[{"command":"openDialog","selector":"#drupal-modal","settings":null,"data":"\u003Cdiv id=\u0022republish_modal_form\u0022\u003E\u003Cform class=\u0022modal-form-example-modal-form ecl-form\u0022 data-drupal-selector=\u0022modal-form-example-modal-form\u0022 action=\u0022\/en\/article\/modal\/6293\u0022 method=\u0022post\u0022 id=\u0022modal-form-example-modal-form\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cp\u003EHorizon articles can be republished for free under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\u003C\/p\u003E\n \u003Cp\u003EYou must give appropriate credit. We ask you to do this by:\u003Cbr \/\u003E\n 1) Using the original journalist\u0027s byline\u003Cbr \/\u003E\n 2) Linking back to our original story\u003Cbr \/\u003E\n 3) Using the following text in the footer: This article was originally published in \u003Ca href=\u0027#\u0027\u003EHorizon, the EU Research and Innovation magazine\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003ESee our full republication guidelines \u003Ca href=\u0027\/horizon-magazine\/republish-our-stories\u0027\u003Ehere\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003EHTML for this article, including the attribution and page view counter, is below:\u003C\/p\u003E\u003Cdiv class=\u0022js-form-item form-item js-form-type-textarea form-item-body-content js-form-item-body-content ecl-form-group ecl-form-group--text-area form-no-label ecl-u-mv-m\u0022\u003E\n \n\u003Cdiv\u003E\n \u003Ctextarea data-drupal-selector=\u0022edit-body-content\u0022 aria-describedby=\u0022edit-body-content--description\u0022 id=\u0022edit-body-content\u0022 name=\u0022body_content\u0022 rows=\u00225\u0022 cols=\u002260\u0022 class=\u0022form-textarea ecl-text-area\u0022\u003E\u003Ch2\u003EPlacebo therapy: consider yourself cured\u003C\/h2\u003E\u003Cp\u003E\u2018When I went to medical school, I was taught that patients whose condition improved after taking a placebo were not ill to start with,\u2019 said Professor Christian B\u00fcchel at the University Medical Center Hamburg-Eppendorf in Germany. Over the past decade, his research on the human brain has turned this view inside out.\u003C\/p\u003E\u003Cp\u003E\u2018Advances in neuroscience have been the real game-changer,\u2019 he said. \u2018In the 1970s, scientists noticed that the placebo effect could be toned down by blocking certain receptors in the nervous system.\u2019 This made it possible to define and quantify the mechanisms of placebo action for the first time.\u003C\/p\u003E\u003Cp\u003EMoving from subjective feelings to chemistry helped establish placebo research as a scientific discipline. But the potential of the field was initially limited by the risks involved in testing its predictions on live human brains.\u003C\/p\u003E\u003Cp\u003EOver the past decade, Prof. B\u00fcchel has met this challenge with medical imaging techniques that can track physiological responses in the brain without even touching it, and even produce live video streams of brain areas while administering drugs and emotional stimuli to test subjects.\u003C\/p\u003E\u003Cp\u003EAs part of a research project funded by the EU\u2019s European Research Council (ERC), Prof. B\u00fcchel has compared brain activity in patients receiving painkillers, respiratory medication and performance-enhancing drugs.\u003C\/p\u003E\u003Cp\u003ECommon trends suggest that some physiological reactions have nothing to do with the content of the pills that are taken, but are produced by the mind regardless of the substance ingested. \u2018We are finally looking into the neurobiological channels of the placebo effect itself,\u2019 said Prof. B\u00fcchel.\u003C\/p\u003E\u003Cp\u003ELast year, his team published magnetic resonance images that show how painkillers reduce activity in an enigmatic region of the brain called the anterior insular cortex, which is known for its role in functions as diverse as consciousness, cigarette cravings and orgasms.\u003Cblockquote class=\u0022tw-text-center tw-text-blue tw-font-bold tw-text-2xl lg:tw-w-1\/2 tw-border-2 tw-border-blue tw-p-12 tw-my-8 lg:tw-m-12 lg:tw--ml-16 tw-float-left\u0022\u003E\n \u003Cspan class=\u0022tw-text-5xl tw-rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n \u003Cp class=\u0022tw-font-serif tw-italic\u0022\u003E\u2018What surprises me is that nobody is designing treatments around patient expectations yet.\u2019\u003C\/p\u003E\n \u003Cfooter\u003E\n \u003Ccite class=\u0022tw-not-italic tw-font-normal tw-text-sm tw-text-black\u0022\u003EProf. Andrea Evers, Leiden University, The Netherlands\u003C\/cite\u003E\n \u003C\/footer\u003E\n\u003C\/blockquote\u003E\n\u003C\/p\u003E\u003Cp\u003EProf. B\u00fcchel demonstrated that raising patients\u0027 expectations of a painkiller not only affects how stoically people respond to pain, but the mental cue also decreases activity in the anterior insula. \u2018Expectations do not just affect how we experience pain stimuli,\u2019 said Prof. B\u00fcchel. \u2018They can reduce the stimulus itself.