
> > ly real experience...what ever you mean by real...we see =C2 we hear we tou=
> > ch we smell we taste...=C2=20
> >>>>>> =C2 one interpret this with our mind...
> >>>>>> otherwise this world would make no sense what so ever...=C2=20
> >>>>>> =C2 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?...=C2=20
> >>>>>> i'd say they are the starting point not the all end to understand=
> > ing the world...
> >>>>>> we need our minds to make sense of the world surely?...and hence =
> > an intellect...
> >>>>>> =C2 then it becomes real real real... and one is able to communic=
> > ate that reality to others
> >>>>>> =C2 and then there is a consensus
> >>>>>> =20
> >>>>>> merle
> >>>>>> =20
> >>>>>> =C2=20
> >>>>>> Merle,
> >>>>>> =20
> >>>>>> IMO only experience is real, and by that 'experience' I mean sens=
> > ory experience (sight, sound, touch, smell, taste).
> >>>>>> =20
> >>>>>> That's it. That's all.
> >>>>>> =20
> >>>>>> ...Bill!
> >>>>>> =20
> >>>>>> --- In Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@> wr=
> > ote:
> >>>>>>>
> >>>>>>> =20
> >>>>>>> =20
> >>>>>>> =C3=82=C2 bill..thank you for your clarification...so what is N=
> > OT an illusion bill?...and what is real in your world?...merle
> >>>>>>> =20
> >>>>>>> =20
> >>>>>>> =C3=82=C2=20
> >>>>>>> Merle,
> >>>>>>> =20
> >>>>>>> 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'.
> >>>>>>> =20
> >>>>>>> Western medicine tries to alleviate it by prescribing medicatio=
> > ns.
> >>>>>>> =20
> >>>>>>> Most religions try to alleviate it by prescribing faith in God.
> >>>>>>> =20
> >>>>>>> Art, music, work, activities of all sorts, etc.. help alleviate=
> > it by having you concentrate on something else.=20
> >>>>>>> =20
> >>>>>>> Zen IMO tries to alleviate it by helping you experience these a=
> > re delusive.
> >>>>>>> =20
> >>>>>>> ...Bill!=20
> >>>>>>> =20
> >>>>>>> --- In Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@> =
> > wrote:
> >>>>>>>>
> >>>>>>>> =20
> >>>>>>>> =20
> >>>>>>>> =C3=83=E2=80=9A=C3=82=C2 i thought this was a good article as=
> > to what bill talks about..illusions... hence zen appropriate..correct me i=
> > f i am incorrect...bill...
> >>>>>>>> merle
> >>>>>>>>>
> >>>>>>>>>
> >>>>>>>>>
> >>>>>>>>>
> >>>>>>>>> Worried Sick
> >>>>>>>>> Expectations can make you ill. Fear can make you fragile. Un=
> > derstanding the nocebo effect may help prevent this painful phenomenon.
> >>>>>>>>> By=C3=83=E2=80=9A=C3=82=C2 Megan Scudellari=C3=83=E2=80=9A=
> > =C3=82=C2 |=C3=83=E2=80=9A=C3=82=C2 July 1, 2013
> >>>>>>>>> =C3=83=E2=80=9A=C3=82=C2=A9 BRYAN SATALINO
> >>>>>>>>> Something strange was happening in New Zealand. In the fall =
> > of 2007, pharmacies across the country had begun dispensing a new formulati=
> > on of Eltroxin=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"the only thyroid hormone re=
> > placement drug approved and paid for by the government and used by tens of =
> > thousands of New Zealanders since 1973. Within months, reports of side effe=
> > cts began trickling in to the government=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=
> > =C3=A2=E2=80=9E=C2=A2s 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, includin=
> > g eye pain, itching, and nausea. Then, the following summer, the floodgates=
> > opened: in the 18 months following the release of the new tablets, the rat=
> > e of Eltroxin adverse event reporting rose nearly 2,000-fold.1
> >>>>>>>>> The strange thing was, the active ingredient in the drug, th=
> > yroxine, was exactly the same. Laboratory testing proved that the new formu=
> > lation was bioequivalent to the old one. The only change was that the drugm=
> > aker, GlaxoSmithKline, had moved its manufacturing process from Canada to G=
> > ermany, and in the process altered the drug=C3=83=C2=A2=C3=A2=E2=80=9A=C2=
> > =AC=C3=A2=E2=80=9E=C2=A2s inert qualities, including the tablets=C3=83=C2=
> > =A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2 size, color, and markings.
