Do we really understand Placebo?

A recent article in the USA Today discussed “the placebo effect” and the debate surrounding it. According to the American Medical Association “a placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated.” Perhaps more important to the understanding of the placebo effect is the belief of the patient.

According to a national (USA) survey in 2008 as many as 50% of physicians prescribe placebos at least once a month. The interaction of mind and body that underlies the placebo effect has been known for many years. Tension exists regarding the placebo as some believe it is unethical for doctors to deceive patients by not telling them about the placebo intervention. However, 1 in 20 doctors who prescribed placebos explicitly described them as such to patients. The question is do placebos actually make patients feel better and does this outweigh the responsibility to inform patients about their use.

Across studies with different medical conditions results suggest there is an active treatment effect of placebo and in some cases this may be significant. Factors such as warmth, empathy, duration of doctor-patient interaction and communication of positive expectation might play an important role in healthy outcomes. If these factors are indeed important and contributory to a positive outcome for a patient, the need to deceive is removed.

Perhaps placebo reflects the long held belief that our brains can have an impact on the condition of our body. Perhaps a message delivered by a person that the patient perceives as knowing and within a context the brain perceives as credible can lead to our own body helping to solve the medical issue. Further, given the rather consistent positive impact of “placebos” on patient outcomes it seems time to begin rethinking the therapeutic effect of mind over matter and to integrate such care into the standard regimen of our “health care system.”

Kindness, Forgiveness, and the Brain in 2009

Most people, including specialists, tend to focus on the human brain as a cognitive system. Discussion is typically about memory, attention, spatial skills, etc. which is interesting and important. However, the human is much more than a cognitive tool. It is our emotional, relational, motor, and creative system as well.

As we enter a brand new and exciting year (2009) we are offered an opportunity to introspect (always a good thing to do) and do two things: first we should recognize our strengths and keep expressing them. Second, we should recognize our weaknesses and try to correct them. With regard to the relational and emotional parts of our brain, 2009 can be a great year to work on these brain functions.

Kindness and forgiveness with a large dose of positivity is a great place to start. We can actually exercise these functions and brain regions by being nice, forgiving others and apologizing, and attending to the positive in all situations. While this sounds great and probably reflects the “right thing to do” it is not easy. Human nature, perhaps our DNA massaged over many years, has become resistant to such behaviors.

Maybe you can join me in 2009 by trying to do one nice thing for another and yourself every day, forgive when the situation arises and do not ever be afraid to apologize, and declare aloud a positive aspect for every situation. Your brain will be exercised in relational and emotional functions and will feel better about itself which means you will feel better about yourself!

Happy New Year!

Dr. Nussbaum

The Importance of Sleep for the Brain

Sleep is a highly active time for brain development and brain function. There are four primary stages of sleep including Rapid Eye Movement (REM) when we dream and deep sleep or stage four sleep. It is thought that deep sleep and REM tend to decline with advanced age and these are perhaps the parts of sleep when consolidation of information takes place. As such sleep quantity and quality have a major role in what and how well we process and remember information.

REM sleep occupies about 25% of our total sleep and it is during REM that we dream. We tend to be paralyzed during this part of our sleep so we cannot act out our dreams. Without REM and deep sleep we can become lethargic, depressed, and make mistakes. Significant sleep disorders affect more than 35 million Americans and many more around the world. Sudden sleep is known as narcolepsy and can occur while driving which leads to a high number of fatal car accidents. Sleep Apnea, the first phase of narcolepsy, occurs because of a blockage of the airway and results in sudden gasps for air while sleeping. Apnea is most common in middle age, obese and hypertense males.

When considering lifestyle changes for brain health (e.g. brain fitness, brain games), one of the most important aspects of life is sleep. We tend to not get enough sleep and our brains run on fatigue much of the time. Napping is a lost art and we do not rest enough. As a result, our brains are over-stimulated, stressed, and tired. Consider this blog a permission slip to get a good night sleep and to take a nap sometime this week.