Posts Tagged ‘Erik Vance’

Conclusions for Suggestible You

March 29, 2017

There have been a dozen posts on Erik Vance’s “Suggestible You:  The Curious Science of your Brain’s Ability to Deceive, Transform, and Heal” because there is so much interesting material that is relevant to a healthy memory.  Nevertheless, these posts just scratch the surface.  Readers are encouraged to read the original book.

The power of our minds is enormous.  Our brains are an extremely valuable gift.  We need to use them to best advantage and to help them grow.  It is hoped that these dozen or so “Suggestible You” posts have accomplished  that.

Not much has been written about meditation, not because meditation was not covered in the book.  It was covered, but HM thought that the importance of meditation had been covered fairly well in other healthy memory blog posts.  And there will be many more posts on mindfulness and meditation in the future.

Suggestibility can have an enormous effect on many medical conditions, but not all of them.  Although Parkinson’s responds well to placebos, Alzheimer’s does not.  This makes sense, because suggestibility  involves the brain and Alzheimer’s destroys the brain.  The healthy memory blog has many posts on how to build a cognitive reserve.  There are many people who died with the defining amyloid plaques and neurofibrillary tangles of Alzheimer’s, have never shown any of the cognitive or behavioral symptoms.  It is said that a cognitive reserve precluded the cognitive and behavioral symptoms.

Anxiety responds to placebos, as does depression.  The pharmaceutical companies are spending a fortune trying to beat placebo effects.   But obsessive-compulsive disorders traditionally do not respond well to placebos.  Although the pain and nausea of cancer can be eased with placebos, tumors cannot.  Vance writes that the spontaneous regression—the sudden retreat of a tumor for no obvious reason is more common than you might think, but is not a product of suggestion (at least not that we know of).

And don’t forget to be suggestible to yourself.  When sad, remember that you can cheer yourself up, and that it is your mind and the chemicals in your body that affect your mood.  And you do have an ability to control your emotions due to your own suggestibility.  Meditation and mindfulness can also help here.

© 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.

Rules from Suggestible You

March 28, 2017

The author Erik Vance closes with several rules that HM feels obliged to pass along to you.

Rule #1:  Don’t endanger yourself.   Some alternative health remedies are physically dangerous.  For example, Mercury is a poison, incorrect chiropractic treatment can seriously damage your spine, and a careless hypnotist can implant terrifying memories that a may not be yours.  HM adds that you need to be aware not only of hypnotists, but also of misguided psychotherapists who can also implant false memories.

Rule #2:  Don’t Go Broke.  Be suspicious of expensive placebos.   Although more expensive placebos might work somewhat better than cheaper ones, there is a limit.  People have gone broke on treatments and approaches that do not work.  HM adds that they key component of all of these treatments is your mind, and you mind costs nothing aside from the time and cognitive effort.

Rule #3:  Don’t send any creature to extinction.  HM would be surprised if this warning was relevant to any HM readers.  But avoid any treatments that endanger animals.

Rule #4:  Know yourself.  Stay within your limits and use your common sense.

© Douglas Griffith and healthymemory.wordpress.com, 2017. 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.

Suggestible You 11

March 27, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform and Heal.  This is the eleventh post on this book. This post deals with depression.

Vance describes depression as like being chemically sedated into someone you don’t recognize.  He writes that given the choice, he might prefer excruciating chronic pain to depression, then goes on to note many people suffer from both.  He notes that about 7%  of Americans will experience clinical depression this year, losing the United States more than $200 billion.

It is clear that placebos are effective against depression.  Remember that to be declared effective the drug is compared against a placebo.  But when antidepressant drug tests are examined about 75% to 80% of their efficacy can be attributed to placebo effects.  Moreover, there was no real difference between high and low doses, which is odd.  Differences are expected with truly effective drugs.

Moreover, over the past few decals, scientists have noticed a distinct uptick in the power of the placebo effect on pain and depression trials.  Some experts even say that if Prozac had to compete against the placebo effect today, it would not have been cleared by the FDA.  Once a drug clears the Phase III, placebo-controlled trial, it is certified regardless of how it performs in later experiments.