> >>>>>>>>> So why were people getting sick? In June, it turned out, new=
> > spapers and TV stations around the country had begun to directly attribute =
> > the reported adverse effects to the changes in the drug. Following widespre=
> > ad 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 c=
> > overage had the highest rates of reported ill effects, suggesting that perh=
> > aps a little social persuasion was at play.
> >>>>>>>>> =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"Nocebo=C3=83=C2=A2=
> > =C3=A2=E2=80=9A=C2=AC (meaning =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"I sh=
> > all harm=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC) is the dastardly sibling of plac=
> > ebo (=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"I shall please=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC).
> >>>>>>>>> But Eltroxin takers were not making up their symptoms. The f=
> > eelings were real, but in the vast majority of cases they could not be attr=
> > ibuted to the drug=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s p=
> > harmacological properties. The patients were victims of the nocebo effect.
> >>>>>>>>> =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"Nocebo=C3=83=C2=A2=
> > =C3=A2=E2=80=9A=C2=AC (meaning =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"I sh=
> > all harm=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC) is the dastardly sibling of plac=
> > ebo (=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"I shall please=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC). In a placebo response, a sham medication or procedure =
> > has a beneficial health effect as a result of a patient=C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s expectation. Sugar pills, for example=
> > , can powerfully improve depression when the patient believes them to be an=
> > tidepressants. But, researchers are learning, the reverse phenomenon is als=
> > o common: negative expectations can actually cause harm.
> >>>>>>>>> When Parkinson=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=
> > =9E=C2=A2s patients undergoing deep brain stimulation were told that their =
> > brain pacemaker was going to be turned off, symptoms of their illness becam=
> > e more pronounced, even when the pacemaker was left on.2=C3=83=E2=80=9A=C3=
> > =82=C2 When people with and without lactose intolerance were asked to inges=
> > t lactose, but were actually given glucose, 44 percent of those with lactos=
> > e intolerance and 26 percent of those without it still complained of stomac=
> > h pain.3=C3=83=E2=80=9A=C3=82=C2 And men treated for an enlarged prostate w=
> > ith a commonly prescribed drug and told that the drug =C3=83=C2=A2=C3=A2=E2=
> > =80=9A=C2=AC=C3=85"may cause erectile dysfunction, decreased libido, [and] =
> > problems of ejaculation,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC but that these ef=
> > fects were =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"uncommon,=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC were more than twice as likely to experience impotence a=
> > s those who were not so informed.4
> >>>>>>>>> On paper, it sounds like psychobabble=C3=83=C2=A2=C3=A2=E2=
> > =80=9A=C2=AC"a negative effect caused by a sham treatment based on a patien=
> > t=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s expectations=C3=83=
> > =C2=A2=C3=A2=E2=80=9A=C2=AC"but it is a real biochemical and physiological =
> > process, involving pain and stress pathways in the brain. And mounting evid=
> > ence suggests that the nocebo effect is having a substantial negative impac=
> > t on clinical research, medicine, and health.
> >>>>>>>>> =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"Nocebo is at least a=
> > s important as the placebo effect and may be more widespread,=C3=83=C2=A2=
> > =C3=A2=E2=80=9A=C2=AC says Ted Kaptchuk, director of Harvard=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s Program in Placebo Studies at Beth=
> > Israel Deaconess Medical Center in Boston, Massachusetts.
> >>>>>>>>> Now that this pernicious phenomenon is starting to receive t=
> > he recognition it deserves, the question is: What exactly can be done about=
> > it?
