Thanks for the great pointer, Amy.
It is clear that fundamental, physiologic brain studies are already on
the way to changing the way we understand learning, decision making, the
placebo effect, life, the universe, and everything.
I find Parasuraman, Neuroergonomics, very useful.
Are others aware of other paradigm-shifting publications along this
frontier?
Jim
James M. Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System
>>> "Dr. Amy Price" <[log in to unmask]> 3/23/2011 9:40 PM >>>
Dr. Cuello and Group,
This article on placebos was interesting as it explores pre-frontal
cortex involvement/robustness with strength of placebo. This could
indicate infants may not have sufficiently advanced development to
engage executive function with full sequencing , Alzheimers disease face
similar limitations and for septicaemia, placebo is not effective at
all. The role of the prefrontal cortex involvement in placebo could
raise even more ethical issues in cognitively vulnerable populations.
This could help explain the placebo working as a dose extender as the
reward networks are actively engaged and the next dose comes quickly and
regularly enough to discourage extinction. This suggests to me that
patient care and validation in those that present with cognitive
challenges may take other sensory routes that at least equal the power
of placebo. It seems social rejection/physical pain light up same
areas ROI on fMRI and when they become chronic produce similar brain
atrophy.
Benedetti F, Carlino E, Pollo A .( 2011) ‘How placebos change the
patient's brain’. Neuropsychopharmacology, Department of Neuroscience,
University of Turin Medical School, Turin, Italy.
[log in to unmask] Jan;36(1):339-54. Epub 2010 Jun 30.
http://www.ncbi.nlm.nih.gov/pubmed/20592717
Best regards,
Amy
Amy Price
http://empower2go.org
Building Brain Potential
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Dr. Carlos
Cuello
Sent: 20 January 2011 01:02 PM
To: [log in to unmask]
Subject: placebo effect in paediatric cases
As I was explaining a mother of a patient of mine about the placebo
effect and why we should not use antibiotics on certain conditions, she
asked for more information about the placebo effect on children. "i
mean" she said "I agree with adults having the placebo effect,
adolescentes as well, but what about the newborns? the toddlers?"
I was amuse by her willingness to learn more so I ran a fast search on
the placebo effect on children and I would like to hear more opinions
from the group (I know Ben Goldacre might be reading and he could have
more info about it) as this is an excellent "heuristic" for this kind of
questions. I tried pubmed using search strategy
("placebo response"[tiab] OR "placebo effect"[tiab]) AND (children OR
child OR neonate OR newborn OR adolescent OR child OR pediatric)
but obviously the results were far beyond my other errands so I will
check it later in detail.
Meanwhile, I found this excellent systematic review
<http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050166>
evaluating the placebo effect in children with refractory epilepsy
exposed to antiepileptic drugs (AEDs) or placebo
Surprisingly there was not only the placebo effect present, but it was
almost 2 times stronger than in adults.
Another narrative review on the ADHD topic, where authors state the the
"proxy placebo effect" might be present in ADHD studies. You can find it
here <http://www.ncbi.nlm.nih.gov/pubmed/19363369>
Most of studies I´ve found have been performed in adolescents with
neuropsychiatric conditions.
Does anyone have any information/studies of the placebo effect on
newborns?
Cheers
PS. (NOTE): I MIGHT SHARE WITH THE EBM GROUP THE INFORMATION YOU SEND
ME DIRECTLY IF I CONSIDER IT VALUABLE FROM THE ACADEMIC AND EDUCATIONAL
POINT OF VIEW, UNLESS YOU SPECIFICALLY ASK ME TO KEEP THE INFORMATION
CONFIDENTIAL (AND I WILL GLADLY DO IT) =)
--
Carlos A. Cuello-García, MD
Director, Centre for Evidence-Based Medicine
Tecnologico de Monterrey School of Medicine
Cochrane Collaboration Iberoamerican branch
CITES piso 3. Morones Prieto 3000 pte. Col. Doctores 64710
Monterrey, NL. Mexico.
☎ +52.81.8888.2223 & 2154. Fax: +52.81.8888.2148 Skype:
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