Posts Tagged ‘placebo’

Cheap? Yes. Fake? Not at all.  It’s another genetic study on the placebo effect and it highlights the fact that our brains are not static input-out machines that were built from scratch using a genetic blueprint.  Rather, what we expect and believe matters … a lot.

How does it work?  Nobody knows for sure, but dopamine has been implicated in synaptic mechanisms that are used to register the fulfillment or violation of expectations.  For example, if you believe that a certain something will happen … and something better happens, your brain produces a burst of dopamine.  If something worse happens, then you get a drop in dopamine.  Your expectations and beliefs influence your dopamine levels.

Apparently, some of us metabolize dopamine faster vs. slower which may be related to a weaker vs. stronger placebo response.  For example, my rs4680 GG fast dopamine metabolizing genotype says, the “medicine in my mind” is not very strong.  But, on the other hand, I do watch A LOT of Grey’s Anatomy.

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Sweating it out as a new yoga-meditation student, my instructor often says, “Make this pose feel good”!  Bend here, press there, twist, up on one hand and … feel good? If you’ve practiced yoga, you may know what I’m talking about.  And, if you’re like me, you’re hooked on this unique aspect of yoga.  With an emphasis on breath control and meditation, yoga allows its practitioners to “feel the pleasure” instead of “feel the pain”.

Admittedly, I’ve had many sore morning-afters, but I’m starting to find that when I’m intensely focused on my breath, the experience of moving in and out of postures is a pleasurable one – not like other activities motivated by a “come on!  push it!” & “no pain, no gain” mentality.

This yogic mentality has led to a profound change in my life.

Read the rest in Elephant Journal

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Cover of "The New Medicine"
Cover of The New Medicine

Check out part 1 of the PBS documentary “The New Medicine” – on the “new” efforts in modern medicine to harness the connection between mind and body to optimize health and healing.  In the video, several physicians demonstrate the way in which various mindfulness-ish practices are now a part of the standard drug & surgical treatment process.  They are not practicing yoga per se, but the similarities are obvious (perhaps even less potent than traditional yogic body and breath control training).

In a surprising twist, one interviewee, Deborah Schwab, RN, NP, MSN of Blue Shield of California noted how a study of so-called “guided imagery” (patients are given a CD with various guided imagery meditations) was associated with shorter hospital stays, and lower medication costs to the tune of $2,000 per patient.

“Folks who thought this type of stuff was too flaky or too California found that it didn’t turn out to be that way at all!”

Imagine that … one day offsetting the cost of yoga sessions with a health insurance deduction?  Just unroll your mat and swipe your Blue Cross insurance card?

Another interviewee is Dr. Richard Davidson:

In our culture, we have not given the training of the mind – in particular the training of emotions – sufficient credence.  … Imagine someone who spends as much time training their mind as someone in our culture spends practicing golf!

In one of Davidson’s studies, it turned out that even folks who practice just a “meager” amount of meditation showed a more dramatic immune response to flu vaccination.  When one of Davidson’s research volunteers, Buddhist monk Barry Kerzin/Tenzin Choerab was asked what he gets from his meditation practice, he replied:

Tears of joy.

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One of the most mysterious aspects of modern medicine is the so-called placebo effect.  Imagine a drug company that has a new pill.  To see if it works, they give one group of people (the “test” group) the real pill and they give another group of people (the “control” group) an identical looking pill that does not contain any medicine (sugar pill).  If the the “test” group improves in health and the “control” group does not – voila! – one can conclude that the medicine works.

What happens when the “control” group gets better?  Hunh?  but there was no medicine … how can they get better? This is known as the placebo effect – wherein a persons EXPECTATIONS lead them to feel better.

Believe it or not, it happens all the time in scientific research and in the pharmaceutical industry.  Apparently the brain has a way of convincing the body that things are getter better (or worse).  You probably have probed this complex mind-body interface at some point … “is the pain really in my back, or perhaps just in my head?” Indeed, you can almost hear the frustration among the blue suits in a big pharma board room,  “Mind and body are connected?” “How much is this damned mind-body problem going to cost us?”  Its a multi-billion dollar problem!

Ancient yogis seemed to understand the placebo/mind-body phenomenon.  Its a part of what makes yoga so interesting.  Its ALL ABOUT THE CONNECTION between mind and body – not one vs. the other.

Most folks who practice yoga will attest to its mental and physical benefits.  This is true.  However, one can still ask the valid question of whether the actual benefits are real?  The purely physical benefits (muscles) are not in doubt.  But, does yoga really improve a person’s mental life – or do we just want to think so (a placebo response)?  I mean, have you left the yoga studio (fully relaxed) only to honk the horn after being cut off in traffic?  Did yoga really change you?  Is there evidence – in the scientific sense – that yoga leads to mental well-being?

Hats off to Dru worldwide – an organization that is “passionate about positive health and wellbeing. With yoga and meditation at [its] core.” – for taking on this important question!

In an article entitled, “The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace”  [PMID: 20369218]  published in the Scandinavian Journal of Work, Environment & Health, researchers from Dru Education Center, University of Gothenburg, Harvard Medical School and Bangor University used the scientific method and compared 24 people (mostly women with mean age of 39) who participated in a 1 hour yoga class each week (for 6 weeks) to 24 people who did not participate in the yoga training (the control group).  Importantly, these groups were selected at random and showed similar profiles for age, prior yoga experience and health condition.

