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Mind and Body
Written and researched by Bob Murray, PhD
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Laughter Eases Hospital Pain
February 25, 2002
The hero of the film Patch, the doctor Patch Adams, evidently got it right. Medical experts in the USA have now found laughter helps children relax, and this has a major impact on how they deal with and accept pain.
They believe the healing power of humor can reduce pain and stimulate immune function in children with cancer, Aids or diabetes and in children receiving organ transplants and bone marrow treatments. Their study reinforces practices adopted by UK hospitals, where laughter is used as a tool to make hospital wards a friendlier place.
Dr Margaret Stuber, who led the US research, said: "We think laughter could be used to help children who are undergoing painful procedures or who suffer from pain-expectation anxiety. In the future, patients watching humorous videos could become a standard component of some medical procedures."
The US study, Rx Laughter, is a collaboration between the entertainment industry, pediatrics and psychiatry. They asked 21 children aged eight to 14 to put their hand into cold water and found the whole group tolerated the temperature longer while watching a funny video.
Those who laughed most remembered less of the pain and hormone tests on their saliva showed their stress levels were lower after laughing.
Dr Stuber said: "Rx Laughter's goal is to ease ill children through some of these medical procedures and minimize the traumatic effects that children experience. In some instances laughter may even reduce the amount of anaesthesia necessary."
Hospitals in the UK have recognized the power of laughter and some use "clown doctors" to go into children's wards and inject a bit of fun. The clown doctors are provided by The Theodora Children's Trust charity and entertain children on a one-to-one basis.
Theodora director Joanie Speers said: "The clowns are not doctors or therapists, but very well trained artists. Their job is simple, but they have a very big impact. Some of these children are so traumatized they don't want to know. The clown doctors get them to laugh and they respond better."
The team of 10 clown doctors visit about 30,000 children and their families every year at hospitals in London, Manchester and Cambridge.
That laughter is good medicine is not new. Two years ago a study carried out in the US suggested that laughing and having a good sense of humor can protect against heart disease.
The study by doctors at the University of Maryland found that people who fail to raise a smile in stressful or uncomfortable situations may be more likely to develop heart problems. The authors suggest that a daily dose of laughter -- by watching a funny video for instance -- should be recommended by doctors alongside exercise and a low-fat diet as a way of staying healthy.
Read more about clown doctors on BBC News
Read more about laughter preventing heart disease on BBC News
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Gorgeous Muscles -- In Your Dreams!
November 26, 2001
One of the points that Alicia Fortinberry makes in all her classes (and
Repatterning Movement Audio-cassettes)is that if you just imagine yourself doing a particular exercise, you will benefit. Studies have shown that those who imagine they are practising their sport, or their musical instrument, do equally well as those who actually do the work.
Well now a new study has provided the answer to a couch-potato's dream -- just imagining yourself exercising can increase the strength of even your large muscles.
The discovery could help patients too weak to exercise to start recuperating from stroke or other injury. And if the technique works in older people, they might use it to help maintain their strength.
Muscles move in response to impulses from nearby motor neurons. The firing of those neurons in turn depends on the strength of electrical impulses sent by the brain.
"That suggests you can increase muscle strength solely by sending a larger signal to motor neurons from the brain," says Guang Yue, an exercise physiologist at the Cleveland Clinic Foundation in Ohio. Yue and his colleagues have already found that mentally visualising exercise was enough to increase strength in a muscle in the little finger, which it uses to move sideways. Now his team has turned its attention to a larger, more frequently used muscle, the biceps.
They asked 10 volunteers aged 20 to 35 to imagine flexing one of their biceps as hard as possible in training sessions five times a week. The researchers recorded the electrical brain activity during the sessions. To ensure the volunteers were not unintentionally tensing, they also monitored electrical impulses at the motor neurons of their arm muscles.
Every two weeks, they measured the strength of the volunteers' muscles. The volunteers who thought about exercise showed a 13.5 per cent increase in strength after a few weeks, and maintained that gain for three months after the training stopped. Controls who missed out on the mental workout showed no improvement in strength.
The research was presented at the Society for Neuroscience conference in San Diego.
Read more in New Scientist online
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Sex Keeps You Young
November 26, 2001
As the old saying goes, "A little bit o' what you fancy does you good." Apparently, according to some scientists, more than a little bit does even better.
