By Deepak Chopra, Author, 'Spiritual
Solutions'; founder, The Chopra Foundation
For decades the placebo effect has existed basically as a nuisance, so far as
the medical profession is concerned. Some people benefit from being given a
sugar pill instead of an actual drug. This remarkable result cannot be marketed,
however. It doesn't fall within the ethics of medicine to prescribe fake drugs.
Therefore, a doctor in practice, whose training has drummed into him that "real"
medicine means drugs and surgery, will shrug off the placebo effect as
psychosomatic, or "It's all in your head."
This attitude shuts down a fascinating possibility, that a patient's expectations plays a major role in being well or getting sick.
The placebo effect is real medicine, because it triggers the body's healing system. One could argue that this is the best medicine, in fact, since a.) drugs do not trigger the healing system and b.) the placebo effect has no side effects. Staying well means that the body is taking care of itself -- and you -- through a feedback loop of chemical messages. Circulating throughout the bloodstream, lymphatic system, and central nervous system, chemical messages are crucial to the healing system, because they keep every cell in communication with every other.
Like it or not, every thought, decision, and action influences this feedback loop. The "or not" is important. Unwittingly, we damage the body's natural state of health with negative input. The fact that this input comes from the brain means that thoughts, moods, and expectations, however intangible, get translated into chemical messages just as surely as molecules of aspirin or glucose. You and I bear the responsibility of sending positive messages to our cells as opposed to negative ones.
This is a prelude to an overview of the nocebo effect that recently appeared in the New York Times. The placebo effect, which is based on a person's positive expectation, has been widely studied. Its opposite, the nocebo effect, has not. But clearly, a negative expectation can be powerful. Subjects who volunteer for drug trials sometimes drop out, for example, because the side effects of the new drug are too severe. This is true even when the side effects are being induced by a sugar pill and not a real drug. To quote from the Times article:
If these percentages seem rather low, consider the following remarkable finding: A study on lactose intolerance took a group of subjects who complained of intestinal problems caused by lactose, the sugar found in milk. Some of these people had been diagnosed with lactose intolerance; others only suspected that they had it. When asked to take lactose by the experimenters, "44 percent of people with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptoms" -- and yet all had actually been given glucose, which doesn't do harm to the intestines.
The two authors of the Times article, Paul Enck and Winfried Häuser, are German professors of psychology and psychosomatic medicine respectively, and their overview covered 31 studies in the nocebo effect. The most telling case they refer to was a patient who took 26 placebo antidepressants in a suicide attempt and had his blood pressure fall "perilously" low, as would happen overdosing on real antidepressants. What makes this case so telling is that it demonstrates that the body can turn any mental intention into its chemical correlation.
The key to the placebo effect is that the patient expects a good outcome, while in the nocebo effect the expectation is of a bad outcome: I will be pleased versus I will not be pleased. Set aside the medical implications. We make judgments about all of our experiences every day, expecting them to turn out well or badly. Does this point to a holistic placebo versus nocebo effect? We'll explore that possibility in the next post.
This attitude shuts down a fascinating possibility, that a patient's expectations plays a major role in being well or getting sick.
The placebo effect is real medicine, because it triggers the body's healing system. One could argue that this is the best medicine, in fact, since a.) drugs do not trigger the healing system and b.) the placebo effect has no side effects. Staying well means that the body is taking care of itself -- and you -- through a feedback loop of chemical messages. Circulating throughout the bloodstream, lymphatic system, and central nervous system, chemical messages are crucial to the healing system, because they keep every cell in communication with every other.
Like it or not, every thought, decision, and action influences this feedback loop. The "or not" is important. Unwittingly, we damage the body's natural state of health with negative input. The fact that this input comes from the brain means that thoughts, moods, and expectations, however intangible, get translated into chemical messages just as surely as molecules of aspirin or glucose. You and I bear the responsibility of sending positive messages to our cells as opposed to negative ones.
This is a prelude to an overview of the nocebo effect that recently appeared in the New York Times. The placebo effect, which is based on a person's positive expectation, has been widely studied. Its opposite, the nocebo effect, has not. But clearly, a negative expectation can be powerful. Subjects who volunteer for drug trials sometimes drop out, for example, because the side effects of the new drug are too severe. This is true even when the side effects are being induced by a sugar pill and not a real drug. To quote from the Times article:
We found that 11 percent of people in fibromyalgia drug trials who were taking fake medication dropped out of the studies because of side effects like dizziness or nausea ... The discontinuation rates because of side effects in placebo groups in migraine or tension drug trials were as much as 5 percent.
If these percentages seem rather low, consider the following remarkable finding: A study on lactose intolerance took a group of subjects who complained of intestinal problems caused by lactose, the sugar found in milk. Some of these people had been diagnosed with lactose intolerance; others only suspected that they had it. When asked to take lactose by the experimenters, "44 percent of people with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptoms" -- and yet all had actually been given glucose, which doesn't do harm to the intestines.
The two authors of the Times article, Paul Enck and Winfried Häuser, are German professors of psychology and psychosomatic medicine respectively, and their overview covered 31 studies in the nocebo effect. The most telling case they refer to was a patient who took 26 placebo antidepressants in a suicide attempt and had his blood pressure fall "perilously" low, as would happen overdosing on real antidepressants. What makes this case so telling is that it demonstrates that the body can turn any mental intention into its chemical correlation.