> >>>>>>>>> Evil effects
> >>>>>>>>> ALLERGIC TO NOCEBO
> >>>>>>>>> =C3=83=E2=80=9A=C3=82=C2=A9 BRYAN SATALINO
> >>>>>>>>> According to several recent studies, pain and itch appear to=
> > be especially susceptible to verbal suggestion. Recently, researchers in t=
> > he Netherlands demonstrated that people who are told that a stimulus will c=
> > ause itch feel the itch more intensely than those told that the stimulus is=
> > unlikely to cause itch. The finding could have implications for chronic it=
> > ch conditions, says first author Antoinette van Laarhoven of Radboud Univer=
> > sity Nijmegen Medical Center. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"More =
> > knowledge about nocebo effects on itch can give us some targets to reduce [=
> > those effects].=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC
> >>>>>>>>> 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 inflated=C3=83=C2=A2=
> > =C3=A2=E2=80=9A=C2=AC"in this case, until the moment it becomes painful. Th=
> > e 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 re=
> > peated distensions. Those individuals who experienced more pain also had el=
> > evated levels of cortisol, again linking nocebo to anxiety. =C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC=C3=85"We could show that a nocebo effect may be induced =
> > even by mere information,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Sven Benson=
> > , an author on the paper.
> >>>>>>>>> Another area of health that researchers suspect may be affec=
> > ted by nocebo is the increased incidence of asthma and allergies. =C3=83=C2=
> > =A2=C3=A2=E2=80=9A=C2=AC=C3=85"It=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=
> > =80=9E=C2=A2s certainly possible,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Man=
> > fred Schedlowski, who studies placebo and the immune system at University H=
> > ospital Essen. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"From experimental da=
> > ta, we know an allergic reaction can be conditioned.=C3=83=C2=A2=C3=A2=E2=
> > =80=9A=C2=AC
> >>>>>>>>> In an oft-cited case from 1886, John Mackenzie, a surgeon in=
> > Baltimore, described how he=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=
> > =9E=C2=A2d =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"obtained an artificial r=
> > ose of such exquisite workmanship that it presented a perfect counterfeit o=
> > f the original,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC 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 nost=
> > rils, and a tight chest.12 Similarly, people allergic to dogs may begin sne=
> > ezing when they simply see a dog across the way. Researchers have even show=
> > n 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=
> > . =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"We=C3=83=C2=A2=C3=A2=E2=80=9A=C2=
> > =AC=C3=A2=E2=80=9E=C2=A2re in such a primitive state of understanding this =
> > phenomenon, particularly in a clinically oriented way, that we just need to=
> > do more research,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says bioethicist Frank =
> > Miller of the National Institutes of Health.=20
> >>>>>>>>> In 1997, Fabrizio Benedetti, a neurophysiologist at the Univ=
> > ersity of Turin Medical School in Italy, was busy mapping the biochemical p=
> > athways involved in placebo responses when he performed a simple study that=
> > revealed a distinct neural mechanism driving the body=C3=83=C2=A2=C3=A2=E2=
> > =80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s nocebo response. He gave consenting post=
> > operative patients reporting mild pain an injection that they were told wou=
> > ld increase their pain within 30 minutes. The injection was either saline s=
> > olution or proglumide, which blocks a hormone implicated in pain hypersensi=
> > tivity and associated with anxiety. Neither substance actually causes any d=
> > iscomfort.
> >>>>>>>>> When saline was injected, patients experienced increased pai=
> > n. When proglumide was injected, they had no pain increase=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC"the nocebo effect was absent.5=C3=83=E2=80=9A=C3=82=C2 I=
> > n one fell swoop, Benedetti identified a biochemical reaction responsible f=
> > or the nocebo response, and he showed that it could be blocked.