Couples who have sex at least three times a week look more than 10 years younger than the average adult who makes love twice a week, says consultant neuro-psychologist Dr David Weeks, who has made a 10-year study of the subject.
"Pleasure derived from sex is a crucial factor in preserving youth. It makes us happy and produces chemicals telling us so," he claims. "I would say that famous people with youthful good looks, such as Goldie Hawn, Helen Mirren and Joan Collins, all enjoy very active and healthy sex lives."
Dr Weeks said loving couples make more of an effort to keep themselves in good shape for their partners and will also benefit from the physical and emotional effects of sexual intercourse. "There are physiological factors too," said Dr Weeks. "Sex is the most intense kind of pleasure and that triggers certain chemicals. In women it produces a human growth hormone which helps the process."
Regular, loving sex came second to physical and mental activity as the factors most important to retaining youth. The research discovered that people can benefit from working and socialising with younger and older people and from having younger partners.
The study also concluded that people who look younger are more altruistic, confident and have more intellectual activity.
Dr Weeks warns it is loving intercourse with a regular partner, and not promiscuous sexual activity, which gives the most benefit. "Casual sex would bring a lot of the detrimental things to staying youthful such as anxiety and the absence of security. Both those things are associated with a loss of youth."
Dr Weeks, of the Royal Edinburgh Hospital, released the findings after interviewing more than 3,500 people aged 18 to 102 in Britain, Europe and the US.
He found that a person's genetic make-up was 25% responsible for youthful looks, with behaviour accounting for 75%.
I am not sure whether it is the sexual act or the feeling of being loved that the frequency of the act represents which is the cause of youthful looks. I once knew a prominent Dominican monk in his eighties who looked no more than the mid-fifties. He was, however, sure in the love of God. BM
Read more in BBC News
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The Placebo Effect -- Fact Or Fiction
October 7, 2001
That there is a placebo effect (where people get as much benefit from a placebo -- the famous 'sugar pill' and similar 'medications' which contain no active compounds -- as they do from pharmaceutical drugs) has been accepted by researchers since 1955.
In that year Henry K. Beecher published a study called "The Powerful Placebo" in the Journal of the American Medical Association. Reviewing 15 clinical trials, Beecher claimed that on average about one out of three patients found relief from placebos alone. Although some specialists have challenged the placebo effect for years, in the minds of most physicians and in the public consciousness, it remained a fact -- until this May.
That's when two researchers from the University of Copenhagen concluded in the New England Journal of Medicine that "there is no justification for the use of placebos in medical practice." They had pooled data from 114 previously published clinical trials that compared patients who received placebos with those who got no treatment whatsoever. Sifting the numbers through statistical sieves, the doctors found no significant overall difference in how the two groups fared. The media responded to the Danish study by gleefully vivisecting the placebo effect. "It's a scam," sneered the Boston Globe. "More myth than science," pronounced the New York Times. Within several weeks, a new medical 'fact' was born: placebos are useless.
However other researchers are now coming out of the woodwork to claim that the Copenhagen study doesn't prove what it says it does.
"Their own data show that placebo is significantly better for pain than no treatment is," observes Walter A. Brown, a psychiatrist at Brown University, quoted in Scientific American. That result seems credible, because 27 of the 114 trials measured the effect on pain. But the remaining trials lumped into the analysis looked at 39 other maladies, ranging from infertility and compulsive nail biting to marital discord and orgasmic difficulties. For each of these problems the number of patients was too small to allow any firm conclusion except that placebos do much more for some illnesses than for others.
That in itself is an indication that placebos have value, says one psychologist. "One placebo cannot be more effective than another unless placebos are capable of producing an effect," argues Irving Kirsch, a psychologist at the University of Connecticut. "It makes no sense to evaluate the magnitude of the placebo effect in general," he says.
And Brown agrees: "If you tested penicillin on 40 different clinical conditions, you would get similar results: it works for some infections, but it won't do anything for arthritis."
Other meta-analyses have shown measurable placebo effects for depression, asthma and phobic anxiety, Kirsch points out. Parkinson's Disease now joins that list.
In mid-August, A. Jon Stoessl and his co-workers at the University of British Columbia in Vancouver reported in Science that they could see the effect of placebo treatment in brain scans of people with Parkinson's disease. This is one of very few studies ever to look beyond whether a placebo works to how it works.
