How many drugs wouldn't work without the patent knowing that they're ingesting a drug? In other words, if you were to *covertly* administer a given drug (pt has no knowledge they are ingesting a drug at all), how much of that drug's efficacy would disappear?
In this study, diazepam didn't reduce anxiety symptoms when administered covertly:
Words have power - they can make us happy, sad etc. How much of a drug's efficacy comes from how the prescriber presents it vs the actual chemical effect in-vivo?
I love it. Great point. When giving any treatment you should sell it realistically that you think it will benefit the patient and of course counsel on possible side effects. Words to have power
Emotional strain can undo the gains of eating well, sleeping deeply, and moving regularly.
In a 2022 study published in the Annals of Behavioral Medicine, men with hypertension were more likely to read neutral faces as angry—a perceptual bias that predicted later blood pressure spikes. A Taiwanese study found that people who bottled up their emotions yet ruminated on conflicts kept their pressure high long after arguments ended.
That slow recovery from conflict may matter more than the initial spike. When tension lingers, stress hormones and vessel tone stay elevated, and the body forgets how to relax.
“Every patient I see with difficult-to-control hypertension has a strong need for control,” Thaik said. “The opposite—surrender—is often the key that unlocks healing.”
Hypertension is “the biology of resistance,” a physical echo of the mind’s need to hold on, she said.
*I just Love this next line*
“Fear imagines a dark future,“ Thaik said. ”Faith imagines a hopeful one. Only faith lets the body rest.”
What to Do
Thaik tells patients to interrupt the cycle—take a breath, say a prayer, step outside. Even a few seconds of release can nudge pressure back toward normal.
The Power of Small Shifts
Blood pressure doesn’t rise overnight, nor does it settle quickly. It builds through small imbalances and unwinds the same way.
A Simple Prescription
Morning light to reset rhythm (check)
Movement every half hour to awaken circulation (check)
Water to keep blood flowing (check)
Unprocessed, mineral-rich food to restore balance (check)
Rest at regular hours (check)
Moments of calm to quiet the mind (check)
Faith and hope (check)
Screens off before bed (check)
***All the checkmarks are how I intend my Angel House to operate daily. Staff range from absolute joyful adherance, having adopted these habits to their own benefit -- to rolling their eyes, but it's 85% plus in practice, because Now the most alert of our residents Ask, Are we going for a walk, because I know Doreen wants us to! LOL
Even a modest five- to 10-point drop in blood pressure can lower the risk of heart attack or stroke by about 20 percent. (great news in general, and we've doubled that result without meds)
The real prescription, Thaik said, is gentler: small acts of care layered with trust. Give yourself what your favorite plant needs—light, movement, water, and peace. When you do, the body remembers what balance feels like. **Words to warm the heart of an urban farmer like me!**
Why I think scepticism of complementary medicine is unwarranted... with evidence from RCT... which doesn't measure the most powerful reason why they work - the placebo effect. I'll quite happily take something for the placebo effect - which EBM, which has me asking the NNT, does its best to undermine. I certainly feel that doctors lie to patients about the efficacy of meds (ie we give patients the impression the NNT is 1 rather than 12) but lying to patients does enable the placebo effect. But getting a placebo effect knowingly is hard.
There are limits to the placebo effect - having experienced tolerance, not expecting it, there definitely is a drug effect that innumerable opiate users could tell you about.
Part of my cynicism about contemporary medicine is the erosion of the art of caring and the substitution of algorithms and defensive medicine for relationship.
AFAIK there is no perfect test of defiency and some papers recommend everyone should just supplement B12 anways. It certainly can;t be called a placebo. Nor is it safe for everyone. If it's cyano form, there is evidence this makes kidney disease patients die sooner.
My dad, who was a small town doctor, once spoke to me about his experience with giving B12 shots. “When I first went into practice I had all these patients wanting B12 shots for fatigue. None of them had pernicious anemia and I refused their requests, thinking there’s no scientific basis for it. But after I’d been in practice for about 10 years, I relented, saying to myself it caused no harm and it actually might help some of these patients with vague symptoms for whom my evidence-based treatments had been unsuccessful. It seemed like a reasonable thing to do. And then, after 20 years of practice, I started taking B12 shots myself.”
This wonderful article contains a lot of truth and wisdom that can't be found in textbooks and can only be learned through experience. The placebo effect from an office visit and conversation with a physician is a genuine service and is generally underappreciated. As Dr. Engler notes below, appreciation of the nocebo effect is also very important. This is especially true today as people are peppered with "information" via the internet which is often nonsensical.
Fantastic article. During a 2 month medical school rotation on the Navajo reservation in Shiprock,NM, nearly every adult patient with an illness refused to leave unless they got a prescription for Niripsa. While certainly not a pure placebo, Niripsa (aspirin spelled backwards, ensured a happy patient who would follow all the other directions the doctor ordered.
Wow! When I was a second year resident (1976) I spent 2 months in Shiprock working in a clinic as part of the Indian Health Service. I was there that I learned that many Navajo did not view western medicine from a standpoint of science but that we had magical powers in the syringe much as the medicine man had magical powers. Therefore they preferred injections to tablets.
