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Posts Tagged ‘Drugs’

Beware the Placebo Effect!

It’s All In Your Mind!

Everyone knows that a placebo — a fake medication or sham procedure, typcially used as a control in a medical trial — can nonetheless have a positive effect, relieving real symptons like pain, bloating or a depressed mood. The placebo effect is a result of the patient’s expectation that the treatment will help.

But expectations can also do harm. When a patient anticipates a pill’s possible side effect, he can suffer them even if  the pill is fake.  This “nocebo” effect has been largely overlooked by researchers, clinicians and patients. In an article recently published in the journal Deutsche Arzteblatt International, we and our colleague Ernil Hansen reviewed 31 studies, conducted by us and other researchers, that demonstrated the nocebo effect. We urge doctors and nurses to be more mindful of its dangers, particularly when informing patients about a treatment’s potential complications.

The placebo effect is a result of the patient’s expectation that the treatment will help.

Consider the number of people in medical trials who, though receiving placebos, stop participating because of side effects. We found that 11 percent of people in fibromyalgia drug trials who were taking fake medication dropped out of the studies because of the side efects like dizziness or nausea. Other researchers reported tht the discontinuation rates because of side effects in placebo groups in migraine or tension drug trials were as much as 5 percent. Discontinuation rates in trials for statins ranged from 4 percent to 26 percent.

In a curious study, a team of Italian gastroenterologists asked people with and without diagnosed lactose intolerance to take lactose for an experiment on its effects on bowel symptons. But in reality the participants received glucose, which does not harm the gut. Nonetheless 44 percent of people with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptons.

In one remarkable case, a participant in an anti-depressant drug trial was given placebo tablets — and then swallowed 26 of them in a suicide attempt. Even though the tablets were harmless, the participant’s blood pressure dropped perilously low.

The nocebo effect can be observed even when people take real, non-placebo drugs. When medical professionals inform patients of possible side effects, the risk of experiencing those side effects can increase. In one trial, the drug finasteride was administered to men to relieve the symptons of prostate enlargement. Half of the patients were told that the drug could cause erectile dysfunction while the other half  were not informed of this possible side effect. In the informed group, 44 percent of the participants reported that they experienced erectile dysfunction; in the uninformed group, that figure was only 15 percent.

In a similar experiment, a group of German psychologists took patients with chronic lower back pain and divided them into two groups for a leg flexion test. One group was told that the test could lead to a slight increase of pain, while the other group was told that the test had no effect on pain level. The first group reported stronger pain and performed fewer leg flexions than the second group did.

Just knowing that a drug can have side effects may increase your chances of suffering them.

A doctor’s choice of words matters. A team of American anesthesiologists studied women about to give birth who were giiven an injection of local anesthetic before being administered an epidural. For some women, the injection was prefaced by the statement, “We are going to give you a local anesthetic that will numb the area so that you will be comfortable during the procedure.” For others, the statement was, “You are going to feel a big bee sting; this is the worst part of the procedure.”  The perceived pain was significantly greater after the latter statement, which emphasized the downside of the injection.

“Words are the most powerful tools a doctor possesses, but words, like a two-edged sword, can maim as well as heal.” – Dr Bernard Lown

The nocebo effect presents doctors and nurses with an ethical dilemma: on one hand, they are required to tell patients about the possible complications of a treatment; on the other hand, they want to minimize the likelihood of side effects. But if merely telling patients about side effects increases their likelihood, what is to be done?

Better communication is the answer. When talking with patients, doctors and nurses often say things with intended negative suggestions, like “it’s just going to bleed a bit” or “you must avoid lifting heavy objects — you don’t want to end up paralyzed.” We recommend more extensive training in communication for doctors and nurses, to help them use the power of their words appropriately. As the great cardiologist Bernard Lown once said, “Words are the most powerful tools a doctor possesses, but words, like a two-edged sword, can maim as well as heal.”

This article writtenby Pail Enck, a professor of psychology at the University of Tuebingen and Winfried Huser, an associate professor of psychosomatic medicine at the University of Munich first appeared in the August 12, 2012 issue of The New York Times.

You May Be At Risk for a Stroke or Heart Attack

Blood pressure, cholesterol level among key factors

Study clarifies four top  risks for heart attack, strokes. Having just one risk factor such as high cholesterol or smoking–can significantly increase the odds of suffering a stroke or heart attack in your lifetime according to a new study published in the New England Journal of Medicine.

