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Saturday, May 15, 2021

Self-fulfilling prophecy

From Wikipedia, the free encyclopedia
 

A self-fulfilling prophecy is the sociopsychological phenomenon of someone "predicting" or expecting something, and this "prediction" or expectation coming true simply because the person believes it will and the person's resulting behaviors align to fulfill the belief.

This suggests that people's beliefs influence their actions. The principle behind this phenomenon is that people create consequences regarding people or events, based on previous knowledge of the subject.

There are three factors within an environment that can come together to influence the likelihood of a self-fulfilling prophecy becoming a reality. These would be appearance, perception and belief. When a phenomenon cannot be seen, appearance is what we rely upon when a self-fulfilling prophecy is in place. When it comes to a self-fulfilling prophecy there also must be a distinction “between 'brute and institutional' facts”. The philosopher John Searle states the difference as “facts [that] exist independently of any human institutions; institutional facts can only exist within institutions”

There is an inability of institutional facts to be self-fulfilling. For example, the old belief that the Earth is flat (institutional) when it is known to be spherical (brute) is not self-fulfilling. There has to be a consensus by “large numbers of people within a given population” aside from being institutional, social, or bound by the laws of nature for an idea to be seen as self-fulfilling.

A self-fulfilling prophecy can have either negative or positive outcomes. It can be concluded that establishing a label towards someone or something significantly impacts their perception and influences them to establish self-fulfilling prophecy. Interpersonal communication plays a significant role in establishing these phenomena as well as impacting the labeling process. Intrapersonal communication can have both positive and negative effects, dependent on the nature of the self-fulfilling prophecy.

A self-fulfilling prophecy has been considered an inherently false conception based on the way Merton defines self fulfilling, which makes it a restrictive theory due to the fact that it must be a false idea from the start in order for the resulting outcome to have proved the initial thought to be true.

The expectations of a relationship or the inferiority complex felt by young minority children are examples of the negative effects of real false beliefs being self-fulfilling.

American sociologist W. I. Thomas was the first to discover this phenomenon. In 1928 he developed the Thomas theorem (also known as the Thomas dictum), stating that,

If men define situations as real, they are real in their consequences.

In other words, the consequence will come to fruition based on how one interprets the situation. Because of the way the Thomas’ defined a self-fulfilling prophecy it can be regarded as relatively flexible and can apply to many things such as culture. On a societal level, there can be a consensus on what's deemed true depending on the importance of the part of the culture even if it is a false assumption and as a result of this perception of the culture it will become the outcome based on the behavior of the society. A person’s perception can be “self-creating” if the belief they have is acted upon by their behavior which aligns with the outcome.

Building on Thomas' idea, another American sociologist, Robert K. Merton, used the term "self-fulfilling prophecy" for it, popularizing the idea that “a belief or expectation, correct or incorrect, could bring about a desired or expected outcome.” While Robert K. Merton is typically credited for this theory since he coined the name, The Thomas’s developed it earlier on along with the philosophers Karl Popper and Alan Gerwith who also independently contributed to the idea behind this theory in their works which came before Merton as well. Self-fulfilling prophecies are an example of the more general phenomenon of positive feedback loops.

History

Robert K. Merton is a sociologist who was also known as the “father of sociology”. He helped create many different theories such as anomie, social structure as well as the different modes of individual adaption. Merton was deeply passionate and interested in the sociology of science, during his time at Columbia University he was able to research and discover many different concepts such as “social structure, bureaucracy, mass communication, and the sociology of science”. He established what his theory was and he would then start testing it right away without developing the concept. Merton would not worry about developing the theory because he was never looking for a “grand” theory, he was looking for a “practical” theory.

Merton applied this concept to a fictional situation called “The Last National Bank”. In his book Social Theory and Social Structure, he uses the example of a bank run to show how self-fulfilling thoughts can make unwanted situations happen. Rumors spread around the town about the Millingville bank and Merton mentions how a number of people falsely believe the bank was going to file for bankruptcy. Because of this false fear, many people decide to go to the bank and ask for all of their cash at once. The owner of the bank, Cartwright Millingville was once proud about the bank being alive and well which was thanks to the ubiquitous trust in the bank which gave it its stability but as the week fell upon what was called “Black Wednesday”, things took a turn when the depositors lost faith in the validity of the bank according to Merton. These actions cause the bank to indeed go bankrupt because banks rarely have the amount of cash on hand to satisfy a large number of customers asking for all of their deposited cash at once. The people with money in the bank were the ones to define their perception or truth of the bank’s ability to safely hold their money without risk. They were able to determine their new definition of the bank which became an overall consensus as many rushed to withdraw whatever was left after their scramble to ensure their money was secure in their own hands. Their loss of faith led to the bank's eventual failure which was not an initially true assumption until the depositors made it so.

Merton concludes this example with the analysis, “The prophecy of collapse led to its own fulfillment”.

While Merton's example focused on self-fulfilling prophecies within a business, his theory is also applicable to interpersonal communication since it is found to have a “potential for triggering self-fulfilling prophecy effects”. This is due to the fact “that an individual decides whether or not to conform to the expectations of others”. This makes people rely upon or fall into self-fulfilling thoughts since they are trying to satisfy other's perceptions of them. This theory was applied to experiments done by Dr. Robert Rosenthal and Lenore Jacobson in the Pygmalion in the Classroom Study who tested the IQ’s of 1st and 2nd grade elementary students. Where random students' IQ scores aligned with the expectation the teachers had been given about the students eventual success.

Self-fulfilling theory can be divided into two behaviors, one would be the Pygmalion effect which is when “one person has expectations of another, changes her behavior in accordance with these expectations, and the object of the expectations then also changes her behavior as a result”.

Additionally, philosopher Karl Popper called the self-fulfilling prophecy the Oedipus effect:

One of the ideas I had discussed in The Poverty of Historicism was the influence of a prediction upon the event predicted. I had called this the "Oedipus effect", because the oracle played a most important role in the sequence of events which led to the fulfilment of its prophecy. [...] For a time I thought that the existence of the Oedipus effect distinguished the social from the natural sciences. But in biology, too—even in molecular biology—expectations often play a role in bringing about what has been expected.

An early precursor of the concept appears in Edward Gibbon’s Decline and Fall of the Roman Empire: "During many ages, the prediction, as it is usual, contributed to its own accomplishment" (chapter I, part II).

Applications

Examples abound in studies of cognitive dissonance theory and the related self-perception theory; people will often change their attitudes to come into line with what they profess publicly.

Teacher expectations influence student academic performance. In the United States, the concept was broadly and consistently applied in the field of public education reform, following the "War on Poverty". Theodore Brameld noted: "In simplest terms, education already projects and thereby reinforces whatever habits of personal and cultural life are considered to be acceptable and dominant." The effects of teacher attitudes, beliefs and values, affecting their expectations have been tested repeatedly. Students may study more if they had a positive experience with their teacher. Or female students may perform worse if they expected their male instructor is a sexist.

The phenomenon of the "inevitability of war" is a self-fulfilling prophecy that has received considerable study.