> >>>>>>>>> It was Benedetti=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=
> > =80=9E=C2=A2s work that finally convinced physician-bioethicist Howard Brod=
> > y that the nocebo effect=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"allegedly first m=
> > entioned in the scientific literature in 1961 by physician Walter Kennedy, =
> > who called the phenomenon a =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"quality=
> > inherent in the patient rather than in the remedy=C3=83=C2=A2=C3=A2=E2=80=
> > =9A=C2=AC=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"was real.
> >>>>>>>>> =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"For many years, I di=
> > smissed the value of the term =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=8B=C5"no=
> > cebo,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC=C3=A2=E2=82=AC=C2=B0=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC sa=
> > ys Brody, chair of family medicine and director of the Institute for the Me=
> > dical Humanities at the University of Texas Medical Branch in Galveston, wh=
> > o first began studying the placebo effect in the 1970s. He and others had l=
> > ong assumed that nocebo and placebo were two sides of one coin, that the sa=
> > me process in the brain supported both illusory effects=C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC"one was just manifested as a positive outcome, while the ot=
> > her caused harm. But after reading Benedetti=C3=83=C2=A2=C3=A2=E2=80=9A=C2=
> > =AC=C3=A2=E2=80=9E=C2=A2s work, Brody changed his tune: =C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC=C3=85"I received my comeuppance,=C3=83=C2=A2=C3=A2=E2=80=9A=
> > =C2=AC he laughs.
> >>>>>>>>> With that first biochemical evidence, others also began reco=
> > gnizing the importance of nocebo, and a few inquiring minds began to study =
> > it. Nevertheless, compared to placebo, the nocebo effect remains vastly und=
> > erstudied: a PubMed database search will turn up more than 163,000 publicat=
> > ions on =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"placebo=C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC and fewer than 200 on =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=
> > =85"nocebo.=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC Of those, only a few dozen are=
> > empirical studies; most are reviews. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=
> > =85"The placebo phenomenon has a tremendous fascination for the public=C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC"a gee-whiz thing with a positive spin, a way=
> > to be healthy without taking drugs,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says =
> > Frank Miller, a bioethicist at the National Institutes of Health. =C3=83=C2=
> > =A2=C3=A2=E2=80=9A=C2=AC=C3=85"But nobody is very enthusiastic about the no=
> > cebo phenomenon.=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC
> >>>>>>>>> In addition, the nocebo effect has become notoriously diffic=
> > ult to study. Few institutional review boards will allow scientists to indu=
> > ce pain in their subjects, and some even refuse to let researchers mislead =
> > their volunteers. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"My ethics committ=
> > ee will not allow me to do it,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Paul E=
> > nck, a psychologist at the University of T=C3=83=C6'=C3=82=C2=BCbingen in G=
> > ermany, =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"unless I tell the subjects =
> > that I am deceiving them=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC"a requirement that obviously defeats the purpose of the dec=
> > eption. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"It makes life really misera=
> > ble as a [nocebo] researcher,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Enck.
> >>>>>>>>> The tragedy of this lack of investigation, researchers asser=
> > t, is that controlled trials about the nocebo effect are needed to further =
> > understand and prevent nocebo=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=
> > =9E=C2=A2s insidious effects on medicine and research. =C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC=C3=85"In clinical drug trials, the placebo effect=C3=83=C2=
> > =A2=C3=A2=E2=80=9A=C2=AC"and now we know the nocebo effect=C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC"can be really, really large,=C3=83=C2=A2=C3=A2=E2=80=9A=
> > =C2=AC says Manfred Schedlowski, a clinical researcher at the University Ho=
> > spital Essen in Germany. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"This hinde=
> > rs the development of new drugs.=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC
> >>>>>>>>> In December 2012, for example, a meta-analysis revealed the =
> > shockingly large impact of the nocebo effect in clinical trials: in 18 fibr=
> > omyalgia drug studies, 11 percent of 3,546 patients in the placebo arm=C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC"meaning they were receiving a completely ine=
> > rt substance=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"dropped out of the study beca=
> > use of side effects including dizziness and nausea.6=C3=83=E2=80=9A=C3=82=
> > =C2 Other studies have calculated that nocebo effects cause between 4 and 2=
> > 6 percent of patients taking placebo to leave a clinical trial because of s=
> > ide effects from an inert treatment.