For drug manufacturers trying to get new drugs approved, this is a problem.  But it should not be a problem for depression sufferers.  Remember the reason of including placebos in these tests is that placebo effects are real.  Placebos are much less expensive than the drugs, and carry no side effects.  HM wonders, as long as they are 75% to 80% effective, why take the drug.  Physicians should also be asking the same question.  Now it is clear why drug companies continue to try to develop new anti-depressants.  But after some many decades of research, with all the antidepressants already approved, and with placebos being largely effective without any adverse effect why bother.? At some point the difficulty in exceeding the effect of the placebo might prove so expensive that drug companies might abandon the effort.

© Douglas Griffith and healthymemory.wordpress.com, 2017. 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.

Suggestible You 10

March 26, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.     This is the tenth post on this book.  This post describe the role of  placebos in addiction.

Approximately 1 in 10 Americans is addicted to some kind of drug—mostly alcohol, although opioid addiction is gaining quickly.  Traditionally addiction has been viewed as a moral failing or a lack of willpower.  Today we understand addiction is mostly physiological, specifically around dopamine.  This is not surprising since this neurotransmitter deals with the anticipation and enjoyment of rewards.  Vance note that this includes sugar, sex, money, a high score on Grand Theft, as well as drugs.

Unfortunately, drug use doesn’t just change the way you feel for a couple of hours: it can also change the brain itself.  When the nervous system is presented with an abundance of pleasurable chemical stimulation through drug use, the nervous system gets overwhelmed and shuts down its production of dopamine to bring itself back into equilibrium.  This creates a bad feedback loop in which the person finds himself short on dopamine whenever he’s not using the drug.   Food no longer tastes as good, and sex can lose its thrill.  Taking the drug that caused this problem is the only way to get back to something close to normal.

Addiction literally changes the way the brain works.  Not only do addicts have less dopamine from drug overuse, but also their  dopamine receptors are affected (either changing their numbers or changing how well they transmit messages).  Regular drug uses twists memories so both the drug and the circumstances surrounding the drug use.  Addiction causes the brain’s impulse control centers to shut down, which greatly increases the chances of relapse.  If cocaine addicts are shown an image of blow for as little as 33 milliseconds, which is too fast to register in consciousness, they will have immediate cravings.

Vance sees addiction as sort of a perversion of all the brain circuits and processes  in his book.  Consequently he thinks that suggestion and expectation may hold the answers to overcoming it.  Naloxone, the drug that first helped expose the chemical nature of placebos and blocks placebo responses altogether, wasn’t invented for placebo research.  It serves a crucial role in medicine as an emergency treatment for drug overdoses.  It’s also pretty effective at blocking the effects of heroin or oxycodone.
A closely related drug, naltrexone, is one of the most effective treatments for alcohol abuse.

People get tipsy when a nonalcoholic beer is substituted for an alcoholic beer.  This also works the other way.  A study at Minot State University doctored root beer to give it the same alcohol level as regular beer.The researchers offered the doctored drink to a group of unsuspecting volunteers, while another group received regular beer.  Not surprisingly, both groups got tipsy after a few drinks. What is interesting is that those who drank beer actually absorbed more alcohol into their blood than those who thought they were drinking soda but were in fact consuming just as much alcohol.

It is clear that work on treatment is still a work in progress, but progress is being made.

Some two million Americans are addicted to prescription opioid drugs and about 19,000 died from overdoses in 2014.  This is about twice the number who died from heroin overdoses, and three times the number who died from cocaine.  One theory of pain is that after an injury, the pain never leaves, it just gets gradually covered up by the body’s internal medicine.  A team led by Bradley Taylor gave naloxone to patients who had recovered from an injury and for many of them the pain came right back as if pain had been hiding under the surface for this whole time.  These patients displayed some of the hallmarks of opioid withdrawal.  During the process of recovering from pain, we actually become dependent on our own opioids.   Taylor thinks that this may be the key to understanding not only addiction, but also the switch from short-term to chronic pain.

Given this understanding, NIH researcher Luana Colloca, whom we have encountered previously, is studying the role placebos my play.  She mixed a few placebo pills into a group of pain patients’ medication.  Each week they have five or six pain pills and one or two placebos.  As the week progressed, she upped the placebos and topped the opioids until the artificial was administered only about half the time.  The results of the project are not reported, but the idea is clear.  The patient is trained to expect pain relief when taking a pill.  Gradually she takes the pill away and lets the patient’s own expectation cover the pain relief.  The patient uses her expectations to switch from an external drug to an internal one.

