Manipulating the Placebo Effect?
` *Newsflash!* I have just read a Nature News article that there is some headway in understanding the placebo effect! (As published in Neuron.) This may one day lead to doctors actually using it to help patients, which I've always thought they ought to!
` The presence of the placebo effect - which is basically a benefit that is perceived apart from (or in absence of) medical treatment - has long been known to complicate medical trials (as I have mentioned in my first/last post).
` It explains why an ailing patient can feel as if they are improving, even dramatically, though they have received no real treatment at all. As it turns out, the presence and even the strength of the placebo effect has been linked to activity in a part of the brain called the nucleus accumbens.
` This brain structure is known to activate when we anticipate a future reward. Not only that, but when it is overactive we can develop addictions to things like drugs and gambling.
` According to the head of the study, Jon-Kar Zubieta of the University of Michigan, "This is driving the idea that you can manipulate the placebo effect, to increase it for therapeutic treatment."
` One way it could be done is to urge doctors to be more optimistic about their patients' treatment options and, says I, to give them more undivided attention. Seeing as how much of 'alternative' medicine seems to rely on this principle, that seems reasonable to me!
` On the other hand, methods to reduce or otherwise control the placebo effect might actually improve the accuracy of telling the effects of placebo apart from those of the actual treatment during medical trials.
` Zubieta and team have tested it out this way: They injected salt solution into the cheek of each of their thirty volunteers. Then, the subjects were given a mystery injection that was either a painkiller or a placebo.
` What they didn't know was that they had all gotten placebos!
` Some of the volunteers were also re-injected with the salt solution, but not offered anything else. That time, most of them reported that the mystery injection had been more effective than nothing. And yet, it was - technically - nothing!
` Interestingly, there was a lot of variation in the level of each person's placebo effect, and the team figured it might have something to do with the nucleus accumbens. So, they scanned the brains of fourteen of the volunteers, and sure enough, they measured more dopamine being produced in that area - a sign that indicates a reward being anticipated.
` They also found that the more dopamine that was being produced in the nucleus accumbens, the stronger the placebo effect was.
` The people with the highest dopamine output (and placebo effect) also had the most optimism concerning future rewards, which was revealed later when their brains were scanned while they played a gambling game.
` As neuropsychologist Chris Frith at University College London notes; "The doctors who do best are the ones who are most deluded that their treatments do work."
` Incidentally, this is exactly what science writer Toby Murcott says keeps alternative medicine practitioners in business. But that's a Whole 'nother Story.
11 comments:
I would think that the act of injecting the patient with a needle could cause an amount of pain, and therefore change the dopamine production and receptors enough perhaps to skew these results. I'd like to see results from an orally administered placebo trial.
So, does this mean that addicts are especially susceptible to the placebo effect?
Did you know that the placebo effect is much more than that? Did you know it can melt tumors like snowballs on a hot stove?
There was once a man named Wright who had orange-sized cancerous tumors all over his body. He needed an oxygen mask to breathe and had to have two quarts of milky fluid drained out of his chest every day.
His doctor, Klopfer, didn't think Wright would survive the next few days. Wright heard about this new drug treatment, Krebiozen, and his doctor, Klopfer, gave it to him even though he didn't think it would do much good.
To his amazement, a couple days later he found Wright alive and with the tumors only half the size as before! Ten days later he had no cancer at all! He could even fly his own plane! But then he read newspaper articles that said Krebiozen was worthless and the tumors came back! But then, Dr. Klopfer told him it was a mistake, gave him more Krebiozen and the tumors went away!
But THEN a couple months later, Wright read that the AMA found that Krebiozen was worthless in treating cancer. The cancer came back and he died. Pretty powerful stuff, huh?
S. E. E. Quine:
Maybe the results of the "placebo effect" fall into the areas of pure psychology, namely that there is no interaction of mind and molecules but one of pure mental activity. Whatever the reason placebos do work many times and those that have the highest success rate occur when there are strong wills between the physician and patient--both who believe in the efficacy of the placebo. But lines have to be drawn when virulent diseases strongly resist such activity. And as usual, as you mentioned, the quacks and charlatans are ever present to provide false hope and extract the dollars from the bank account.