We believe that the placebo effect can be harnessed for therapeutic value. See our Health News Special Edition story
"Myths of Depression Challenged" for research about the effectiveness of placebos in anti-depressant trials, and related stories
"Patients Demand Powerful Drugs" and
"Advertising Can Make Us Well". BM
For an overview of placebo studies see the Scientific American
For the U. British Columbia study see New Scientist
Read more in Nature
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Social Stress 'Can Kill'
September 4, 2001
As if there weren't enough evidence to show it already, new research shows that social creatures, such as mice and humans, can have their health severely impaired by bad relationships.
US researchers, working with mice, have found that social stress can trigger potentially deadly over-activity by the immune system. They believe that the results could be directly relevant to humans. They found that stressful social interactions stimulated a dangerous inflammatory response in the mice equivalent to the human condition septic shock.
The mice were put into either "social stress" or "physical restraint" groups. In the first, subordinate mice were placed in a cage with an aggressive dominant mouse for two hours a day. Mice from the second group were confined in a cylindrical tube for 16 hours without access to food or water.
When the mice were exposed to a bacterial toxin the socially stressed animals were twice as likely to die as those suffering physical hardship.
The stressed mice were found to produce high levels of chemicals called cytokines. These chemicals regulate the functioning of the immune system. However, they can stimulate inflammation.
Not only were cytokines higher in the stressed mice, the chemicals seemed to be resistant to the effect of other hormones called glucocorticoids, which normally keep inflammation in check. The result was a mouse equivalent of septic shock -- a deadly disorder characterised by a severe fall in blood pressure and widespread damage to body tissues.
Researcher Dr Ning Quan, from Ohio State University in Columbus, said: "During infection, there is a balancing act of the immune system. You want inflammatory cells to kill the bacteria at the site, but you don't want too many at the site.
"Septic shock is directly association with over-inflammation. Sometimes it's not the infection itself that kills a person; rather, it's that the body doesn't properly respond to inflammation."
Doctors had noted glucocorticoid resistance in people who were suffering from major depression or infected with HIV.
Dr Quan said: "Chronic social stress in these patients may contribute to the development of glucocorticoid resistance, which could put these folks at increased susceptibility to inflammatory diseases including septic shock."
In our Uplift Program, which counters stress and depression very effectively, we emphasize the value of functional relationships. Since humans are social animals, the better our connections to each other the better our mental and physical health. BM
Read more in The New York Times
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Patients Demand Powerful Drugs
September 4, 2001
Women with breast cancer want the reassurance of having chemotherapy -- even if there is little evidence it will help them, says research (see our health news story "Leading Cancer Charity Claims Chemotherapy Doesn't Work"). Women having powerful drug treatment for early breast cancer following surgery were asked whether they would make the same choice again in hindsight.
Many said they would ask for chemotherapy -- even in a situation where doctors were saying there it was unlikely to benefit them. This came as a surprise to doctors, who would not normally countenance giving any treatment which appears unlikely to improve the patient's survival chances.
However, the research team believes that the need of cancer patients to "take control" of their disease prompts this apparently irrational demand.
The research, published in the British Journal of Cancer, involved a survey of 78 women, who were all having regular check-ups. Some were having chemotherapy, others were not.
Although the side-effects of the drugs can be severe, including hair loss, nausea, weight loss and fatigue, in general, even the tiniest increase in their chances was enough to prompt most to choose chemotherapy. And 40% of those already on chemotherapy said they would have been prepared to take it, even if doctors said it would not improve their survival chances.
Dr Anne Stiggelbout, from the Leiden University Medical Centre, where the survey was conducted, said: "With chemotherapy there's always a trade-off between the temporary deterioration in the patient's quality of life and the chance of their cancer not returning. We wanted to know the minimum benefit that a patient would need before she would opt for chemotherapy -- just how low should we go?"
Dr Sylvia Jansen, who performed the research and interviewed the patients, said that the women's response might seem irrational, but could be a reflection of the hidden psychological benefits of chemotherapy. She said: "We think that taking the treatment may help to combat the feeling of helplessness that can come with a cancer diagnosis. As one of our patients remarked: 'At least I've done everything I could.'"