> >>>>>>>>> The nocebo effect may also have a worrisome effect on vaccin=
> > e use. In 2011, researchers at the French vaccine manufacturer Sanofi Paste=
> > ur analyzed 33,275 vaccine side-effect reports and found that doctors and p=
> > atients preferentially report disease-specific side effects, such as measle=
> > s-like rash following measles immunization, even when the vaccine contains =
> > only proteins, sugars, or killed organisms that won=C3=83=C2=A2=C3=A2=E2=80=
> > =9A=C2=AC=C3=A2=E2=80=9E=C2=A2t cause symptoms of the disease. The nocebo e=
> > ffect has =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"great potential=C3=83=C2=
> > =A2=C3=A2=E2=80=9A=C2=AC to exacerbate rumors and fears, and to cause a vac=
> > cine crisis similar to the Eltroxin events in New Zealand, the authors writ=
> > e.7
> >>>>>>>>> But the most common place where the nocebo effect makes an a=
> > ppearance is in everyday visits to clinics and hospitals. =C3=83=C2=A2=C3=
> > =A2=E2=80=9A=C2=AC=C3=85"In places like primary care, people are swimming i=
> > n placebo and nocebo effects,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Kaptchu=
> > k.
> >>>>>>>>> Thomas D=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=
> > =A2Amico, chief of thoracic surgery at Duke University Medical Center in Du=
> > rham, North Carolina, says that even before he heard the term nocebo effect=
> > , he was aware of it in the clinic. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85=
> > "I=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2ve listened to some=
> > well-respected colleagues give information [to a patient], and I thought, =
> > =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=8B=C5"Gosh, I know the operation and e=
> > ven I wouldn=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2t want it=
> > ,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2=C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC he says. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"There=C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s too much detail and to=
> > o much emphasis about things that could go wrong.=C3=83=C2=A2=C3=A2=E2=80=
> > =9A=C2=AC Measuring the effect of such detail on an individual patient is h=
> > ard to quantify, he says, but fear and distress before an operation has bee=
> > n associated with slow postoperative recovery and delayed wound healing.
> >>>>>>>>> Nuts and bolts
> >>>>>>>>> =C3=83=E2=80=9A=C3=82=C2=A9 BRYAN SATALINODespite the dispro=
> > portionate amount of effort put into placebo research, since Benedetti=C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s 1997 discovery there=
> > =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s been an uptick in t=
> > he funding and time devoted to investigating the mechanisms behind nocebo, =
> > with impressive results. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"Without a =
> > doubt, there=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s been a =
> > level of research and a sophistication of research that has made a quantum =
> > jump in the last decade or so,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Brody.
> >>>>>>>>> In 2007, for example, Benedetti discovered that the hypothal=
> > amic-pituitary-adrenal axis in the brain, an important part of the body=C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2s =C3=83=C2=A2=C3=A2=E2=
> > =80=9A=C2=AC=C3=85"stress system,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC is activ=
> > ated during a nocebo response, as detected by an increase in the secretion =
> > of the hormones ACTH, from the pituitary gland, and cortisol, from the adre=
> > nal 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 heal=
> > thy volunteers to expect pain on their right forearm, they watched as the h=
> > ippocampus lit up when people experienced pain from a sham acupuncture devi=
> > ce.
> >>>>>>>>> Through Benedetti=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=
> > =80=9E=C2=A2s and Kaptchuk=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=
> > =C2=A2s work, it is now clear that a person=C3=83=C2=A2=C3=A2=E2=80=9A=C2=
> > =AC=C3=A2=E2=80=9E=C2=A2s expectation of pain can induce anticipatory anxie=
> > ty, triggering the activation of cholecystokinin, the hormone that Benedett=
> > i blocked with proglumide. Cholecystokinin-mediated pathways in turn facili=
> > tate pain transmission, which occurs in specific areas of the brain. The fi=
> > nding does not coincide with what is know about the biochemistry of the pla=
> > cebo effect=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"which seems to be at least par=
> > tly regulated by opioid release=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"suggesting=
> > the two phenomena have distinct mechanisms.