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.     This is the tenth post on this book.  This post describe the role of  placebos in addiction.

Approximately 1 in 10 Americans is addicted to some kind of drug—mostly alcohol, although opioid addiction is gaining quickly.  Traditionally addiction has been viewed as a moral failing or a lack of willpower.  Today we understand addiction is mostly physiological, specifically around dopamine.  This is not surprising since this neurotransmitter deals with the anticipation and enjoyment of rewards.  Vance note that this includes sugar, sex, money, a high score on Grand Theft, as well as drugs.

Unfortunately, drug use doesn’t just change the way you feel for a couple of hours: it can also change the brain itself.  When the nervous system is presented with an abundance of pleasurable chemical stimulation through drug use, the nervous system gets overwhelmed and shuts down its production of dopamine to bring itself back into equilibrium.  This creates a bad feedback loop in which the person finds himself short on dopamine whenever he’s not using the drug.   Food no longer tastes as good, and sex can lose its thrill.  Taking the drug that caused this problem is the only way to get back to something close to normal.

Addiction literally changes the way the brain works.  Not only do addicts have less dopamine from drug overuse, but also their  dopamine receptors are affected (either changing their numbers or changing how well they transmit messages).  Regular drug uses twists memories so both the drug and the circumstances surrounding the drug use.  Addiction causes the brain’s impulse control centers to shut down, which greatly increases the chances of relapse.  If cocaine addicts are shown an image of blow for as little as 33 milliseconds, which is too fast to register in consciousness, they will have immediate cravings.

Vance sees addiction as sort of a perversion of all the brain circuits and processes  in his book.  Consequently he thinks that suggestion and expectation may hold the answers to overcoming it.  Naloxone, the drug that first helped expose the chemical nature of placebos and blocks placebo responses altogether, wasn’t invented for placebo research.  It serves a crucial role in medicine as an emergency treatment for drug overdoses.  It’s also pretty effective at blocking the effects of heroin or oxycodone.
A closely related drug, naltrexone, is one of the most effective treatments for alcohol abuse.

People get tipsy when a nonalcoholic beer is substituted for an alcoholic beer.  This also works the other way.  A study at Minot State University doctored root beer to give it the same alcohol level as regular beer.The researchers offered the doctored drink to a group of unsuspecting volunteers, while another group received regular beer.  Not surprisingly, both groups got tipsy after a few drinks. What is interesting is that those who drank beer actually absorbed more alcohol into their blood than those who thought they were drinking soda but were in fact consuming just as much alcohol.

It is clear that work on treatment is still a work in progress, but progress is being made.

Some two million Americans are addicted to prescription opioid drugs and about 19,000 died from overdoses in 2014.  This is about twice the number who died from heroin overdoses, and three times the number who died from cocaine.  One theory of pain is that after an injury, the pain never leaves, it just gets gradually covered up by the body’s internal medicine.  A team led by Bradley Taylor gave naloxone to patients who had recovered from an injury and for many of them the pain came right back as if pain had been hiding under the surface for this whole time.  These patients displayed some of the hallmarks of opioid withdrawal.  During the process of recovering from pain, we actually become dependent on our own opioids.   Taylor thinks that this may be the key to understanding not only addiction, but also the switch from short-term to chronic pain.

Given this understanding, NIH researcher Luana Colloca, whom we have encountered previously, is studying the role placebos my play.  She mixed a few placebo pills into a group of pain patients’ medication.  Each week they have five or six pain pills and one or two placebos.  As the week progressed, she upped the placebos and topped the opioids until the artificial was administered only about half the time.  The results of the project are not reported, but the idea is clear.  The patient is trained to expect pain relief when taking a pill.  Gradually she takes the pill away and lets the patient’s own expectation cover the pain relief.  The patient uses her expectations to switch from an external drug to an internal one.

Suggestible You 9

March 25, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive”, Transform, and Heal.  This post is about the placebo response and related phenomena.   This is the ninth post on this book.

This post is on what might be called “marketing placebos.”  You can market yourself to yourself through what you think about yourself and via self talk.  “I  have a chance, I think I should apply for the job, position, …”  “versus “I have no chance for the job, position, …, so I’m not going to apply.”  A much larger example might be, “life is not worth living” versus, “Such an opportunity life presents, think of all the things I can learn, all the things I can do, the nice friends I can have.”  In fact, just forcing ourselves to smile can make us feel better.

