Medicine, Meaning and the “Placebo Effect” – Daniel E. Moerman

I picked up this book because David H. Newman mentions it several time in his book Hippocrates’ Shadow. He mentions it to make the point that medicine is not as effective as it seems, and that the human body, through things like the placebo response, does a lot of the healing work that we attribute to medicine.

Daniel E. Moerman is a medical anthropologist who dislikes the term placebo effect, because it is often used pejoratively and because it downplays the breadth of healing initiated by the body. He prefers the term “meaning response”, because our bodies are responding to the meaning we attach to the intervention. If someone is unaware they have been given a placebo, they don’t respond. For instance, studies have shown acupuncture to be effective for pain relief, but acupuncture given while the patient is under general anesthesia for some other reason have no effect on pain.

Moerman observes that the meaning response is so powerful it makes sense for medicine to invoke it as much as possible. Patients who respond to placebos are often seen as gullible or naïve, but he points out that no one has been able to establish any common characteristics of placebo responders. The beliefs of the medical professionals seem to be at least as important as the beliefs of the patient. In one study, patients were told they would be given either placebo, naloxone, or fentanyl for dental surgery pain. Placebo or naloxone would not reduce their pain, but fentanyl would reduce it markedly. The medical professionals were told that because of an administrative mistake, no patients would receive fentanyl in the first week of the experiment – that is no patients would get active medicine. Thereafter, patients might receive any of the treatments. All the patients were given placebo, and the study found that in the first week (when providers thought there was no chance the patients were getting fentanyl), patients had no decrease in pain. But after the first week, patients had significant pain relief from the placebo they received. Somehow the doctors were conveying to the patients that there was now a chance that they would get pain relief, and the patients were responding to that message.

I thought this book was interesting and important for medical professionals and patients, but also for counselors. He has two chapters on the meaning response in psychotherapy. One of the puzzles of psychotherapy is that psychotherapy is more effective than no treatment, but all methods of psychotherapy are about as effective as each other. Moerman argues that psychotherapy is invoking the meaning response, and lays out a framework for understanding it.

This is a more academic work than most books I read, but still very readable. I wish it was more widely read, because I thought it was an important book.

Medicine, Meaning and the “Placebo Effect”
Daniel E. Moerman
2002
Available from Amazon

In a Sunburned Country - Bill Bryson

If you haven't read Bill Bryson, you are missing out. He is a very funny travel writer and commenter on the English language. I just re-read In a Sunburned Country, which I love because it's about Australia. I've read many of his books including A Short History of Nearly Everything and Bryson's Dictionary of Troublesome Words, which I only single out to emphasize that it's not only his travel writing that is funny, interesting, and worth reading.

In a Sunburned Country
Bill Bryson
2000
Available from Amazon

Almost French - Sarah Turnbull

An Australian journalist meets a Frenchman at a dinner party in Romania. She goes to France to spend a week with him, and ends up staying and ultimately marrying him. It's been a while since I read a book by an Australian, and I had forgotten what a nice writing style Australians tend to have: direct, self-reflective, anjd unsentimental. Other books by Australians I have loved: Motherhood by Anne Manne, Searching for Charmian by Suzanne Chick, A Fence Around the Cuckoo by Ruth Park - though she's actually a New Zealander, she feels Australian to me.

This book is mostly about adjusting to the different culture in France as compared to Australia. She writes about being ignored, one-upped, or critiqued at dinner parties, about strangers being rude, about watching in astonishment as her boyfriend removed all the paintings from the walls of a hotel room because he thought they were ugly. She writes about taking her dog to a patisserie (which is completely normal in France) and having a stranger say loudly and disapprovingly to his wife, "Imagine that, a dog in a patisserie." And by this point, the author had been in France long enough that she smiled and said sweetly to him, "Imagine that, a dickhead in a patisserie." Her boyfriend was so happy for her.

