BTRIPP (btripp) wrote,

Thinking yourself well ...

This is another of those “Early Reviewer” books from … and it seems that, after years of reviewing there, I've gotten into a relationship with the LTER “almighty algorithm”, where if I request a science book, the odds are pretty good that I'm going to get that one sent to me. This came out as part of the November batch, so if I had gotten around to reading it right away, I would have actually been “early”, as this just came out a couple a weeks ago (not necessarily a “feature” in the LTER program, which frequently gets books as something of an afterthought from the publishers, sometimes considerably later than their release date).

Anyway, Jo Marchant's Cure: A Journey into the Science of Mind Over Body is a look at how, as exemplified in a wide number of research studies, the mind affects the body – often in ways that are quite counter-intuitive. Part of this is the by-now familiar issue with placebos. It's a major irritation (embarrassment?) for the pharmaceutical industry that absolutely neutral placebo pills in double-blind studies will perform as well as, or in many cases better than the drugs being tested. This is where the book starts off.

It is amazing what's in the literature about this … I'm cherry-picking three examples to describe here .. first, there was one kid with severe autism that, almost inexplicably, got notably better following a procedure involving running a tube down to his stomach. The doctors tried to sort out all the possible factors, and eventually identified a hormone the kid had been given that was designed to increase digestive enzymes. The child's parents were begging the doctors to keep giving the kid the hormone, which they did for a few doses, but then stopped as it was an “off label” use. However, by this time word of the “results” had spread through the whole autism community, and hundreds of families were clamoring for access to the prescription. Eventually a strict double-blind test was set up, with half the patients getting the hormone and half getting a saline shot. What this showed was that there was no difference in improvement between the two … however, both showed a 30% improvement on the autism test scale. Another illustration here was an Italian researcher who has set up a lab high up in the Alps, where he's testing effects of altitude sickness … here subjects are asked to exercise while their blood, etc. is being monitored. The division here is then between a group that's given oxygen, and another that's just breathing air through a mask. The group that only thought they were getting oxygen showed similar changes in prostaglandin levels and vasodilation … although (obviously) the actual oxygen levels in their bloodstream stayed the same. Most remarkable, though, is the material on fake surgeries, where subjects either got an actual procedure or a detailed “play acting” of one. The procedure was “vertebroplasty, which injects medical cement into the fractured bone to strengthen it” (in the spine) and the researchers had 131 patients at 11 medical centers, with the patients aware that they had only a 50/50 chance of getting the actual procedure. What was amazing here is that, even with surgery there was no significant difference between the results of the two groups – both sets of patients reported in follow-ups having their pain reduced by almost half. The story focuses on one lady, who was nearly crippled from a fall, who walked out of the hospital after the sham procedure, reported feeling vastly better, and resumed her previous activities (including golf!) afterwards.

The author then goes into a chapter on Pavlovian-style conditioning, which shows that the mind (& body) can be “tricked” into responding (because of other external cues) as though actual medications were being used. One patient ended up having her dosage effectively halved over the course of a year by utilizing cod liver oil and rose perfume as accompaniments to her actual drugs, which led her immune system to act like it was getting the drugs even when she was just being exposed to the taste/scent cues. As bizarre as this sounds, it's not really all that much different from having one's mouth water at the thought of biting into a lemon, or having one's gut go all acrophobic when seeing a vertiginous video scene.

Another fascinating bit here was in studies of exercise and fatigue … looking for a way to improve the performance of athletes … one set of researchers noted:
Obviously, there is a physical limit to what the body can achieve. But rather than responding directly to tired muscles … the brain acts in advance of this limit, making us feel tired and forcing us to stop exercising well before any peripheral signs of damage occur. In other words, fatigue isn't a physical event, but a sensation or emotion, invented by the brain to prevent catastrophic harm.
One area that Marchant looks into is that of pain management … she paints some really gruesome pictures of the work needed for burn victims (many wounded soldiers), and how toxic the drugs can be. She points out:
... the U.S. … makes up less than 5% of the global population but consumes 80% of the world's supply of opioid prescription drugs. By 2012 15,000 Americans were dying each year from prescription pill overdoses, more than from heroin and cocaine combined.
… with the CDC calling painkiller addiction “the worst drug epidemic in U.S. History”. As an alternative to the painkiller drugs, several centers are using Virtual Reality systems which cut pain scores by 35%, and can reduce pain ratings as much as 40% on top of patients drug doses. Needless to say, I found this interesting as my last full-time job was working with a “metaverse developer”, creating projects in Second Life. The author says “there is relatively little research interest in non-pharmacological methods to help people deal with pain”, and cites a Stanford researcher's view
... that part of the reason for the lack of enthusiasm is economic. Pain relief is a billion-dollar market, and drug companies have no incentive to fund trials that would reduce patient's dependence on their products … And neither have medical insurers, because if medical costs come down, so do their profits … “there's no intervening industry that has the interest in pushing {non-pharmacological methods}
She notes that this might be about to change, with the acquisition by Facebook of Oculus, whose “Rift” provides Virtual Reality immersion for somewhere around $350 rather than the $90,000 that some of the hospital systems run.

There is a lot of stuff in here … mindfulness, biofeedback, even an extensive look at Lourdes … however, at the end she veers into areas that she holds don't have any effect, Reiki, Homeopathy, “aura cleansing”, faith healing, all of which she notes score no better than placebo results (of course, those are enough for many). However, those “touchy-feely” approaches might be appreciated just because they are high-contact:
a health science researcher at the Mayo Clinic … wants to help doctors take account of how patients feel, instead of relying solely on physical tests. That's tough to do in a rushed appointment. “In modern medicine doctors usually only have one-to-three minutes of any given clinical visit with a patient that are unaccounted for ...”
Yet, she further notes that only 0.2% of the $30 billion NIH budget goes to testing mind-body therapies. This is in relation to these rather horrific data points (pardon the large quote):
      But the main threats facing us now are not acute infection, easily cured with a pill, but chronic, stress-related conditions for which drugs are not nearly as effective. We've seen that in many cases, painkillers and antidepressants may not work much better than placebo. The top ten highest grossing drugs in the U.S. help only between 1 in 25 and 1 in 4 of the people who take them; statins may benefit as few as 1 in 50.
      Meanwhile, medical interventions are causing harm that dwarfs any damage done by alternative treatments. In 2015, an analysis of psychiatric drug trials published in the British Medical Journal concluded that these drugs are responsible for more than half a million deaths in the Western world each year, in return for minimal benefits. Meanwhile, medical errors in hospital are estimated to cause more than 400,000 deaths per year in the U.S. alone – making it the third leading cause of death after heart disease and cancer – with another 4-6 million cases of serious harm.
Again, I've really only been able to skim the surface of the material that's in Cure, and while not all of it is as gripping as the bits highlighted above, it's an real eye-opener.

As noted, at this writing this has been out less than two weeks, so it should certainly be available at your local bookstore (if you still have a local bookstore) … otherwise, the on-line guys have it at a substantial (40% off of cover) discount. The book has both strengths and weaknesses largely based on the wide array of specific topics addressed … it's a bit of a firehose of info, without much of it really having a resolved state when the author moves on to the next thing, and I don't think she is able to weave the multiple threads into a whole. It is a font of fascinating stuff that's happening out there, and if you're interested in this sort of thing, you may well want to check it out.

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Tags: book review
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