WSJ article on placebo effect
Mr. Pubmed
For the Role of the Brain in Healing
It has been almost a year since a paper in the New England Journal of
Medicine seemed to bury the placebo effect with finality.
Phrases like "medical myth," "urban legend," and even "scam" flew over
the airwaves and filled medical meetings. The idea that a patient's
expectation of cure would help effect that cure seemed headed for the
ash heap of biology.
It hasn't worked out that way.
Criticism of the NEJM paper has been nonstop. And a year of new
research shows that reports of the death of the placebo effect are
exaggerated.
The controversial study was a "meta-analysis." After poring over 114
published studies of clinical trials that compared real drugs with
sugar pills and no treatment at all, statisticians at the University
of Copenhagen concluded that patients given no treatment improved just
as quickly as patients given placebos.
The implication? That getting better was the result of the natural
course of disease, not of the patients' beliefs. (Only pain showed a
placebo response.) Scientists have since argued that by comparing very
dissimilar studies of many medical conditions, the NEJM paper muddied
the waters. But even critics acknowledge the study did a lot of good.
"It shook up the field and showed the need for more rigorous, more
precise studies," says Dr. Ted Kaptchuk of Harvard Medical School.
Over the years, researchers have found that believing you will be
cured can lower blood pressure, lift depression, mitigate asthma and
allergies, ease pain including angina, and stop gastric reflux, he
says. The latest discoveries do more than add to that list. "They're
beginning to show us the basic mechanisms that might underlie the
placebo effect," says Dr. Kaptchuk, by documenting accompanying brain
changes.
Two of the new studies looked at depression. In one, neuroscientists
in Toronto gave depressed men either fluoxetine (Prozac) or a
pharmacologically inert sugar pill. None of the men knew which they
were taking. Four of 10 receiving the drug improved; so did four of
seven on placebo. Then, using the brain-imaging technique called PET,
the researchers compared the two groups.
In the current American Journal of Psychiatry, they report that, in
the men who got better, there was an increase in activity in the
"thinking" frontal lobes and a decrease in the "emotional" limbic
region. (Depression is typically marked by high limbic and low frontal
activity.) That doesn't mean patients can trade in Prozac for M&Ms.
Still, "the changes were comparable whether the men got drug or
placebo," says Dr. Helen Mayberg of the University of Toronto.
Psychiatrist Andrew Leuchter of UCLA got comparable results. "People
who get better on placebo have a change in brain function just as
surely as people who get better on antidepressants," he says. But
while 52% of the patients on drugs felt better, 38% on placebo did.
Curiously, the two groups had different brain changes, suggesting
there is more than one way to fix a depressed brain.
After the study ended, Dr. Leuchter saw an even more startling
demonstration of the power of belief. When he told patients they had
been on a sugar pill, most relapsed into depression and went on
medication, he told me. But at least one realized he got better on his
own -- and stayed well without drugs.
It isn't surprising that depression has a psychological side that can
be tapped by a placebo, but Parkinson's disease? Last summer,
researchers at the University of British Columbia reported what
happened when they injected Parkinson's patients with either an inert
solution or a standard drug. The drug mimics the effect of the brain's
dopamine, whose scarcity causes the disease, found Dr. Jon Stoessl.
The placebo boosted natural levels of dopamine.
Not coincidentally, in lab animals the expectation of reward triggers
the release of dopamine. Might the thought, "this treatment will make
me well," do the same in people? That dopamine underlies the placebo
effect is only one of many intriguing, and contending, theories now
coming to the fore. Another holds that something as gossamer as
thoughts can activate the same analgesic pathways that drugs do: both
morphine and placebo boost blood flow to a area of the brain packed
with opiate receptors.
Harvard psychology professor Stephen Kosslyn suspects that the stress
hormone cortisol acts as an obstacle to recovery from disease. "Maybe,
with a placebo, you believe that what the doctor is doing will help
you," says Dr. Koslyn. Maybe believing really can make it so.
Send comments to science...@wsj.com.
Updated May 10, 2002
Anonymous User
> Maybe believing really can make it so.
This makes research results so much more difficult to interpret. If this is
true, then reported "cures" and any sort of subjective patient report after
treatment has to be seen as almost worthless. A huge problem, it seems to me.
-------
Better newsgroup at http://www.chronicprostatitis.com/wwwboard
Jim
cluster grouping dissimilar diseases. CPPS?
Jim Boy
Vic...@webtv.net
mrpu...@hotmail.com (Mr. Pubmed)
posted:
disease. "Maybe, with a placebo, you believe.
that what the doctor is doing will help you," says
Dr. Koslyn. Maybe believing really can make it
so.
Send comments to science...@wsj.com.
Updated May 10, 2002
_____________________________________
Consider this:
"Gomez (1982) has emphasized that psychogenic illness and/or death is a
psychological process that may occur over a matter of days, weeks, or
even months. Although the precise mechanisms remain uncertain, the
essential explanation makes intuitive sense: if faith can heal, fear can
maim or kill. Physicians have backed up with statistical studies
something that most people take for granted - that the likelihood of
becoming ill or even dying depends, to some extent at least, on one's
state of mind. Feelings of depression, hopelessness, or despair somehow
create a vulnerable state (Pattison 1974; Rahe et al. 1971; Rahe et al.
1973). Loneliness would hardly seem to be a fatal affliction, yet a
disproportionate number of spouses die in the first year after the death
of their mates (Parkes et al. 1969; Rees and Lutkins 1967).
Psychologists have labeled this the "giving up / given up" complex and
have suggested that, when an individual responds thus to a particular
life situation, disease and/or death may intervene (Engel 1968, 1971).
The "giving up / given up" complex provides a useful conceptual
framework for considering psychogenic death or illness"..........
from:http://home.tiscali.de/alex.sk/A_Davis.html
Read the whole thing, interesting.
If the subject of that page interests you, see the 1988 film by Wes
Craven, The Serpent and the Rainbow.