Practice Reading: The Influence of Nothingness

A

Interested in creating a new alternative medicine? It's simple. Here's the recipe: Be warm, empathetic, reassuring, and enthusiastic. Your treatment should involve physical contact, and each session with your patients should last at least thirty minutes. Encourage your patients to actively participate in their treatment and understand how their conditions relate to their overall lives. Inform them that their bodies possess the innate power to heal themselves.

Encourage them to pay directly from their own pockets. Describe your therapy using familiar language but sprinkled with a touch of mysticism: energy fields, flows, blockages, meridians, forces, auras, rhythms, and the like. Invoke ancient wisdom dismissed by the dominance of rigid, mechanistic science. You might say, 'But surely something invented on the spot couldn’t possibly work?'

B

Actually, yes, it can – often well enough to sustain a livelihood. A comfortable livelihood if you're convincing enough, or better yet, genuinely believe in your therapy. Many illnesses improve on their own, so if you're fortunate and apply your treatment at just the right time, you'll receive credit. But that’s just part of it. Some of the improvement would genuinely be your doing. Your healing prowess would result from a paradoxical force acknowledged by conventional medicine yet oddly uncertain: the placebo effect.

C

Placebos are treatments that lack direct physiological effect but still work because the patient trusts in their healing potential. Typically, it refers to a sham pill, but it applies equally to any device or procedure, from a bandage to a crystal to surgery.

The presence of the placebo effect suggests that even dubious treatments may yield genuine benefits. This is why any mention of placebos remains contentious for many practitioners of complementary and alternative medicine, who might view it as akin to accusations of fraudulence. Indeed, the placebo effect is a significant aspect of all medical care, whether conventional or not, although its role is often overlooked or misunderstood.

D

One of CAM's greatest strengths may lie in its practitioners’ ability to harness the placebo effect for real healing. According to Edzard Ernst, professor of CAM at Exeter University, “CAM practitioners excel at generating non-specific effects and fostering strong therapeutic relationships.” The question remains whether CAM can be integrated into mainstream medicine, as some advocate, without losing much of this effectiveness.

E

It’s unsurprising that our mental state can affect our physiology: anger dilates the blood vessels in the face; sadness stimulates tear production. However, the exact mechanisms by which placebos exert their medical influence remain largely unknown. Most of the limited research conducted so far has centered on pain management, as it is one of the most common complaints and lends itself well to experimental investigation. Researchers have focused on endorphins, natural chemicals similar to morphine that help regulate pain.

F

The precise mechanisms by which placebos exert their therapeutic effects are still largely unclear. Much of the scarce research has concentrated on pain management, given its widespread occurrence and suitability for experimental study. Attention has turned to endorphins, neurochemicals akin to morphine that play a role in pain modulation. Don Price, an oral surgeon at the University of Florida studying the placebo effect in dental pain, remarks, “Any of the neurochemicals involved in transmitting or modulating pain impulses could also contribute to generating the placebo response.”

G

“Endorphins, however, appear to play a leading role.” Recent work by Fabrizio Benedetti of the University of Turin has reinforced this view, demonstrating that the placebo effect can be nullified by naloxone, a drug that blocks endorphin activity. Benedetti induced pain in human volunteers by inflating a blood pressure cuff on their forearm multiple times a day for several days, administering morphine each time to manage the pain.

On the final day, without disclosing the change, he substituted morphine with a saline solution. Remarkably, the saline still alleviated the subjects’ pain—a classic example of placebo analgesia. However, when naloxone was added to the saline, the pain relief disappeared. This provided direct evidence that placebo-induced pain relief is mediated, at least in part, by these natural opioids.

H

Nevertheless, the mechanisms by which belief triggers the release of endorphins, or why most individuals cannot induce placebo pain relief through sheer willpower, remain unknown. Although scientists lack a precise understanding of how placebos function, they have amassed substantial knowledge on how to elicit this effect. For instance, a rheumatologist in London found that red placebo capsules proved more effective as painkillers than blue, green, or yellow ones.

Studies conducted on American students indicated that blue pills are more effective as sedatives compared to pink ones, which are generally more suitable for stimulants. Additionally, branding plays a role: if you prefer Aspro or Tylenol for headaches, their chemically identical generic versions may prove less effective.

I

The manner in which treatments are administered also makes a difference. Decades ago, during the introduction of the major tranquilizer chlorpromazine, a doctor in Kansas categorized his colleagues based on their attitudes—enthusiastic, openly skeptical, or adopting a 'let’s try and see' approach. His findings suggested that the more enthusiastic the doctor, the better the drug performed. Ernst's recent survey of published studies comparing doctors' bedside manner consistently found that those who conveyed warmth, friendliness, and reassurance were more effective than those who maintained a formal, less reassuring demeanor.

