Section 3
The Power of Nothing
Geoff Watts, New Scientist (May
26th, 2001)
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A
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Want
to devise a new form of alternative medicine? No problem. Here is the
recipe. Be warm, sympathetic, reassuring and
enthusiastic. Your treatment should involve physical contact, and each session with your
patients should last at least half an hour, treatment and understand how their disorders
relate to the rest of their lives. Tell them that their own bodies possess the true
power to heal. Make them pay you out of their own pockets. Describe your
treatment in familiar words, but embroidered with a hint of mysticism: energy
fields, energy flows, energy blocks, meridians, forces, auras, rhythms and
the like. Refer to the K J knowledge of an earlier age: wisdom carelessly
swept aside by the rise and rise of blind, mechanistic science. Oh, come
off it, you are saying. Something invented off the top of your head could
not possibly work, could it?
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B
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Well yes, it
could - and often well enough to earn you living. A good living if you are sufficiently convincing, or better
still, really believe in your therapy. Many illnesses get better on their own, so if you are
lucky and administer your treatment at just the right time you will get the credit. But that’s
only part of it. Some of the improvement really would be down to you. Your healing power would
be the outcome of a paradoxical force that conventional
medicine recognizes but remains oddly ambivalent about: the placebo effect.
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C
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Placebos
are treatments that have no direct effect on the body, yet still work
because the patient has faith in their power
to heal. Most often the term refers to a dummy pill, but it applies just as much to any device
or procedure, from a sticking plaster to a crystal to an operation. The existence of the
placebo effect implies that even quackery may confer real benefits, which is why any
mention of placebo is a touchy subject for many practitioners
of complementary and alternative medicine, who are likely to regard it as tantamount to a charge of
charlatanism. In fact, the placebo effect is a powerful part of all medical care, orthodox or otherwise,
though its role is often neglected or misunderstood.
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D
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One of the
great strengths of CAM may be its practioners’ skill in deploying the
placebo effect to accomplish real healing.
"Complementary practitioners are miles better at producing non-specific effects and
good therapeutic relationships," says Edzard Ernst, professor of CAM at Exeter
University. The question is whether CAM could be integrated into conventional medicine, as some
would like, without losing much of this power.
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E
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At
one level, it should come as no surprise that our state of mind can
influence our physiology:
anger opens the superficial blood vessels of the face; sadness pumps the tear glands. But exactly how
placebos work their medical magic is still largely unknown. Most of the
scant research done so far has focused on the control of pain, because it’s
one of the commonest compaints and lends itself to experimental study. Here,
attention has turned to the endorphins, morphine-like neurochemicals known
to help control pain.
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F
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But exactly
how placebos work their medical magic is still largely unknown. Most of the scant research to date has focused on
the control of pain, because it’s one of the commonest
complaints and lends itself to experimental study. Here, attention has
turned to the endorphins, natural
counterparts of morphine that are known to help control pain. "Any of the neurochemicals
involved in transmitting pain impulses or modulating them might also be involved in generating
the placebo response," says Don Price, an oral surgeon
at the University of Florida who studies the placebo effect in dental pain.
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G
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"But
endorphins are still out in front." That case has been strengthened by
the recent work of Fabrizio Benedetti of the
University of Turin, who showed that the placebo effect can be abolished by a drug, naloxone,
which blocks the effects of endorphins. Benedetti induced
pain in human volunteers by inflating a blood-pressure cuff on the forearm.
He did this several times a day for
several days, using morphine each time to control the pain. On the final day, without
saying anything, he replaced the morphine with a saline solution. This still relieved the
subjects’ pain: a placebo effect. But when he added naloxone
to the saline the pain relief disappeared. Here was direct proof that
placebo analgesia is mediated, at least in
part, by these natural opiates
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H
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Still, no one
knows how belief triggers endorphin release, or why most people can't achieve placebo pain relief simply by
willing it. Though scientists don’t know exactly how placebos work, they have accumulated
a fair bit of knowledge about how to trigger the effect.