Marketing placebos are like pain placebos in that they require healthy input from the reasoning prefrontal parts of the brain.  Most companies achieve this in one of two ways.  One way is by creating, cultivating, and enhancing a particular brand.  The other is via the price tag.  If a company tells you it has a new line of brain-enhancing drinks, and you believe it, you’ll likely find that, your cognitive performance actually improves after drinking it.  And if they tell you it’s an especially expensive brand, your performance will likely go up even more.  This same principle applies to branding.  Vance notes that studies suggest that athletes perform better when they drink favored water out of a Gatorade bottle.  And students’ test scores rise when they use a pen labeled “MIT.”

The researchers who did these studies correlated the subjects’ level of suggestibility to how they thought about the nature of intelligence and learning.  Those who thought of intelligence as more or less fixed were more suggestible to brands than those who saw intelligence as fluid.  So readers of the healthy memory blog should not be as suggestible to brands  as people who do not read this blog.  This is because growth mindsets are repeatedly advocated in this blog.  If this point is not obvious, enter “growth mindsets” or “Carol Dweck” into the healthy memory blog search block.

Fad diets can be regarded as an example of marketing placebos.  Key to the success of these diets, is a good story that makes the diet compelling.  The placebo effect likely plays a large part in the initial success of the diet.  And in the long term, few of them work.  Lost weight usually finds a way to return.

Vance argues that this same expectation applies to most of the “toxins” we read about.   He writes, “Evil free radicals and toxins are just stories.  We buy them or we don’t.”  And remember the role that social inputs play in amplifying placebo effects.

These effects extend to athletics.runners who thought they were getting blood doping shaved 1.2% of their times.  Another study demonstrated that weight lifters improved their performance by 12% to 16% when they were taken caffeine (a known, albeit legal performance enhancer), but were actually only taking placebos.

Suggestible You 8

March 24, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This post is about the placebo response and related phenomena.   This is the eighth post on this book.

“Satan Worshippers, Aliens, and Other Memories of Things That Never Happened” is the title of Chapter 6.  It begins with the following quote from Josh Billings, “There are lots of people who mistake their imagination for their memory.”  This post will explain why this is so, and that a misunderstanding of memory and how memory works led to much misery between and among families and to the false imprisonment of innocent people.

As healthy memory blog readers should know, we do not have direct contact or knowledge with the physical world.  See the healthy memory blog posts “Understanding Beliefs,” “Revising Beliefs,” and “More on Revising Beliefs.”  We construct mental models based on the data coming from our senses.  As we experience more and learn more we develop new models, revise old models, and form connections among related or associated models.

Too many people think that our eyes and ears act like video cameras and tape recorders, that we see and hear what is and that these recordings are permanent and accurate.  Consequently, in the courts a great deal of belief is put on eyewitness testimony, when data indicate that eyewitness testimony is flawed and prone to error.

In reality, our eyes and ears are taking light and sound and turning them into electrical signals in the brain.  The brain then constructs a version of what is being perceived and what makes sense.  Expectations from prior models play an important role in this process.  Our brains have to make assumptions and take shortcuts and sometimes makes mistakes.  Optical illusions, blind spots, and hallucinations are all examples of how our brains misinterpret what is being perceived—sometime to very confusing and dangerous ends.

Similarly, memories are not like flash drives.  Memory is an integrated constructive process that is constantly refining itself, rebuilding, restructuring, and finding shortcuts.  And sometimes, our memories play tricks on us,  Memory processes can be divided into three stages.  First the information has to be encoded.  Then there is the process of consolidation during storage.  The third phase is retrieval, which is the recall of the memory.  Changes occur throughout this process and some changes can be erroneous.

The failure to understand how memory works and its malleability that can lead produce errors resulted in teachers and caretakers being falsely accused of sexually abusing children, and of Satanic rituals.  As near as can be understood, the people who conducted these investigations honestly believed that these children were being sexually abused.  But their beliefs poisoned their investigations.  They asked leading questions and repeatedly questioned these children to the point of exhaustion.  Unfortunately, the courts and juries, who were equally ignorant of how memory works, sent innocent people to jail.  This problem continued for much longer than it should have, and it took way too many years for these erroneous convictions to be overturned.