J

Warmth, friendliness, and reassurance are precisely the strengths of CAM (Complementary and Alternative Medicine). Many aspects of CAM's approach—such as physical contact, generous time allocation, and suggestions of extraordinary healing abilities—are likely to impress patients. It's therefore not surprising that CAM practitioners are generally adept at harnessing the placebo effect, as noted by Arthur Kleinman, a professor of social anthropology at Harvard University.

Questions 1-6

Utilize the information provided in the passage to match the actions (listed A-H) with the individuals below.

Enter the appropriate letters A-H into boxes 1-6 on your answer sheet.

Note: You may use any letter more than once.

A - Should be easily comprehensible

B - Should improve naturally over time

C - Should not involve any elements of mysticism

D Must endure for a minimum period.

E Requires timely intervention.

F Should receive greater acknowledgment.

G Can generate significant income.

H Avoid dependence on any specific treatment method.

1 Sessions with a complementary therapist

2 A complementary therapist’s explanation of the therapy

3 A committed complementary therapist

4 Patients convinced of complementary practices

5 Progress of patients undergoing complementary therapy

6 Traditional medical practitioners (aware of placebo effect)

Questions 7-9

Select the correct letter, A, B, C, or D.

Write your answers in boxes 7-9 on your answer sheet.

7. In the fifth paragraph, the writer uses the example of anger and sadness to illustrate that:

• A. People’s feeling could affect their physical behaviour
• B. Scientists don’t understand how the mind influences the body.
• C. Research on the placebo effect is very limited
• D. How placebo achieves its effect is yet to be understood.

8. Studies on pain management receive the most attention because

• A. Scientists have discovered that endorphins can help to reduce pain.
• B. Only a limited number of researchers gain relevant experience
• C. Pain reducing agents might also be involved in the placebo effect.
• D. Patients often experience pain and like to complain about it

9. Fabrizio Benedetti’s research on endorphins indicates that

• A. They are widely used to regulate pain.
• B. They can be produced by willful thoughts
• C. They can be neutralized by introducing naloxone.
• D. Their pain-relieving effects do not last long enough.

Questions 10-14

Are the following statements consistent with the information provided in the Reading Passage?

On your answer sheet, write in boxes 10-14

TRUE           if the statement is correct

FALSE          if the statement is incorrect

NOT GIVEN if the information is not provided in the passage

10 Scientists have enough information to fully comprehend the placebo effect.

11 A researcher based in London found that red pills should be withdrawn from the market.

12 People’s brand preferences could also influence their healing process.

13 Medical doctors have a range of views of the newly introduced drug of chlorpromazine.

14 Alternative practitioners are rarely recognized for employing the placebo effect.

Answers:

1. D (Đoạn A, “Your treatment should involve physical contact, and each session with your patients should last at least half an hour.”)

2. A  (Đoạn A , “Describe your treatment in familiar words, but embroidered with a hint of mysticism.”)

3. G (Đoạn B, “A good living if you are sufficiently convincing, or better still, really believe in your therapy.”)

4. B (Đoạn B, “Many illnesses get better on their own, so if you are lucky and administer your treatment at just the right time you will get the credit.”)

5. H (Đoạn C, “Placebos are treatments that have no direct effect on the body, yet still, work because the patient has faith in their power to heal.”)

6. F (Đoạn C, “In fact, the placebo effect is a powerful part of all medical care, orthodox or otherwise, though its role is often neglected or misunderstood.”)

7. A (Đoạn E, “At one level, it should come as no surprise that our state of mind can influence our physiology…”)

8. D (Đoạn H, “Though scientists don’t know exactly how placebos work, they have accumulated a fair bit of knowledge about how to trigger the effect”)

9. C (Đoạn G, “…Fabrizio Benedetti of the University of Turin, who showed that the placebo effect can be abolished by a drug, naloxone, which blocks the effects of endorphins.”)

10. FALSE (Đoạn H, “Though scientists don’t know exactly how placebos work, they have accumulated a fair bit of knowledge about how to trigger the effect.’)

11. NOT GIVEN (Không có thông tin)

12. TRUE (Đoạn H, “Even branding can make a difference: if Aspro or Tylenol is what you like to take for a headache, their chemically identical generic equivalents may be less effective.”)

13. TRUE (Đoạn I, “…when the major tranquilliser chlorpromazine was being introduced, a doctor in Kansas categorised his colleagues according to whether they were keen on it, openly skeptical of its benefits, or took a “let’s try and see” attitude.”)