Many diseases that terrified people of the past are practically forgotten today. Doctors quickly dealt with them, as soon as they changed conspiracies, bloodletting and dubious, and even dangerous drugs (for example, like mercury) for scientifically proven drugs and methods. However, people in white coats still have a lot of work to do, and soon they may re-examine some of their principles of treatment. Moreover, in favor of a completely unexpected direction.
Agree with nerves
In April 2014, the US agency DARPA announced the creation of the Department of Biological Technologies. The event is significant if we take into account the specifics of the agency. His mission is to look into the future further than others and turn science fiction into reality. As part of one of the projects, the department intends to develop a brain stimulation technology that corrects nervous disorders (from depression to chronic pain).
The SUBNETS (Systems-Based Neurotechnology For Emerging Therapies) project is notable for the fact that it outright refuses to try medication. DARPA specialists have chosen a different path, where it is not the chemical properties of cells that are affected, but the mode of their electrical activity, and the stimulation parameters should depend on the response of neurons. In fact, this is a direct dialogue with the nervous system.
In medicine, electrical stimulation has been used for decades, and this method sometimes brings success where drugs are powerless. By sending a signal through electrodes deep into the brain, it is possible to trigger the healing process even in patients who are in a state of minimal consciousness, as reported in 2007 by researchers from the Department of Neurology at Cornell University College of Medicine. It is like awakening: a person begins to move, eat and speak independently.
In this way, they try to help people suffering from depression, obesity or Parkinson's disease. But the technology has one decisive drawback - you have to open the skull. Therefore, it will not receive wide distribution. It would be great to find a milder way of acting on the nervous system while avoiding the side effects of pharmacology. In other words, come up with a treatment without drugs and without traumatic interference in the body. But is it real?
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Treatment without drugs
In search of an answer, it is worth turning to the research of Fabrizio Benedetti, a neurophysiologist at the University of Turin. He is one of the leading experts in the targeted study of placebo effects, and he uses deep brain stimulation in his experiments.
As a therapy for patients with Parkinson's disease, electrical impulses are applied to the region of the subthalamic nuclei. This reduces the excessive activity of neurons in this area and leads to an improvement in the patient's well-being and movement. However, Benedetti, before initiating stimulation, injected patients, convincing them that he was injecting an effective drug.
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But in reality, the patients were injected with ordinary saline, a medical "dummy" with no medicinal properties. Moreover, the electrode inserted into the brain was used not for stimulation, but only for reading the activity of cells. The result of the experiment was completely unexpected.
After the injection, the patients began to move more easily, and the level of arousal in their subthalamic nuclei decreased as if they had received a series of impulses. Somehow, the brain independently normalized its mode of operation in response to the fiction. This was the first time scientists were able to register the placebo effect at the level of individual neurons.
Today, such effects can no longer be taken lightly. As it turned out, not only a dummy pill or an illusion of electrical impact, but also a sham surgery can act as a placebo. The prestigious The New England Journal of Medicine has more than once published articles that simulated knee flushing gives the same positive effect as real arthroscopy: patients get rid of arthritis.
Some drugs do not make it to the official sale because they are no better than placebo in preliminary tests. But these are active substances developed by specialists for a specific biochemical function. Here we are faced with an unexpected phenomenon - the ability of the body to start the process of its recovery with the help of the psyche. This does not always work, and its capabilities are limited. But their real limit is not known for certain.
Medicine of the future
Let us give a risky forecast: medicine will be based on the management of self-healing mechanisms. At least for some of the violations. Doctors will learn to conduct an indirect dialogue with the nervous system, choosing the right stimuli in each case.
A placebo is not just an inert thing, it triggers a whole cascade of biochemical changes in a person, including the endocrine, immune and nervous systems. That is why the study of placebo effects is receiving serious attention today. Having studied the phenomenon at a fundamental level, it may be possible to find a way to strengthen it many times over.
The scenario outlined follows the idea of the famous psychologist Nicholas Humphrey from Darwin College, Cambridge University. He suggests that for most of human history, doctors and healers worked precisely due to the placebo effect. Their recipes had a very distant relationship to the physiological component of disease. Nevertheless, even absurd methods had a certain positive effect. Humphrey singles out the "health management system" as part of the overall management of homeostasis.
The work of this system gradually, in the course of cultural evolution, became dependent on the very fact of the presence of doctors, medicines and procedures. But all this time she acts spontaneously, by herself. Science will take control of it and significantly increase its power and capabilities, although, of course, patients will not be stuffed with mercury or witchcraft potions. True, future treatments may seem much stranger to us.
Putative placebo mechanisms
Placebo use can reduce pain by opioid or non-narcotic exposure to expectations and / or conditioned reflex mechanisms. Opioids produced by the body can inhibit the respiratory centers.
The heart's sympathetic nervous system, which secretes adrenaline, may also be suppressed during placebo pain relief, although the mechanism is unknown (pain relief and / or opioid compensatory effects). Cholecystokinin counteracts the effect of endogenous opioids, thereby decreasing the response to placebo. Placebo can also affect the release of serotonin in the pituitary and adrenal glands, mimicking the effect of some pain medications.
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Fabrizio Benedetti, Professor of Neurophysiology and Human Physiology, Department of Neurosciences, School of Medicine, University of Turin:
“The public is interested in the placebo effect because it promises to expand our understanding of the limits of a person's inner capabilities.
Scientists - because the influence of beliefs on human behavior holds promise for studying the internal control of emotional, sensory, and peripheral processes.
The placebo study is essentially a study of how the context of beliefs and values shapes the processes of perception and emotion in the brain and ultimately affects mental and physical health. Modern neuroscience is considering the idea that subjective expectations and values have a specific physiological basis that can have a significant impact on thinking, motor processes and internal homeostasis.