A form of B12 Deficiency Affecting the Central Nervous System May Be New Autoimmune Disease- B12 deficiency with normal labs caused by antibodies to B12 uptake receptors
For years, giving vitamin B12 shots to people with normal vitamin B12 levels has been considered a “poster child for unscientific medicine.” But a new study shows that the old-time doctors may have been right. And millions of people may be suffering from crippling neurologic problems that may potentially be helped by B12 shots or tablets. Despite totally normal blood levels.
Why?
A new study showed that B12 deficiency in the brain in people with the autoimmune disease lupus was four times as common in those with neurologic and brain symptoms. These people had normal blood vitamin B12 levels but severe deficiency in the brain fluid. It was found that they had an autoimmune molecule that blocked the B12 from getting from the blood into the brain.
These autoantibodies target CD320 — a receptor important in the cellular uptake of B12. While the person’s blood tests are normal, B12 in the patient's brain fluid (CSF) are nearly undetectable.
This is not a rare phenomenon.
6% of the population has these antibodies--so we are unnecessarily contributing to potentially crippling effects from B12 deficiency (despite normal labs) , when they could be easily prevented
This is a nice anecdote, but you have to be careful. I have been pressured to try various kinds of alternative medicine, which was expensive and time-consuming and didn't work. When I researched these things online, and found that there was no evidence that they worked, I felt angry that my time and money was wasted, and lost respect for the physician. I remember telling one doctor to "stop sending me to quacks." Fortunately, my PCP does not do this, so far as I know.
I’m all in on EBM. But I recognize that RCT can only discern average causal effects in select populations. It has less to say on individual, case by case scenarios.
Relieving symptoms is half of the reason why we do this. So if something works for a particular patient, even if we don’t know why, and even if “on average” it shouldn’t, by all means keep going anyway.
What I have always taught is that if a patient complains of something, acknowledge it, touch it (it you can, at least lay hands on the patient and examine), and ask questions. It may be a "nothing", but the fact that a physician has taken the time to listen and touch cures a lot of things.
Fantastic read
What a beautiful essay. Well written and compassionate. And I learned from it.
Well written😀!
Thought problem - put ethics aside for a moment:
How many drugs wouldn't work without the patent knowing that they're ingesting a drug? In other words, if you were to *covertly* administer a given drug (pt has no knowledge they are ingesting a drug at all), how much of that drug's efficacy would disappear?
In this study, diazepam didn't reduce anxiety symptoms when administered covertly:
https://linkinghub.elsevier.com/retrieve/pii/S1474442204009081
Words have power - they can make us happy, sad etc. How much of a drug's efficacy comes from how the prescriber presents it vs the actual chemical effect in-vivo?
I love it. Great point. When giving any treatment you should sell it realistically that you think it will benefit the patient and of course counsel on possible side effects. Words to have power
Wait a minute! She lived to 100? Did you ever consider that maybe it was the B12 shots?
Seeming to touch on the same themes,
This is from Epoch Health, Brain Health:
Emotional strain can undo the gains of eating well, sleeping deeply, and moving regularly.
In a 2022 study published in the Annals of Behavioral Medicine, men with hypertension were more likely to read neutral faces as angry—a perceptual bias that predicted later blood pressure spikes. A Taiwanese study found that people who bottled up their emotions yet ruminated on conflicts kept their pressure high long after arguments ended.
That slow recovery from conflict may matter more than the initial spike. When tension lingers, stress hormones and vessel tone stay elevated, and the body forgets how to relax.
“Every patient I see with difficult-to-control hypertension has a strong need for control,” Thaik said. “The opposite—surrender—is often the key that unlocks healing.”
Hypertension is “the biology of resistance,” a physical echo of the mind’s need to hold on, she said.
*I just Love this next line*
“Fear imagines a dark future,“ Thaik said. ”Faith imagines a hopeful one. Only faith lets the body rest.”
What to Do
Thaik tells patients to interrupt the cycle—take a breath, say a prayer, step outside. Even a few seconds of release can nudge pressure back toward normal.
The Power of Small Shifts
Blood pressure doesn’t rise overnight, nor does it settle quickly. It builds through small imbalances and unwinds the same way.
A Simple Prescription
Morning light to reset rhythm (check)
Movement every half hour to awaken circulation (check)
Water to keep blood flowing (check)
Unprocessed, mineral-rich food to restore balance (check)
Rest at regular hours (check)
Moments of calm to quiet the mind (check)
Faith and hope (check)
Screens off before bed (check)
***All the checkmarks are how I intend my Angel House to operate daily. Staff range from absolute joyful adherance, having adopted these habits to their own benefit -- to rolling their eyes, but it's 85% plus in practice, because Now the most alert of our residents Ask, Are we going for a walk, because I know Doreen wants us to! LOL
Even a modest five- to 10-point drop in blood pressure can lower the risk of heart attack or stroke by about 20 percent. (great news in general, and we've doubled that result without meds)
The real prescription, Thaik said, is gentler: small acts of care layered with trust. Give yourself what your favorite plant needs—light, movement, water, and peace. When you do, the body remembers what balance feels like. **Words to warm the heart of an urban farmer like me!**
Why I think scepticism of complementary medicine is unwarranted... with evidence from RCT... which doesn't measure the most powerful reason why they work - the placebo effect. I'll quite happily take something for the placebo effect - which EBM, which has me asking the NNT, does its best to undermine. I certainly feel that doctors lie to patients about the efficacy of meds (ie we give patients the impression the NNT is 1 rather than 12) but lying to patients does enable the placebo effect. But getting a placebo effect knowingly is hard.
