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PC SPES. Dietary supplement of chrysanthemum, licorice, ginseng, saw palmetto, scutellaria, and three other herbs Used for advanced prostate cancer Small Phase I/II studies suggest safety, improved quality of life, reduction of pain, and lower PSA levels (Pfeifer, BJU Int., 2000)

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PC SPES

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PC SPES

  • Dietary supplement of chrysanthemum, licorice, ginseng, saw palmetto, scutellaria, and three other herbs

  • Used for advanced prostate cancer

  • Small Phase I/II studies suggest safety, improved quality of life, reduction of pain, and lower PSA levels (Pfeifer, BJU Int., 2000)

  • Loss of libido, breast tenderness, and lower PSA levels associated with potent estrogenic activity (DiPaola, NEJM, 1998)


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PC SPES for Prostate Cancer


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Identification of PC SPES-Regulated Genes in Prostate Epithelial Cells

Nelson, 2001


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Dietary Supplement Research

  • Effectiveness

  • Mechanisms

  • Interactions


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CAM Domains

Manipulative and Body-Based Systems

Biologically Based Systems

Massage Chiropractic

Diets Herbals

Common

CAM

Practices

Yoga Prayer Meditation

Reiki Magnets Qi qong

Mind-Body Medicine

Energy Therapies

Homeopathy Naturopathy

Alternative Medical Systems


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What Is Hypnosis?

  • Intense focus on a suggested response leads to involuntary changes in perception, mood, memory, or physiology

  • Subject of great controversy and popular misunderstandings since developed by Mesmer in 18th C. France


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Hypnosis Alters Color Processing in the Brain

  • 8 hypnotizable subjects viewed identical patterns in color or gray scale during PET scanning

  • Randomly told to see color or gray scale

  • Blood flow to cortical color processing regions increased when asked to perceive color and decreased when told to see gray scale, regardless of what they were actually shown

Kosslyn SM, Thompson, WL, Spiegel D, et al. Am J Psychiatry 2000;157:1279-84


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Kosslyn SM, Thompson, WL, Spiegel D, et al. Am J Psychiatry 2000;157:1279-84


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Kosslyn SM, Thompson, WL, Spiegel D, et al. Am J Psychiatry 2000;157:1279-84


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Kosslyn SM, Thompson, WL, Spiegel D, et al. Am J Psychiatry 2000;157:1279-84


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The Placebo

  • Historically, an inactive or innocent management contrivance to encourage healing in the absence of specific therapeutics

  • Relied upon to “control” for nonspecific effects that might confound calculation of the true benefits of a novel intervention


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The Placebo – A ‘Pious Fraud’

“One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of coloured water, and powders of hickory ashes, than all other medicines put together.”

Thomas Jefferson (1743-1826)


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‘The Powerful Placebo’

  • Analysis of the aggregate percentage of patients satisfactorily relieved by a placebo across multiple clinical trials

  • 1082 patients in 15 controlled trials

  • 35.2 ± 2.2% “average significant effectiveness”

  • HK Beecher, JAMA, 1955


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‘The Powerless Placebo’

  • Systematic review of outcomes for 8525 subjects in 116 controlled trials

  • No overall benefit attributable to placebo

  • Significant differences only for continuous subjective outcomes

  • 27% (95% CI of 15-40%) reduction in pain associated with placebo

  • Hrobjartsson & Gotzche, NEJM,2001


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“Such a report can hardly negate an experienced physician’s awe at a phenomenon that might impress even a dispassionate biometrician, should he ever venture within the range of a real patient.”

S.B. Nuland, The American Scholar, 2001


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Placebo Analgesia: Spatially Specific and Mediated by Endogenous Opioid Systems

  • Pain induced in all 4 limbs with capsaicin

  • Patients told they were to receive a powerful local anesthetic

  • Placebo cream applied to 1 limb

  • Analgesia achieved only in the treated limb

  • Analgesia abolished by IV naloxone

  • Benedetti et al., J Neurosci, 1999


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10

10

pain

pain

0

0

0

15

0

15

minutes

minutes

Right Hand

Left Hand

Placebo

expectation

Placebo

expectation

Right Foot

Left Foot

10

10

pain

pain

0

0

0

15

0

15

minutes

minutes

Benedetti et al. 1999


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10

10

pain

pain

0

0

0

15

0

15

minutes

minutes

Right Hand

Left Hand

Placebo

expectation

Naloxone

Placebo

expectation

Right Foot

Left Foot

10

10

pain

pain

0

0

0

15

0

15

minutes

minutes


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This Is Your Brain on Placebo

rostral anterior cingulate cortex

Placebo and Opioid Analgesia - Imaging a Shared Neuronal Network

Petrovic, PP et al. February 7 2002; 10.1126/science.1068836, Science Express Reports


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The Placebo Effect

  • Relieves pain

  • Works through the opioid system

  • Anatomically specific

  • Shares the same neuronal pathways as narcotics


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RFAs

  • Elucidation of the Underlying Mechanisms of Placebo Effect

  • The Placebo Effect in Clinical Practice

BMJ Books

March 6, 2002

Edited by:

Harry A. Guess

Arthur Kleinman

John W. Kusek

Linda W. Engel


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Evidence Leads to Understanding

Potential benefits of dietary supplements may be offset by untoward drug interactions.


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Evidence Leads to Understanding

The mind-body dialogue yields powerful, even surprising, physiological responses.


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Understanding Leads to Acceptance

CAM will be integrated with conventional medicine as science affords a fuller understanding of its benefits and risks.


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Charles Rosenberg, Ph.D.

Professor of the History of Science

Harvard University

July 18, 2002

Alternative to What? Complementary to Whom? On Some Aspects of Medicine's Scientific Identity

Arthur Kleinman, M.D.

Professor of Social Anthropology Harvard University

Lillian Presley Professor of Medical Anthropology and Psychiatry

Harvard Medical School

November 7, 2002

The Global Transformation of Health Care: Cultural and Ethical Challenges to Medicine


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N a t i o n a l C e n t e r f o r C o m p l e m e n t a r y a n d A l t e r n a t i v e M e d i c i n e


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