` Indeed, Mercury, while there is a limit on what your state of mind can do, at least reducing unpleasant emotions and creating optimism in itself keeps you healthier.
` As far as I have heard, depression and anxiety for people with potentially deadly diseases can be enough to kill them off while otherwise they had been doing well.
` You know, Charles, after a while I started wondering myself why they didn't use a placebo one can swallow. Why two injections? I wonder if it would be different if they had used a pill?
` Galtron, that may be! I don't really know, though....
` Noettica, I have heard of this case. Outside of ethical concerns regarding honesty, I admit I have found little analysis on that incident.
` However, cases this dramatic seem to be relatively rare. It's very interesting nonetheless.
` Mercury, do you know anything of this?
S. E. E. Quine:
Indeed, "Krebiozen" was analyzed by the FDA recently from a sample of the horse serum supplied by Dr. Stevan Durovic and was found to be nothing more than a chemical called "creatine".
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-creatine.html
However, the debate continues. For the most part it is just bogus science and an injustice for those suffering from serious ailments.
i am always a bit sceptical at these studies. for one i would like them to use addicts to test these pain killers. as a person who has lived many years with chronic pain and with an addictive personality i waded into the world of pain killers testing this and testing that to avoid another bout with addiction. as each sample arrived via the mail from friends with the same condition i began making notes on effect and time each one provided. i chose a rather common drug abused by many because it alleviated pain and left able to function thru daily routines. it also was a drug i could control with periods on and periods off. there were a few i never took more than once and threw away the rest simply because they made me uncomfortable. having been well traveled thru the counseling community and doctors i consistently found that most were easily manipulated......so what i am wondering here....what are the groups populated with? there is an old saying on the streets that you can never make a heroin addict believe bad heroin is good heroin. now let us back up and populate the same experiment with real experts on pain medication and see what happens. remember the old snake oils usually consisted of alcohol and other drugs that did make one feel like the tin man on WD40. i included a link to the original story to your thoughts.....you will find me on WSS under literature....good thoughts and looking forward to more....Timray
A good link on placebos.
"Something out of nothing: the placebo effect" by, Aaron K. Vallance
http://apt.rcpsych.org/cgi/content/full/12/4/287
I suppose the identification of the structure could be useful for the treatment of addictions, although it also creates a bit of fear in me, also. The reason for that would be that this opens the possibility of advertising agencies and their ilk, to use fMRI to more effectively sell products that really are of no utility.
That reminds me of my favourite essay by Lewis Thomas, in which he tells how warts can be hypnotized away. Convinced by hypnotism, people DO it, but we don't know how they do it. He said it proved our bodies knew things that we didn't.
` I have heard the warts thing as well - in fact, it was the answer on a Psych 101 quiz to something like; 'choose which disorder hypnotism can treat'!
` It is most odd. Then again, I used to get severe hives, irritability and cloudy thinking after consuming dairy products, plus the strong craving for more; and I grew up believing it was an allergy. (That didn't stop me from using the effects to distract me from my troublesome life.)
` What's really odd is, after drinking organic milk for the first time I was amazed to find that nothing happened! I ran around jumping for joy - it was as if I had drank poison and lived!
` Soon afterward, I drove all the way out into the country to a little shack that sold organic ice cream.
` It was amazing.
` This exhilarating experience got me believing that probably added hormones were causing the effect. I believed it so blindly that I didn't care about any actual scientific measurements of the hormone content.
` I couldn't believe those to the point where I thought someone must be making a mistake. I even defended it brazenly in the Skeptic forum!
` Then then one day, after letting some conventional milk get to me like never before (I had strong cravings sometimes), a friend convinced me that it was all psychosomatic.
` In my highly-emotional state, I believed him. Really believed him. And then had a bunch of non-organic cheese.
` Nothing happened.
` Here's what I worked out from all the details of my symptoms in the previous two decades: The experience of having (non-organic) dairy products was causing nervous breakdowns - which I had apparently suppressed to the point of clouding my mind - as well as hives.
` To a large extent, it had made my already-bad life ten times worse. If only I had known back then what it had been - probably some kind of conditioning.
` I can't imagine how it started - I'd been that way for as long as I can remember! (I wonder what other kinds of things that children have from an early age that were 'programmed' into them?)
` So glad to be rid of it, though!
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