Tor Wager makes his living inflicting pain. As a psychologist at Columbia University, he zaps people with brief electric surges in order to study the placebo effect, one of the most mysterious phenomena in modern medicine. In one recent experiment, Wager and a group of colleagues delivered harsh shocks to the wrists of 24 test subjects. Then the researchers rubbed an inert cream on the subjects’ wrists but told them it contained an analgesic. When the scientists delivered the next set of shocks, eight of the subjects reported experiencing significantly less pain.
The idea that an innocuous lotion could ease the agony of an electric shock seems remarkable. Yet placebos can be as powerful as the best modern medicine. Studies show that between 30 and 40 percent of patients report feeling better after taking dummy pills for conditions ranging from depression to high blood pressure to Parkinson’s. Even sham surgery can work marvels. In a recent study, doctors at Houston’s Veterans Affairs Medical Center performed arthroscopic knee surgery on one group of patients with arthritis, scraping and rinsing their knee joints. On another group, the doctors made small cuts in the patients’ knees to mimic the incisions of a real operation and then bandaged them up. The pain relief reported by the two groups was identical. “As far as I know, the placebo effect has never raised the dead,” says Howard Brody, a professor at the University of Texas Medical Branch and author of a book on the subject. “But the vast majority of medical conditions respond to placebo at least to some degree.”
How do placebos have such an effect? Nobody knows. Studies have shown that our brains can release chemicals that mimic the activity of morphine when we’re treated with placebo analgesics. But only lately have researchers begun to pin down the underlying physiological mechanisms. In his groundbreaking electrical-shock experiment, Wager used functional MRI to examine images of the brain activity of his subjects. When a person knew a painful stimulus was imminent, the brain lit up in the prefrontal cortex, the region used for high-level thinking. When the researchers applied the placebo cream, the prefrontal cortex lit up even brighter, suggesting the subject might be anticipating relief. Then, when the shock came, patients showed decreased activity in areas of the brain where many pain-sensitive neurons lead.
One day, this sort of research could point toward new treatments that harness the mind to help the body. Until then, doctors are divided on the ethics of knowingly prescribing placebos. Some think it’s shady to perform mock surgery or offer a patient pills that contain no active ingredients. Yet the best doctors have always employed one form of placebo: Studies show that empathy from an authoritative yet caring physician can be deeply therapeutic. Maybe handing out the occasional sugar pill isn’t such a bad idea.
Shannon Brownlee, senior fellow at the New America Foundation
Return to Big Questions: http://www.wired.com/42
There is an argument that the placebo effect works because there is an evolutionary advantage in our ability to respond to treatment (no matter what), but I think that one thing worth considering is the fact that medication very often represents treatment by others.
Perhaps as social organisms our awareness of being valued by others is reason in itself to respond to placebos. This could be the case when we are provided with medication by another person (representing to us our value or worth to others) or in the case of an ill person with dependents, self administration would be symbolic of the dependents' need for the ill person. In either case the medication or treatment becomes a token of social status and worth.
By this reading the placebo effect could be explained as part of the same spectrum of phenomena that includes at one end very ill people's apparent capacity to live long enough to see important events in their lives (births, marriages etc.) and at the other end the clearly detrimental effects of treatments representing low worth (e.g. solitary confinement.)
Autism is (as I understand it) the inability to read social cues. If that is the case it may be worth investigating whether autistic people have a relatively diminished response to placebos...
contributed by Guest User on Jan 24 4:19pm
In Chinese medicine, the mind itself is a vital substance in the body. They call this substance "Shen" and consider it a major player in disease and healing processes. It is not merely an esoteric or spiritual component, but an aspect of physiologic function that is deeply integrated with the blood and body structures. From this vantage point, activating the mind means activating physiologic function.
There's great flurry in neurology regarding the search for memory - how exactly do we store and process memory? Yes, we can locate specific filing locales in the brain, but that alone is insufficient to explain all facets of memory. Many believe and seek to prove that memory is stored in every cell in the body, somehow regenerated and/or lost as cells regenerate and function. Western science has also had a lot of fun discovering levels of communication between organ systems and the brain, pathways we once assumed were unidirectional now reveal sophisticated two-way dialogues. The digestive system and the heart each send independent messages to the brain and "make decisions" on their own. There is more to the way we function than just a brain running the show. That's like saying the CPU and motherboard in my laptop are typing these vowels and consonants, turning them into words, phrases and concepts.
The mind is not the brain. It is what runs the brain, and the entire body. It is substantial and esoteric simultaneously and we brain-thinkers tend to stop short of understanding what the mind truly is. If two elementary cells can differentiate into the complex organs, materials and personality of a human being, why not believe that the mind in charge of the body has the capacity to rewrite any program it chooses? Pain can be overcome by thought. Pain can be caused by thought. Why not?
Laurie Perez, L.Ac
http://www.xincare.com
contributed by Laurie Perez on Feb 6 9:51am
Most placebos have an apparent 'effect' in diseases or conditions in which subjective perception is known to make a difference. Our perception of pain is well known to be influenced by both psychological and socio-cultural factors. We interpret the effects of these influences as the powerful involvement or our minds on our somatic selves.
