Incredible and true: the placebo effect

Incredible and true: the placebo effect - The placebo effect is a mysterious thing. I have always been fascinated by the idea that something so inert and harmless as a sugar pill can ease the pain of a person or speed recovery with only the hope that it would.

Studies using placebo - an inactive treatment such as a sugar pill - in an attempt to understand the true impact of the active substance.

Comparing what happens to a group of patients taking the active drug with the results of those taking a placebo may help researchers understand how good is the active drug.

The word "placebo" comes from Latin and means "I will please." And "please" did. In study after study, many people taking a placebo improved program in your symptoms or condition.

The placebo effect is real

Recent research on the placebo effect only confirms how powerful it can be. - And the benefits of treatment with placebo are not just "in your head" measurable physiological changes can be observed in those who received placebo, similar to those seen in people who take drugs effective. in particular, blood pressure, heart rate, and blood test results were shown to improve subsets of research subjects who responded to placebo.

Of course, not everyone has a therapeutic response to a placebo. If that were the case, we would not need medication at all. Instead, we just could exercise the power of suggestion. Understanding why some people improve with placebo treatment and others are not the "holy grail" of research placebo.Nocebo: Placebo evil twinThe power of suggestion is a double edged sword. If you plan a treatment to help you, they are more likely to do so. And if you expect to prejudicial treatment, it is more likely to feel the negative effects. This is called "nocebo effect" (Latin for "I will harm").  

For example, if you tell someone that a headache is a common side effect of a particular drug, that person is more likely to report headaches, even if they are actually taking a placebo. The power of expectation is great and probably plays an important role in the benefits and side effects of commonly prescribed drugs.

It is the power of the placebo effect increases?

A new fascinating study examined the impact of the placebo effect in 84 trials for treatment of nerve pain that occurred over the last 23 years. The researchers found that the placebo effect has become much stronger, but this observation was seen in US studies.  

What for? One theory is that the flow of direct to consumer advertising of drugs in the United States (which is banned in most other countries) raises expectations of a drug to help patients. Stronger and expectations of a drug can lead to a greater placebo effect efficiency.

Another theory links the increased effectiveness of placebos to test their own research: the largest, most expensive and most elaborate judgment, plus expectations of study participants. Analyses of this type tend to be more common in the US than elsewhere.

Whatever the reason, there is a downside to this trend. A powerful placebo effect makes it more difficult for the researchers show that a new drug works. The stronger the placebo effect, it becomes more difficult to show a significant difference between the placebo and active drug - even if the active drug is quite good. Consequently, some effective drugs can "fail" in clinical trials. And that could lead researchers to spend their education outside of the US

What future?

Research on the pros cons of the placebo effect has changed the number of people think about this phenomenon. We used to think that the placebo effect is limited to those influenced disease-free "real"; Now we know better. But there is much that remains a mystery. We do not know how to predict who will respond to a placebo or how to reliably operate their power.  

And it is important to note that while "feeling better" is important, they do not always come with genuine health benefits. For example, some study subjects who took a placebo for asthma reported improvement of their symptoms but their lung function measures are not really better.

Yet the day will come when a better understanding of the placebo effect and, in appropriate circumstances, which are used effectively in clinical practice. Like many people either do not respond to standard medications or have unpleasant side effects, that day can not come soon enough.
By: Robert Shmerling, M.D.

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Challenge your mind and body to hone their thinking skills

Challenge your mind and body to hone their thinking skills - My friend Betty is one of the most impressive elders that I met him. At 88, her voice is strong and his heart is young, and it seems to have so much energy and enthusiasm as he did in 1982 when I met her. It exercises, friends, gardens, to pay their own bills, follow the news, and is constantly reading and ask questions. How do you stay so strong? "I guess I'm just a curious person, boy," he laughs.

But living there how Betty - always learn new things, and keep busy with friends and favorite activities - is exactly what experts say can help keep our skills sharp thinking. "Cognitive and social commitment demonstrated a protective effect against cognitive decline, while the loss, depression and social isolation of hearing is associated with cognitive impairment," says Dr. Kathryn Papp, a neuropsychologist and professor of neurology at Harvard Medical School.

How it works?
Dr. Papp said he does not know the exact reasons for the mental and social engagement, protecting our thinking abilities, but we have some ideas. "Until the 1990s, we thought that people are born with however many brain cells die with now know that new cell growth. - A process called neurogenesis - occurs throughout life, even in Does old age, "says.