Professor Gordon McVie, director general of the UK Cancer Research Campaign, said: "We have got to remember that a cancer patient's goal is to live at all costs. This suggests that for women with breast cancer, adjuvant chemotherapy not only improves their chances of survival but also gives them a sense of control over their lives."
Not only do placebos act as effectively as the 'real' drugs (see our Health News Special Edition story
"Myths of Depression Challenged" for research about the effectiveness of placebos in anti-depressant trials, and an overview of the debate in "The Placebo Effect -- Fact or Fiction") but it would seem that the chemo drugs themselves have this placebo effect. With any illness the important thing is belief -- whether that belief is in a protecting god, a physician or a chemical compound. BM
Read more in the British Journal of Cancer
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Is It All In The Mind?
July 2, 2001
There are a number of diseases which seemingly affect millions of individuals but which apparently have no physical basis. Among them are Chronic Pain Syndrome, Chronic Fatigue Synrome, ADD/ADHD and now Chronic Lyme Disease. What they have in common is that they have large and potent advocacy groups who insist that the ailments have a physical cause -- whether the culprit is a microorganism or a genetic imbalance. Many (the ADD/ADHD group and the Chronic Lyme group) try and silence their critics and richly reward those physicians and lawyers who support them.
One of the most prominent victims of this sort of activism is Dr Allen Steere, one of the world's most renowned medical researchers and rheumatologists. It was he who first identified Lyme Disease in the United States over 25 years ago. An article about him in the New York Times Magazine details the steps he has had to take to protect himself from death treats and attempts to take away his licence to practice medicine. His crime? He believes that those who claim that they have an particular form of Lyme disease have been misled.
The patients groups insisted that he was denying them treatment for an acute form of chronic Lyme disease, that they believed slipped into the bloodstream undetected and remained there for years, causing joint pain, chronic fatigue, suicidal depression, paralysis and even death. Affirming their diagnoses were a growing number of patient advocacy groups, practitioners and psychiatrists who argued that the disease had become a full-scale epidemic, a modern-day plague crippling thousands of Americans.
As the world's foremost expert on the illness, however, Steere did not believe many of them had Lyme disease at all, but something else -- chronic fatigue or mental illness or fibromyalgia -- and he had refused to treat them with antibiotics. Many doctors and insurance companies had followed his lead, and in turn, hordes of patients had started to stalk him. They showed up at his public engagements, holding signs that read "How many more will you kill?" and "Steer Clear of Steere!" They depicted him in the media as a demon, worse than the spirochetes, the tick-borne bacteria that they claimed inhabited their bodies and that, because of his restrictive diagnosis, they could not eliminate.
Early on, he tried to explain why, based on the science, he didn't believe many of them had Lyme disease and, even if they did, why long-term antibiotics might not help. But none of it seemed to matter. On the Web, in virtual worlds Steere did not know or understand, patients who believed they had the paralyzing illness vilified him. Egged on by advocacy groups, they infected his sterile world, trying to destroy his reputation and career.
The problem is, of course, that many doctors and insurance companies do not realise that there is no real distinction between the mind and the body. Recent research, reported on this site, has indicated that, for example, can be a cause of such 'physical illnesses' as diabetes, osteoporosis or heart disease. The American insurance industry is unwilling, or unable, to pay for ongoing therapy but for some reason is perfectly willing to pay for years of antibiotics to try to treat the 'physical' cause of chronic Lyme disease. This is manifestly unfair to the sufferers because their real, emotional/psychological, problems are not being treated and their overuse of antibiotics is rendering those drugs increasingly ineffective.
Reports (June 20, 2001) that a Boston drug company has developed a far more accurate test for Lyme disease may solve that particular problem, but the ongoing difficulty in dealing with psychogenic disorders is likely to remain.
Reported in the New York Times
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Depression May Cause Diabetes
July 2, 2001
No one is sure why, but diabetics appear to be twice as likely to suffer from depression as those without the disease, and the link between depression and diabetes is even stronger in women, a new study shows. This comes on the heels of research (which we have documented in many stories relating to depression) showing depression has a probable causal link to osteoporosis, heart disease, cancer, chronic pain syndrome, chronic fatigue and a string of other ailments.
