Expertise and placebo research in Italy

Roman Forum (picture courtesy of Flickr.com user Mshai)

I remember walking around the city of Rome many years ago and seeing the impressive stone ruins – the remains of government buildings in the old Roman Forum – and thinking that they really were advanced for that time period. The Roman Forum “has been called the most celebrated meeting place in the world, and in all history.”¹

In my previous post I looked at an almost lighthearted but curious case of how extensive knowledge of anatomy commonplace in Italy seems to result in a winter disease unique to them. This gives an example of how thought can have an impact on health.

But in all seriousness, Italy is very much at the forefront of some significant research on a mind-body connection. For example, a search on “placebo AND research AND italy” (in the search bar) at pubmed.gov (which stores abstracts containing the results of clinical studies) yields 1,901 results.

And in a book review, in The New England Journal of Medicine, of “Placebo Effects: Understanding the Mechanisms in Health and Disease” by Fabrizio Benedetti from Turin, Italy, the reviewer, Howard A. Brody, M.D., Ph.D., writes, “It is no exaggeration to say that Benedetti heads the foremost laboratory for the study of placebo effects in the world.

Fabrizio Benedetti, M.D. has remarkable credentials. He is Professor of Physiology and Neuroscience at the University of Turin Medical School and at the National Institute of Neuroscience, Turin, Italy. He has been nominated member of The Academy of Europe and of the European Dana Alliance for the Brain. He was consultant of the Placebo Project at the US National Institute of Health and member of the six strong Placebo Study Group at Harvard University, and held positions at the University of California and the University of Texas.

Benedetti identified some basic mechanisms of placebo responses across a variety of medical conditions including the areas of pain reduction, motor skill improvement, immune system response, and in antidepressant trials. And the results may depend upon the personality traits of the patient, whether use of a placebo is done with or without the patient’s knowledge, and other factors.

In “Placebos and painkillers: is mind as real as matter?” by Luana Colloca & Fabrizio Benedetti, the authors write, “Today, the placebo effect represents a promising model that could allow us to shed new light on mind–body interactions. The mental events induced by placebo administration can activate mechanisms that are similar to those activated by drugs, which indicates a similarity between psychosocial and pharmacodynamic effects.

Note: psychosocial effects result from social factors and individual thought and behavior. Pharmacodynamic effects result from drugs. In short, studying placebos enables us to see how thought and drugs can yield similar effects, thus confirming a mind-body connection and showing that thought affects health.

Here’s one example of this, found in results published in The Journal of Neuroscience in 2005 entitled, “Neurobiological Mechanisms of the Placebo Effect“³ by Benedetti and four others including Jon-Kar Zubieta from the Department of Psychiatry and Molecular Behavioral Neuroscience Institute at The University of Michigan. It states “placebo-induced expectation of motor improvement activates endogenous dopamine in the striatum of parkinsonian patients. ”

The study measured results three ways: what the patient said in describing the result, a clinical assessment by a neurologist, and a measurement of brain activity (single-neuron firing rate).  For responders (those having a positive effect) all three measurements showed a shift in the same direction and for nonresponders all three measurements showed no change.  This suggests that studying placebos in Parkinson patients provides a good model for this kind of study, as the different measurements of results yield a consistent result. This gives credibility to using placebo studies to identify how thought can have an effect on health similar to that of drugs.

It’s summation (with emphasis added by me): “The placebo effect appears to be a very good model to understand how a complex mental activity, such as expectancy, interacts with different neuronal systems.

So, I appreciate the contributions being made to placebo research in Italy that supports the growing recognition that thought affects health. The next big step is to see how spirituality coupled with thought, or consciousness, is key — but one step at a time.

Can’t you just imagine a few pillars and part of a block wall amongst the Roman ruins for a centuries-old institute of mind-body research. I didn’t see one when I was there, but this kind of makes me think there could have been one!

______________________________
¹ According to Wikipedia: Roman Forum
² Book review by Howard A. Brody, M.D., Ph.D. in the New England Journal of Medicine: “Placebo Effects: Understanding the Mechanisms in Health and Disease” By Fabrizio Benedetti. 295 pp., illustrated. New York, Oxford University Press, 2009. $59.95. ISBN: 978-0-19-955912-1
³ The Journal of Neuroscience, November 9, 2005, 25(45):10390-10402; doi:10.1523/JNEUROSCI.3458-05.2005; SYMPOSIA AND MINI-SYMPOSIA; Neurobiological Mechanisms of the Placebo Effect; Fabrizio Benedetti, Department of Neuroscience, University of Turin Medical School, 10125 Turin, Italy, Helen S. Mayberg, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia 30322, Tor D. Wager, Department of Psychology, Columbia University, New York, New York 10027, Christian S. Stohler, School of Dentistry, University of Maryland, Baltimore, Maryland 21201, and Jon-Kar Zubieta,  Department of Psychiatry and Molecular and Behavioral Neuroscience Institute, The University of Michigan, Ann Arbor, Michigan 48109
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