Fear of failure leads to deterioration of results, even if the person is objectively able to adequately cope with the problem. For example, fear of falling leads to more falls among older people.

Americans of Chinese and Japanese origin are more likely to die of a heart attack on the 4th of each month. This is because number 4 is "unlucky" in these cultures. The pronunciation of "4" and "death" is very similar in Chinese.

The idea is similar to that discussed by the philosopher William James as "The Will to Believe." But James viewed it positively, as the self-validation of a belief. Just as, in Merton's example, the belief that a bank is insolvent may help create the fact, so too, on the positive side, confidence in the bank's prospects may help brighten them. Similarly, Stock-exchange panic episodes, and speculative bubble episodes, can be triggered with the belief that the stock will go down (or up), thus starting the selling/buying mass move, etc.

A more Jamesian example: a swain, convinced that the fair maiden must love him, may prove more effective in his wooing than he would had his initial prophecy been defeatist.

There is extensive evidence of "Interpersonal Expectation Effects", where the seemingly private expectations of individuals can predict the outcome of the world around them. The mechanisms by which this occurs are also reasonably well understood: it is simply that our own expectations change our behaviour in ways we may not notice and correct. In the case of the "Interpersonal Expectation Effects", others pick up on non-verbal behaviour, which affects their attitudes. An example includes the Pygmalion in the Classroom study where teachers were told arbitrarily that random students were likely to show significant intellectual growth As a result, those random students actually ended the year with significantly greater improvement when given another IQ test “The control group for all grade levels gained about eight points between the two tests, while the treatment group gained about twelve;”  Although the exact actions behind what the teachers did to lead the study towards the initial expectation of student success is unknown, teachers who have higher expectations typically, give “more time to answer questions, more specific feedback, and more approval”.

A classic experiment was conducted by Robert Rosenthal and Lenore Jacobson in American elementary schools in 1968. Using a simulation test, he convinced the staff that some of the students he chose at random were intellectually gifted and would show excellent results in the future. When measuring intelligence at the end of the school year, 45 percent of children selected as "high-grade" showed an increase in their IQ of 20 or more, with some children showing an improvement of 30 points.

People adapt to the judgments and assessments made by society, regardless of whether they were originally correct or not. There are certain prejudices against a socially marginalized group (e.g. homeless people, drug addicts or other minorities), and therefore people in this marginalized group actually begin to behave in accordance with expectations. If the behavior is influenced solely by the expectations of a particular person in power (e.g., a leader, teacher, doctor, or researcher), then we are talking about the Pygmalion effect.

Relationships

A leading study by Columbia University found that self-fulfilling prophecies have some part in relationships. The beliefs by people in relationships can impact the likelihood of a breakup or the overall health of the relationship. It was suggested by L. Alan Sroufe, that “rejection expectations can lead people to behave in ways that elicit rejection from others.” The study looked at the inner workings behind the role of self-fulfilling prophecies in romantic relationships of people who were deemed high in rejection sensitivity which was defined as “the disposition to anxiously expect, readily perceive, and overreact to rejection”. Couples were sampled from Columbia University and prompted to journal their thoughts and feelings in regards to their relationships. The psychologist professor Dr. Geraldine Downey found that women were more likely to experience rejection sensitivity in comparison to the negativity held by men about the future of their relationships. “RS was a stronger predictor of concern about rejection during conflict, and of feeling lonely and unloved after conflict, in women than in men” The original hypothesis aligned with the findings that “HRS women may be more likely to behave in ways that exacerbate conflicts.” The conclusion was that women with high rejection sensitivity were more likely to “behave in ways that erode their partners' relationship satisfaction and commitment.” The feelings of rejection would eventually cause the women to stop the relationship from the built up dissatisfaction.

Other specific examples discussed in psychology include:

International relations Applications

Self-fulfilling prophecies have been apparent throughout history where different countries fall into the ‘Thucydides trap’. This term has been coined by Graham Allison and is defined by the occurrence of a rising power threatening a ruling or dominant power. Thuycidides was an Athenian historian and general who recorded the Peloponnesian war between Sparta and Athens.  Thuycidides wrote, ““It was the rise of Athens and the fear that this instilled in Sparta that made war inevitable.” Of the 12 out of 16 wars that have occurred throughout history, each time the countries involved have succumbed to this tendency. The common theme of feeling threatened by another worldly power that may eventually surpass them puts the dominant power in a position to act on its fears which would equate to a potential war.  A present day example of this sense of worry and anxiety is of China's rapid progression which threatens the U.S. as a dominant or ruling power. If the United States were to let the continuous growth of China lead into competition and the behavior of trying to restrict the growth of China it would push the two powers towards war which would be the result of the self-fulling prophecy. American political scientist Joseph Nye Jr. suggests to security analysts not to be too hasty as to allow their fear of impending conflict to become a reality and cause a self-fulfilling prophecy to occur. If countries make others out to be an enemy in their head, they secure the future of hostility. Another example of self-fulfilling prophecies is when the U.S. invaded Iraq back in 2002 based on the assumption it was a terrorist threat. However, according to evidence, it shows that no threat was posed by Iraq.  The decisions made by the Bush administration stemmed from the desire to overthrow and dominate the regime which resulted in Iraq becoming a terrorist threat and a stronghold for the terrorist organization known as Al Qaeda., and henceforth confirming the initial belief of a potential threat. The belief that democratic peace is the best way to maintain a country is only deemed true among the masses falls into the category of being a self-fulfilling prophecy. If one country perceives another as peaceful and not restricting their ability to grow and function as they currently do, the belief will be held by both. This makes the definition when applied to countries as flexible for the possibility that it can also depend on the consensus of those who believe in a specific principle.

Stereotype

Self-fulfilling prophecies are one of the main contributions to racial prejudice and vice versa. According to the Dictionary of Race, Ethnicity & Culture "Self-fulfilling prophecy makes it possible to highlight the tragic vicious circle which victimizes people twice: first, because the victim is stigmatized (STIGMA) with an inherent negative quality; and secondly, because he or she is prevented from disproving this quality." To prove this, the author uses the example that Merton used in his book about how white workers expected that black people would be against the principles of trade unionism because white workers considered black workers to be “undisciplined in traditions of trade unionism and the art of collective bargain-ing.” This prediction caused the event to happen (black workers would be against trade unionism), because this forecast became fact when all white people started to believe this and did not let the black workers get a job at any white men's business. Which made black workers unable to learn or approve the principles of trade unionism since they were not given the chance of working in a work environment where these principles were seen or experienced.  

In the article “The Accumulation of Stereotype-based self-fulfilling Prophecies.” The authors mention how teachers can encourage stereotype-based courses and can interact with students in a manner that encourages self-fulfilling thoughts. The example that was given was the one of a female student who seemed to do bad in math and her math teacher and counselor “channel her in the direction of confirming sex stereotypes” By this the author means that the teachers never encouraged her to improve her abilities in math. Instead, the teacher and the counselor recommended classes that were dominated by females.