There were also too many cases of clinical psychologists and psychiatrists, many with Freudian conceptions of sex and repressed memories, inadvertently place memories of sexual abuse in the patients’ and clients’ minds.  Innocent parents were accused by their own children of sexual abuse.  These nightmares outdid the fiction of  Franz Kafka.   Imagine the pain that this caused within families. HM thinks that most of theses errors have been corrected, but he still fears that there are still therapists who should be avoided.  Be vary careful when choosing a therapist, and keep a watchful eye out doing the therapy.

Elizabeth Loftus is the leading psychologist who conducted research in this area, and who spent countless frustrating hours testifying in court.

Enter “false memory” into the healthy memory search block to find more posts on this topic.

© 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.

Suggestible You 7

March 23, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This post is about the placebo response and related phenomena.   This is the seventh post on this book.

This post is about hypnosis.  During the late 50s and early 60s researchers at Stanford and Harvard came up with 12-step scales to quantify how suggestible to hypnosis someone is.  Their research led these researchers to conclude that hypnotic susceptibility is a fixed trait.  Susceptibility to hypnosis doesn’t change much  from late adolescence until death.  The most spectacular  forms of hypnosis  work only on the most hypnotizable 10% or so of the population.  Another 10% do not respond to hypnosis at all, and 80% fall somewhere in between.

A Canadian psychologist Pierre Rainville successfully hypnotized one group not to feel any pain from hot water poured on their hands and another group to believe that they could feel pain but that it would not bother them.  Their brains were scanned with positron emission tomography (PET) and found two very different neural reactions to pain.  This suggested that the sensation of pain and the emotions associated with it have separate triggers as well a how crucial emotion is to our experience of pain.  There is also neurological evidence that there are two different pathways for pain.  One dealing with the response to the pain itself, and the second to the interpretation of the pain.  It is this latter response that characterized chronic pain.  See the previous healthy memory blog posts “Pain and the Second Dart,”  “To Treat Chronic Pain, Look to the Brain Not Body,” and “Controlling Pain in Our Minds.”

Rainville’s work indicates that hypnosis often involves parts of the brain associated with attention, emotion regulation, and pain.  People seem  to be wired differently for hypnosis, and that this doesn’t change much over the course of our lives.  Research has also shown that the capacity to be hypnotized is not tied to intelligence or willpower.

Some tend to think of hypnosis as being another placebo.  The consensus  is that they are not related.  Hypnotic susceptibility remains relatively stable throughout one’s life, whereas placebo responsiveness can change from day to day.  And the drug naloxone, which is effective at blocking placebo responses doesn’t block hypnosis.  So although they are not the same, they both tap into a deep force in the brain:  expectation.

Psychologist Marcel Kinsbourne says, “There is a wave of bottom-up information coming up from the external world, up into your brain.  There is a wave of information coming from the cortex that consists of your evaluations, your beliefs, your expectations.  Consciousness is these two waves hitting each other.  It’s a collision.  And this is where hypnosis and placebos do their work.”

Suggestible You 6

March 22, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This post is about the placebo response and related phenomena.   This is the sixth post on this book.

This post is on nocebos.  Remember that placebo is Latin for “I shall please.”  Nocebo means “I shall harm.”  So nocebos can be thought of as negative placebos.

In 1886 a physician named John Mackenzie was treating a woman with a serious case of hay fever and asthma.  For a variety of reasons, he was not convinced that the patient’s condition was fully authentic.  For her next visit he place a rose in his office.  As soon as she sat it she had powerful allergic reaction that brought on an asthma attack.  The flower was artificial and served as the nocebo.

Cholecystokinin (CCK) is a key messenger in activating intestinal functions, including digestion and the release of gastric acid and bile.  It also plays a role in making you feel full after a good meal.  But if you inject CCK into someone, it causes anxiety and nausea and can induce panic attacks.  It also seems to increase pain by lessening the impact of internal opioids.  Fabrizio Benedetti set up an experiment with patients recovering from  minor surgery in which he gave them a drug and told them it would make their pain worse when it was actually just saline.  The patients did report more pain with the saltwater injection.  Then Benedetti blocked their brains’  CCK release with another drug.  Now the patients felt better when the CCK was blocked.  Vance wrote,”What opioids are for placebos is what CCK is for nocebos; a mechanism giving expectation power in the body.  And whereas blocking opioids killed the placebo response and made patients feel worse, blocking CCK actually supercharged pain relief by allow the brain’s internal pharmacy to run wild.”

