In another piece of research looking at the psychoneurological mechanisms involved in placebo responses, we can clearly see that the placebo response is neither “nothing”, nor something artificial. In fact, it seems to be an integral part of every single therapeutic intervention.
By falsely dividing drugs into “verum” and “placebo”, or “proven” and “ineffective” we fail to understand these intrinsic biological healing capacities.
This is an interesting paper because it explores this phenomenon in detail, but the part which really struck me was the reference to the work of Benedetti et al on patients with Alzheimers. They show that damage to the prefrontal cortex specifically reduces the placebo response in these patients. Not only does it reduce the response to a prescribed placebo, but it results in the reduction of effectiveness of drugs such as analgesics, presumably because part of EVERY drug action is a placebo action and as this component is inhibited, the drug dose needs to be increased to continue the desired effect.
I’m sure a lot more work needs to be done to understand these mechanisms but it is encouraging to find research which at least begins with the hypothesis that the placebo effect is neither a trick nor is it equivalent to doing nothing.
Heroes Not Zombies 
‘as the placebo effect is basically a psychosocial context effect, these data indicate that different social stimuli, such as words and rituals of the therapeutic act, may change the chemistry and circuitry of the patient’s brain’.
this jumps out to me bob, i keep coming back to much of the satisfaction/ or dissatisfaction people get from visiting doctors is at the level of gift giving, social magic (especially when placed alongside the more objective data looking at the relative lack of efficacy of many medical inputs). my experience is of the darker side of this, i suppose the nocebo effect.
i wonder, in the societies in which this gift giving was observed the individual with power to influence was usually someone who lived in and amongst the people it was his role to enact. this is completely different here. gaps between those who have access to resources of all sorts- identity, words, has intensified, geographical and social distances between people have grown, hence the escalation in bridging services of all sorts across disciplines/ organisations. does this bring with it greater efficacy, or less, when it comes to matters of suggestion. one thing i found myself reflecting on as a student was my tendency to say ‘yes’ quite a lot without actually thinking about what it was i was saying yes too!
Another speculation, in The Gift (1990) Mauss argues the practice of exchange implicates people into a system of reciprocity so as to constitute and reproduce sociality. Gifts in this case can be conceptualised as the giving of one’s time and interest, perhaps even more so if the gifts are those given by an individual of a higher social status. ‘Their’ time, how it has in effect become embodied and known through practice, and the giving of this, is part of this effect? The ‘social’ aspects of a consultation from this perspective are thus not simple matters of small talk but constitute to some extent the social meaning and so value of the interaction between GP and patient. Some people need some form of recognition as existing with whatever issue it is they present with.
I wonder if one consequence of withholding the ‘gift’ is to abort reciprocity and perhaps a sense of obligation that is at the basis of being-with-others (what is at the basis of much complaints from both GPs and patients). Denying conversation, in this sense, may be felt as an inability to engage with or a form of ignorance of a patient’s circumstances, what it means to them.
Does this mean that over time such approaches can come to be identified with GPs who appear beyond moral and social exigencies of behaviour and for whom the time they have is very much their own, a perception that can lead more resourceful patients to avoid these ‘injurious’ situations and look elsewhere for more supportive GPs. Those without those resources of course seem to come up against ‘themselves’ time and time again.
http://edge.org/conversation/the-evolved-self-management-system
I thought that this essay might fit here ……I think his reasoning and optimism towards the end of the essay was really inspiring !