It turns out that the human brain has great potential for something called neuroplasticity, or in other words, being very malleable. It seems to challenge our brain - for example, by learning a new skill - leading to real changes in the adult brain. "You can create new connections between brain cells by altering the balance of neurotransmitters available and change how to make connections," says Dr. Papp.

Being socially engaged can help repel social isolation and depression, both of which have been linked to decreased cognitive functioning in the future. Having good social support also reduces stress, another thing that we know that this has a negative impact on thinking skills.

Other factors 
A healthy lifestyle is also associated with neurogenesis, including getting enough sleep, avoid overeating, and the big boss of all: exercise. "The researchers found that physical exercise leads to the release of cellular growth factors that are important to neurogenesis," says Dr. Papp.And this combination of growth and new brain cells factors that come from a healthy, stimulating the brain, and stay connected socially in a meaningful way can actually help protect the brain and keep it more resistant to changes that cause dementia.

Start your engine 
What is the best way to speed up your thinking skills? Start with mini-challenges for the brain:

 *   Brush your teeth with the hand not commonly used.
 *   Take a different route or shop work.
 *   Eat a piece or two dinner with eyes closed.
 *   Listen to a new type of music.
 *   Do jumps 60 seconds (or any physical activity).
 *   Sit in a different place in your home or at a favorite restaurant."This requires the brain to do a job because it clashes with something you have not experienced before," says Dr. Papp.

You can also search for activities that integrate brain stimulation, physical activity, and social commitment, such as:

*   learn to play a sport or game (tennis, table tennis, golf)
*   learn to dance (try the cha-cha, rumba and merengue)
*   take a class by planting flowers or vegetables
*   learning tai chi, which has been shown to increase thinking skills.

If physical activity is not possible, consider taking a class in

*   painting (watercolors start, then switch to oils)
*   piano, flute, guitar or
*   write stories (or memories)
*   Computers
*   flower arrangement
*   hosiery (useful for Christmas presents!)
*   a new language.

Or you can participate in any new activities that you find interesting, such as:

 *   Volunteer at a local charity
 *    explore a new city
 *    join a book club
 *    try a new restaurant or new types of foods
 *    become a museum of education
 *    helping at a local school or daycare
 *    join a club collector (Dolls, stamps, souvenirs). 

"The best activities are those that are nice," says Dr. Papp. And just as it is important to stick to a diet medications or exercise, should take a model to always learn, as my friend Betty, to reap the benefits. "I like to ask questions and hear the stories of people," he said. "I never want to stop learning."

She would have made a great reporter, that one. But I'm glad I can be the one to share the news flash here, which is that staying mentally sharp decline in the use of your brain and your body, whatever your age.
By: Heidi Godman

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Sleep like a caveman?

Sleep like a caveman? - Are we sleep less than our ancestors did? Previous research that examined the primitive cultures geographically isolated, and further research where subjects lived without modern conveniences, suggest that sleep duration was reduced with the introduction of artificial lighting and other aspects of modern society.  

Public attention, however, a recent study has attracted called into question this belief.

The authors of this study analyzed the sleep duration and time in three geographically isolated tribes living in Africa and South America. They found that the average time for the members of each tribe has spent sleeping ranged from 5.7 to 7.1 hours per night, quite similar to reported sleep duration in most modern societies. In addition, the researchers suggest that these tribes, sleep and wakefulness are not related to the presence of environmental light and dark, but with changes in body temperature.

These claims are certainly controversial and contradicts previous research in this area. More studies are needed before we can confirm this theory. And other scientists have expressed reservations about the methods of research and design used in the study.

Whether or not these new results are correct will be a vigorous scientific debate. However, they should not be allowed to ignore the fact that 40% of US adults sleep less than seven hours per night self now recommended by the American Academy of Sleep Medicine and other professional organizations. Sixteen percent of us sleep less than six hours per night.  

Many studies show that the amount of sleep under 6 and possibly less than seven hours per night is associated with a decrease in physical and mental performance levels, increased rates of obesity, heart disease and diabetes, and premature death.

We sleep less than our ancestors is certainly interesting for anthropologists and scientists from sleep. However, it has little relevance to reverse the epidemic of sleep deprivation in the country. For much of the US population is not getting sleep is necessary for optimal health, we must continue to focus on why this is happening and find ways to reverse the trend.
By: Stuart Quan, MD

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Is ADHD or autism?

Is ADHD or autism? - The deficit disorder, attention deficit hyperactivity disorder (ADHD) and autism may look very similar. Children with one of them can be very active and impulsive, and can have concentration problems and interact with others. In fact, it can be difficult to differentiate between.

