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diseases. The biochemical traces of this influence are only beginning to be outlined. Modern research indicates a biological, tangible substrate to the placebo effect. The placebo's pharmacomimetic behaviour can even imitate a drug's side effects. In a 1997 study of patients with benign prostate hypertrophy, some patients on a placebo complained of various side effects ranging from impotence and reduced sexual activity to nausea, diarrhoea and constipation. Another study reported placebo side effects as including headaches, vomiting, nausea and a variety of other symptoms.” woot ieee eek ene enna activity to nausea, diarrhoea and constipation. Another study Somatic pathways reported placebo side effects as including headaches, vomiting, In the mid-1990s, researcher Fabrizio Benedetti conducted a nausea and a variety of other symptoms.” novel experiment whereby he induced ischaemic pain and soothed it by administering morphine. When morphine was replaced by a The placebo effect in surgery saline solution, the placebo presented analgesic properties. But how deep can the placebo effect trespass into the well- However, when naloxone (an opiate antagonist) was added to the defined area of medicine? Surely it can't joust with medicine's saline solution, the analgesic properties of the water were strike force; it cannot challenge surgery. Or can it? blocked. Benedetti reached the conclusion that the placebo's In 1939, an Italian surgeon named Davide Fieschi invented a analgesic properties were a result of specific biochemical paths. new technique for treating angina pectoris (chest pain due to Naloxone blocked not only morphine but also endogenous ischaemia or lack of blood/oxygen getting to the heart muscle, opioids—the physical pain-relievers.” usually due to obstruction of the coronary arteries).* Reasoning The endogenous opioids, endorphins, were discovered in 1974 that increased blood flow to the heart and act as pain antagonists. Benedetti's would reduce his patients' pain, he suggestion of a placebo-induced performed tiny incisions in their chests release of endorphins was supported and tied knots on the two internal by findings produced with MRI and mammary arteries. Three quarters of From numerous research PET scans.** Placebo-induced the patients showed improvement; one endorphin release also affects heart quarter of them was cured. The findings, it is logical and rather rate and respiratory activity.*' As surgical intervention became standard safe to conclude that there is researcher Jon-Kar Zubieta described, procedure for the treatment of angina "...this [finding] deals another serious for the next 20 years. But in 1959, a a biochemical substrate to blow to the idea that the placebo effect young cardiologist, Leonard Cobb, put the placebo effect. is a purely psychological, not physical, the Fieschi procedure to the test. He phenomenon".” operated on 17 patients: on eight of Further findings support the notion them he followed the standard that the placebo effect presents a procedure; on the other nine he biochemical substrate in both performed only the tiny incisions, letting epression and Parkinson's disease. the patients believe that they'd had the real thing. The result was a Analysing the results of PET scans, researchers estimated the real upset: those who'd had the sham surgery did as well as those glucose metabolism in the brains of patients with depression. who'd had the Fieschi technique.* That was the end of the Fieschi Glucose metabolism under placebo presented differentiations that technique and the beginning of the documented surgical placebo were similar to those caused by antidepressants such as effect. fluoxetine.” In patients suffering from Parkinson's disease, a In 1994, surgeon J. Bruce Moseley experimented with the placebo injection promoted dopamine secretion in a similar way surgical placebo. He split a small group of patients suffering from to that caused by amphetamine administration. ** Benedetti osteoarthritis of the knee into two equal groups. Both groups demonstrated that the placebo effect provoked decreased activity were told that they would undergo arthroscopic surgery, but only in single neurons of the subthalamic nucleus in patients with the first group got the real thing. The other group was left Parkinson's disease.* virtually untreated, with the doctor performing only tiny incisions From numerous research findings, it is logical and rather safe to to make the arthroscopic scenario credible. Similar results were conclude that there is a biochemical substrate to the placebo reported in both groups.” effect. But what is more intriguing to it is its relation to Moseley, stunned by the outcome, decided to perform the trial perception. It would appear that perception and the codes and with a larger statistical sample in order to reach safer conclusions. symbols that the animate computer, the brain, utilises in order to The results were replicated: arthroscopic surgery was equal process internal and external information strongly determine the therapeutically to the placebo effect.” The placebo had found its potency and form of placebo response. way into surgical rooms. In a recent study, patients were purposely misinformed that Perhaps the most impressive aspect of surgical placebo arose in they had been infected by hazardous bacilli and they subsequently a groundbreaking 2004 study. In the innovative field of stem-cell underwent treatment. However, there were no bacilli and the research, a new approach was taken with Parkinson's disease. treatment administered was a placebo. Guess what? Some of the Human embryonic dopamine neurons were implanted through study subjects developed infection-like conditions that were not tiny holes in the patients’ brains. Once again, the results were treatable by the placebo medication.* The mind interpreted the encouraging. And once again, the procedure failed to do better fictional bacilli as hazardous and instructed the body to respond to than a placebo. In this case, the placebo involved tiny holes them as if they were real. incised in the skull without implantation of stem cells. As the Despite the placebo's potency and its importance for a new researchers confessed, "The placebo effect was very strong in this perception of health where body and mind heavily interact, large study". numbers of scientists continue to regard the placebo as an But how can it be that the therapeutic expectancy alone often insignificant systematic error, a troublesome nought. According produces results equal to those from actual surgery? It appears to cancer researcher Gershom Zajicek: "There is nothing in the that the mind is exerting control over somatic processes, including pharmacokinetic theory which accounts for the placebo effect. In JUNE — JULY 2007 NEXUS * 29 From numerous research a biochemical substrate to the placebo effect. www.nexusmagazine.com