African American psychologist Kenneth B. Clark studied the responses of Black children ages 3–7 years old to black and white dolls in the 1960s. From his reports on his research, the term "self-fulfilling prophecy" made its first appearance in educational literature. The theory of self-fulfilling prophecy contributed to the impact of racism on the children. The responses from Clark's study ranged from some calling the black doll ugly and one girl bursting into tears when prompted to pick the doll she identified with. The black children internalized the inferiority they learned and acted as such as a result of their placement within society. Clark who aided in pushing the Supreme court decision towards the desegregation of schools in the case of the Brown v. The Board of Education, also noted the influence of teachers on the achievement levels between black and white students. ““the importance of the role of teachers in developing self-image, academic aspirations and achievements of their students”” prompted Clark to begin a study in 10 inner-city schools where he assessed the attitudes and behaviors of teachers. The belief held by teachers was that minority students were dumb and therefore they didn’t put effort into them. The low expectations of the teachers aligned with their initial belief which was low IQ test scores.

Clark wrote, ““If a child scores low on an intelligence test because he cannot read and then is not taught to read because he has a low score, then such a child is being imprisoned in an iron circle and becomes the victim of an educational self-fulfilling prophecy””

Kenneth B. Clarks ideas about educational Self-fulfilling prophecies opened up minds to the effectiveness of teaching and the expectations teachers place upon students.

Literature, media, and the arts

In literature, self-fulfilling prophecies are often used as plot devices. They have been used in stories for millennia, but have gained a lot of popularity recently in the science fiction genre. They are typically used ironically, with the prophesied events coming to pass due to the actions of one trying to prevent the prophecy (a recent example would be the life of Anakin Skywalker, the fictional Jedi-turned-Sith Lord in George Lucas' Star Wars saga). They are also sometimes used as comic relief.

Classical

Many myths, legends, and fairy tales make use of this motif as a central element of narratives that are designed to illustrate inexorable fate, fundamental to the Hellenic world-view. In a common motif, a child, whether newborn or not yet conceived, is prophesied to cause something that those in power do not want to happen. This may be the death of the powerful person; in more light-hearted versions, it is often the marriage of a poor or lower-class child to his own. The events come about, nevertheless, as a result of the actions taken to prevent them: frequently child abandonment sets the chain of events in motion.

Greek

In Greek literature a “prophete” is defined as “one who speaks for another.”

Oedipus in the arms of Phorbas.

The best-known example from Greek legend is that of Oedipus. Warned that his child would one day kill him, Laius abandoned his newborn son Oedipus to die, but Oedipus was found and raised by others, and thus in ignorance of his true origins. When he grew up, Oedipus was warned that he would kill his father and marry his mother. Believing his foster parents were his real parents, he left his home and travelled to Greece, eventually reaching the city where his biological parents lived. There, he got into a fight with a stranger, his real father, killed him and married his widow, Oedipus' real mother.

Although the legend of Perseus opens with the prophecy that he will kill his grandfather Acrisius, and his abandonment with his mother Danaë, the prophecy is only self-fulfilling in some variants. In some, he accidentally spears his grandfather at a competition—an act that could have happened regardless of Acrisius' response to the prophecy. In other variants, his presence at the games is explained by his hearing of the prophecy, so that his attempt to evade it does cause the prophecy to be fulfilled. In still others, Acrisius is one of the wedding guests when Polydectes tried to force Danaë to marry him, and when Perseus turns them to stone with the Gorgon's head; as Polydectes fell in love with Danaë because Acrisius abandoned her at sea, and Perseus killed the Gorgon as a consequence of Polydectes' attempt to get rid of Danaë's son so that he could marry her, the prophecy fulfilled itself in these variants.

Greek historiography provides a famous variant: when the Lydian king Croesus asked the Delphic Oracle if he should invade Persia, the response came that if he did, he would destroy a great kingdom. Assuming this meant he would succeed, he attacked—but the kingdom he destroyed was his own. In such an example, the prophecy prompts someone to action because he is led to expect a favorable result; but he achieves another, disastrous result which nonetheless fulfills the prophecy.

When it was predicted that Cronos would be overthrown by his son, and usurp his throne as King of the Gods, Cronus ate his children, each shortly after they were born. When Zeus was born, Cronos was thwarted by Rhea, who gave him a stone to eat instead, sending Zeus to be raised by Amalthea. Cronos' attempt to avoid the prophecy made Zeus his enemy, ultimately leading to its fulfilment.

Roman

Romulus and Remus nursed by a she-wolf

The story of Romulus and Remus is another example. According to legend, a man overthrew his brother, the king. He then ordered that his two nephews, Romulus and Remus, be drowned, fearing that they would someday kill him as he did to his brother. The boys were placed in a basket and thrown in the Tiber River. A wolf found the babies and she raised them. Later, a shepherd found the twins and named them Romulus and Remus. As teenagers, they found out who they were. They killed their uncle, fulfilling the prophecy.

Arabic

A variation of the self-fulfilling prophecy is the self-fulfilling dream, which dates back to medieval Arabic literature. Several tales in the One Thousand and One Nights, also known as the Arabian Nights, use this device to foreshadow what is going to happen, as a special form of literary prolepsis. A notable example is "The Ruined Man Who Became Rich Again Through a Dream", in which a man is told in his dream to leave his native city of Baghdad and travel to Cairo, where he will discover the whereabouts of some hidden treasure. The man travels there and experiences misfortune after losing belief in the prophecy, ending up in jail, where he tells his dream to a police officer. The officer mocks the idea of foreboding dreams and tells the protagonist that he himself had a dream about a house with a courtyard and fountain in Baghdad where treasure is buried under the fountain. The man recognizes the place as his own house and, after he is released from jail, he returns home and digs up the treasure. In other words, the foreboding dream not only predicted the future, but the dream was the cause of its prediction coming true. A variant of this story later appears in English folklore as the "Pedlar of Swaffham".

Another variation of the self-fulfilling prophecy can be seen in "The Tale of Attaf", where Harun al-Rashid consults his library (the House of Wisdom), reads a random book, "falls to laughing and weeping and dismisses the faithful vizier" Ja'far ibn Yahya from sight. Ja'far, "disturbed and upset flees Baghdad and plunges into a series of adventures in Damascus, involving Attaf and the woman whom Attaf eventually marries." After returning to Baghdad, Ja'far reads the same book that caused Harun to laugh and weep, and discovers that it describes his own adventures with Attaf. In other words, it was Harun's reading of the book that provoked the adventures described in the book to take place. This is an early example of reverse causality. In the 12th century, this tale was translated into Latin by Petrus Alphonsi and included in his Disciplina Clericalis. In the 14th century, a version of this tale also appears in the Gesta Romanorum and Giovanni Boccaccio's The Decameron.

Hinduism

The prophets involved in this religion are considered to be very superior, they have the highest ranking on the class system that one could have, and religious temples or shrines are built in their honor. It is believed in the Hindu religion that the prophets can foretell the future due to what they are experiencing in the “present” time. Many of these prophets are seen to act as “saviors” and “restore justice to the world.”

Krishna playing his flute with Radha.