Nocebo effects are much easier to create than placebo effects.  Negative expectations can be stronger than positive expectations.  Vance note that nocebos and placebos in the brain take two different routes.  They look similar, go to similar places, share some of the same highways, but still are totally different routes, and nocebos take all the best shortcuts.  This does make  sense, as the aversion to pain is fundamental not just to being human, but also to being alive.  Colloca notes that although the nocebo affects the same reward/expectation regions in the brain, it also includes one more that placebos do not:  fear.  The hippocampus plays a key role in the storage of memories and it also plays a key role in fear conditioning anxiety.  Brain imaging indicates that while the hippocampus is mostly absent from placebo effects, it lights up during the experience of nocebos.

Fear is at the heart of nocebos, and fear is a powerful emotion.  Fear headlines in the news elicit much stronger responses that do pleasant ones.  In 2014, even before anyone had died of Ebola in the United States, 25% of Americans were worried they or their families could contract it.  Thousands of people visited doctors claiming they had signs of the virus, and 650 of those people had symptoms serious enough for their cases to be passed on to federal officials.  As it turned out, only four people in the United States had the disease:  a visitor who got it in Liberia, two nurses who had treated him, and a doctor who had been working in an Ebola.

So we need to be careful to not let our fears get out of hand.  And let us hope that doctors make more use of nocebos in treating pain.

Suggestible You 5

March 21, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This book is about the placebo response and related phenomena.   This is the fifth post on this book.

Vance describes the story of a man diagnosed ten years ago being severely debilitated in late stage Parkinson.  He volunteered for an experiment in which the medication was directly injected into a critical part of the brain.  To control for the placebo effect, these experiments require sham surgery that copies everything about the surgery except for the critical drug injected into the brain.  The study involved 51 participants.  Twenty-four people got the real surgery and 27 got the sham surgery.  The drug proved to be a failure.  However, the participant of interest did show a remarkable recovery.  However, he was one of those who had received sham surgery.

This dramatic example makes the point that there are large individual differences in the response to placebos.  Kathryn Hall of Harvard University was interested in studying possible genetic bases for this enhanced responsively.  She discovered the COMT gene.  The COMT genes codes for an enzyme in the brain, also called COMT, or catechol-O-methyltransferase.  Vance writes that this is one of the best-studied brain pathways in the world, and may be the most fascinating link he has discovered as a science writer.

Here’s how it works.  Dopamine has enormous power and is important for body movement and good moods.  However, it is possible to have too much of a good thing.  A mechanism is need to sweep up the bits we don’t need—the extra dopamine molecules floating around our skull that aren’t doing anything useful.  COMT gets rid of the excess dopamine molecules.  COMT is an extremely long and complicated enzyyme.  Fortunately, it is one within its machinery that defines how well it works.  Depending upon an individual’s genetics there are two types of this crucial portion of the enzyme:  valine (val) or methionine (met).  If one’s brain has val in that one spot, the enzyme performs its job of removing excess dopamine.  However, if the enzyme has met in that one spot, it is much less effective.  The brain is left with lots of excessive dopamine.

Remember that each trait in the body is a combination from each of the parents.  COMT works in a similar manner.  So we have val/met, but also val/vals and met/mets.  So 25% of the population are val/vals,and 25% are met/mets, 50% of the population are val/mets.

Hall conducted an experiment pairing COMT genes with placebos.  She enrolled 262 patients with irritable bowel syndrome (IBS) into an experimental treatment involving acupuncture.  She selected patients with either moderate or severe cases of IBS and then divided them into three groups. One group, the true control group, was put on a waiting list and given nothing.  The other two groups were told that they would get acupuncture, but they were unknowingly given fake acupuncture.  Half of the participants got treatment from a comforting, caring acupuncturist while the others got treatment from a cold, uncaring acupuncturist.

Here are the results.  People on the waiting list stayed the same regardless of their genes.

Met/mets with the uncaring acupuncturist  did better than the val/vals, but just barely.

