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a lot of side effects and here i already feel them so. many effects and many side effects of medications are caused by the placebo effect what this is all about this is what i'm going to talk to this doctor your highness laugh at on here in berlin at the school of psychology welcome to the church. the placebo effect shows us that psychological factors are important component for the focusing of medical treatment the letter word placebo means i will please so it's a promise in medical terms we call a placebo or

a medication that doesn't contain any active ingredients especially in pain treatment we know that placebos do work at the patients have to believe in them. knows a lot about pain his ordeal started after a hernia operation it was a beginning of a medical odyssey. paid for by about the pain started a week after the surgery and he got more intense as it got worse and worse with pain in the lower body wish that i could barely stand it i visited loads of doctors hoping to find a solution but they couldn't find anything i took more and more painkillers which led to me withdrawing even at home in the end i was spending all my time at home that's all i have to say afterwards i knew the t.v. programming by heart and i had as fans a book. the manager had to quit his job he was incapacitated the pain

completely took over his life. then he was given the chance to take part in a study he was told that research was being done on your feedback a special kind of pain management therapy for him it was a real medical treatment that gave him hope. really concentrated on looking at the circle to see if i could somehow influence this through certain breathing techniques or visual focus techniques really deeply into it as he. didn't realise was that the experimenters were just pretending that he was controlling his brain activity in actual fact his brain was not linked up with the computer at all. the video was being played on the monitor it was a placebo a fake therapy. and i had the feeling a hundred fifty percent that i was influencing the image through my movement my

breathing technique my gaze. the treatment worked later the ruse was revealed to him. a successful example of the placebo effect which may play a role in medical therapies the power of expectation has been especially well researched in the area of pain management. to see those activate the same neurotransmitters in the brain the dura least by real pain medication that means the placebo effect is real. it's likely that expectation plays a crucial role and that was also a decisive factor in our experiment that is built up the expectation that this form of treatment would work and does a hundreds form vote vote what's astonishing is that havel birches pains have largely subsided even though he knows that he underwent

a fake treatment. persuaded me that only you can change your situation. and if an experiment like this worked then you could take other things into your own hands. on purely with your own mind you managed to get away from the pain that . he became more active exercise a healthier diet and above all he started going out and meeting up with friends once again. just to vini a more i did the less pain i heard. on a pain scale of one to twelve i was at eleven. today after several months of gone by i'd say i'm now at level one. it's almost gone. down to zero thanks can only work if patients believe there is even a pain medicine only then will they have any chance at all of experiencing self

efficacy or the placebo effect as we call it. to the nuts. but in every day medicine this wisdom is often not apply. medicines are prescribed without comment pills are simply handed out in the hospital and before an operation risks and side effects are more frequently emphasized than their desired outcome it all boils down to positive expectations. with them a medical therapies healing effect is far more potent than without. i'm here to school of psychology in berlin. thanks for having me today. research with placebos in a quite different way so what you do. we took patients undergoing a very. short cycle. where we target expectations positive way and we compare that to patients that underwent

a procedure so what did you do did you just. get over now so we did. pass the last expectations we wanted to talk about things that matter to time in their everyday life. we set up a personalized expectation plan. that would show the cost after surgery like for six weeks after surgery three months of surgeries six months of surgery which activities that are important to them are realistic that they could regain and then we put it in imagination exercise and thinking about six months after the surgery everything went well where are you going to be what are you feeling what can you do and this actually works yes so i'm going to tell you about one example we had. a woman who before her cardiac disease was very active she was going on vacation in mountain c.

in italy and she would like she really left wondering around back and up the mountain she wasn't able to do that anymore because of a disease so we explained to her that it's really realistic that after surgery she's going to be physically able to do this again that we imagined. how she was spect six months after surgery and running up the hill or walking feeling the sun and feeling the the joy back again did she do the motion even after that yeah that's that's a really nice anecdote so actually three months after surgery i got a postcard from the comal incident where she wrote me that she has been walking up and down the hills through this is well yeah. i use it as a g.p. in my practice exactly and you definitely should do that so what i would recommend this is that you talk to the patient get a feeling of how he understands to deal with us and treatment you're going to