Self-fulfilling prophecies appear in classical Sanskrit literature. In the story of Krishna in the Indian epic Mahabharata, the ruler of the Mathura kingdom, Kansa, afraid of a prophecy that predicted his death at the hands of his sister Devaki's son, had her cast into prison where he planned to kill all of her children at birth. After killing the first six children, and Devaki's apparent miscarriage of the seventh, Krishna (the eighth son) was born. As his life was in danger he was smuggled out to be raised by his foster parents Yashoda and Nanda in the village of Gokula. Years later, Kansa learned about the child's escape and kept sending various demons to put an end to him. The demons were defeated at the hands of Krishna and his brother Balarama. Krishna, as a young man returned to Mathura to overthrow his uncle, and Kansa was eventually killed by his nephew Krishna. It was due to Kansa's attempts to prevent the prophecy that led to it coming true, thus fulfilling the prophecy.

Ruthenian

Oleg of Novgorod was a Varangian prince who ruled over the Rus people during the early tenth century. As old East Slavic chronicles say, it was prophesied by the pagan priests that Oleg's stallion would be the source of Oleg's death. To avoid this he sent the horse away. Many years later he asked where his horse was, and was told it had died. He asked to see the remains and was taken to the place where the bones lay. When he touched the horse's skull with his boot a snake slithered from the skull and bit him. Oleg died, thus fulfilling the prophecy. In the Primary Chronicle, Oleg is known as the Prophet, ironically referring to the circumstances of his death. The story was romanticized by Alexander Pushkin in his celebrated ballad "The Song of the Wise Oleg". In Scandinavian traditions, this legend lived on in the saga of Orvar-Odd.

European fairy tales

Many fairy tales, such as The Devil With the Three Golden Hairs, The Fish and the Ring, The Story of Three Wonderful Beggars, or The King Who Would Be Stronger Than Fate, revolve about a prophecy that a poor boy will marry a rich girl (or, less frequently, a poor girl a rich boy). This is story type 930 in the Aarne–Thompson classification scheme. The girl's father's efforts to prevent it are the reason why the boy ends up marrying her.

Another fairy tale occurs with older children. In The Language of the Birds, a father forces his son to tell him what the birds say: that the father would be the son's servant. In The Ram, the father forces his daughter to tell him her dream: that her father would hold an ewer for her to wash her hands in. In all such tales, the father takes the child's response as evidence of ill-will and drives the child off; this allows the child to change so that the father will not recognize his own offspring later and so offer to act as the child's servant.

In some variants of Sleeping Beauty, such as Sun, Moon, and Talia, the sleep is not brought about by a curse, but a prophecy that she will be endangered by flax (or hemp) results in the royal order to remove all the flax or hemp from the castle, resulting in her ignorance of the danger and her curiosity.

Shakespeare

Shakespeare's Macbeth is another classic example of a self-fulfilling prophecy. The three witches give Macbeth a prophecy that Macbeth will eventually become king, but afterwards, the offspring of his best friend will rule instead of his own. Macbeth tries to make the first half true while trying to keep his bloodline on the throne instead of his friend's. Spurred by the prophecy, he kills the king and his friend, something he, arguably, never would have done before. In the end, the evil actions he committed to avoid his succession by another's bloodline get him killed in a revolution.

The later prophecy by the first apparition of the witches that Macbeth should "Beware Macduff" is also a self-fulfilling prophecy. If Macbeth had not been told this, then he might not have regarded Macduff as a threat. Therefore, he would not have killed Macduff's family, and Macduff would not have sought revenge and killed Macbeth.

Modern

Fiction

Similar to Oedipus above, a more modern example would be Darth Vader in the Star Wars films, or Lord Voldemort in the Harry Potter franchise and the Big Three in Percy Jackson & the Olympians – each attempted to take steps to prevent action against them which had been predicted could cause their downfall, but instead created the conditions leading to it.

Another, less well-known, modern example occurred with the character John Mitchell on BBC Three's Being Human. The Disney television series That's So Raven stars Raven-Symoné as the title character with the ability to see into the future with a strange situation. The extreme steps that the character takes to prevent the situation are almost always what lead to it. In George R. R. Martin’s book series A Song of Ice and Fire, Cersei Lannister kills a friend of hers after hearing a prophecy, from Maggy the Frog, that said friend will soon die.

The song "Iron Man" by British heavy metal band Black Sabbath follows the story of a self-fulfilling prophecy of a man who travels into the future and sees the apocalypse and tries to warn people, but ends up causing the apocalypse.

New Thought

The law of attraction is a typical example of self-fulfilling prophecy. It is the name given to the belief that "like attracts like" and that by focusing on positive or negative thoughts, one can bring about positive or negative results. According to this law, all things are created first by imagination, which leads to thoughts, then to words and actions. The thoughts, words and actions held in mind affect someone's intentions which makes the expected result happen. Although there are some cases where positive or negative attitudes can produce corresponding results (principally the placebo and nocebo effects), there is no scientific basis to the law of attraction.

Sports

In Canadian ice hockey, junior league players are selected based on skill, motor coordination, physical maturity, and other individual merit criteria. However, psychologist Robert Barnsley showed that in any elite group of hockey players, 40% are born between January and March, versus the approximately 25% as would be predicted by statistics. The explanation is that in Canada, the eligibility cutoff for age-class hockey is January 1, and the players who are born in the first months of the year are older by 0–11 months, which at the preadolescent age of selection (nine or ten) manifests into an important physical advantage. The selected players are exposed to higher levels of coaching, play more games, and have better teammates. These factors make them actually become the best players, fulfilling the prophecy, while the real selection criterion was age. The same relative age effect has been noticed in Belgian soccer after 1997, when the start of the selection year was changed from August 1 to January 1.

In 2008, researchers published a study on how the self-fulfilling prophecy impacted coaching. The study was based on college basketball players and their coaches. Using the CBAS and CDAS (Coaching Behavior Assessment System and Cole’s Descriptive Analysis System) the researchers analyzed the basketball players and coaches. They also used a questionnaire to gather data from the college basketball players. The main component that was analyzed in this study is the feedback that the coaches gave and how the players perceived that feedback. Based on the results of the study, researchers determined that that head coaches gave more biased feedback while assistant coaches gave more critical feedback. This was due to the fact that when the head coaches gave players “feedback” it caused the players to make more mistakes when compared to assistant coaches. Also, researchers found that athletes that were expected to do good often had a really positive perception of their coaches while college basketball players that weren’t expected to do as good often viewed their coaches more negatively.

Researcher Helen Brown published findings of two experiments performed on athletes in regard to the effect that the media has on them. In the first experiment, the athletes were labeled and categorized. During the experiment, the media reporter stated their expectations for the athlete, which would either be good, bad, or a neutral outlook. As a result, from this first experiment, it was concluded that the athlete’s performance was impacted in both a good way and a bad way when they heard what the media’s perception and outlook of their performance was. Experiment two took place in 2012 in London. The difference between experiment two and experiment one is that it happened face to face. The key components being studied in the athletes were their thought process as well as their responses to these expectations that the media was making about them. As a result from the second experiment performed, it was concluded that the media does impact athletes, it impacts their judgement, their thought process and it can even have a dangerous and destructive impact on some athletes. This shows that the self-fulfilling prophecy was fulfilled because when the athlete and the media reporter came face to face and the media reporter began stating their expectations that they expect the athlete to fulfill they were able to “influence the athlete’s cognition.”