Val/vals with the caring acupuncturist did about as well as the val/vals with the uncaring acupuncturist and all the people on the waiting list. In short, no placebo effect.

The val/mets who got the caring acupuncturist did about five times better.

The results of the met/mets who got the caring doctor went through the roof.

Clearly the kind words  meant something totally different to one genotype than it did with the others.  Hall had divided the placebo responders into measurable groups.Met/mets—those people who were born with lazy enzymes and a little too much dopamine in their responses were more prone to placebo responses.

Although the COMT gene plays a large role in the creation of the COMT enzyme, it’s not the only gene that does so.  Other genes help build the enzyme that can boost or cripple its performance, as well as all the other genes in you body that affect dopamine.    COMT also goes after epinephrine and norepinephrine, neurotransmitters that are key to regulating adrenaline, cardiac, function, and our response to stress.

So, in summary, the interactions are complex.  But different factors that contribute to the immune response are being identified.  Genes, the administrator of the placebo, and our fellow human beings are factors.

Suggestible You 4

March 20, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This book is about the placebo response and related phenomena.   This is the fourth post on this book.

An important question is whether there is a way to enhance the placebo effect, or even make it permanent.  In 2015 Karin Jensen, a placebo researcher at Harvard,  published an experiment that showed how our brains can self-medicate even when we are not paying attention.  She set up a two phase experiment in which subjects wore a painful heat pad that flared up whenever they saw a picture of a certain face and died down when they saw another, similar face.  The brain learns that one face is bad and the other face is good.

In the next phase, after the relationship had been ingrained in the participant, she turned the heat to somewhere in the middle.  This time she showed the picture for only a fraction of a second, so the participants could barely see the face.  The subconscious mind could spot the difference, but the conscious mind could not.  Nevertheless the participants continued to feel pain with the bad face, and less pain with the good face, even when they could not consciously distinguish the faces.  With enough practice, people can unconsciously trigger the placebo effect with the flash of one face, even though their conscious mind has no idea its happening.

The placebo effect can also be altered by peer pressure.  One of Wager’s students, Leonie Koban, set up an experiment in which people  rated various levels of heat pain applied to their arms by a metal pad.  After gauging each person’s pain threshold, she asked them to rate how much pain they expected to feel before she applied it, but with one additional crucial element.  They would also be able to see how other people had rated the same pain.  These previous reports of pain were totally made up.  Still, people who felt a strong pain rated it lower if that’s what they thought others had done.  And people who were told others had felt a lot of pain rated the pain highly even if it was mild.  This peer pressure placebo effect was twice as strong as the normal placebo effect!  As a check, Koban recorded their skin conductance, which is a physiological response to pain.  On the basis of skin conductance it was impossible to differentiate from a genuine experience.

It seems that people are programmed with a preexisting need to go with the herd.  People quickly tapped into a more powerful placebo response than if they had spent hours conditioning themselves.  So someone else’s opinion is not only powerful, but it can be more powerful than your experience and even more powerful than repeated conditioning.  So we are hardwired to follow other people’s opinions.

Vance suggests that there might be some biochemistry involved in this interaction.  Luana did an experiment similar to the one reported in Suggestible You 2 in which a green screen induced a placebo effect.  The participants in this new experiment were given a dose of vasopressin before the green screen experiment. In yet another experiment the participants were given a dose of a related hormone, oxytocin.  These drugs greatly enhanced the placebo effect.  These hormones play a large role in social interactions among people.  Vasopressin seems to regulate social communication and conciliatory behavior.  Oxytocin seems to be involved in experiences of empathy, trust, and social learning.  So the same chemicals that draw us together as humans and allow us to work together can also boost the placebo response altogether.

Suggestible You 2

March 18, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This book is about the placebo response and related phenomena.   This is the second post on this book.

Vance participated in an experiment in Luana Colloca’s laboratory on the campus of the National Institutes of Health.  Dr. Colloca attached a variety of devices to Vance including two on his left hand.  One device delivered the shock, the other, on his middle finger.  She said that this device will tap into the A-B fibers in his hand that will occasionally interrupt the shocks, nearly cutting the pain altogether.  As he explained it, the difference between the weak shock and the powerful shock would be that one has a crossing guard and the other does not.  He was told that he would know which one was coming via a screen that will turn green when the A-B fibers are blocking the pain and red when they are not.