advise to him tell him where and when he's going to acknowledge or actually going to experience the improvement of the treatment and i would advise you to build. practitioner patient relationship being impacted. giving sentences of good expectation hope doesn't mean i could even use some sugar pills with no active ingredients in it to get some through pubic results so actually there's a lot of research showing that a lot of general practitioners are giving placebos in some sort of way but just giving a sugar pill and telling your patients something else is unethical. so we can use this in placebo research but it's unethical in clinical practice fortunately at least placebo research is beginning to find results

about open placebo research which is you tell the patient i'm giving you a placebo there's no medication in it somehow know that it works. and it's probably going to help you and it's the worse so the research is still in infancy but and there's already the first studies that show that even those patients with an open placebo can improve there's also an evil twin to the principle called no simple hand seeing the side effects of medication and this is one of the reasons some of my patients throw away their pills. patients are always told to carefully read medicine information leaflets but is it really necessary due to his age seventy three usually he advice. side effects can be really dangerous for example.

good information. but protect patients. they've been a legal requirement since the late one nine hundred seventeen. explain to patients about the benefits of a given drug every single. study shows that ninety percent of people surveyed believe the medicines information is important. the information makes twenty nine percent of those surveyed feel anxious people over age sixty seven percent. of scientific.

medicine can have side effects. simply because people expect them to many studies have been conducted on so this very question. i didn't see groups receiving real medicine or. on average one in four complaints of side effects even the people in the placebo group given the medicine. so does that mean that you can feel side effects just because he would expect to. take for example.

even. complained of the side effects. the participants we mentioned what could happen. it's very clearly evident that side effects of both groups. so it's very clear that just. leads to the.

patient. the expectation of. perhaps the advice should be. await this information leaflet from my patients because they have all those side effects on it and patients get but i'm not allowed to do this so how can i listen the reason of my patients i would recommend is to engage in an open discussion with

the patient ask her or him what did she understand about the leaflet she has specific concerns and then you should take your knowledge as a doctor and your experience as a doctor to set those side effects in a bigger context you could tell her like well they're under stock you meant for legal reasons but in all my years of practice i never noticed anybody having decided that and then of course you should outline the benefits of the medication. that usually are bigger than the side effects but we just saw in the report that patients who were taking placebos also had the new siebel effect that they got side effects even there's no effect at all in the sugar pill so it doesn't mean if i read this awfully long information leaflets here in this state it may produce some coughing does it mean i just will start coughing because i just read it well one explanation is that we all have some doctors even we are not sick once we have

a headache once we have a backpack and. the information leaflet automated medication puts that into a different context so if you read and leaflet that this medication can produce a headache. you focus on the headache and then you set it into the context of the make medication you think ok the medication is bad and which may lead to not taking the pill were supposed to which will tampa your benefit of the medication as it should be i'm always convinced that the medication prescribed to my patients will work and i always weigh the side effects against the good effects so how can i transfer this knowledge to my patients well i think it's easier to just break it down in a common sense language. and tell about the benefits that outweigh the potential side effects and any words of phrases i should. using my talk to my patient this. research already. indicates that if you say

eighty percent of my patients not getting side effects just produce less no c. will collect and if you say twenty percent will get the side effect and good of you christian from deacon you can from florida in the us and he'd like to know whether it's wrong to be critical to what it was effects because i mean in the end cases patients are hurt by medications no absolutely not that's not wrong because as a patient you should be well informed to make sometimes a really important especially undergo this treatment that has potential side effects. and well especially if the side effects. dramatic you need to have the information to weigh all the homes things but then you should enter into a discussion with a doctor which has medical knowledge has experience and might help you make that up

decision. quite right thanks so much for the straight talk thank you and this is the point usually in the show i tell you to write us an email if you do have any questions but let me put this in a more positive way today if you want us to answer any questions please write us an e-mail. in an upcoming show we'll be looking at psychosomatic disorders emotional problems can often be behind physical conditions why and what help is available if you have questions about that send an email to end good shape at d w dot com and write psychosomatic medicine in the subject line we look forward to hearing from you. how does this week on reposition work again many of us don't know because the first eight calls is ages back but there's one thing for sure if you don't help in that emergency it's the worst thing you could do.

