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SEEKING TO ILLUMINATE THE MYSTERIOUS PLACEBO EFFECT

By ERIK VANCE

New York Times

Dr. Tor D. Wager (pronounced WAY-gur) is a professor of psychology at the University of Colorado. His specialty is neuroscience and brain imaging, but his passion is the placebo effect - a phenomenon that has undergone a resurgence in recent years and is now being studied by researchers.

Much of this attention is a result of the kind of brain imaging Wager does, and he is a leading figure in the new generation of placebo researchers.

Which may make his background seem unlikely. Wager, 35, was raised in Christian Science, a religion mostly known for its aversion to medical treatment. His family was not strict about it, however; he recalls an incident from his Colorado childhood that could have served as a harbinger for his career.

As a baby, he says, he came down with a rash, and after much prayer his mother took him to a doctor, fearing scarlet fever. "The doctor said, 'Here's a cream, rub it on there,' and it went away," Wager said.

So did his mother's distress. Her pulse probably slowed, he says now, and her breathing relaxed - the effect a placebo may have on a terrified patient.

Increasingly, placebo effects are being viewed as real and tangible, if mysterious. In various surveys, 45 percent to 85 percent of American and European practitioners say they have used placebos in clinical practice, and 96 percent of academic physicians in the United States say they think placebos have therapeutic effects.

Placebo research has gained respectability in recent years, thanks largely to the work of Dr. Fabrizio Benedetti, an Italian neuroscientist widely seen as the patriarch of the field. Benedetti argues that there is not a single placebo effect, but many.

One common effect involves the assumption that a particular pill is responsible for easing pain or discomfort that is actually subsiding naturally. Another is classic Pavlovian conditioning, in which a patient is so accustomed to feeling better after a shot that it works no matter what is in it. Another is the relief a patient like Wager's mother feels when a doctor offers a concrete solution.

As a graduate student at the University of Michigan, Wager used imaging to watch emotions in the brain. It was fascinating work, he says, but emotions are hard to define with precision and he wanted to do something that could help patients.

He decided to look at placebos in a clinical setting. Within a few years, Wager's name was at the top of a groundbreaking study in the journal Science that used functional magnetic resonance imaging - a specialized scan that measures changes in blood flow - to link specific brain activation to people experiencing a placebo effect (in this case rubbing unmedicated cream on a burn). Since then, he has written roughly a dozen scientific papers on placebo effects, including a 2007 study linking pain-related effects to parts of the brain that process opium or heroin (which may help explain why many placebos are temporary).

The persistent question - why some people are more responsive to placebos than others - has long frustrated scientists. "There's decades of research that has more or less failed," Wager said. "New methods are going to let us get a lot more out of it."

Solving the mystery would potentially unlock whole new areas for therapy. But for him it is a deeper question, tied to his childhood religion and the way he sees the world.

"What is the placebo effect?" he asked. "It's not some weird magical thing that just kind of happened out of the blue.

"I think it's connected to systems that generate emotional responses," he continued. "It's a window into ways in which psychological factors can affect brain and body factors that are related to health."

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