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Fabrizio Benedetti
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2011 > BSP 77 Neurobiology of Placebos

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message 1: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
I just posted BSP 77, which is an interview with Dr. Fabrizio Benedetti, author of Placebo Effects and The Patient's Brain. The focus of our conversation is the neurobiology of placebos.

Click here for detailed show notes, including references and episode transcripts.

Click here to listen to BSP 77.


message 2: by Diane (new)

Diane | 9 comments So glad to see you were able to interview Benedetti! For any form of intervention (for pain in particular), which is
a)non-medicinal
b)non-surgical
... understanding placebo response, and how the brain produces it, is enormously important. As a manual therapy PT devoted to reducing perceived pain in patients, I have spent a 40 year career eliciting this. It's great to learn the details!

Diane

Thanks again for a great


message 3: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
Diane wrote: "So glad to see you were able to interview Benedetti! For any form of intervention (for pain in particular), which is
a)non-medicinal
b)non-surgical
... understanding placebo response, and how the b..."


Diane,

You will definitely want to read his books, especially The Patient's Brain, because it has a lot about the healer-patient relationship that we didn't have time to talk about.


message 4: by Diane (new)

Diane | 9 comments I already read his book last winter, and deconstructed every chapter. We discussed it on a study thread at SomaSimple where I uploaded all my study notes in the form of detailed slides. I LOVED the book. It jived completely with all the ideas I've ever entertained about all body work being to humans as social grooming is to animals. We are all vertebrates, so we all have sort of the same nervous system hook-ups. Something in there allows creatures to sit still to let others (even other species) pick their nits or comb out the leaves.. We aren't all that much different, just more human. :) It ties in with what Panksepp talked about with the emotional states originating in way deeper parts of the brain than cortex. Expectation pathways too by the sound of it.


message 5: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
Diane wrote: "I already read his book last winter, and deconstructed every chapter. We discussed it on a study thread at SomaSimple where I uploaded all my study notes in the form of detailed slides. I LOVED the..."

What key idea(s) did we miss in Dr. Benedetti's interview?


message 6: by Diane (new)

Diane | 9 comments I don't think you missed anything critical, Ginger. :)
I would have spent the entire time asking him detailed questions about pain, probably, since helping people move through that is not just my job but my obsession, you could say.. :)

In his book there is a rather long chapter near the beginning in which he discusses animal research/research done on animals. It seems kind of odd, as though he may have been conflicted about the issue himself and wanted to reinforce the need for it. I would have been curious enough to ask him about that.

You do have a great way of synthesizing large amounts of material easily and quickly and summarizing it for everyone. Thank you again.


message 7: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
Diane wrote: "I don't think you missed anything critical, Ginger. :)
I would have spent the entire time asking him detailed questions about pain, probably, since helping people move through that is not just my j..."


I really wish we had had time to talk about pain, especially since the research in the field is so extensive. However, I felt it was important to highlight that placebo effects extend to virtually all systems of the body, AND they lead to objective changes.


message 8: by Diane (new)

Diane | 9 comments ->"I felt it was important to highlight that placebo effects extend to virtually all systems of the body, AND they lead to objective changes."

I agree, that was the most important point to elicit. It's exciting that the immune system is trainable (subject to conditioning). The immune system (cytokines, etc) is part of what stimulates the nervous system into developing a pain presentation.


message 9: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
Diane wrote: "->"I felt it was important to highlight that placebo effects extend to virtually all systems of the body, AND they lead to objective changes."

I agree, that was the most important point to elicit...."


Good point. There is a great deal of interaction between all the systems, but the interaction between the nervous system and endocrine system is so extensive that some researchers refer to it as a single neuro-endocrine system.


message 10: by Theodore (new)

Theodore (theordore) | 1 comments BSP #77 was an amazing eye-opener for this medical neophyte. And it is just one of several very valuable programs in Ginger's series. Bravo!