But the difference is very important.

In a recently published study in the journal Pediatrics, the researchers analyzed nearly 1,500 children between the ages of 2 and 17 who had a current diagnosis of autism (as reported by their parents). They found that those who received a diagnosis of ADHD before they had a diagnosis of autism were diagnosed with autism an average of 3 years later than those who received the diagnosis of autism first - and were 30 times more likely to get diagnosed with autism when they were 6 years of age or older.

Why is it important? Although there is much that we do not know about autism, one thing we know is that the earlier treatment begins, the better the child does in the long run. While autism can be diagnosed already at the age of 24 months, the median age at diagnosis is more than 4 years. Each year, the diagnosis is delayed is a year that the child does not receive assistance - which may have consequences for life. So to have the diagnosis delayed three years - and delays beyond these first crucial years - it is a real tragedy.

It is not always easy for general pediatricians to diagnose autism in young children. Special training is required, and it takes time, something that the average busy pediatrician did not. And since the social aspects of autism may not be apparent until the child begins school, parents do not realize that your child has problems with the other socializing - and can not say pediatrician. Given this, and given that most parents prefer to hear that their child has ADHD, he or she has autism, and therefore not push for more tests, it is understandable how this happens.

Autism is not the only diagnosis that can mimic ADHD. Children with learning problems, sleep disorders, hearing loss and other problems are often misdiagnosed with ADHD.

So before deciding on a diagnosis of ADHD, especially in young children, parents should talk to their doctor about whether to have more tests would be a good idea. These are difficult conversations to have, but most importantly, can make all the difference when it comes to getting a child the help he or she really needs.

For more information about autism and how to recognize it, check the Law on the starting page on the website of the Centers for Disease Control and Prevention of Diseases.
By: Claire McCarthy,MD 

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The problem with prescription painkillers

The problem with prescription painkillers - Pain. It is an almost inevitable part of human experience. Whether as a result of an injury or accident, surgery, or a health problem, such as a headache or infection, arthritis or fibromyalgia, pain can interfere with your ability to sleep , work and enjoy life.

There are many ways to treat pain. Opioids are a. Examples include hydrocodone (Vicodin used), oxycodone (Percocet used), methadone, codeine and morphine. These prescription drugs reduce pain recognition brain by binding to certain receptors in the body. In many situations, opioids are a reasonable choice for pain control - for example, severe pain caused by cancer.

Part of the problem is that a person can develop a tolerance to these drugs. Finally, increasing doses may be required to achieve the same level of pain relief. Overdose may prevent a person from breathing and cause death. In addition, the body can become physically dependent on these drugs, so that withdrawal symptoms if the drug is stopped.  

These factors are a recipe for dependence, which is the loss of control over the use of a drug, even if it harms the person. Furthermore, opioids may also cause a "high" pleasant and are often used for recreational purposes and not for its intended medical purpose, which further increases the risk of addiction. Opioid dependence is the greatest risk factor for addiction to heroin.

What is the opiate epidemic? 
The epidemic of opioid is the crisis currently facing our countries in terms of widespread abuse of opioid analgesics. Much of the problem comes from the increased availability of these drugs. Four times as many prescription painkillers are offered each year, compared to 1990 At the same time, we are seeing an increase in deaths from overdose of opiates.  

Thank you for the efforts to fight against this problem, the number of prescriptions for opioids and opioid-related deaths 44 people appears to have stabilized since 2012. However, on average, in the US a day die from overdose 'prescription opioid pain relievers. Double the number of deaths from heroin overdose.

What is being done about the epidemic of opiate?
Health authorities are working to educate health professionals on the safe prescribing and educate the public about the risks of opioid analgesics, especially when used for chronic noncancer pain. For example, state monitoring programs to track the number of prescriptions for these drugs are filled, to try to prevent drug abuse. They also make efforts to increase the availability of drug treatment, including detoxification (or "Detox") programs.

Specially licensed physician Treatment programs can provide methadone maintenance for people who have difficulty leaving opioids. These programs provide controlled dose of methadone given under careful monitoring, which reduces withdrawal symptoms, drug cravings, and the risk of overdose.

Trained doctors can prescribe other treatments such as buprenorphine / naloxone (Suboxone), which reduces withdrawal symptoms by partially mimicking the effects of opioid receptors in the body less than a "high" risk and fewer overdose.

Expanding access to naloxone (Narcan) - a drug "rescue" that blocks the effects of opioids on the body - can help prevent some overdose deaths. Naloxone Rescue Kits come in nasal spray and forms of self-injection, and are available without prescription in some states. However, as the application of naloxone has increased, therefore the cost of such kits.

