Merle,
You asked: "if we did not have "dreams"... where would we be?".
We would be right here, right now - exactly the same place we'd be if we did
have dreams.
And yes, I have dreams - desires that the future will unfold in a certain way
that is beneficial to my self - but I don't (at least try not to) form
attachments to them.
...Bill!
--- In Zen_Forum@yahoogroups.com, Merle Lester <merlewiitpom@...> wrote:
>
>
>
> Â bill...if we did not have "dreams"... where would we be?...surely you have
> "dreams" that come true...merle
>
>
> Â
> 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:
> >
> >
> >
> > ÃÂ bill..so what about dreams and predictions ....?.... dreams and
> > predictions can come true ..." i had a dream"..martin luther king jr
> > ÃÂ do they fall in your notion of illusions and delusions?
> > ÃÂ is anything real for you?
> > ÃÂ 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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