There are limits to the placebo effect - having experienced tolerance, not expecting it, there definitely is a drug effect that innumerable opiate users could tell you about.
Part of my cynicism about contemporary medicine is the erosion of the art of caring and the substitution of algorithms and defensive medicine for relationship.
AFAIK there is no perfect test of defiency and some papers recommend everyone should just supplement B12 anways. It certainly can;t be called a placebo. Nor is it safe for everyone. If it's cyano form, there is evidence this makes kidney disease patients die sooner.
My dad, who was a small town doctor, once spoke to me about his experience with giving B12 shots. “When I first went into practice I had all these patients wanting B12 shots for fatigue. None of them had pernicious anemia and I refused their requests, thinking there’s no scientific basis for it. But after I’d been in practice for about 10 years, I relented, saying to myself it caused no harm and it actually might help some of these patients with vague symptoms for whom my evidence-based treatments had been unsuccessful. It seemed like a reasonable thing to do. And then, after 20 years of practice, I started taking B12 shots myself.”
This wonderful article contains a lot of truth and wisdom that can't be found in textbooks and can only be learned through experience. The placebo effect from an office visit and conversation with a physician is a genuine service and is generally underappreciated. As Dr. Engler notes below, appreciation of the nocebo effect is also very important. This is especially true today as people are peppered with "information" via the internet which is often nonsensical.
Fantastic article. During a 2 month medical school rotation on the Navajo reservation in Shiprock,NM, nearly every adult patient with an illness refused to leave unless they got a prescription for Niripsa. While certainly not a pure placebo, Niripsa (aspirin spelled backwards, ensured a happy patient who would follow all the other directions the doctor ordered.
Wow! When I was a second year resident (1976) I spent 2 months in Shiprock working in a clinic as part of the Indian Health Service. I was there that I learned that many Navajo did not view western medicine from a standpoint of science but that we had magical powers in the syringe much as the medicine man had magical powers. Therefore they preferred injections to tablets.
Maybe the B12 was NOT a pleacebo.
A form of B12 Deficiency Affecting the Central Nervous System May Be New Autoimmune Disease- B12 deficiency with normal labs caused by antibodies to B12 uptake receptors
https://www.medscape.com/viewarticle/form-b12-deficiency-affecting-central-nervous-system-may-be-2024a1000c5q
https://www.science.org/doi/10.1126/scitranslmed.adl3758
For years, giving vitamin B12 shots to people with normal vitamin B12 levels has been considered a “poster child for unscientific medicine.” But a new study shows that the old-time doctors may have been right. And millions of people may be suffering from crippling neurologic problems that may potentially be helped by B12 shots or tablets. Despite totally normal blood levels.
Why?
A new study showed that B12 deficiency in the brain in people with the autoimmune disease lupus was four times as common in those with neurologic and brain symptoms. These people had normal blood vitamin B12 levels but severe deficiency in the brain fluid. It was found that they had an autoimmune molecule that blocked the B12 from getting from the blood into the brain.
These autoantibodies target CD320 — a receptor important in the cellular uptake of B12. While the person’s blood tests are normal, B12 in the patient's brain fluid (CSF) are nearly undetectable.
This is not a rare phenomenon.
6% of the population has these antibodies--so we are unnecessarily contributing to potentially crippling effects from B12 deficiency (despite normal labs) , when they could be easily prevented
I was just about to post about this, glad you did. Reading through all the comments it appears no one is aware of this important recent discovery.
This is a nice anecdote, but you have to be careful. I have been pressured to try various kinds of alternative medicine, which was expensive and time-consuming and didn't work. When I researched these things online, and found that there was no evidence that they worked, I felt angry that my time and money was wasted, and lost respect for the physician. I remember telling one doctor to "stop sending me to quacks." Fortunately, my PCP does not do this, so far as I know.
I’m all in on EBM. But I recognize that RCT can only discern average causal effects in select populations. It has less to say on individual, case by case scenarios.
Relieving symptoms is half of the reason why we do this. So if something works for a particular patient, even if we don’t know why, and even if “on average” it shouldn’t, by all means keep going anyway.
The late Bill Bengston showed there is a healing intent that may mean placebos are potent medication.
What I have always taught is that if a patient complains of something, acknowledge it, touch it (it you can, at least lay hands on the patient and examine), and ask questions. It may be a "nothing", but the fact that a physician has taken the time to listen and touch cures a lot of things.
Nocebo is absolutely critical too.
https://open.substack.com/pub/sanityunleashed/p/nocebo-effects-during-the-covid-event