The research tracked more than 250,000 participants from 18 different studies over a period of 50 years. It is the first study to look at the risks for white and black men and women across the generations. Previously clinicians would calculate a patient’s risk by projecting into the next decade. Now, with such a broad data pool, doctors can predict the likelihood of a major cardiovascular event well into the future.

This information comes from a story in the Chicago Tribune reported by Bonnie Miller Rubin. Dr. Donald Lloyd- Jones, chair and associate professor of preventive medicine at Northwestern University’s Feinberg School of Medicine and the study’s lead investigator shared his findings with the Tribune.

Q. What does the study tell us now that we didn’t know before?

  • A. We have known for decades that four risk factors–blood pressure, cholesterol levels, smoking and diabetes–are related to cardiovascular disease, which is the number one killer for men and women in the U.S. What we hadn’t appreciated is the long-term risks. We now know that whether male, female, black or white, the effect of the risk factors remained consistent in determining lifetime risk, regardless of when you were born.

Q. What do these findings mean?

  • A.  That regardless of your age, sex or race, if you have optimal risk factors, your chance of having a heart attack or stroke is really low. And if a peer of the same age, sex and race has even one of these factors, he or she has a dramatically higher chance of developing a cardiovascular event during their life span.

Q. How do you define opimal cholesterol and blood pressure levels?

  • A. Total cholesterol level of less  than 180, blood pressure is less than 120 on top and 80 on the bottom.

Q. Can you give me an example of how having even one risk factor increases your likelihood of stroke or heart attack?

  • A. Men who are 45 years old and have all four factors at optimal levels–in other words, optimal blood pressure,cholesterol and no smoking or diabetes–have only a 1.4 percent risk of a heart attack event in their lifetime. In contrast, adding just one risk factor raises the chances to 40 percent for men and 20 percent for women. With two it increases to 50 and 41 percent respectively.

Q. How much do genes play in all this?

  • A. At a certain point, genes do influence factors like cholesterol levels. You can’t completely change everything but you can trump a lot of that. By keeping these other things healthy, you can delay  the day when, say, you might need medication to take care of the part that you can’t accomplish solely through lifestyle changes.

Q. Are there other factors  that play a part in cardiovascular disease?

  • A. Sleep and stress clearly play into the incremental risk. We also know that shift work can mess up a person’s metabolic profile. There is some important research going on in these areas, but at the end of the day, it’s by maintaining the four big factors that you can dramatically reduce your risk.

Q. If you have less than ideal levels of  the Big Four, can you undo the damage?

  • A. Once placques start forming in the artery walls you can slow them down and stabilize them with lifestyle changes and medication, but you can’t make them go away completely. They’re still there, taking up space and potentially obstructing blood flow. So you can be a 35-year-old and have the arteries of a 55-year-old. That’s why it’s so important that young people understand the importance of their choices. That we really need to get our foot in the door now–while they’re in their 20s and 30s, even though heart disease might not get them until their 50s or 60s.

Q. Do you ever eat a hot dog or cheeseburger?

  • A. Unfair question! Of course I do. But that has to be done in moderation and it means I have to make a trade-off to reduce calories, fat and sodium elsewhere, and that I should go burn it off with a good brisk walk.

There are few things I can do to help you with most risk factors, but one I can do and that is to help remove stress from your life. How? If you need more money, a steady income flow either part or full-time. then you should look to taking me up on my exclusive offer to buy a copy of my book HOW TO BECOME A MAIL ORDER MILLIONAIRE and save $10. It’s available at all times from Amazon at the published price of $39.95 plus s&h, but to readers of my blog you can order it direct from the publisher for only $29.95 plus $3.50 s&h. Total $33.45. Just send a check or money order to SUPERIOR PRESS 333 N. Michigan Avenue, Suite 1032, Chicago, IL 60601. Sold on a risk free money back guarantee of satisfaction.

