<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%>Newsletter DEC 05

CONTINUING ED CHRONICLE™ - 
DECEMBER / NEW YEAR'S ISSUE


PLACEBOS

A Scientific and Ethical Perspective

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TABLE OF CONTENTS

1. DEFINITIONS

• Placebo
• Nocebo

2. OVERVIEW

a. The Placebo Effect
b. The Healing Power of Placebos

3. THE SCIENCE OF PLACEBOS

a. Biological Aspects
b. Psychological Aspects
c Clinical Aspects

4. PLACEBOS AND PAIN
5. PLACEBOS AND DEPRESSION
6. RESEARCH
7. ETHICS AND PLACEBOS
8. RESOURCES


DEFINITIONS
Placebo/Nocebo

PLACEBO

1. Placebo:

  • A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well.
  • An inactive substance or preparation used as a control in an experiment or test to determine the effectiveness of a medicinal drug.

2. Something of no intrinsic remedial value that is used to appease or reassure another.

Placebo: A placebo is an inactive substance used in clinical trials as a control, with which comparisons can be made to the real drug. It is used to determine if any effects are real or psychological.

NOCEBO

Nocebo -- WorldWideWords.com

Nocebo -- MedTerms.com

The Nocebo Effect - Placebo's Evil Twin

Placebo and Nocebo: Effects and phenomena in general practice"

"Everybody knows what a placebo is, until you ask him"

"A Placebo is an agent, whose assumption is not consistent with the art of natural science, so that its effect could be proved for the purpose of treatment by accepted law of causality"

Nocebo is not only a cause but often a result ."

Skeptics Dictionary:

Placebo Effect
Nocebo Effect

OVERVIEW

The Placebo Effect: Real or Imagined?

The most common use of placebos is to test new medications. Previous studies have shown that patients respond to a placebo according to their expectations. Placebos are often more effective after the patient has received the actual drug. Scientists can only speculate on how the placebo effect works.

CEU Article #1
Newsletter CEU: NL1205

The Healing Power of Placebos

Research has confirmed that a fake treatment, made from an inactive substance like sugar, distilled water, or saline solution, can have a "placebo effect"-- that is, the sham medication can sometimes improve a patient's condition simply because the person has the expectation that it will be helpful. For a given medical condition, it's not unusual for one-third of patients to feel better in response to treatment with placebo.

The Placebo effect

  • Types of placebos
  • The misconception of ‘imaginary’ disorders
  • Influencing factors
  • How placebos work
  • The argument against placebos
  • The placebo effect is doubted by some
  • Things to remember

What's wrong with the placebo effect?
(An opinion)

THE SCIENCE OF PLACEBOS

Biological Aspects

The Scientist: The Biological Basis of the Placebo Effect, Dec. 9, 2002
Imaging technologies bring empirical rigor to the study of a mysterious medical phenomenon.

Psychological Aspects

Feelings of hope create striking brain effects that could help alleviate serious afflications like pain, Parkinson's Disease and Depression, Researchers report.

“But only now are researchers finding scientific evidence that hope uses the same neurological pathways to heal, as does real medication. ”

A new spin on the placebo effect
"Research is showing the power of expectations, that they have physical - not just psychological - effects on your health."

Clinical Aspects

Harnessing the Placebo Effect
Moreover, it is clear that the placebo effect extends beyond medications to elements of the patient-physician encounter itself. In fact, the term "placebo effect" may be inadequate to describe this wide-ranging benefit; it would probably be more accurate to speak of "the response to the healing situation."


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BOOKS

PLACEBOS AND PAIN

Placebos trigger an opiod hit in the brain

Study reveals mechanism behind placebo effect
Findings could lead to new ways to treat patients with chronic pain.

Findings published today in the journal Science offer fresh evidence in support of the existence of a placebo effect and suggest how a brain influenced by this effect changes its response to pain.

CEU Article #2
Newsletter CEU:
NL1205

Pain and the placebo: What we have learned.

CEU Article #3
Newsletter CEU:
NL1205

Placebo Effect Produces Real Painkillers

Previous studies have shown that the brain reacts physically when a person is given a sham pain treatment, but the new study is the first to pinpoint a specific brain chemistry mechanism for a pain-related placebo effect. It may help explain why so many people say they get relief from therapies and remedies that would appear to have no actual physical benefit. The researchers believe it may lead to more efficient use of cognitive, or psychological, therapy for people with chronic
pain.

A study from the University of Michigan (U-M) has provided the first direct evidence that endorphins - the brain's own pain-fighting chemicals - do play a role in the phenomenon known as the placebo effect.

 

PLACEBOS AND DEPRESSION

Are Antidepressants Worthless?
A 2001 Swedish study of brain scans reported in The Scientist suggest the placebo effect and opioid analgesia "may have a common neural mechanism," and a 2002 University of Toronto study of brain scans revealed that Prozac and a placebo worked on similar areas of the brain (Prozac, though, worked on more areas of the brain).

CEU Article #4
Newsletter CEU: NL1205

Listening to Prozac but Hearing Placebo:
A Meta-Analysis of Antidepressant Medication
(Abstract)

Placebo alters brain function of people with depression

RESEARCH

Deception in Research on the Placebo Effect

Placebo Research at the UCLA Neuropsychiatric Institute-- Placebo Research Publications

'Nocebo Effect' May Explain Some Drug Side Effects

The Mysterious Placebo Effect
Understanding it can help avoid flawed study designs.

Science Plumbs Placebo Effect

ETHICS and PLACEBOS

CEU Article #5
Newsletter CEU: NL1205

Ethics of a placebo group

Is It Always Unethical to Use a Placebo in a Clinical Trial?

Placebo: Pro and Con

Concensus Report Defends Ethics, Utility of Placebo in Clinical Trials of Mood Disorders

The Unacceptable Use of a Placebo

Should Research Ethics Change at the Border? The use of Placebos in HIV drug trials has raised concerns about reseach ethics in developing countries.

RESOURCES

Resources - Links

PLACEBO HUMOR

THE END

ADVISORS
Toni Cesta, PhD, RN, FAAN
Director Case Management
St. Vincents Catholic Med'l Centers NY
Elaine Cohen, EdD, RN, FAAN
Dir Case Management and
Assoc Professor
Univ Colorado Health Sciences Center
Tim Field, PhD,
Author, Consultant, Educator and Vocational Expert
CMSA's 2004
Case Manager of the Year

Major Melanie Prince, RN, CCM
Julie Smart, Ph.D, CRC, NCC, LPC, ABDA, CCFC
Professor & Director
Rehab Counselor Education Program
Utah State University
Peggy Rossi, BSN, MPA, CCM, CPUR
Director of Utilization and Case Mgmt
Catholic Healthcare West California
Vivian Campagna, RN, CCM
Director Case Management
St. Clare's Hospital & Health Center,
New York, NY
Interested in being part of our
Advisory Board? Contact us
1-866-850-5999


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