A London rheumatologist found, for example, that red dummy capsules made
more effective painkillers than blue,
green or yellow ones. Research on American students revealed
that blue pills make better sedatives than pink, a colour more suitable for stimulants. Even branding can make a
difference: if Aspro or Tylenol are what you like to take for a headache, their chemically
identical generic equivalents may be less effective.
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I
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It
matters, too, how the treatment is delivered. Decades ago, when the major
tranquilliser chlorpromazine
was being introduced, a doctor in Kansas categorised his colleagues according to whether they were keen
on it, openly
sceptical of its benefits, or took a "let’s
try and see,’
attitude. His conclusion: the more enthusiastic the doctor, the better the drug performed. And this, year
Ernst surveyed published studies that compared doctors'
bedside manners. The studies turned up one consistent finding:
"Physicians who adopt
a warm, friendly and reassuring manner," he reported, "are more
effective than those whose
consultations are formal and do not offer reassurance”
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J
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Warm,
friendly and reassuring are precisely CAM, s
strong suits, of course. Many of the ingredients of that opening recipe —
the physical contact, the generous swathes of time, the
strong hints of supernormal healing power 一
are just the kind of thing likely to impress patients.
It’s hardly surprising, then, that complementary practitioners are
generally best at mobilising
the placebo effect, says Arthur Kleinman, professor of social anthropology at Harvard University.
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Questions 27-32
Use the
information in the passage to match the deed (listed A-H) with people below.
Write the
appropriate letters A-H in boxes 27-32 on your answer sheet.
NB you may use any
letter more than once
A
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Should easily be understood
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B
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Should improve by itself
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C
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Should not involve any mysticism
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D
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Ought to last a minimum length of time.
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E
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Needs to be treated at the right time.
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F
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Should give more recognition.
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G
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Can earn valuable money
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H
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Do not rely on any specific treatment
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27
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Appointments with alternative
practitioner
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28
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An alternative practitioners description
of treatment
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29
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An alternative practitioner who has faith in what he
does
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30
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The illness of patients convinced of
alternative practice
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31
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Improvements of patients receiving alternative
practice
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32
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Conventional medical doctors (who is
aware of placebo)
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Questions 33-35
Choose the correct
letter, A, B, C or D.
Write your answers
in boxes 33-35 on your answer sheet.
33
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In the fifth paragraph, the writer uses
the example of anger and sadness to illustrate that:
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A
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People’s feeling could affect their
physical behaviour
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B
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Scientists don't understand how the mind influences the body.
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C
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Research on the placebo effect is very
limited
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D
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How placebo achieves its effect is yet to be understood.
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34
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Research on pain control attracts most of
the attention because
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A
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Scientists have discovered that endorphins can help to reduce pain.
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B
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Only a limited number of researchers gain
relevant experience
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C
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Pain reducing agents might also be involved in placebo effect.
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D
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Patients often experience pain and like
to complain about it
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35
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Fabrizio Benedettfs research on endorphins indicates that
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A
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They are widely used to regulate pain.
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B
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They can be produced by willM thoughts
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C
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They can be neutralized by introducing
naloxone.
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D
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Their pain-relieving effects do not last long enough.
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Questions 36-40
Do the following
statements agree with the information given in Reading Passage 3?
In boxes 36-40 on
your answer sheet, write
TRUE
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if the statement is true
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FALSE
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if the statement is false
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NOT GIVEN
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if the information is not given in the passage
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36
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There is enough information for
scientists to fhlly understand the placebo effect.
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37
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A London based researcher discovered that
red pills should be taken off the market.
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38
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People's preference on brands would also have effect on their
healing.
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39
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Medical doctors have a range of views of
the newly introduced drug of
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40
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Alternative practitioners are seldom known for applying placebo
effect.
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