How I Stopped Worrying and Learned to Love the OWS Protests

That’s the headline to Matt Taibbi’s article in the current issue of ROLLING STONE MAGAZINE. Last week’s post was from a conservative columnist who writes for FORTUNE MAGAZINE. It’s only fair for a progressive view–and there’s few as good as Matt Taibbi. He alone is well worth subscribing to one of my favorite magazines ROLLING STONE. Herein are excerpts:

“I have a confession to make. At first I misunderstood Occupy Wall Street. The first few time I went down to Zuccotti Park, I came away with mixed feelings. I loved the energy and was amazed by the obvious organic appeal of the movement, the way it was growing on its own. But my initial impression was that it would not be taken very seriously by the Citibanks and Goldman Sachs of the world. You could put 50,000 angry protestors on Wall Street, 100,000 even, and Lloyd Blankfein is probably not going to break a sweat. He knows he’s not going to wake up tomorrow and see Cornel West or Richard Trumka running the Federal Reserve. He knows modern finance is a giant mechanical parasite that only an expert surgeon can remove. Yell and scream all you want but he and his fellow Franksteins are the only ones who know how to turn the machine off.

That’s what I was thinking during the first few weeks of the protests. But I’m beginning to see another angle. Occupy Wall Street was always about something much bigger than a movement against big banks and modern finance. It’s about providing a forum for people to show how tired they are not just of Wall Street but EVERYTHING. This is a visceral, impassioned, deep-seated rejection of the entire direction of our society, a refusal to take even one more step forward into the shallow commercial abyss of phoniness, short-term calculation, withered idealism and intellectual bankruptcy that American mass society has become. If there is such a thing as going on strike from one’s own culture, this is it. And by being so broad in scope and so elemental in its motivation, it‘s flown over the heads of many on both the right and the left.

The right-wing media wasted no time in cannon-blasting the movement with its usual idiotic clichés, casting Occupy Wall Street as a bunch of dirty hippies who should get a job and stop chewing up Mike Bloomberg’s police overtime budget with their urban sleepovers. Just like they did a half-century ago, when the debate over the Vietnam War somehow stopped being about why we were brutally murdering millions of innocent Indochinese civilians and instead became a referendum on bralessness and long hair and flower-child rhetoric, the depraved flacks of the right-wing media have breezily blown off a generation of fraud and corruption and market-perverting bailouts, making the whole debate about the protestors themselves—their hygiene, their ‘envy’ of the rich, their ‘hypocrisy’.

The protestors, chirped Supreme Reichskank Ann Coulter, ‘needed three thing: showers, jobs and a point’. Her colleague Charles Krauthammer went so far as to label the protestors hypocrites for having iPhones. ‘OWS’, he said is Starbucks-sipping, Levi’s- clad, iPhone clutching protestors (denouncing) corporate America even as they weep for Steve Jobs, corporate titan, billionaire eight times over’. Apparently because Goldman and Citibank are corporations, no protestors can ever consume a corporate product—not jeans, not cellphones and definitely not coffee’—if he also wants to complain about tax money going to pay off some billionaire banker’s bets against his own crappy mortgages.

Meanwhile on the other side of the political spectrum, there were scads of progressive pundits like me who wrung our hands with worry that OWS was playing right into the hands of assholes like Krauthammer. DON’T GIVE THEM ANY AMMUNITION! we counseled. STAY ON MESSAGE! BE SPECIFIC!. We were all playing the Rorschach-test game with OWS trying to squint at it and see what we wanted to see in the movement. Viewed through the prism of our desire to make near-term, within the system changes, it was hard to see how skirmishing with cops in New York would help foreclosed-upon middle-class families in Jacksonville and San Diego.

What both sides missed is that OWS is tired of all this. They don’t care what we think they’re about, or should be about. They just want something different.

We’re all born wanting the freedom to imagine a better and more beautiful future. But modern America has become a place so drearily confining and predictable that it chokes the life out of that built-in desire. Everything from our pop culture to our economy to our politics feels oppressive and unresponsive. People want to go someplace for at least five minutes where no one is trying to bleed you or sell you something.

I think I understand now that that’s what the Occupy movement is all about. It’s about dropping out if only for a moment, and trying something new. It doesn’t need to tell the world what it wants. It is successful for now, just by being something different.”

These are only excerpts from Matt’s excellent article in the November 22nd issue of ROLLING STONE MAGAZINE. To read it in its entirety, pickup a copy or better yet become a subscriber. I’ve been hooked on their political reporting for 25 years and with age, year after year, it only gets better.

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