Initially I thought this book was a fun (and funny) trifle, but I found myself talking about it with friends and they found that it helped them understand their past interactions in France and with the French. My husband said that now he understood why his date with a French exchange student in high school went so badly. He took her to the Skate House for roller-skating and then to Char-Grill, an outdoor-seating-only burger joint, where she ordered black coffee and chain-smoked. I know he still thinks Char-Grill is a good place to take a date - "It has great atmosphere!" he says - because he took me there when we first started going out. In fairness, back when my husband was in high school Char-Grill had better atmosphere; there was an African-American church beside it and you could sit in the parking lot and listen to the gospel choir practice.

Almost French: Love and a New Life in Paris
Sarah Turnbull
2004
Available from Amazon

Gay Marriage - Jonathan Rauch

A lucid, compelling argument for why gay marriage is important. It was fascinating to read an analysis of what marriage is for. I am unequivocally in favor of gay marriage, and I have never understood what people meant when they said that gay marriage would undermine marriage. Jonathan Rauch attempts to get at whay people may mean when they say that, and then explains why he thinks the failure to provide gay marriage undermines marriage. In a nutshell, more and more people believe that being gay is unchangeable, and they are not willing to discriminate. By not allowing gay marriage, organizations (states, cities, companies) are forced to come up with alternatives like civil unions or domestic partnerships, which then are competitors to marriage and reduce marriage's special place in our society. Plus I hadn't before had a conscious understanding of what marriage is for. It was clear to me that it wasn't about having children, as some people say when they are trying to say why gay people shouldn't be allowed to marry. But while I felt it was important, I couldn't have put it into words. This book gave me a framework for thinking about what marriage is for and why it is important.

I read this after reading an Op-Ed piece in the NYTimes by Jonathan Rauch and David Blankenhorn, president of the (conservative) Institute for American Values: A Reconciliation on Gay Marriage. This piece is interesting because the two authors have opposing views on gay marriage, and together they suggest a compromise acceptable to both of them.

Gay Marriage: Why it is Good for Gays, Good for Straights, and Good for America
Joanathan Rauch
2004
Available from Amazon

The Fabric of the Cosmos - Brian Greene

Brian Greene is seriously good at explaining things. Wow. And he's so generous to his reader. He's forever saying things like, "You're probably wondering how how this point I'm making here can be reconciled with the idea I introduced 4 pages ago." And I'm never wondering about that - I just can't keep the ideas in my head that long. But it is so nice to be treated as if I'm that smart. My husband, who is a physicist and no slouch himself, calls Brian Greene "the rock star physicist." I've got to find a way to see him speak in person.

This book is about what makes up space-time. I found the material more difficult that his previous book, The Elegant Universe, especially the middle section where he talks about whether time really exists or not. But the difficulty is worth it, because the ideas (and as I said, the explanations) are so fascinating. He talks about theoretical models for time machines, the prospects for actual time travel, what a "moment" really means.

As an added bonus, check out this fascinating Scientific American article: Was Einstein Wrong? A Quantum Threat to Special Relativity. Readable and surprising, it talks about how quantum non-locality undermines all of special relativity by allowing distant simultaneous events.

The Fabric of the Cosmos: Space, Time, and the Texture of Reality
Brian Greene
2004
Available from Amazon

Pachelbel Rant

Sorry I've been gone so long. We think we might be moving soon, and I've been occupied with planning for that.

So here's a fun one before I get back to the real thing. A comedian named Rob Paravonian talks about the plague of Pachelbel's Canon in D.

Available from YouTube
Also, check out his website at robprocks.com

The World's Largest Hedge Fund is a Fraud - Harry Markopoulos

This is the memo that Harry Markopoulos wrote to the SEC in 2005 about why he thought Bernie Madoff was a fraud. He first contact the SEC in 1999, and this memo is an attempt to get thngs moving because 6 years of talking wouldn't. If we knighted people in the US, we would knight Harry Markopoulos.

Technical but riveting reading.

Available from the WSJOnline