The placebo effect is well known. Tell someone, “Hey, this pill will make your headache go away” and, though the pill is just a sugar pill and has no pain mediating qualities, will indeed make the headache go away in some small percentage of the population. The placebo effect is the power of suggestion in medicine.
The placebo effect has a kind of evil twin, known as the nocebo effect. If I tell you that the placebo pill you are taking will have the side-effects of dry mouth and diarrhea, guess what you’ll be more likely to experience? So here is the problem. With real medicines with real side-effects, those side-effects are more likely to occur if the patient knows about them. So we have ourselves a dilemma here. I as a hypothetical doctor have two options: 1) warn you about all possible side-effects because it is my duty to ensure you are informed so you can care for yourself or 2) not warn you about all possible side-effects because my doing so is a potentially harmful act, worsening your condition. What is a doctor good to do? What would you want your doctor to do?
Penny Sarchet, winner of the Wellcome Trust Science Writing prize, dives into how scientists are working to counter the dreaded nocebo so that being informed doesn’t mean being in pain.
Until recently, we knew very little about how the nocebo effect works. Now, however, a number of scientists are beginning to make headway. A study in February led by Oxford’s Professor Irene Tracey showed that when volunteers feel nocebo pain, corresponding brain activity is detectable in an MRI scanner. This shows that, at the neurological level at least, these volunteers really are responding to actual, non-imaginary, pain. Fabrizio Benedetti, of the University of Turin, and his colleagues have managed to determine one of the neurochemicals responsible for converting the expectation of pain into this genuine pain perception. The chemical is called cholecystokinin and carries messages between nerve cells. When drugs are used to block cholecystokinin from functioning, patients feel no nocebo pain, despite being just as anxious.
The findings of Benedetti and Tracey not only offer the first glimpses into the neurology underlying the nocebo effect, but also have very real medical implications. Benedetti’s work on blocking cholecystokinin could pave the way for techniques that remove nocebo outcomes from medical procedures, as well as hinting at more general treatments for both pain and anxiety. The findings of Tracey’s team carry startling implications for the way we practise modern medicine. By monitoring pain levels in volunteers who had been given a strong opioid painkiller, they found that telling a volunteer the drug had now worn off was enough for a person’s pain to return to the levels it was at before they were given the drug. This indicates that a patient’s negative expectations have the power to undermine the effectiveness of a treatment, and suggests that doctors would do well to treat the beliefs of their patients, not just their physical symptoms.
Doctors have found what is potentially a new way to determine if a patient who appears to be in a permanent vegetative state is actually conscious:
The research team, led by Damian Cruse and Adrian M. Owen of the University of Western Ontario, gave simple instructions to 16 people said to be “vegetative”: each time you hear a beep, imagine squeezing your right hand into a fist. The subjects were given this task and another — hear a beep, wiggle your toes — and ran through up to 200 repetitions.
In healthy people who executed these instructions, the EEG picked up a clear pattern in the premotor cortex, the area of the brain that plans and prepares movements; the electrical flare associated with the hand was distinct from that associated with the toes.
The brains of three of the supposedly vegetative people showed precisely that; the subjects were a 29-year-old, a 35-year-old and a 45-year-old, all men who had been pronounced vegetative three months to two years previously.
Heh.
More than 5,000 people signed a petition demanding that the White House disclose the government’s knowledge of extraterrestrial beings. More than 12,000 signed another petition seeking formal acknowledgment of an extraterrestrial presence engaging with the human race.
In response, Phil Larson of the White House office of science and technology policy wrote that the US government has no evidence that life exists outside Earth, or that an extraterrestrial presence has contacted any member of the human race.
“In addition, there is no credible information to suggest that any evidence is being hidden from the public’s eye,” Larson wrote.
However, he did not close the door entirely on a close encounter of an alien kind, noting that many scientists and mathematicians believe the chances are high that there is life somewhere among the “trillions and trillions of stars in the universe” – although the chances that humans might make contact with non-humans are remote.
So can we petition the White House to disclose the government’s stance on God?