> >>>>>>>>> =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"Even if placebo and =
> > nocebo are on a continuum of expectation, different mechanisms kick in at d=
> > ifferent points along that continuum,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says=
> > Tor Wager, director of the Cognitive and Affective Control Laboratory at t=
> > he University of Colorado, Boulder, who studies the brain pathways underlyi=
> > ng 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 sh=
> > owing them an image of one of two faces. The researchers then showed the vo=
> > lunteers the faces again, but with identical, moderate heat applied to thei=
> > r 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.9=
> > =C3=83=E2=80=9A=C3=82=C2 =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"It was a r=
> > eally risky experiment,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Kaptchuk. =C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"We were really surprised. We couldn=C3=
> > =83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2t believe it, actually.=
> > =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC
> >>>>>>>>> The biochemical and physiological discoveries about nocebo h=
> > ave made the phenomenon more credible in the medical community. =C3=83=C2=
> > =A2=C3=A2=E2=80=9A=C2=AC=C3=85"These brain measures provide objective evide=
> > nce on the physical system implementing these squishy, fuzzy changes in emo=
> > tion and expectation,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC says Wager.
> >>>>>>>>> Most nocebo research to date, however, focuses on basic mech=
> > anisms, not on how to deal with the phenomenon in the clinic. =C3=83=C2=A2=
> > =C3=A2=E2=80=9A=C2=AC=C3=85"Translational research has been a stepchild in =
> > scientific investigations of this phenomenon,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=
> > =AC says Miller. Understanding the mechanism is important, but at the end o=
> > f 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 tha=
> > t medical consent forms might actually cause harm. Using the chance occurre=
> > nce 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 a=
> > spirin against sulfinpyrazone, a medicine already approved to treat gout, a=
> > s a treatment for chest pain. Patients at two of the three centers hosting =
> > the trial were informed that =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=85"side e=
> > ffects are not anticipated beyond occasional gastrointestinal irritation an=
> > d, rarely, skin rash.=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC At the third center,=
> > patients=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=A2=E2=80=9E=C2=A2 consent for=
> > ms did not mention gastrointestinal effects. Seventy-six patients out of 39=
> > 9 (19 percent) given the first consent form that mentioned GI irritation wi=
> > thdrew from the study, citing GI issues, compared to just 5 out of 156 (3 p=
> > ercent) who received the second form.10
> >>>>>>>>> With the nocebo effect, doctors are caught between a rock an=
> > d a hard place: their medical duty to primum non nocere, =C3=83=C2=A2=C3=A2=
> > =E2=80=9A=C2=AC=C3=85"First, do no harm,=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC a=
> > nd the ethical and regulatory obligation of informed consent. What do you d=
> > o when informed consent leads to harm?
> >>>>>>>>> Last year, Kaptchuk and colleague Rebecca Wells, also at Har=
> > vard Medical School, sparked a debate on this topic in the pages of the=C3=
> > =83=E2=80=9A=C3=82=C2 American Journal of Bioethics. They proposed a middle=
> > ground called contextualized informed consent. Doctors, they suggested, mi=
> > ght choose not to tell patients every last side effect of a treatment in gr=
> > eat detail, but instead provide information to a patient tailored to his or=
> > her level of anxiety, such as leaving out nonspecific side effects=C3=83=
> > =C2=A2=C3=A2=E2=80=9A=C2=AC"those that are not a direct result of the pharm=
> > acological action of the drug=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"including he=
> > adache, nausea, and fatigue.
> >>>>>>>>> Nocebo is at least as important as the placebo effect and ma=
> > y be more widespread.=C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC"=C3=83=E2=80=9A=C3=
> > =82=C2=AD 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. =C3=83=C2=A2=C3=A2=E2=80=9A=C2=AC=C3=
> > =85"I c
>
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