August 9, 2011

Not-So-Great Expectations: The Nocebo Effect

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August 9, 2011
Bottom Line’s Daily Health News
In This Issue...
  • "I Cured my Acid Reflux... in my Kitchen!"
  • Not-So-Great Expectations: The "Nocebo" Effect
  • Blood Pressure "Switch" Found on Human Body...
  • When Lightning Strikes
  • Mood Changer

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Not-So-Great Expectations: The "Nocebo" Effect

You’re probably well acquainted with the "placebo effect," in which a medication or other medical intervention makes you feel better simply because you expect it will... but you may not know that this sweetly innocent power of suggestion has a dark side, too. Researchers call it the "nocebo" effect, and it operates exactly the same way but in reverse. Instead of reacting to the expectation that a treatment will solve a medical problem, the nocebo effect makes people suggestible to experiencing nasty side effects from it, such as aches, nausea, balance problems -- you get the idea. So just being told that a particular drug might cause you to feel bad may bring on problems. In other words, many of us who do take drugs are running around suffering from unpleasant side effects that may well be concoctions of our minds rather than the medication!

Take the Bad with the Good

With the goal of educating all of us in this lesser-known phenomenon, I contacted Ted Kaptchuk, LAc, an acupuncturist and associate professor of medicine at Harvard Medical School, a leader in placebo and nocebo research, a field that’s attracting increased attention. Dr. Kaptchuk said that though the nocebo effect is much less widely known, it occurs in the very same types of drug tests in which the placebo effect is encountered. Some of the test subjects given sham pills end up experiencing adverse reactions, the same ones that they’ve been told they might experience if given the actual medication. For instance, if test subjects believed (falsely) that they were taking aspirin, some of them might experience nausea, vomiting, stomach pain and/or heartburn -- each of which can be a side effect of real aspirin.

Interestingly, studies have shown that different parts of the brain produce the placebo and nocebo effects, Dr. Kaptchuk said, but the mechanisms are similar for both...
  • Expectation: Use of certain words, descriptions and even colors create unconscious suggestions about what responses/reactions are appropriate
  • Conditioning: A side effect experienced in the past makes one more likely to experience it in similar situations in the future
  • Anxiety: Emotional state may increase susceptibility to manifest emotional disturbance as physical symptoms
  • Selective attention: Being asked to focus on the presence or absence of symptoms makes one more likely to think the symptom is being experienced
The nocebo effect is harder to study, however. While researchers are already exploring ways to harness the placebo effect for actually treating several conditions, including irritable bowel syndrome, Dr. Kaptchuk said that it is much harder -- practically and ethically -- to conduct useful experiments that aim to make people feel worse.

Say No to Nocebo

Nevertheless, he said, scientists are designing nocebo research that focuses on precisely what causes it (and to what degree) and also how to prevent it. Until we know more, Dr. Kaptchuk said, we would all do well to understand that being suggestible to negative effects is real and to take several steps to limit its impact....
  • When a doctor prescribes medication for you, it may help to keep in mind that side effects can be the result of the power of suggestion as described above. For some people, just being conscious that this result can occur may help lessen or even prevent the side effects.
  • When discussing a drug with your doctor, be sure the doctor addresses each potential side effect’s typical frequency of occurrence. Aspirin, for example, can cause nausea -- but it does so only rarely. By knowing that a side effect is rare, you can harness the power of suggestion by telling yourself that you are very unlikely to experience it.
That’s called the power of positive thinking!

Source(s):

Ted Kaptchuk, LAc, associate professor of medicine at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.


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When Lightning Strikes

The weather outside is frightful, inside it’s so delightful... it’s awfully early in the year to sing this song, but it’s what came to mind as I was researching this story on a particular hazard of summertime weather -- lightning. It’s far more "frightful" than snow or ice -- lightning can kill you instantly. While some of us may already know exactly what to do when there’s lightning around, it’s remarkable how many people don’t know or simple don’t take lightning seriously enough. I decided to seek out the latest information on staying safe.