How do people who use prescription painkillers can reduce the risk of abuse and overdose? 

People taking opioid analgesics should follow these steps:

 *  Store medicines safely and never share with anyone.
 *  Take the medication exactly as directed.
 *  Ask your doctor if a lower dose may be an option.
 *  Ask your doctor about other ways to manage pain - many non-pharmacological options can help.
 *  If the drug is not working properly, talk to your doctor.
 *  Do not take overlapping requirements of several suppliers.
 *  Do not take these drugs with other substances, such as alcohol or prescription sedatives for anxiety.
 *  Naloxone have a first aid kit available and train friends and family members how to use.
 *  If you think you may be developing an addiction, seek help as soon as possible.
By: Wynne Armand, MD

 

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A check to check: Do you really need an annual physical?

A check to check: Do you really need an annual physical? - In the US, annual physical exams are part of the structure of our health care system. 

For adults, even if they are perfectly healthy, visiting a doctor yearly long been regarded as the basis of good care.  

But recently, experts have begun to wonder if our collective belief in this ritual is reasonable. Do the benefits of annual care really as big as we think? Patients can get the benefits of the annual review by other means?

In a recent editorial in the New England Journal of Medicine, Drs. Allan Prochazka Ateev Mehrotra and explore the complex issues surrounding the annual medical examinations. In the name of improving the "value" in health care argue that these routine visits should not continue.

The evaluation of benefits and risks of the annual review 

As physicians and experts in health care policy, the authors understand that it will be difficult for us to change this practice.

Although a number of professional guidelines recommend that doctors should not follow the tradition of the annual review, the data show that the frequency of these tests has not diminished. Doctors and patients are very attached to the practice, and polls show that most believe it should continue.

But what are the real benefits of this practice? A careful review of several large studies have shown that these annual visits make no difference in health outcomes. In other words, you are seen by your doctor once a year does not necessarily prevent getting sick, or even help you live longer.

And some of the components of an annual visit can actually cause damage. For example, laboratory tests and tests that are controlled in healthy patients (unlike individuals exhibiting symptoms or diseases known) are statistically more likely to be "false positives" - that is, when the test results suggest there is no problem.

Although these inaccurate results reach only a small percentage of the 200 million adults who undergo these tests, monetary and emotional costs, practices are huge.

Drs. Mehrotra and Prochazka indicate that reducing the number of annual tests to save time and money. The time that primary care physicians currently spend on these visits could be used to address urgent needs and expand access to health care for the needy.

They recognize that this change will be a hard sell, in part because many physicians and patients perceive the annual visit as a critical opportunity to cement the doctor-patient relationship and a way to ensure that people receive appropriate examinations and care preventive.

Three steps to better care model 

To encourage this change, the authors propose three steps. First, they recommend a new type of business to concentrate solely on the doctor-patient relationship.

This would allow those who are new to a doctor to have a first visit to establish a relationship, and allow others to be seen in a routine range (perhaps every 3 years or less) to keep. The focus would be more on medical and social history, and less on laboratory testing or screening.

Secondly, they recognize that if the annual survey should be discarded, primary care doctors will have to find a way to proactively monitor the care of their patients in preventive care.

They suggest that the wait for patients to keep their annual visits to check this approach is too "passive" and encourage practices to move to "active participation" of their patients. Ways to do may include risk assessments online, waiting questionnaires, and a review of preventive care at each visit to the doctor. 

Finally, they suggest that doctors and patients to accept this change, taxpayers must make changes. The authors recommend that no health plans and government programs to pay for annual visits and regular checks used as a measure of quality of care.

The disappearance of the annual review will feel like a loss for many patients and their doctors. But the authors encouraged to think creatively to keep important values ​​of this visit new and more effective ways.

His "verify" suggests that the "health check" in need of major surgery. To push the metaphor, if we follow through their suggestions and like any procedure, you will be healthier in the end, but we will all probably feel a little pain we are going through it.

This discussion is not only theoretical for me. As primary care physician, I agree that the benefits of the annual review can and should be achieved by other means. At the same time, I know it will be difficult to make these changes with my patients.

The interruption of the annual physical is experienced as a loss, as a form of abandonment, for some. The most powerful way to treat this is to recognize and name the loss, and letting patients know that significant portions of the Annual suffer: attention to their needs, when they need care and attention to your Routine preventive care - just all without the annual visit.
By: Amy Ship, MD.

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