Sunday, September 20, 2009

Talking to the Gene


From my forthcoming book.
Copyright 2009 by Christine M. Skolnik

Stress, Cortisol, and Genetic Expression

Physiologically speaking, stress is practically synonymous with the production of cortisol in the body. This hormone regulates the expression of various genes associated with the immune system. Too much cortisol inhibits immune responses; hence the commonly observed, and scientifically-grounded phenomenon of individuals becoming ill after a period of heightened stress (Andreasen 234-39; Martin 167-70). Cortisol production, however, can be controlled through cognitive framing and emotional regulation strategies, among them the explicitly rhetorical.

An experiment conducted by a group of psychiatrists at the University of Michigan showed a significant positive impact of cognitive intervention on subjects exposed to pentagastrin, a stress-inducing substance (Abelson 668). This intervention was obviously rhetorical, meant to lend subjects a greater sense of control by giving them more information before and during administration, as well as an opportunity to ask questions. Subjects in the CI (cognitive intervention) group received more detailed instructions accompanied by a five-minute conversation, a light that indicated pentagastrin flow, and options for controlling or stopping the flow (Abelson 670). Cortisol levels were markedly decreased in the CI versus the control group, even in subjects with panic disorder (Abelson 671). Interestingly, none of the subjects actually stopped the flow of pentagastrin (Ableson 670). These findings clearly indicate that stress responses may be psychologically inhibited and that such interventions could “help ameliorate cortisol-mediated deleterious effects of stress on health” (Abelson 674-75). This experiment also shows a direct connection between a rhetorical intervention, an increased sense of control, and decreased cortisol levels.

The connection between stress and illness is not news. The role of the genes in immune responses, however, is generally unknown, as is the fact that cognitive framing and emotional response can affect genetic expression through the fluid dynamics of hormones. The relationship between stress and cortisol suggests a continuum of various external and internal environments: the external factors causing stress; our personal psychological reactions to those factors; the biochemical environment of our bodies (presence of stress hormones); and the biochemical environment of our cells which afects genetic expression (Cloninger 279; Ridley Genome 150; Schneiderman). This continuum, furthermore, suggests various points of intervention—occasions when individuals can exert influence to reduce the negative psychological and physiological effects of stress. While most of the research on cortisol involves regulation of environmental factors by research scientists, stress can also be modulated by various strategies of emotional self-regulation (some of which are discussed in preceding chapters). To the extent that individuals can reduce their emotional stress responses they can also reduce the production of cortisol and boost their immune systems through autonomic genetic processes. This overall process, then, is paradigmatic of an individual’s ability to “talk back to the gene.” That is to say, individuals can affect genetic expression through cognitive, emotional, and rhetorical strategies.

Sunday, September 6, 2009

Faith in Medical Science



From my forthcoming book; Copyright 2009 by Christine M. Skolnik

The legitimacy of medical science rests on faith as well as fact. That is to say the empirical grounds for the positive effects of conventional medicine are clearly reinforced by the rhetorical discursive practices in which they are articulated. Television advertisements for new drugs employ both technical and value language. These messages are compelling not only in terms of the medical information they convey but in the emotional presentation of various medical problems and cures. With compelling speech and visuals they not only promote a particular drug but the value of drug therapy in general. The drug industry itself, though criticized for being profit driven, is also accorded the respect of a cutting-edge scientific enterprise, partly through marketing and partly through a national pride in our research and development accomplishments. Other forms of medical technology also are accorded the same respect if not awe, when we consider and indeed pay related costs. The high cost of medical treatment in the US in general may, in fact, bolster the ethos of medical personnel, technologies, and related industries.

Researchers also suspect that the placebo effect is operative in the administration of conventional drugs and therapies, and there is empirical support for this hypothesis. That is to say conventional drugs and therapies are bolstered by the same factors that contribute to the placebo effect (Vase). Researchers have even speculated that in some cases prescribed drugs simply function as placebos. Antibiotics, for example, often work as placebos when administered for viral conditions, that would not typically require or respond to antibiotics (Hart). Researchers have also suggested that doctors could and should capitalize on the placebo effect by adopting a more psychologically sophisticated bed-side manner: “in practice such an approach could be implemented by interfacing standard treatments with attention to patients’ thoughts, beliefs, and feelings about the treatment and with attempts to optimize their perception of the treatment (Vase). Placebo researchers argue that such an approach would not only be more effective but also more ethical, given what we now know about the placebo effect (Vase).

The role of persuasion and faith is most evident in situations where, for various reasons, the subject is completely unaware that they are receiving a placebo. In most placebo trials the possibility that the patient is receiving a placebo engenders an element of doubt as well as faith—and results usually reflect that balance. In cases where subjects believe they are simply receiving an active drug, however, the percentage of positive placebo responses is typically much higher. Of course such conditions cannot be replicated in a conventional experimental setting for ethical reasons. However reviews of trials where subjects were given treatments later discovered to be ineffective, show startling results. In such cases positive placebo responses can be as high as 80 % (Hart).

The effectiveness of the placebo in this case, again, rests on a modern, scientific world view that associates drug therapy with medical cures, and values conventional medical practices. Ironically the findings of placebo experiments undermine these conventional practices to a certain extent, while implicitly legitimizing alternative approaches, especially those that integrate mind and body. Mindfulness-based cognitive-behavioral therapy, support groups, and meditation capitalize on many of the mind-body connections now known to be operative in the placebo effect.

Placebo researchers have extensively studied the neurological substrates of the placebo effect and the relationship between various mind, brain, and bodily
responses. Whereas the placebo affect was once assumed to be the result of response bias, research shows not only dramatic changes in brain activity but also the release of endogenous opioids in response to placebo administration (Hart; Price; Vase). Placebo administration can change not only the perception and subjective experience of pain but also objective factors. In experiments where opioid production in response to a placebo was artificially blocked (through administration of naloxone, an opioid antagonist), patients did not typically experience a placebo effect (Hart; Vase). This is clear evidence that the placebo works on the body as well as the mind and the brain, and that analgesic placebo effects are very real (subject to objective verification). Thus psychological and rhetorical factors involved in the placebo effect are instrumental in actually producing a drug-like substance within the body. This information in addition to the likelihood that a placebo effect is operational in conventional drug therapies complicates the distinction between active and inert substances, and our assumptions about various types of therapy. Just as alternative therapies may be very effective for those persuaded of their efficacy, so too conventional therapies may capitalize on the faith which patients place in the medical profession and conventional approaches.