Iraq, Afghanistan, and the decade or so of not-war-but-still-war that’s been going on has not killed large number of soldiers (relative to past conflicts), but has maimed a huge percentage of those returning home from battle. Those returning previously faced few options to repair their injuries. Now, there looks to be some real progress in regenerative muscle medicine:
[Dr. Stephen] Badylak and colleagues at the University of Pittsburgh’s McGowan Institute for Regenerative Medicine are only one of several groups leading far-out research projects that are part of the Pentagon’s Armed Forces Institute of Regenerative Medicine (AFIRM), a massive, $250 million undertaking meant to quickly usher regenerative medicine into the mainstream. Already, military brass have fast-tracked clinical trials for “bone cement” to replace metal screws and plates and accelerated the sophistication of face and hand transplants — a handful of which have now been conducted in the United States.
The tantalizing prospect of regrowing tissue using Badylak’s technique first made headlines in 2007, when he announced the successful regrowth of a small portion of fingertip using a concoction based on cells derived from a pig’s bladder. His approach with muscle tissue is similar: Surgeons start by implanting what’s called an extracellular matrix, a sort of “cellular glue,” whose key components are growth factor proteins from pig bladders. Those proteins trigger the body’s own stem cells to flock to the area and initiate the process of tissue growth and wound repair — which adult muscles normally wouldn’t do. Combined with an intensive rehab program to essentially “exercise” the nascent muscle, the body is able to restore not only basic muscle tissue, but the tendons and nerves that are necessary for function.
“The patient needs to do their part, and that involves a lot of work — we aren’t just putting a cast on the leg and waiting,” Badylak said. “But these soldiers coming in with 60, 70 percent muscle loss, they’ll do anything to get their lives back.”
The only interface that has every really mattered: how do I translate my thoughts into action?
The body can be bypassed.
Project Black Mirror should have a kickstarter soon. Fund them.
Oh my goodness. The happiness this brings.
Anthony Gregory, a researcher with the Independent Institute, makes the case in The Atlantic for legalizing organ sales:
Several years ago, transplant surgeon Nadley Hakim at St. Mary’s Hospital in London pointed out that “this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done safely, the donor will not suffer.”
Bringing the market into the open is the best way to ensure the trade’s appropriate activity. Since the stakes would be very high, market forces and social pressure would ensure that people are not intimidated or defrauded. In the United States, attitudes are not so casual as to allow gross degeneracy. Enabling a process by which consenting people engage in open transactions would mitigate the exploitation of innocent citizens and underhanded dealing by those seeking to skirt the law.
You know what’s great in a video game? Side quests. Lots of content. Games that let me choose my own path and do extra, fun, cool things in addition to the main storyline. I’ve only been playing Batman: Arkham City for a day now, and there is already so much to choose from. The downside to all of this? I’m pretty sure I am terrible at prioritizing my role as the Dark Knight. Penny Arcade illustrates this embarrassing tendency artfully:
The panel calls-out a couple things here that made the first game’s puzzle quests a bit ridiculous, but in Arkham City, there is actually a compelling reason to solve the puzzles over saving a lone goon.
When you solve the very first of the Riddler’s puzzles, he sends the Bat a message saying that this time, out smarting him is a “matter of life and death.” So now there is not just the “this is a Batman game and the Riddler’s puzzles are a mechanism in the game” level of finding the trophies and hidden images, but there is also the much more frightening and true to the “Riddler is a psychopathic super-villain who uses violence to force Batman into a test of wits” aspect of the game. This makes me very stressed. The sane, day to day part of my brain knows that events are not realtime in Arkham City. If I ignore a main quest for half an hour while I dick around trying to pilot a remote control batarang through some unnecessarily twisty ductwork, then no one is going to die due to my lack of diligence. The game will wait for me to get my act together and go rescue some hostages or pour Round-Up on Poison Ivy or whatever it is they need me to do next.
However, more and more games are adding zero-sum decisions to gameplay. Folks like BioWare and Square Enix are forcing me to choose between saving hostages or learning the truth of the larger plot. I keep imagining the game is just going to confront me with a Sophie’s choice, comic book style, where I have Bane on one side of the city and Mr. Freeze on the other, both seconds from slaughtering innocents, neither willing to wait for the Bat nor aware of the other’s plans. Like the Riddler, many super-villain plots revolve around attracting the Bat’s attention. Not so much in actually harming any set group of people, but in doing so with a larger purpose. What happens when multiple super-villains begin attempting to get “louder” in their demands for attention? Who is at fault? Does Batman take responsibility for, as Commissioner Gordon so eloquently puts it at the end of Batman Begins, “escalation?”