Causal loop

A self-fulfilling prophecy may be a form of causality loop. Predestination does not necessarily involve a supernatural power, and could be the result of other "infallible foreknowledge" mechanisms. Problems arising from infallibility and influencing the future are explored in Newcomb's paradox. A notable fictional example of a self-fulfilling prophecy occurs in classical play Oedipus Rex, in which Oedipus becomes the king of Thebes, whilst in the process unwittingly fulfills a prophecy that he would kill his father and marry his mother. The prophecy itself serves as the impetus for his actions, and thus it is self-fulfilling. The movie 12 Monkeys heavily deals with themes of predestination and the Cassandra complex, where the protagonist who travels back in time explains that he cannot change the past.

Glutamate flavoring

From Wikipedia, the free encyclopedia

Crystalline monosodium glutamate (MSG)

Glutamate flavoring is the generic name for flavor-enhancing compounds based on glutamic acid and its salts (glutamates). These compounds provide an umami (savory) taste to food.

Glutamic acid and glutamates are natural constituents of many fermented or aged foods, including soy sauce, fermented bean paste, and cheese. They can also be found in hydrolyzed proteins such as yeast extract. The sodium salt of glutamic acid, monosodium glutamate (MSG), is manufactured on a large scale and widely used in the food industry.

Glutamic acid versus glutamates

When glutamic acid or any of its salts are dissolved in water, they form a solution of separate negative ions, called glutamates, and positive ions like H
3
O+
or Na+
. The result is actually a chemical equilibrium among several ionized forms, including zwitterions, that depends on the pH (acidity) of the solution. Within the common pH range of foods, the prevailing ion can be described as OOC-C(NH+
3
)-(CH
2
)2-COO, which has an electric charge of −1.

Only the glutamate ion is responsible for the umami flavor, so the effect does not depend significantly on the starting compound. However, some crystalline salts such as monosodium glutamate dissolve much better and faster than crystalline glutamic acid. This has proven to be an important factor in the implementation of substances as flavor enhancers.

Discovery

Although they occur naturally in many foods, glutamic acid and other amino acid flavor contributions were not scientifically identified until early in the twentieth century. In 1866, the German chemist Karl Heinrich Ritthausen discovered and identified the compound. In 1907, Japanese researcher Kikunae Ikeda of the Tokyo Imperial University identified brown crystals left behind after the evaporation of a large amount of kombu broth as glutamic acid. These crystals, when tasted, reproduced the ineffable but undeniable flavor detected in many foods, especially seaweed. Professor Ikeda coined the term umami for this flavor. He then patented a method of mass-producing the crystalline salt of glutamic acid known as monosodium glutamate.

Isomers

Further research into the compound has found that only the L-glutamate enantiomer has flavor-enhancing properties. Manufactured monosodium glutamate consists to over 99.6% of the naturally predominant L-glutamate form, which is a higher proportion of L-glutamate than can be found in the free glutamate ions of fermented naturally occurring foods. Fermented products such as soy sauce, steak sauce, and Worcestershire sauce have levels of glutamate similar to those in foods with added monosodium glutamate. However, 5% or more of the glutamate may be the D-enantiomer. Nonfermented naturally occurring foods have lower relative levels of D-glutamate than fermented products do.

Taste perception

Glutamic acid stimulates specific receptors located in taste buds such as the amino acid receptor T1R1/T1R3 or other glutamate receptors like the metabotropic receptors (mGluR4 and mGluR1), which induce the flavor known as umami. This is classified as one of the five basic tastes (the word "umami" is a loanword from Japanese; it is also referred to as "savory" or "meaty").

Structures of inosine-5'-monophosphate (top) and guanosine-5'-monophosphate (bottom).

The flavoring effect of glutamate comes from its free form, in which it is not bound to other amino acids in protein. Nonetheless, glutamate by itself does not elicit an intense umami taste. The mixing of glutamate with nucleotides inosine-5'-monophosphate (IMP) or guanosine-5'-monophosphate (GMP) enhances the taste of umami; T1R1 and T1R3 respond primarily to mixtures of glutamate and nucleotides. While research has shown that this synergism occurs in some animal species with other amino acids, studies of human taste receptors show that the same reaction only occurs between glutamate and the selected nucleotides. Moreover, sodium in monosodium glutamate may activate glutamate to produce a stronger umami taste.

Two hypotheses for the explanation of umami taste transduction have been introduced: the first posits that the umami taste is transduced by an N-methyl-D-aspartate (NMDA) type glutamate ion channel receptor; the second posits that the taste is transduced by a metabotropic type glutamate receptor (taste-mGluR4). The metabotropic glutamate receptors such as mGluR4 and mGluR1 can be easily activated at glutamate concentration levels found in food.

Sources

Natural occurrence

Glutamate is ubiquitous in biological life. It is found naturally in all living cells, primarily in the bound form as a constituent of proteins. Only a fraction of the glutamate in foods is in its "free" form, and only free glutamate produces an umami flavor in foods. The savory flavor of tomatoes, fermented soy products, yeast extracts, certain sharp cheeses, and fermented or hydrolyzed protein products (such as soy sauce and fermented bean paste) is partially due to the presence of free glutamate ions.

Asia

Japanese cuisine originally used broth made from kombu (kelp) to produce the umami taste in soups. Manufacturers, such as Ajinomoto, use selected strains of Corynebacterium glutamicum bacteria in a nutrient-rich medium. The bacteria are selected for their ability to excrete glutamic acid, which is then separated from the nutrient medium and processed into its sodium salt, monosodium glutamate.

Rome

In the Roman Empire glutamic acid was found in a sauce called garum, made from fermenting fish in saltwater. The flavor enhancing properties of glutamic acid allowed Romans to reduce the use of expensive salt.

Concentration in foods

The following table illustrates the glutamate content of some selected common foods. Free glutamate is the form directly tasted and absorbed whereas glutamate bound in protein is not available until further breakdown by digestion or cooking. In general, vegetables contain more free glutamate but less protein-bound glutamate.

Food Free glutamate (mg/100 g) Protein glutamate (mg/100 g)
Makombu (kelp) 3190
Rausu kombu (kelp) 2286
Rishiri kombu (kelp) 1985
Hidaka kombu (kelp) 1344
Nori (seaweed) 1378
Marmite 1960
Vegemite 1431
Japanese fish sauce 1383
Roquefort cheese 1280
Parmesan cheese 1200 9847
Korean soy sauce 1264
Chinese soy sauce 926
Japanese soy sauce 782
Oyster sauce 900
Green Tea 668
Cured Ham 337
Sardine 280
Grape juice 258
Clam 208
Scallop 159
Squid 146
Oyster 137
Mussel 105
Peas 200 5583
Tomatoes 140 238
Corn 130 1765
Potatoes 102
Cow milk 2 819
Human milk 22 229
Eggs 23 1583
Chicken 44 3309
Duck 69 3636
Beef 33 2846
Pork 23 2325
Salmon 20 2216

Hydrolyzed protein

Hydrolyzed proteins, or protein hydrolysates, are acid- or enzymatically treated proteins from certain foods. One example is yeast extract. Hydrolyzed protein contains free amino acids, such as glutamate, at levels of 5% to 20%. Hydrolyzed protein is used in the same manner as monosodium glutamate in many foods, such as canned vegetables, soups, and processed meats.