The key to the placebo effect is that the patient expects a good outcome, while in the nocebo effect the expectation is of a bad outcome: I will be pleased versus I will not be pleased. Set aside the medical implications. We make judgments about all of our experiences every day, expecting them to turn out well or badly. Does this point to a holistic placebo versus nocebo effect? We'll explore that possibility in the next post.
Mainstream medicine has uncovered the placebo effect and discounted it at the
same time. But more and more it appears that a patient's expectations, beliefs,
and personality are important in the outcome of an illness. By extension, they
are also important is preserving health. In the first post devoted to this
topic, I cited new research on the opposite of the placebo effect, known as the
"nocebo effect," in which negative expectations produce bad results. In drug
trials, patients who are given dummy pills can have either positive or negative
outcomes despite the fact that the fake drug is chemically inert.
If you're a researcher running such a trial, you'd simply discount the placebo-nocebo effect as "statistical margin of error." Nothing counts except the real drug and how it affects your subjects. But in real life, outside controlled experimental conditions, the implications spread much wider.
The body operates as a vast feedback loop, with each of 50 trillion cells sending and receiving messages all the time. To be understood, a message must be written in chemical form. The vast majority of messages are coded as brain chemicals that enter the bloodstream, along with minute electrical impulses generated in brain, heart, and muscles. When you delve into the structure of brain cells, the source of these electrochemical impulses, you find that genes must be activated to produce them. The picture becomes incredibly complicated -- imagine the body as a biological Internet with trillions of computers and just in the brain alone up to a quadrillion connections -- but the upshot is clear-cut. What you think, do, and say influences your body.
Two obvious correlates follow. The first is that holistic medicine is the only approach that attempts to consider the entire feedback loop, since conventional medical training is all about bits and pieces. The second is that the input that runs the body's feedback loop matches the output. Since the body is not a thing but a dynamic process of information exchange, the familiar cliché from the computer world, "garbage in, garbage out," applies.
It is up to you to keep the messages that course through your body positive instead of negative. No other duty in life is as important or vital to your health and well-being.
The proof lies in some new assumptions that are promising to overturn our conventional approach to illness and wellness:
In the next post I'll cover how susceptibility works and what you can do to minimize its effects. What we've seen in this post is that holistic prevention isn't an alternative to something else. You are either preventing or not preventing illness all the time. There is no such thing as benign neglect. The feedback loop is inescapable. Rather than considering that a threat, we can create a new model of well-being that gives you much more control over your health for life. Ultimately, the feedback loop that embraces mind and body is the basis for a quantum leap in health for everyone.
To be continued
deepakchopra com
If you're a researcher running such a trial, you'd simply discount the placebo-nocebo effect as "statistical margin of error." Nothing counts except the real drug and how it affects your subjects. But in real life, outside controlled experimental conditions, the implications spread much wider.
The body operates as a vast feedback loop, with each of 50 trillion cells sending and receiving messages all the time. To be understood, a message must be written in chemical form. The vast majority of messages are coded as brain chemicals that enter the bloodstream, along with minute electrical impulses generated in brain, heart, and muscles. When you delve into the structure of brain cells, the source of these electrochemical impulses, you find that genes must be activated to produce them. The picture becomes incredibly complicated -- imagine the body as a biological Internet with trillions of computers and just in the brain alone up to a quadrillion connections -- but the upshot is clear-cut. What you think, do, and say influences your body.
Two obvious correlates follow. The first is that holistic medicine is the only approach that attempts to consider the entire feedback loop, since conventional medical training is all about bits and pieces. The second is that the input that runs the body's feedback loop matches the output. Since the body is not a thing but a dynamic process of information exchange, the familiar cliché from the computer world, "garbage in, garbage out," applies.
It is up to you to keep the messages that course through your body positive instead of negative. No other duty in life is as important or vital to your health and well-being.
The proof lies in some new assumptions that are promising to overturn our conventional approach to illness and wellness:
- Positive lifestyle changes in diet, exercise, and stress
management actually cause your genes to alter their output. They are activated
in life-enhancing ways.
- Meditation seems to affect the production of the enzyme telomerase, which in turn builds telomeres, the end points of
each chromosome. The fraying of telomeres is associated with aging; keeping
telomeres intact is associated with the health and youthfulness of your genes.
- It appears that fat isn't as neutral, chemically speaking, as was always
assumed. Fat cells send out hormonal signals that appear to have deleterious effects,
particularly in triggering inflammation.
- Inflammation is being associated more and more with illness on every front,
including cancer and heart disease. Inflammation is an imbalanced state, the
opposite of homeostasis, the body's normal state of dynamic balance.
- Diseases don't begin when symptoms first appear. In almost every chronic
illness that sets in after childhood, there are precursors in cellular structure
or genes that extend back to childhood, infancy, or even the womb. In other
words, the feedback loop is processing input and output every second of your
life, with long-term consequences.
- Genes are rarely the determinative cause of disease. Far more often they make you susceptible to illness. What determines whether this susceptibility turns into full-blown illness is complex. But it's worth expanding on.
In the next post I'll cover how susceptibility works and what you can do to minimize its effects. What we've seen in this post is that holistic prevention isn't an alternative to something else. You are either preventing or not preventing illness all the time. There is no such thing as benign neglect. The feedback loop is inescapable. Rather than considering that a threat, we can create a new model of well-being that gives you much more control over your health for life. Ultimately, the feedback loop that embraces mind and body is the basis for a quantum leap in health for everyone.
To be continued
deepakchopra com
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