\u2019\u003C\/p\u003E\u003Cp\u003EIn contrast, patients who take performance-enhancing drugs often feel that they are doing better at a task, although Prof. B\u00fcchel measures no change in their physiology or performance. He is working on untangling the cues and substances that cause neural activity, with an eye open for changes that could affect how the body responds to disease.\u003C\/p\u003E\u003Cp\u003EThe potential of placebos to affect our immune response presents an opportunity for improving public health, according to Prof. Andrea Evers, at Leiden University in the Netherlands, who says that there is more to treatment than the composition of a particular drug.\u003C\/p\u003E\u003Cp\u003E\u2018Drug manufacturers report the effects of medical treatments as averages over populations, but every doctor knows that drugs work very differently from one patient to another,\u2019 she said.\u003C\/p\u003E\u003Cp\u003EWhile this variation depends in part on genetics and environment, placebo screening during clinical trials has made it abundantly clear that psychological factors, such as stress, optimism and trust in your doctor, can overshadow the effects of the drug itself.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003ESuggestions and conditioning\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018Every time we take a pill, our minds build up complex expectations based on the suggestions and conditioning that they receive.\u2019\u003C\/p\u003E\u003Cp\u003ESuggestions include the impact of a patient\u2019s environment, a doctor\u2019s attitude or seemingly innocent words like \u2018this may hurt a little\u2019, on what will be thought and felt by the patient throughout the treatment, while conditioning is the body\u2019s automated response to a repeated stimulus. For example, frequent aspirin takers may find that their symptoms fade after swallowing a pill, when the active ingredients in it will only get to work fifteen minutes later.\u003C\/p\u003E\u003Cp\u003EAs a clinical psychologist, Prof. Evers is not surprised that mental processes shape health outcomes. \u2018What surprises me is that nobody is designing treatments around patient expectations yet,\u2019 she said.\u003C\/p\u003E\u003Cp\u003EShe has received a grant from the ERC to learn how psychological responses can be manipulated to boost the effectiveness of treatments against itching and pain.\u003C\/p\u003E\u003Cp\u003EProf. Evers has succeeded in instilling both types of cues in human subjects. In one study, a green light lit up each time that she diminished an itching sensation on the skin of volunteers. As her test subjects grew used to the routine, Prof. Evers occasionally withheld the stimulus reduction, but the green light still soothed volunteers without it. This effect was enhanced when she verbally suggested that it would do so.\u003C\/p\u003E\u003Cp\u003EShe is now investigating whether she can achieve similar results by periodically removing the medication that she administers to patients in tasty milkshakes. If the body can produce the same hormones and immune reactions just by reacting to the milkshake, placebo interventions could eventually reduce drug doses.\u003C\/p\u003E\u003Cp\u003E\u2018Our best results were achieved by combining the right suggestion and conditioning processes, but we are still optimising the cues,\u2019 she said.\u003C\/p\u003E\u003Cp\u003EThe implications could offer welcome news to Europe\u2019s aging population. Prof. Evers points out that chronic conditions of the kind that are spreading in Europe, such as respiratory complications, inflammations, Parkinson\u2019s disease, multiple sclerosis or cancer, tend to be multifactorial. They have no single cause and no single treatment.\u003C\/p\u003E\u003Cp\u003EBy reducing drug doses, placebo research could relieve patients from unnecessary treatment-linked side-effects and alleviate healthcare budget problems. Perhaps more importantly, it could open new avenues towards addressing the multifactorial influences of diseases, and meet them with better, broader treatments.\u003C\/p\u003E\u003C\/textarea\u003E\n\u003C\/div\u003E\n\n \u003Cdiv id=\u0022edit-body-content--description\u0022 class=\u0022ecl-help-block description\u0022\u003E\n Please copy the above code and embed it onto your website to republish.\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003Cinput autocomplete=\u0022off\u0022 data-drupal-selector=\u0022form-zxoawxbzl0pb-0kero7vloxo3kyppswzzkkqn63z0z8\u0022 type=\u0022hidden\u0022 name=\u0022form_build_id\u0022 value=\u0022form-ZxoAWXbZL0Pb-0kerO7VLOXO3KypPswZzKKQN63z0Z8\u0022 \/\u003E\n\u003Cinput data-drupal-selector=\u0022edit-modal-form-example-modal-form\u0022 type=\u0022hidden\u0022 name=\u0022form_id\u0022 value=\u0022modal_form_example_modal_form\u0022 \/\u003E\n\u003C\/form\u003E\n\u003C\/div\u003E","dialogOptions":{"width":"800","modal":true,"title":"Republish this content"}}]