Merle,
Yes, dreams and predictions are delusions especially when they are perceived to
have come true.
And for the 437th time...only experience (sensual) is real IMO.
...Bill!
--- In Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@...> wrote:
>
>
>
> Â bill..so what about dreams and predictions ....?.... dreams and predictions
> can come true ..." i had a dream"..martin luther king jr
> Â do they fall in your notion of illusions and delusions?
> Â is anything real for you?
> Â merle
> 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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