Safety as a flavor enhancer

Studies

Monosodium glutamate (MSG) is regarded as safe for consumption. An association between MSG consumption and a constellation of symptoms has not been demonstrated under rigorously controlled conditions. Techniques used to adequately control for experimental bias include a placebo-controlled double-blinded experimental design and the use of capsules to deliver the compound to mask the strong and unique after-taste of glutamates. Even though there are also reports of MSG sensitivity among a subset of the population, this has not been demonstrated in placebo‐controlled trials.

Controversy

Origin

The controversy surrounding the safety of MSG started on 4 April 1968, when Dr. Robert Ho Man Kwok wrote a correspondence letter to the New England Journal of Medicine, coining the term "Chinese restaurant syndrome". In his letter, Kwok suggested several possible causes before he nominated MSG for his symptoms. This letter was initially met with insider satirical responses, often using race as prop for humorous effect, within the medical community. Some claimed that during the discursive uptake in media, the conversations were recontextualized as legitimate while the supposed race-based motivations of the humor were not parsed.

In January 2018, Dr. Howard Steel came forth claiming that it was actually a prank submission by him under a pseudonym. However, it turned out that there was a Dr. Robert Ho Man Kwok who worked at the National Biomedical Research Foundation, both names Steel claimed to have invented. Kwok's children, his colleague at the research foundation, and the son of his boss there confirmed that Dr. Robert Ho Man Kwok, who had died in 2014, wrote this letter. After hearing about Kwok's family, Steel's daughter Anna came to believe that the admission that the letter was a prank was itself one of the last pranks by her late father.

Reactions

The misconceptions about MSG are tied to racial stereotypes about East Asians, with people specifically targeting East Asian cuisine, whereas the widespread usage of MSG in Western processed food does not generate the same stigma. For instance, the perpetuation of the negative image of MSG through the so-called Chinese restaurant syndrome has been attributed to xenophobic or racist biases.

In 2020, Ajinomoto, the leading manufacturer of MSG, launched the #RedefineCRS campaign to combat what it said was the myth that MSG is harmful to people's health. Following the #RedefineCRS campaign, Merriam-Webster announced it will be "reviewing" the term, which was added to the dictionary in 1993.

Regulations

Regulation timeline

In 1959, the U.S. Food and Drug Administration (FDA) classified monosodium glutamate as generally recognized as safe (GRAS). This action stemmed from the 1958 Food Additives Amendment to the Federal Food, Drug, and Cosmetic Act that required premarket approval for new food additives and led the FDA to promulgate regulations listing substances, such as monosodium glutamate, which have a history of safe use or are otherwise GRAS.

Since 1970, FDA has sponsored extensive reviews on the safety of monosodium glutamate, other glutamates, and hydrolyzed proteins, as part of an ongoing review of safety data on GRAS substances used in processed foods. One such review was by the Federation of American Societies for Experimental Biology (FASEB) Select Committee on GRAS Substances. In 1980, the committee concluded that monosodium glutamate was safe at current levels of use but recommended additional evaluation to determine monosodium glutamate's safety at significantly higher levels of consumption. Additional reports attempted to look at this.

In 1986, FDA's Advisory Committee on Hypersensitivity to Food Constituents concluded that monosodium glutamate poses no threat to the general public but that reactions of brief duration might occur in some people. Other reports have given the following findings:

  • The 1987 Joint Expert Committee on Food Additives of the United Nations Food and Agriculture Organization and the World Health Organization placed monosodium glutamate in the safest category of food ingredients.
  • A 1991 report by the European Community's (EC) Scientific Committee for Foods reaffirmed monosodium glutamate's safety and classified its "acceptable daily intake" as "not specified", the most favorable designation for a food ingredient. In addition, the EC Committee said, "Infants, including prematures, have been shown to metabolize glutamate as efficiently as adults and therefore do not display any special susceptibility to elevated oral intakes of glutamate." Legislation in effect since June 2013 classifies glutamic acid and glutamates as salt substitutes, seasonings, and condiments with a maximum level of consumption of 10g/kg expressed as glutamic acid.

European Union

Following the compulsory EU-food labeling law the use of glutamic acid and its salts has to be declared, and the name or E number of the salt has to be listed. Glutamic acid and its salts as food additives have the following E numbers: glutamic acid: E620, monosodium glutamate: E621, monopotassium glutamate: E622, calcium diglutamate: E623, monoammonium glutamate: E624, and magnesium diglutamate: E625. In the European Union, these substances are regarded as "flavor enhancers" and are not allowed to be added to milk, emulsified fat and oil, pasta, cocoa/chocolate products and fruit juice. The EU has not yet published an official NOAEL (no observable adverse effect level) for glutamate, but a 2006 consensus statement of a group of German experts drawing from animal studies was that a daily intake of glutamic acid of 6 grams per kilogram of body weight (6 g/kg/day) is safe. From human studies, the experts noted that doses as high as 147g/day produced no adverse effects in males when given for 30 days; in a 70 kg (150 lb) male, this amount corresponds to 2.1 g per kg of body weight.

United States

In 1959, the Food and Drug Administration classified MSG as a "generally recognized as safe" (GRAS) food ingredient under the Federal Food, Drug, and Cosmetic Act. In 1986, FDA's Advisory Committee on Hypersensitivity to Food Constituents also found that MSG was generally safe, but that short-term reactions may occur in some people. To further investigate this matter, in 1992 the FDA contracted the Federation of American Societies for Experimental Biology (FASEB) to produce a detailed report, which was published in 1995. The FASEB report reaffirmed the safety of MSG when it is consumed at usual levels by the general population, and found no evidence of any connection between MSG and any serious long-term reactions.

Under 2003 U.S. Food and Drug Administration regulations, when monosodium glutamate is added to a food, it must be identified as "monosodium glutamate" in the label's ingredient list. Because glutamate is commonly found in food, primarily from protein sources, the FDA does not require foods and ingredients that contain glutamate as an inherent component to list it on the label. Examples include tomatoes, cheeses, meats, hydrolyzed protein products such as soy sauce, and autolyzed yeast extracts. These ingredients are to be declared on the label by their common or usual names. The term 'natural flavor' is now used by the food industry when using glutamic acid. Because of lack of regulation, it is impossible to determine what percentage of 'natural flavor' is actually glutamic acid.

The food additives disodium inosinate and disodium guanylate are usually used in synergy with monosodium glutamate-containing ingredients, and provide a likely indicator of the addition of glutamate to a product.