Where the so-called placebo effect fails to manifest itself is in diseases with more concrete biological origins. Take cancer, for instance. As scientists, we study the therapeutic effects or our high-tech, genomic research derived biological treatments, often comparing them to placebo. We express our results as either worse, the same or, hopefully, better than placebo. Looking at historical data on cancer outcomes, we easily conclude that the placebo effect is no different than the natural outcome of that particular cancer. While the 30 or 40% placebo 'effect' is often seen when the placebo is compared to a real treatment (ie 30% of participants treated with placebo report improved fill in the blank vs x% with study medication) . Placebo vs nothing has no effect in cancer. In other words, while pain may be modulated by whatever you want to define as the 'mind', cancer, and other biological diseases are not subject to these influences. Sure there are case reports and anecdotal evidence of cancers getting 'better' because of this or that belief, but these are very poorly documented, studied and entirely irreproducible.
We've cloned the entire human genome, we are in the process of systematically decoding its secrets. We are at the dawn of a quantum leap in our understanding of human physiology and disease. But just because there is still so much modern science does not understand, does not mean that we should jump to conclude that antiquated theories of 'vital substances' should rush in to fill those lacunes.
Michael Sebag, MD, PhD.
The point of mentioning Shen and mind as a vital substance was to describe the perception of Chinese medicine on how placebo might work, not to negate the merits of genomic discovery. Contrary to popular misconceptions, Chinese medicine does not rely on thought or belief for treatment; it relies on physical therapies, internal medicine and lifestyle / nutritional regulation. In other words, it is equally focused on the physical body and its biology.
The CM theory of how the mind plays a role in physiology may belong to a very old medical paradigm, but it's not actually outdated or in conflict with the discoveries of the current era. It may simply hold one of those keys to decoding a mystery as intriguing as the placebo effect.
Laurie Perez, L.Ac
http://www.xincare.com
contributed by Laurie Perez on Feb 6 2:24pm
I agree, the theory of 'vital substances' to explain physiological responses does not in any way negate the merits of genomic research. What it does, however, is somewhat more nefarious, as it attempts to comprehensively fill in the gaps that lie beyond the leading edge of our research endeavours. While I agree that there are merits in Chinese traditional medicine, much of it remains unexplained, incomprehensible and irreproducible in scientific settings. Centuries of practice has led to an empiric knowledge of the effects of certain herbs, roots, tree barks and preparations. The biochemistry, pharmacology and physiology needed to understand these effects are only now being applied to the study of tranditional Chinese medicine. A quick look at scientific publications on a variety of traditional Chinese therapies reveals that these may have specific reproducible biochemical properties. Not all of them work, but some do. Those that do, likely do not rely on a placebo effect.
As a society, we spend an exceedingly large amount money on the exploitation of the 'placebo' effect. Many 'alternative' therapies are at best, unproven, although I admit that they may 'stimulate' the placebo effect. The problem is that as placebos, 'alternative' therapies are expensive. We have turned down too many cancer patients that could benefit from our newly discovered biological therapies. These new targeted therapies cost, sometimes unjustifiably, a fortune and we are running out of money. Why waste so much of our precious health-care dollars on expensive placebos?
contributed by Michael Sebag on Feb 6 3:42pm
In my opinion, the theory of 'vital substances' should be understood in a way similar to our understanding of the theory of the 'atom'. There is no 'atom' as the term was originally meant -- an indivisible particle. Go down far enough, and everything is patterns of energy. The word 'atom' remains useful as a signifier in the context of our ongoing work in physics, and our definition and understandings of 'atoms' continue to expand. Similarly, the Chinese Medical theory of 'vital substances' is useful within the context of CM practice. We may never find a physical entity we could call 'shen' (or 'chi' or 'jing', to name the other two vital substances). The meaning of 'substance' in the phrase 'vital substance' has never meant a visually observable physical entity, however. A better translation of 'substance' into the terminology of modern science might be 'perceptible web of causation in the body'.
This concept of a web of causation, where everything is a dependent variable of everything else, is the essence of Chinese Medical theory. It is also something that modern science is still struggling to come to grips with. It is clear that biological systems are immense webs of nested and inter-locking feedback loops; nonetheless, most biomedical research is done using traditional experiment structures attempting to isolate a the behavior of a dependent variable.
In looking at the effects we call 'placebo', it might be useful to investigate the patterns that produce these 'placebo' effects -- or the 'spontaneous remissions' that happen in some cases where no 'placebo' application has been recorded. The words 'placebo' and 'spontaneous remission' both remove our attention from what has happened: a person got well through a mechanism we do not currently understand. The various systems of our bodies, coordinated through a wide range of information transfer mechanisms, continuously maintain our well-being. For example, most cancers are eliminated by the immune system before they are detected by any sort of medical system. Biomedicine has given up on the ancient Greek theories of 'vital substances', and for good reasons. Unfortunately, we now lack terminology and a philosophy of experimental inquiry that would allow us to easily investigate the aspects of the human system that make us whole. (There are numerous inroads being made of course -- the work of neuroendocrinologists such as Candace Pert, and the heart-brain-body interactions described as 'physiological coherence' by the HeartMath Institute researchers are two examples).
Whether we use (and redefine through research) Chinese words like 'shen' to represent the information patterns within the body that make us whole, use and redefine English words like 'spirit' and 'integrity', or we invent new words that better suit our modern sensibilities, we will undoubtedly require such a concept to understand the way in which people become well.
Nathaniel White
contributed by Nathaniel White on 2007-02-09 12:05 GMT
reposted from: http://www.eu.socialtext.net/wired-mag/index.cgi?why_do_placebos_work
my highlights / emphasis / comments
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