Vance said that the small shock feels like a pinprick or a pinch, but the bigger shock doesn’t feel like a bigger pinprick. He said that it’s more like a dull squeeze wrapped in fire, localized in his hand but seemingly all over his body as well.  Colloca slowly increased the strength of the shock, working Vance up a scale of 1 to 10 (10 being the worst tolerable pain), testing his pain threshold.  He agreed to a shock level of 6, although he said that this was very uncomfortable.  He went through two rounds of 12 shocks each.

On the third round he noticed that the green (weak) shock) had gotten slightly worse—maybe from a 1 to a 2.   He thinks there might be a problem with the shock blocker.  They ran through 11 more trials and the torture session was over.  When Colloca returned she told him his pain threshold was smack in the middle of the bell curve for pain, which is 100 hertz of electricity.  She remarked that pain thresholds vary tremendously among individuals.

Then Colloca pointed to a sheet of paper showing Vance’s third round and dropped a surprise telling him, “In Block 3 we used green and red both at 100 hertz.  You felt the green as less painful, compared to the red, when actually you received the same, and that is the placebo effect.”  There never was any magic pain-lessening wire.

The question regarding why the placebo effect works was addressed by a team in Scotland in 1975.  We do have a form of homemade opioids called endorphins.  These endorphins play a number of tiles in our brain, such as regulating circadian rhythms,  appetite and body temperature.  They are the primary chemicals that make sex feel so good.  Two neurologists, Jon Levine and Howard Fields conducted a simple experiment with people in pain after dental surgery.

The plan was to give a group of patients who had recently had a dental procedure either a placebo or naloxone.  Naloxone blocks the endorphins.  They told all of the patients that they were receiving a painkiller.  As expected, many of those  who got the placebo felt less pain, whereas the naloxone group felt miserable, as their own natural opioid (endorphin) generator was being blocked.  When naloxone was given to the genuine placebo group, they also felt miserable.  So this study does show that pain placebos work because the brain self-medicates with the opioid like drug endorphins.

Suggestible You

March 17, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This book is about the placebo response and related phenomena.  One of HM’s pet peeves is the expression,”It’s just a placebo response.”  For HM, the placebo response is the most interesting effect in medicine.

Artificial intelligence pioneer Daniel Dennet has written.  “A mind is fundamentally an anticipator, an expectation-generator.”  Expectation is a system of shortcuts our brains have developed to get through the day.  Otherwise we would be stopping every few seconds to figure things out.  Consequently if what you anticipate is negative your mind will make things look (or feel) worse than they actually are.  However, if you expect the best some amazing things can happen in your body.  Somewhere between this expectation and reality lies the mind’s power to heal itself.  Erik Vance writes, “Our uncanny ability to deceive ourselves has startling implications for our health and well-being… Everyone’s door to expectation has a different key, and everyone is susceptible in a slightly different way.  But once that door is unlocked we have access to an amazing power to heal ourselves.”

Placebo comes from the Latin for “I shall please,” and traditionally refers to anything inert that has an effect on a patient.  Vance writes, “…usually lasting less than a day but sometimes longer:  a sugar pill, a saline injection, or sham surgery, often mixed with a little smoke and mirrors.  In other words, nothing.  But in the world of expectation, sometimes nothing is more powerful than something—if it’s wrapped in the right packaging.”

Vance writes that this packaging is different for everybody.  What allows a placebo to work is a topic of continuing research, the most recent of which is presented in his book.    It involves psychology, chemistry, and genetics, aided by the power of storytelling.  The manner in which the placebo is presented is important, which does not necessarily involve deception.  Placebos can be effective even when the recipient knows that it is a placebo.

Vance writes of the importance of theater or how the placebo is presented and to individual differences.  For example, depression patients respond better to yellow placebo pills than to blue ones.  Bigger ones work better than smaller ones, but only to a certain point.  Bear this in mind should you purchase placebo pills on Amazon, and there is a wide variety of placebos available on Amazon.  Fake injections work better than fake pills.  Vance goes on to note that “if you’re French, suppositories work better than either.  Take a quiet moment to ponder the significance of that.”

Placebos are a very complex topic, so a series of posts will be required, which shall follow immediately.