The discussion implied (I think) that "placebo" has varied meanings. I also felt myself sometimes wondering what exactly was the placebo behind an alleged placebo **effect** -- in other words, I felt a need for some further definitional clarifications. I would appreciate getting an education on these matters. Thanks in advance.


message 11: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
Leroy wrote: "BSP #77 was an amazing eye-opener for this medical neophyte. And it is just one of several very valuable programs in Ginger's series. Bravo!

The discussion implied (I think) that "placebo" has var..."


I think part of your confusion might be between use of the word "placebo" and use of the words "placebo effects." Placebo has a very clear-cut definition. It is an inert substance or sham treatment.

However, the term "placebo effects" depends on context. Dr. Benedetti uses the term to precisely refer to the objective effects of giving a placebo; which excludes bias, regression to the mean, etc. Unfortunately, the response to placebo reported in the typical clinical trial includes these factors. As we discussed in the podcast, the reason for this is pragmatic. The goal of the clinical trial is to determine if a treatment is "more effective" than placebo, and includes the need to eliminate bias, etc.

In contrast, in the type of research Benedetti does the goal is to study the actual effectiveness of placebos; that is to say the part that can be measured objectively. (What is measured depends on the body system or disease.)

You might be surprised to know that many physicians are unaware that such objective effects occur, so they assume that the effectiveness of placebos is totally subjective. That is one reason I spent more time in the interview on Parkinson's disease rather than on pain.


message 12: by Ginger (new)

Ginger Campbell (GingerCampbell) | 313 comments Mod
Here is an interesting review of BSP 77 that was posted by Dr. Harriet Hall of the Science Based Medicine blog.

http://www.sciencebasedmedicine.org/i...

It illustrates the common misunderstandings that some physicians (not Dr. Hall, but her readers) have. They seem to confuse acknowledging the validity of placebo research with support for practices like homeopathy, that consistently show no effect beyond that seen with placebo.


message 13: by Fluffybums (new)

Fluffybums | 1 comments Thanks Ginger for a really interesting and informative podcast. The section concerning deep brain stimulation for Parkinson's was particularly eye opening!


message 14: by John (new)

John Brown | 52 comments There is an interesting Horizon program here in the UK on placebos, in which Dr. Benedetti takes part. You can play it at
http://www.bbc.co.uk/iplayer/episode/...

If anyone has problems accessing this from the USA, please comment and I will ask the BBC about it.

I have been experimenting with exercise regimes to drop my blood pressure. A number of Sports Physiologists are doing this world-wide, and they all comment that any new exercise initially works, but after a few weeks or months, has a diminishing effect. I have found the same thing, and that by switching between exercising the legs and the arms, that I can bring back the novelty factor.

This is not surprising, since BP can be lowered as a learned response using bio-feedback.
Any measured parameter is a function both of the underlying physical state of the system, and also of the control mechanisms being applied to it.

This must also apply to digestion, exercise, and anything that depends on BP, blood oxygen and muscle metabolite levels, and on pulse rate.

But all the different control systems seem to be horribly complicated and involve learning/training. Well, Pavlov's dogs salivated on the sound of a bell. In the area of BP, the physiologists refer to "retuning the baro-reflex", but I suspect the control system is much more complex than a simple reflex.

A bit like Chomsky's refutation of Skinner's stimulus-response model of language.
Machine Learning, Logical Induction and Data Mining are hot topics in Artificial Intelligence, but I don't think many people have applied them to medicine yet.

As a control engineer who is used to testing systems against varying-frequency sine waves, or white noise with statistical correlation, or step changes in the set-point variable, or as regulators in the face of "windage" effects, it is interesting to see the very new research on micro-saccades in the eye, where these various analysis methods are starting to be applied.

Physiologists also refer to the "frequency response" of hyper-columns in the visual cortex, whilst it is really edge detection that is the main function of interest.

Fascinating stuff, and I suspect it is of increasing interest to us as we age, and the physical systems start to drift out to the edges of the Gaussian distribution. How to persuade the control systems to compensate for this effect, seems to be what healthy aging is about.


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