Writing in June's Diabetes Care, researchers from the Washington University School of Medicine and the Department of Veterans Affairs in St. Louis said they reached that conclusion after analyzing 25 years of data.
Why the link is there is a bit of a chicken-and-egg problem. Does diabetes cause depression? Does depression cause diabetes? According to the lead researcher, Dr Patrick J. Lustman of Washington University, "In some cases," he said, "depression can cause diabetes. And in other cases, diabetes can cause depression."
It has long been known that diabetes, and indeed almost any illness, can cause depression. However, the idea that the reverse could be true -- that is, that depression could actually lead to diabetes -- would have been considered far-fetched years ago, Dr Lustman said.
One clue may lie in the inactivity and overeating that often go with depression. Each can contribute to diabetes. The higher incidence of depression among diabetic women mirrors the pattern for the population as a whole (see our Health News Depression Special: "Why Women are More Depressed").
Diabetics who are depressed, the researchers added, should seek treatment not just for the diabetes but the depression. The article noted previous studies that found that treating the disorder helped diabetics control their blood sugar.
Reported in the New York Times
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Diet Can Switch on Genes
July 2, 2001
Scientists have created genetically modified mice who can be either black or white, depending on what they eat. Every time the pure white mice drink water laced with certain chemicals their coats turn dark. Once the supplement is removed, they revert to their original color. The team from the University of Virginia that has put the mice through this process of pigment confusion reported their work in the journal Genes and Development.
What this research proves, according to Professor Chris Goodnow of the Australian National University, is that genes are not static during the lifetime of the animal. They are repeatedly switched on and off in different parts of the body at different times of development.
We have said for some time that genes were environmentally triggered, this research merely proves our point. I believe that genes (where there are such genes) which control psychological problems act in the same way. A genetic propensity, say, to depression or bi-polar disorder (manic depression) may be triggered by abuse or ill treatment in childhood or some devastating life occurrence, such as the death of a spouse. This same gene may be controlled by diet and explain why fatty fish, such as salmon, and other foods have been seen as antidepressants. BM
Reported in Genes and Development and the Sydney Morning Herald
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Leading Cancer Charity Claims Chemotherapy Doesn't Work
July 2, 2001
In the advertisement, placed in the UK regional press in May, the Cancer Prevention Research Trust (CPRT) said: "Evidence is accumulating that chemotherapy is ineffective in prolonging the life of cancer patients and proof of life extension is sadly lacking."
It also claimed there may never be a "magic cure" for many forms of cancer, and said efforts should instead be concentrated on prevention. Chemotherapy involves treating cancer cells with drugs designed to kill them.
In its response to an attack on the ad by the Advertising Standards Authority (ASA), the CPRT claimed pathologists made mistakes and that many cancer patients with long survival rates possibly never had cancer.
CPRT founder Victor Fallas said: "Studies have been made comparing cancer patients who have been treated by surgery with patients who were left untreated; survival was the same whether the patients were treated or not. No such studies have been carried out with chemotherapy and marginal studies which have been carried out comparing different cytoxic [cancer killing] agents have only shown a life extension of three to four months."
But Dr Victoria Wilson, Cancer Research Campaign (CRC) science information officer, said the trust's views were "completely misleading, negative and not at all helpful to anyone." She added: "It is inaccurate and depressing to say chemotherapy cannot help when people fighting the disease need to remain positive. The whole slant of what they are saying is wrong. If someone was just about to start chemotherapy, or their loved one was, it would be an extremely upsetting thing to read." She said chemotherapy was able to improve the quality and prolong the life of cancer patients.
She added the group was right to suggest there were many causes of cancer, some of which were understood, such as smoking and lung cancer. But she said it was unlikely all its causes would be understood and that cancer would be completely preventable.
Whether a drug works or not probably depends more on the patient's belief in it's efficacy. This has certainly been shown to be true of antidepressants
(see our Health News Special on Depression) and other medications. It has also been shown that upbeat pharmaceutical advertising makes drugs more potent. The CPRT may be right as a matter of fact about chemotherapy but there is a moral dilemma here: do you advertise the truth on the basis that to tell the truth is always right, or do you suppress the truth on the grounds that you are destroying the faith in the treatment which may be the healing ingredient? More research into the efficacy of chemotherapy drugs is obviously needed. BM
Read more in BBC News
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
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