Posts Tagged ‘Cure’

Some Additional Notes on Cure

February 29, 2016

That is the outstanding book by Jo Marchant, “Cure:  A Journey Into the Science of Mind Over Body.”  There is much in this book that I am not covering.  Meditation and the relaxation response have received extensive coverage in previous posts.  Irritable bowel syndrome (IBS) has received perhaps more attention in previous posts than is deserved.  The importance of he Vagus nerve and Vagal Tone was discussed in the healthy memory blog post “The Importance of the Vagus Nerve in Relieving Stress.”

Marchant devotes a chapter to Rethinking Pain.  Another chapter on the importance of talking and caring.  A chapter on thoughts that kill.  A chapter on the importance of friends. And a chapter on the role of religious beliefs.

In her concluding chapter, she writes how she was hoping to end the book.  She was hoping to write that a new paradigm had been opened in medicine and that the mind would have a significant role in health and healing.  She concluded, however, that such a conclusion was not justified.  One problem still to be overcome is that too many physicians are held captive by their Cartesian mindsets.  By that I mean that the body and the mind are separate entities that do not interact.  Marchant’s book provides ample proof that such is not the case.  Over time as physicians die, retire, and increasing information keeps coming in regarding the importance of the mind in health and healing.

However, a more serious problem is economic.  The money is in drugs.  The drug companies benefit financially, and physicians are offered treatments that are quick involving minimal personal time.   I am continually amazed when I hear or see advertisements for most drugs.  Fortunately, the law requires drug companies to list possible side effects.  My amazement comes from thinking that people would still take these drugs given the possible side effects.  In the end the result in the United States is that we are an overmedicated society with health statistics approximating those of a third world country.

My guess is that the possible revolution will turn into an evolution.  In the meantime, seek out physicians who take the mind into account in their treatments.  And if there is no treatment, ask for a placebo or purchase one on your own.

© Douglas Griffith and healthymemory.wordpress.com, 2016. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

Fighting Fatigue

February 28, 2016

Fighting Fatigue is the fourth chapter in Jo Marchant’s “Cure:  A Journey Into the Science of Mind Over Body.” The key idea here is that the mind plays an important role in fighting fatigue.  It is worthwhile noting that many performance enhancing drugs, such as amphetamines, modafinil, and caffeine, work by influencing the central nervous system, not the muscles themselves.  A fairly recent healthy memory blog post, “Marathon Mind:  How Brain Training Could Smash World Records” obviously makes the same point.  However, what was missing from that blog post was the notion of a central governor.  The chapter documents extensive research showing that the no matter how hard we exercise, the body always takes the precaution to maintain a healthy reserve.  Presumably there is a central governor that controls this.  The question is whether this central governor can be persuaded, or fooled, to tap into some of this reserve.

Elite cyclists when given a pill or drink they believe is a performance enhancer can cycle on an average 2-3% faster.  Psychologist Chris Beedle suggests this is because the placebo increases their optimism and self-belief that persuades the central governor to free up more resources.  Another placebo expert  Fabrizio Benedetti concluded in a paper on fatigue that “a placebo may act as a cue signaling the central governor to inhibit its brake.”

This presence of a central governor might also explain why interval training, which consists of short bursts of high intensity exercise interspersed by recovery periods works so well.  According to sports physiologist Tim Noakes, who formulated the idea of a central governor, regular  sprints that push us close to our limit of maximum performance don’t just increase physical fitness, they also retrain the brain.  They teach the central governor that pushing ourselves that far was okay, so next time it’ll be safe to push ourselves a little bit further.

Chronic Fatigue Syndrome (CFS) is one of the most controversial conditions in medicine.  Its prognosis is extremely poor with trials that followed patients for up to five years concluding that the recovery rate is just 5%.  CFS is also known as myalgic encephalopathy (ME), although not everyone agrees that these are the same conditions.

To treat CFS and ME an approach was developed called graded exercise therapy (GET) that is intended to work as an ultra-gentle form of interval training.  Cognitive Behavioral Training (CBT) was combined with GET to bring the mind further into the treatment protocol.  This approach alarmed many patient groups who developed an alternative approach called adaptive pacing theory (APT).  The apparent belief of the APT group is that this was a real disease unaffected by the mind, and that people needed to learn to live with this illness.