A Bolt from the Blue

In the summer months, lightning is predictably unpredictable -- there’s lots of it and you don’t always see it coming. You’ve heard the term "a bolt from the blue"... it derives from the fact that lightning has been known to light up a bright blue sky (though not so often as a dark and stormy one), and it can travel as far as 10 miles, not only vertically but horizontally as well. Hot summer weather raises the likelihood of thunderstorms, which always bring lightning (whether you see it or not).

According to the National Weather Service, lightning strikes ground some 25 million times a year here in the US, hitting an estimated 400 people and killing about 40, who typically die from severe burns, cardiac arrest and/or respiratory arrest. While 90% of those who have been hit by lightning survive, they often suffer serious side effects that can include paralysis, internal and external burns, deafness, ringing in ears, amnesia and/or confusion, personality change, depression, sleep disturbances, memory dysfunction, headache, fatigue, joint stiffness and muscle spasms.

To learn how to stay safe and what to do if you’re ever with someone struck by lightning, I consulted our contributing medical editor Richard O’Brien, MD, an emergency physician in Scranton, Pennsylvania, who told me he sees lightning victims every summer.

While everyone seems to understand that lightning is dangerous, many are unclear on what they need to do to protect themselves. So, one by one, we went through the facts that are most important to know...

Are You Grounded?

The most important thing to understand about lightning, said Dr. O’Brien, is that it wants to find a way to get into the earth -- it’s called "grounding." The human body, water and metal all are excellent conductors of electricity and will get it to ground very effectively. Rubber, concrete and wood, on the other hand, are protective.

"When thunder roars, go indoors." This is the catchy phrase that the National Weather Service uses to educate people on the most important thing you can do to stay safe from lightning -- get out of its way. Get inside a safe building (one that is fully enclosed with a roof, walls, electricity and plumbing) or seek shelter in a car with a metal roof and the windows up (not a convertible, even with the roof up). "There is no such thing as being safe outdoors in a thunderstorm," said Dr. O’Brien. Even if you are inside, remember that lightning has been known to strike through glass. Stay as far away as possible from windows and skylights. Lightning also has been known to strike through electrical outlets. If it hits an outside wire (phone/cable/electric), it can conduct into the jacks in the house, Dr. O’Brien explains.

Stay dry and disconnected. You can use a cell or cordless phone safely during a thunderstorm as long as the handset is not plugged in or attached to the base. Note that by using a cordless phone you still risk drawing an electrical surge to the base and destroying it. Under no circumstances should you talk on a landline. Any electrical device, handheld or otherwise including an electric stove, is a magnet for lightning, especially when it is using power. Stay out of the shower or bath and don’t use the sinks. "Lightning can come through the plumbing," notes Dr. O’Brien. "If it hits the house, it looks for ground (your metal pipes) and if you’re in the shower, naked and wet, you’ve had it." If you must go outdoors, remember there is no such thing as safe phone use -- even a cell or cordless.

Be patient. Wait to go outdoors until you’ve heard no thunder for 30 minutes.

If Lightning Strikes ...

If you or someone near to you is struck by lightning, get help immediately. Call 9-1-1 (from a safe location if there is one!). If the person is unconscious and without a pulse, perform CPR. The 911 operator can help with advice as well. As a quick guide to CPR, the American Heart Association says to use both hands and push on the chest "hard and fast" to the tempo of the old Bee Gees song Stayin’ Alive.

There’s no need to fear being electrocuted yourself if you touch a person who has been struck by lightning, said Dr. O’Brien -- but you do need to protect yourself from another bolt of lightning. Take whatever measures you can to get yourself and the victim out of danger as fast as possible.

During these summer months, it’s important to be aware that lightning is a clear and present danger -- take it seriously!

Source(s):

Richard O’Brien, MD, attending emergency physician at Moses Taylor Hospital, and associate professor of emergency medicine at The Commonwealth Medical College of Pennsylvania, both in Scranton.


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Mood Changer

Try something with me...

Stand up.

Take a deep breath.

Hold your arms out to the side, palms towards the ceiling.

Look up... and smile.

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Be well,


Carole Jackson
Bottom Line’s Daily Health News


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