Re: Physician, Fool Thyself

[Guest guest]

VEry interesting. I have noted that metformin, a drug, seems to have a placebo

effect in some who lose weight after starting it. They seem to feel they have

been normalized (and have to some extent). Yet those who really believe the

metformin will help them lose weight in addition to activity and diet changes,

seem to lose the most and maintain the loss.

" Ortiz, R.D. " wrote:

http://money.cnn.com/magazines/fortune/fortune_archive/2006/09/18/8386180/index.\

htm

Can believing in a cure make it work? That question has long bedeviled

researchers, who labor to rule out the placebo effect when they test new drugs.

Yet there may be real value - as well as new hope for the sick - in what has

long been dismissed as snake oil.

The hope comes from mounting evidence that believing in a cure or trusting in

the words of a doctor or therapist is not " merely psychological, " but can bring

about genuine physiological changes in people suffering from pain, depression,

and even Parkinson's disease.

Two recent studies show the direction the new science of placebos is taking

(placebo is Latin for " I shall please " ). In one, Harvard Medical School

researchers carried out the first clinical trial ever to compare the

effectiveness of different placebos rather than that of different drugs. This

" upside-down research, " as lead author Ted Kaptchuk called it, is needed to

start finding out what's important about medicine's bedside rituals. While

rituals have little relevance in the treatment of, say, strep throat (you need

antibiotics), in other conditions " rituals may be the critical component, " he

says.

His team looked at pain stemming from repetitive strain injury and compared two

placebos: sugar pills and sham acupuncture, which uses a needle that does not

really penetrate the skin but instead slides secretly back into the needle

holder. Amazingly, both worked (sham acupuncture won). The dueling placebos even

had side effects, with 15% of people who took the sugar pills reporting

drowsiness and 20% feeling pain from the fake acupuncture.

Other studies show that there are actually drugs capable of boosting the power

of belief. Fabrizio Benedetti of the University of Turin found that giving a

drug called proglumide along with a placebo provided greater relief to patients

suffering postoperative pain than a placebo alone. Proglumide works on the

nervous system's opiate receptors, but unlike morphine, it is not a painkiller

by itself: Secretly slipping the drug into the IV line of hospitalized patients

has no effect at all. Instead, Benedetti found, proglumide boosts the brain's

" expectation pathways, " so the drug helps reduce pain if, and only if, it is

associated with a placebo that creates an expectation of pain relief.

These studies come alongside a host of data from brain scanners showing that the

placebo effect produces robust physiological changes. We now know that

pain-relieving endorphins are released after sufferers take a placebo that is

just saline solution. Placebos can even help people suffering from Parkinson's,

boosting the level of dopamine, which is lacking in that condition.

And then there is placebos' power to combat depression. Back in 2002, a study

re-analyzed FDA data for six top antidepressants and found that 80% of their

effect was duplicated in placebo control groups. To the annoyance of drug

companies, the authors suggested that the additional response to the drugs, on

top of the powerful placebo effect, might be " clinically negligible. "

Harnessing the placebo effect could spawn opportunities in both alternative and

conventional medicine - but only with a shift in thinking. Alternative medicine

could focus on finding ways to make the effect more powerful instead of

pretending to offer the same benefits as conventional medicine. Yet publicizing

the placebo effect has risks: If we stop believing in a medicine, it might work

less well. So scientists who debunk alternative medical treatments should think

again about whether it is ethical to destroy people's belief.

How far does placebo power extend? Doctors rightly agree that unlike pain and

depression, infectious diseases and cancer are not going to be helped directly

by placebos. But recovery even from serious illness that is being properly

treated is another matter, as there is much anecdotal evidence that hope plus

trust in your physician speeds convalescence.

Further in the future, we will learn how both active drugs and belief and

rituals work inside the brain. The distinctions between mind and body will break

down, and we'll have a new, improved, unified science of medicine that includes

a healthy dose of snake oil.

Check Nutrition at my site:

Nutrition.teach-nology.com

Ortiz, RD

nrord@...

" Vegetables are a must on a diet. I suggest carrot cake, zucchini bread, and

pumpkin pie. "

Jim , 'Garfield'