As of 2002 the National Academy of Sciences Committee on Dietary Reference Intakes had not set a NOAEL or LOAEL for glutamate.

Australia and New Zealand

Standard 1.2.4 of the Australia New Zealand Food Standards Code requires the presence of monosodium glutamate as a food additive to be labeled. The label must bear the food additive class name (such as "flavor enhancer"), followed by either the name of the food additive (such as "MSG") or its International Numbering System (INS) number (e.g., "621").

Canada

The Canada Food Inspection Agency considers claims of "no MSG" or "MSG free" to be misleading and deceptive when other sources of free glutamates are present.

Ingredients

Forms of glutamic acid that can be added to food include:

The following are also rich sources of glutamic acid, and may be added for umami flavor:

Nocebo

From Wikipedia, the free encyclopedia

A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication, they can suffer that effect even if the "medication" is actually an inert substance. The complementary concept, the placebo effect, is said to occur when positive expectations improve an outcome. Both placebo and nocebo effects are presumably psychogenic, but they can induce measurable changes in the body. One article that reviewed 31 studies on nocebo effects reported a wide range of symptoms that could manifest as nocebo effects including nausea, stomach pains, itching, bloating, depression, sleep problems, loss of appetite, sexual dysfunction and severe hypotension.

Etymology and usage

The term nocebo (Latin nocēbō, "I shall harm", from noceō, "I harm") was coined by Walter Kennedy in 1961 to denote the counterpart to the use of placebo (Latin placēbō, "I shall please", from placeō, "I please"; a substance that may produce a beneficial, healthful, pleasant, or desirable effect). Kennedy emphasized that his use of the term "nocebo" refers strictly to a subject-centered response, a quality inherent in the patient rather than in the remedy". That is, Kennedy rejected the use of the term for pharmacologically-induced negative side effects such as the ringing in the ears caused by quinine. That is not to say that the patient's psychologically-induced response may not include physiological effects. For example, an expectation of pain may induce anxiety, which in turn causes the release of cholecystokinin, which facilitates pain transmission.

Response

In the narrowest sense, a nocebo response occurs when a drug-trial subject's symptoms are worsened by the administration of an inert, sham, or dummy (simulator) treatment, called a placebo. According to current pharmacological knowledge and the current understanding of cause and effect, a placebo contains no chemical (or any other agent) that could possibly cause any of the observed worsening in the subject's symptoms. Thus, any change for the worse must be due to some subjective factor. Adverse expectations can also cause the analgesic effects of anesthetic medications to disappear.

The worsening of the subject's symptoms or reduction of beneficial effects is a direct consequence of their exposure to the placebo, but those symptoms have not been chemically generated by the placebo. Because this generation of symptoms entails a complex of "subject-internal" activities, in the strictest sense, we can never speak in terms of simulator-centered "nocebo effects", but only in terms of subject-centered "nocebo responses". Although some observers attribute nocebo responses (or placebo responses) to a subject's gullibility, there is no evidence that an individual who manifests a nocebo/placebo response to one treatment will manifest a nocebo/placebo response to any other treatment; i.e., there is no fixed nocebo/placebo-responding trait or propensity.

McGlashan, Evans & Orne (1969, p. 319) found no evidence of what they termed a "placebo personality". Also, in a carefully designed study, Lasagna, Mosteller, von Felsinger and Beecher (1954), found that there was no way that any observer could determine, by testing or by interview, which subject would manifest a placebo reaction and which would not. Experiments have shown that no relationship exists between an individual's measured hypnotic susceptibility and their manifestation of nocebo or placebo responses.

Effects

Side effects of drugs

It has been shown that, due to the nocebo effect, warning patients about side effects of drugs can contribute to the causation of such effects, whether the drug is real or not. This effect has been observed in clinical trials: according to a 2013 review, the dropout rate among placebo-treated patients in a meta-analysis of 41 clinical trials of Parkinson's disease treatments was 8.8%. A 2013 review found that nearly 1 out of 20 patients receiving a placebo in clinical trials for depression dropped out due to adverse events, which were believed to have been caused by the nocebo effect. A 2018 review found that half of patients taking placebos in clinical trials report intervention-related adverse events.

Electromagnetic hypersensitivity

Evidence suggests that the symptoms of electromagnetic hypersensitivity are caused by the nocebo effect.

Pain

Verbal suggestion can cause hyperalgesia (increased sensitivity to pain) and allodynia (perception of a tactile stimulus as painful) as a result of the nocebo effect. Nocebo hyperalgesia is believed to involve the activation of cholecystokinin receptors.

Ambiguity of medical usage

Stewart-Williams and Podd argue that using the contrasting terms "placebo" and "nocebo" to label inert agents that produce pleasant, health-improving, or desirable outcomes versus unpleasant, health-diminishing, or undesirable outcomes (respectively), is extremely counterproductive. For example, precisely the same inert agents can produce analgesia and hyperalgesia, the first of which, from this definition, would be a placebo, and the second a nocebo.

A second problem is that the same effect, such as immunosuppression, may be desirable for a subject with an autoimmune disorder, but be undesirable for most other subjects. Thus, in the first case, the effect would be a placebo, and in the second, a nocebo. A third problem is that the prescriber does not know whether the relevant subjects consider the effects that they experience to be desirable or undesirable until some time after the drugs have been administered. A fourth problem is that the same phenomena are being generated in all the subjects, and these are being generated by the same drug, which is acting in all of the subjects through the same mechanism. Yet because the phenomena in question have been subjectively considered to be desirable to one group but not the other, the phenomena are now being labelled in two mutually exclusive ways (i.e., placebo and nocebo); and this is giving the false impression that the drug in question has produced two different phenomena.

Ambiguity of anthropological usage

Some people maintain that belief kills (e.g., "voodoo death": Cannon (1942) describes a number of instances from a variety of different cultures) and belief heals (e.g., faith healing). A "self-willed" death (due to voodoo hex, evil eye, pointing the bone procedure, etc.) is an extreme form of a culture-specific syndrome or mass psychogenic illness that produces a particular form of psychosomatic or psychophysiological disorder which results in a psychogenic death. Rubel (1964) spoke of "culture bound" syndromes, which were those "from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventive measures, and regimens of healing".

Certain anthropologists, such as Robert Hahn and Arthur Kleinman, have extended the placebo/nocebo distinction into this realm in order to allow a distinction to be made between rituals, like faith healing, that are performed in order to heal, cure, or bring benefit (placebo rituals) and others, like "pointing the bone", that are performed in order to kill, injure or bring harm (nocebo rituals). As the meaning of the two inter-related and opposing terms has extended, we now find anthropologists speaking, in various contexts, of nocebo or placebo (harmful or helpful) rituals:

  • that might entail nocebo or placebo (unpleasant or pleasant) procedures;
  • about which subjects might have nocebo or placebo (harmful or beneficial) beliefs;
  • that are delivered by operators that might have nocebo or placebo (pathogenic, disease-generating or salutogenic, health-promoting) expectations;
  • that are delivered to subjects that might have nocebo or placebo (negative, fearful, despairing or positive, hopeful, confident) expectations about the ritual;
  • which are delivered by operators who might have nocebo or placebo (malevolent or benevolent) intentions, in the hope that the rituals will generate nocebo or placebo (lethal, injurious, harmful or restorative, curative, healthy) outcomes; and, that all of this depends upon the operator's overall beliefs in the harmful nature of the nocebo ritual or the beneficial nature of the placebo ritual.