My point here is that I love exploring and flying around as Batman, but I feel guilty about doing it because it requires me to ignore victims. Every time I see some poor schmo amid the alleys of Arkham City, I ask myself: is it wrong to ignore their cry of help if I’m in pursuit of a larger threat? How does one assess that question when you cannot accurately gauge just how crazy a given super-villain is?
My answer is that, right now, video games still make it obvious enough for me to know that, “Hey, it’s ok. That guy is not going to get beaten up unless there is a timer running telling you that, or an Objective Icon appears, or a cut-scene demanding your attention. Until then, trying to achieve your current objective is objectively correct.” I suspect that soon, perhaps very soon, video games will give up on giving us the correct answer. Games will begin forcing us to determine what is “right” on our own. And when that comes, I’m not sure I’m ready for the consequences.
I am an advocate of pursuing anti-aging medicine. What does that mean? It means I support research that would create medical techniques and pharmaceuticals that would prevent age-related health issues, like muscle wasting, mental decay, lowered immune response, and heart disease. It also means I support the right of someone to refuse certain medical treatments based on proper information about their health.
Jane Gross paints a bleak picture of reality:
No one then envisioned the stunning advances in medicine that now keep people alive into advanced old age, often with unintended and unwelcome consequences. Indeed, scientific reports have showed the dangers, not merely the pointlessness and expense, of much of the care Medicare is providing.
Of course, some may actually want everything medical science has to offer. But overwhelmingly, I’ve concluded in a decade of studying America’s elderly, it is fee-for-service doctors and Big Pharma who stand to gain the most, and adult children, with too much emotion and too little information, driving those decisions.
In the last year alone, and this list is far from complete, here is what researchers have found both useless and harmful, according to leading medical journals:
• Feeding tubes, which can cause infections, nausea and vomiting, rarely prolong life. People with dementia often react with agitation, including pulling out the tubes, and then are either sedated or restrained.
• Abdominal and gall bladder surgery and joint replacements, for those who rank poorly on a scale that measures frailty, lead to complications, repeat hospital stays and placement in nursing homes.
• Tight glycemic control for Type 2 diabetes, present in 1 of 4 people over 65, often requires 8 to 10 years before it helps prevent blindness, kidney disease or amputations. Without enough time to reap the benefits, the elderly endure needless dietary limits and needle sticks.
Yet Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet.
…
Why is nobody enraged that our taxes are paying for hip replacements, for example, for people with advanced Alzheimer’s disease, who are incapable of physical therapy? Why is nobody saying out loud, like it or not, that one of our great challenges is figuring out what to do about our elderly people, our fastest growing-population cohort, which will grow exponentially when 76 million baby boomers join the ranks?
The current system is unsustainable, but the alternative is the third rail of health care policy. President Obama’s original legislation included Medicare reimbursement to doctors for discussion of end-of-life issues. These are what Sarah Palin called “death panels”; days later, they were cut from the legislation. An Independent Payment Advisory Board will make recommendations to Medicare about what works and what doesn’t, beginning in 2015, but its proposals are not binding, as intended. A long-term-care insurance provision — with an average daily benefit of a mere $50 — is under siege.
It is not just that the health care system is broken – it is, critically – but that the way we think about health is broken. Gross’ argument is a big step towards addressing that broken thought process. Our words have lost much of their meaning from a century ago. Happiness is a great example. “I am happy” is a phrase we utter when eating ice cream or watching a good film. That’s not what “happiness” meant when it was written down by the Founding Fathers. “Happiness” in that sense is one of flourishing, that one’s entire life is going in the right general direction, as are the lives of those close to you. Happiness is measured in a moment of reflection and thought, not based on an in-the-moment gut check.
Health also has been so tainted. Health, as we use it, is a broken synonym for well-being. But something is lost. “Health” as we use it is not about the person but the body. There is a great doctor colloquialism that goes, “treat the patient, not the disease.” Such an adage has never been so relevant to our current crisis. Cutting edge technology that can be life-saving is only of value when the person receiving the treatments can recover. Again, I emphasize that my argument is not that the treatments are only worthwhile if the body will repair itself completely, but that they are only worthwhile if the person can recover.
We can now keep a body alive well after the person inside of it has wilted away to nothingness. Life is priceless, yes, but so is dignity. Our idea of health needs to move beyond the body to a place where a person can, in their last moments, lucidly say, “I’ve had a good life. I’m happy. Goodbye.”