A large five year study was conducted by Peter White of St. Barthlolomew’s Hospital and his colleagues that included 641 patients.  They were divided into four groups.  A control group that just received routine medical care.  The other groups received this standard care plus CBT, GET, or APT.  This study was published in he journal “Lancet” in 2011.  It reported the APT was completely ineffective. GET and CBT were both moderately helpful, reducing fatigue and disability scores more than the other two groups.  22% of the patients recovered after a year in the CBT and GET groups compared to just 7-8% in the other two groups.  Although this might not look impressive, it showed that GET and CBT were the best treatments available and that recovery from the condition is possible.

The  patient groups remained unimpressed and complained to the Journal.  the Journal answered with a strong endorsement of the research.  Patient groups remain unimpressed.  Apparently they like to believe what they believe and reject scientific evidence.

Pavlov’s Power

February 26, 2016

Pavlov’s Power is the third chapter in Jo Marchant’s “Cure:  A Journey Into the Science of Mind Over Body.”  Remember Pavlov the Russian physiologist who discovered classical conditioning?  Pavlov is the one who discovered that by pairing a stimulus, a bell for example, with the presentation of food caused the dog to salivate when the stimulus alone, called the conditioned stimulus, was presented.  Classical conditioning is one of the fundamental paradigms in psychology.  The question is, does this procedure have any practical uses.  The subtitle of this chapter, How to Train Your Immune System, provides the answer.

Attention deficit hyperactivity disorder (ADHD) describe children who are inattentive, hyperactive, and impulsive.  They are constantly  talking and fidgeting.  unable to wait for their turn, and are unable to focus in school.  Medication helps them to control their symptoms, but still causes problems from irritable outbursts when the drug wears off  to weight loss and stunted growth.  A researcher name Sandler wondered whether a placebo might help these children to manage their symptoms on a lower dose of the drug.  He hoped that the honest delivery of placebos as part of a regime that would harness the power of both expectation and conditioning.   He employed seventy ADHD patients aged six to twelve in a two month trial.  These children were split randomly into three groups.  One group underwent a conditioning regime in which they received their normal medication, but also swallowed a distinctive green and white capsule along with their drug.  For the second month they received half their usual drug along with the placebo capsule.  There were two control groups, neither of which received any conditioning.  One group received their full dose of medication for the first month and a half dose for the second month.  The second control group received the full dose of medication for two months.

Sandler published his results in 2010.  The symptoms of the half-dose control group got significantly worse in the second month of the trial.  However, the conditioned group remained stable, doing just as well as the full dose patients.  There were even hints that the children in this group did even better, suffering fewer side effects than those on the full dose of the drug.

Bob Ader, a psychologist at the University of Rochester was doing research on taste aversion.  He gave a group of rats several doses of water sweetened with saccharin.  Normallt this would be a treat but he paired the water with injections that made the animals feel sick.  Later when the rats are given sweetened water on its own, they associated the sugary case with feeling ill (classical conditioning) and refused to drink it.  Adler then forced-fed them using an eyedropper to see how long it would take to learn to forget the negative association.  Rather than forgetting the negative association they died, one by one.

The drug that was used to make the rats feel sick was cytoxan.  In addition to causing the feeling of sickness, it also suppresses the immune system.  So conditioning reaches far behind normal responses, it can also affect the immune system.  This is a rather dramatic conclusion to draw, and it was not accepted at first.  David Felten, a neuroscientist working at the University of Indiana used a powerful microscope to look at the body tissues from dissected mice.  When Felten followed the different branches of the autonomic nervous he found nerves running right into the hear of immune organs such as the spleen and thymus.

Many scientists found Felten’s results difficult to accept.  However, one who did not was Dr. Jonas Salk, the creator of the Salk vaccine.  Salk wrote, “This research area could turn out to be one of the truly great areas of biology in medicine.  You’ll meet some opposition.  Continue to swim upstream.”

Felten did and stated a collaboration with Ader and his colleague Cohen and moved them to the University of Rochester.  These three are now broadly credited with founding a field of research known as psychoneuroimmunology.  This group went on of discover a complex web of connections.  They found receptors for neurotransmitters—messenger molecules produced by the brain— on the surface of immune cells, as well as new neurotransmitters that could talk to those cells.  The lines of communications went in both directions.  Psychological factors can trigger the release of neurotransmitters that influence immune responses, while chemicals released by the immune system can influence the brain.  For example drowsiness, fever and depressive symptomjtr that confine us to bed when we are well.