Specifically, the investigators sought to “measure” the effects of yoga using 2 instruments:  the Profile of Mood States Bipolar (POMS-Bi) and the Inventory of Positive Psychological Attitudes (IPPA – you can take the assessment here).  As noted by the researchers, these questionnaires allow investigators to track changes in both positive and negative feelings.  To determine whether the yoga experience conferred a psychological benefit, the investigators measured the POMS and IPPA scores at the start and at the end of 6 weeks and then asked whether the change in score was different between the “test” and “control” groups.

The results (nice graph on the Dru website) show that the improvements in score (benefits) were higher in the yoga “test” group than the “control” group (who were on the waiting list for the 6 weeks).

In 7 of the 8 POMS-Bi and IPPA domains, scores for the yoga group improved 2–5 times more than those in the control group over the course of this study. The interaction term from a two-way ANOVA showed that in comparison with the control group, the yoga participants at the end of the program felt significantly less anxious, confused, depressed, tired, and unsure, and had a greater sense of life purpose and satisfaction and were more self-confident during stressful situations. Although the yoga group reported feeling more agreeable (less hostile) than the control group at the end of the program, this difference was not statistically significant.

Thus, the research team validly concludes that the yoga experience was associate with improvements in mental well-being.   This is remarkable given the small size and short duration of the study.  I do recall, when I first started yoga (9 months ago) that I felt sooo much better, so I think I can understand what the participants might have been feeling.

BUT, was this just the placebo response?  Like me, did the study participants want to THINK that it was the yoga that made the difference?  In other words, were the mental wellness benefits due to the EXPECTATION of feeling better – the placebo effect?  The investigators are not unaware of this issue:

Because participants in our study were self-selected, it can be assumed that they were a highly motivated group who wanted to practice yoga. Participant expectations may have included a desire to feel less stressed by the end of the six-week sessions and this may have contributed to their perceived benefit.

So, the data suggest that yoga made a contribution to the mental well-being of the participants.  This is a valid conclusion – and hats off to the research team for conducting the study.  Are the effects “real” or “just in the mind” of the participants?  Does it really matter?

Personally, I don’t think so.  That’s the fun of exploring the mind-body interface via yoga and meditation.  Not “knowing” but rather, just “feeling”!

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Husband:  Darling, I wish you would stop marketing the results of clinical trials for medications that you know have mainly placebo effects with no side effect.

Wife:  Dear, you are missing the point. The placebo lets us know that there is still something magical inside of us … something that hasn’t been educated-out, or televisioned-out, or churched-out, or spanked-out. Even when we know exactly how that whole experience is going to play out, it is still fun to play along. Do you know what I mean?

Husband:  Wait, are we talking about experimercials?

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pointer to: The Neurocritic’s coverage on the association of low-efficiency alleles of MAOA and credit card debt.  Will there be a genotype box to check on future credit card applications? More posts on MAOA here.

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“There is a sucker born every minute”, were the words that looped through my mind on the long train ride home after losing $200 in an unfortunate encounter with a card shark over on Canal Street, many years ago.  I recall that when the card shark (actually a kindly old man) suggested to me that I would easily outwit him and $$ win $$, I have to admit that I really, sort of, well, believed him.  Hmmm, what a sucker indeed.  Come to think of it though, he didn’t even know that I was a GG homozygote at rs4570625 in the tryptophan hydroxylase-2 gene, which according to Furmark and colleagues,  is “a significant predictor of clinical placebo response“.  Lucky for him I guess.

There is actually a lot of mainstream neuroscience research on the placebo response – for good reason – it has a way of complicating & inflating the cost of clinical trials for many neuropsychiatric disorders, but also shows that “overt suggestions” and non-medication-based talk therapies can lead to outcome improvement.  In any case, whether you prefer medication or non-medication modalities of treatment, there is much to be gained from understanding the basic biology of the placebo response. A great review on the biology of the placebo response can be found here.

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Example of a subject in a Ganzfeld experiment.

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As the great J. B. S. Haldane once quipped, “The universe is not only queerer than we imagine; it is queerer than we can imagine.”  So why not delve into the outer reaches of our inner mental life.  Better yet, its Free and Open, thanks to the special issue of Cortex dedicated to recent studies on “Neuropsychology of Paranormal Experiences and Beliefs“.  Yours truly has a token article that gropes for a genetic basis for brain mechanims involved in belief formation.  Lots of fun.

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“Hey, you with the smelly armpits, how about a date ?”

Ahhh, if only this were true ! Sadly, not. However, it would appear that females eschewing us slovenly males may doth protest too much. Recall the popular science lab where females rank their preference to the smell of sweaty t-shirts of unshowered male classmates. Typically, this lab involves the genotyping of a number of Major Histocompatibility (MHC) gene polymorphisms and comparisons that show females prefer the odor of dissimilar MHC genotype. There are, however, well known clusters of odorant receptor genes within the MHC gene super-clusters and these may provide a more direct link from odor to preference. Liza Gross describes related findings in her article, “A Genetic Basis for Hypersensitivity to “Sweaty” Odors in Humans,” where the dosage of an olfactory receptor gene OR11H7P correlated with sensitivity to the odorant isovaleric acid. Although OR11H7P is not located within the commonly assayed MHC super-cluster on human 6p, it is a sweet-smelling step toward understanding mechanisms of female choice.

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