by the time the ambulance arrives it can often be too late for someone who's been injured even bystanders who had first aid training often feel helpless in a medical crisis. the participants in this course have been sent here by their company to learn best first aid practices. so what measures can anyone take an emergency situation. after a traffic accident the first thing to do is flag the site to warn following drivers then call emergency services. if the injured person is unconscious only move them out of the car if they're in immediate danger take care not to aggravate any potential spinal injury if they're unresponsive check whether they're breathing if they are get help if possible to roll them onto their side in the so-called recovery position without twisting them the chin should be stretched and the mouth down so the airways remain open and the person can choke on their tongue. and in

the recovery position a patient sometimes vomits the head should be as low as possible so the vomit can drain from the mouth. please and if the person is not breathing begin cardiopulmonary resuscitation or c.p.r. the lower third of the breast bone should be compressed downwards using your hands and outstretched arms at a rapid rate of one hundred to one hundred twenty compressions a minute the aim is to keep partially oxygenated blood flowing through the body especially to the brain to mouth to mouth breaths can be given every thirty compressions but keep the compressions going until professional help arrives if a defibrillator is available how do you operate it an automated external defibrillator can restore the heart's normal rhythm place the adhesive pads on the person's chest as indicated the defibrillator analyzes whether an electric shock is needed. you can't do anything wrong because the defibrillator automatically

analyzes the heart rhythm and if the diagnosis cardiac arrhythmia of ventricular fibrillation it administers the shock. many would be helpers are scared of making potentially fatal mistakes what can go wrong during first aid. very little apart from maybe doing nothing a lot of highway telephones also connect to emergency centers that offer basic instructions telling a first responder what to do that encourages more people who witness accidents to get actively involved. in germany at least no one need fear legal repercussions if they harm someone while giving first aid. during the battle if you're makin casualties condition like worse while administering first aid you can't be held legally responsible if you responded with reasonable care according to the best of your knowledge was in the underspend a for the victim to survive even with say a further spinal injury and at least they're alive. the overarching need is to

keep the injured person alive until the emergency services get there. many people have a slightly sideways curve spine and this is not a problem but if they've got a severely deformed back it's a disease called scoliosis and this is painful restricts their motion one solution can be a custom made brace on operation but this is a major operation and the only performed by experienced surgeons. this is how his son have agonise back looked until recently a week later she began a new life enabled by an operation that was preceded by a new x. ray technique this technology made it possible to measure the twelve year old spine more precisely. due to the severity

of the disorder her family turned to the spine experts at the shotty hospital in berlin left untreated scoliosis can lead to health problems. marlo's. says is normally a very common disorder about one in every fifty girls has it but usually to a much lesser degree. she'll still grow during puberty there's another growth spurt but then she'll not grow taller instead she'll grow into this so-called deformity that's why surgery would be highly recommended here even though she's only twelve waiting will not help as the curvature will only get worse. to prepare for the operation experts news a new imaging tool a vertical scan or. it's a whole body x. ray machine that scans the entire back while the patient is standing. on the is concerned are we now have

a three dimensional image of her spine but it also shows the connections to her pelvis and hip joints and her families and that helps us determine exactly which profile we need to set using the screw implants. the scanner x. rays cassandra's body layer by layer using a much lower radiation level than the ordinary procedures thanks to the vertical images the positions of the screws can be determined much more precisely. and then pairs of particle screws will be anchored into the spine. which will then be connected to one another over one or two rods on the right and left. but none of . the. one we can on the operation is proving a success because sandra has been on her feet again for three days now. a new image taken with a vertical scan it shows what a success the operation has been. shape of has spine has been almost completely

straight and isn't a total of twenty screws. the curvature went from ninety degrees to only twenty two degrees. do you recognize this this was your spine before and this is it now it's almost straight or yeah do you notice it too because you've grown a bit taller i hope you feel good. she's growing five point five centimeters taller thanks to the operation and care center lights how it feels. to stand for well at first i stood in front of the mirror and saw from the side what my back looks like now and i was actually speechless. because the whole bolch has now gone again against boy and now there's just a small bit. kissinger will have to screw him back for the rest of her life but that's a small price to pay. that's it first day next week

and i'm so then let's all try to say.

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