So Pavlovian conditioning can go way beyond making dogs drool!

Types of Placebos

February 25, 2016

When people think of placebos, people tend to think of pills.  Placebos can also be injections, operations, acupuncture, and so forth.  The anthropologist Moerman says that the active ingredient in placebos is meaning.   The meaning of placebo is positive.  However, there are nocebos whose meaning is negative.  Nocebos can be an effective weapon for terrorists.  Were terrorists to spray a gas over an area, people would likely get sick., even if the gas was harmless.  Or they could claim that water had been poisoned and sicknesses would likely result.  There is one theory that adverse side effects of medications are a type of nocebo.

Placebos are available for sale on the internet.  You can even find them at amazon.com.  And given their effectiveness, you might want to try some of these yourself.  Remember that a placebo can work even you know it is a placebo.  There are also ways of making a placebo more effective.  Size, larger being more effective, and number, more being more beneficial, are also effective.  The effects of color are more complicated with different colors being more effective for different outcomes.

This post is based on content from “Cure:  A Journey Into the Science of Mind Over Body” by Jo Marchant,

Cure: A Journey Into the Science of Mind Over Body

February 23, 2016

The title of this blog post is identical to the title of an outstanding book by Jo Marchant.  The phrase, “it’s just a placebo effect,” has been one of my pet peeves for a long time as I find the placebo effect to be one of the most important facts of medicine.  Any medical trial needs to be run against a placebo treatment as the placebo treatment will result in a measurable effect, and the desire is to measure the effect of the treatment above and beyond the placebo effect.  However, what I find ironic is that this genuine effect is not routinely administered.  Absent some treatment, why not give the patient a placebo as there will be a benefit for at least some of the patients?  The reason that the physician would provide is that the placebo effect is not a real treatment so it would be dishonest to deceive the patient even though the patient might benefit from the deception.  Research has shown that patients still benefit from placebos even when they know that they are indeed placebos.  I find it ironic that physicians routinely treat viruses with antibiotics even though they know that the antibiotic is ineffective against viruses.  This practice has weakened the effectiveness of antibiotics,  Why not administer a placebo shot instead?  Any effect the antibiotic might have would be a placebo effect, so why not simply administer an injection of a placebo?

The truth is that too many physicians are infected with the bias that medicine is physical and that placebos are mental.  They refuse to appreciate the effect that the mind has over the body.  Marchant’s book goes a long way to documenting these effects.  The failure to correct this bias will result in unnecessary deaths, pain, and suffering.

At the outset, Marchant makes two important points about  the limitations of the placebo effect.  The first is that any effects caused by beliefs in a treatment are limited to the natural tools that the body has available  Note, however, that the body might not use some of the natural tools absent a placebo effect.

The second point is that effects mediated by expectations tend to be limited to symptoms—things that we are consciously aware of,such as pain, itching, rashes or diarrhea, as well as cognitive function, sleep and the effects of drugs such as caffeine and alcohol.  Placebo effects also seem to be particularly strong for psychiatric disorders such as depression, anxiety, and addiction.

However, these limitations are not as constricting as they might seem as placebo effects can affect the immune system, which is the disease fighting system of the body.  This is a new field of research, one that has been encouraged by the father of the Salk vaccine, Jonas Salk, called psychoneuroimmunology.  The potential of this new field of research is unknown.

So, who knows what placebos hold for the future, but today in many cases painkillers and antidepressants may not work much better than a placebo.  Moreover there are risks of addiction and side effects with these drugs.  The top ten grossing drugs in the United States help only between 1 in 25 and 1 in 4 of the people who take them,.  Statins might benefit as few as 1 in 50.

A study published in the British Medical Journal concluded that drugs are responsible for more than half a million deaths in the Western world each year with minimal benefit.

I would also call your attention to the healthy memory blog post, “Most Published Research Findings are False.”  So most physicians are working in the dark with research, most of which is wrong.

© Douglas Griffith and healthymemory.wordpress.com, 2016. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.