Yet, it may become even more terminologically complex; for, as Hahn and Kleinman indicate, there can also be cases where there are paradoxical nocebo outcomes from placebo rituals (e.g. the TGN1412 drug trial), as well as paradoxical placebo outcomes from nocebo rituals (see also unintended consequences). Writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton (1973) warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, simply turned their face to the wall and died a premature death: "there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')".

Ethics

A number of researchers have pointed out that the harm caused by communicating with patients about potential treatment adverse events raises an ethical issue. Informing a patient about what harms a treatment is likely to cause is required to respect autonomy. Yet the way in which potential harms are communicated could cause additional harm, which may violate the ethical principle of non-maleficence. It may be possible that nocebo effects can be reduced while respecting autonomy using different models of informed consent, including the use of a framing effect  and the authorized concealment. In fact, it has been argued that forcing patients to learn about all potential adverse events against their will could violate autonomy.

Placebo

From Wikipedia, the free encyclopedia

Placebos are typically inert tablets, such as sugar pills

A placebo (/pləˈsb/ plə-SEE-boh) is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures.

In general, placebos can affect how patients perceive their condition and encourage the body's chemical processes for relieving pain and a few other symptoms, but have no impact on the disease itself. 

Improvements that patients experience after being treated with a placebo can also be due to unrelated factors, such as regression to the mean (a natural recovery from the illness). The use of placebos in clinical medicine raises ethical concerns, especially if they are disguised as an active treatment, as this introduces dishonesty into the doctor–patient relationship and bypasses informed consent. While it was once assumed that this deception was necessary for placebos to have any effect, there is now evidence that placebos can have effects even when the patient is aware that the treatment is a placebo.

In drug testing and medical research, a placebo can be made to resemble an active medication or therapy so that it functions as a control; this is to prevent the recipient or others from knowing (with their consent) whether a treatment is active or inactive, as expectations about efficacy can influence results. In a placebo-controlled clinical trial any change in the control group is known as the placebo response, and the difference between this and the result of no treatment is the placebo effect. Some researchers now recommend comparing the experimental treatment with an existing treatment when possible, instead of a placebo.

The idea of a placebo effect—a therapeutic outcome derived from an inert treatment—was discussed in 18th century psychology but became more prominent in the 20th century. An influential 1955 study entitled The Powerful Placebo firmly established the idea that placebo effects were clinically important, and were a result of the brain's role in physical health. A 1997 reassessment found no evidence of any placebo effect in the source data, as the study had not accounted for regression to the mean.

Etymology

Placebo is Latin for I shall be pleasing. It was used as a name for the Vespers in the Office of the Dead, taken from a phrase used in it, a quote from the Vulgate's Psalm 116:9, placēbō Dominō in regiōne vīvōrum, "I shall please the Lord in the land of the living." From that, a singer of placebo became associated with someone who falsely claimed a connection to the deceased to get a share of the funeral meal, and hence a flatterer, and so a deceptive act to please.

Definitions

The American Society of Pain Management Nursing define a placebo as "any sham medication or procedure designed to be void of any known therapeutic value".

In a clinical trial, a placebo response is the measured response of subjects to a placebo; the placebo effect is the difference between that response and no treatment. For example, the placebo response includes improvements due to natural healing, declines due to natural disease progression, the tendency for people who were temporarily feeling either better or worse than usual to return to their average situations (regression toward the mean), and even errors in the clinical trial records, which can make it appear that a change has happened when nothing has changed. It is also part of the recorded response to any active medical intervention.

Any measurable placebo effect is termed either objective (e.g. lowered blood pressure) or subjective (e.g. a lowered perception of pain).

Effects

How alternative therapies can have a perceived effect:
a) Misinterpreted natural course – the individual gets better without treatment.
b) Placebo effect or false treatment effect – an individual receives an alternative therapy and is convinced it will help. The conviction makes them more likely to get better.
c) Nocebo effect – an individual is convinced that standard treatment will not work, and that alternative therapies will work. This decreases the likelihood standard treatment will work, while the placebo effect of the alternative remains.
d) No adverse effects – Standard treatment is replaced with an alternative therapy, getting rid of adverse side-effects, but also of improvement.
e) Interference – Standard treatment is given alongside an alternative therapy that interferes with its effect. This can both reduce the main effect of the standard treatment, but also decrease (or even increase) side-effects, which may be interpreted as helping. Researchers, such as epidemiologists, clinical statisticians and pharmacologists, use clinical trials to reveal such effects, allowing physicians to offer a therapeutic solution best known to work. "Alternative treatments" often refuse to use trials or make it deliberately hard to do so.

Placebos can improve patient-reported outcomes such as pain and nausea. This effect is unpredictable and hard to measure, even in the best conducted trials. For example, if used to treat insomnia, placebos can cause patients to perceive that they are sleeping better, but do not improve objective measurements of sleep onset latency. A 2001 Cochrane Collaboration meta-analysis of the placebo effect looked at trials in 40 different medical conditions, and concluded the only one where it had been shown to have a significant effect was for pain.

By contrast, placebos do not appear to affect the actual diseases, or outcomes that are not dependent on a patient's perception. One exception to the latter is Parkinson's disease, where recent research has linked placebo interventions to improved motor functions.

Measuring the extent of the placebo effect is difficult due to confounding factors. For example, a patient may feel better after taking a placebo due to regression to the mean (i.e. a natural recovery or change in symptoms). It is harder still to tell the difference between the placebo effect and the effects of response bias, observer bias and other flaws in trial methodology, as a trial comparing placebo treatment and no treatment will not be a blinded experiment. In their 2010 meta-analysis of the placebo effect, Asbjørn Hróbjartsson and Peter C. Gøtzsche argue that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding."

Hróbjartsson and Gøtzsche concluded that their study "did not find that placebo interventions have important clinical effects in general". Jeremy Howick has argued that combining so many varied studies to produce a single average might obscure that "some placebos for some things could be quite effective." To demonstrate this, he participated in a systematic review comparing active treatments and placebos using a similar method, which generated a clearly misleading conclusion that there is "no difference between treatment and placebo effects".

Factors influencing the power of the placebo effect

A review published in JAMA Psychiatry found that, in trials of antipsychotic medications, the change in response to receiving a placebo had increased significantly between 1960 and 2013. The review's authors identified several factors that could be responsible for this change, including inflation of baseline scores and enrollment of fewer severely ill patients. Another analysis published in Pain in 2015 found that placebo responses had increased considerably in neuropathic pain clinical trials conducted in the United States from 1990 to 2013. The researchers suggested that this may be because such trials have "increased in study size and length" during this time period.

Children seem to have greater response than adults to placebos.

The administration of the placebos can determine the placebo effect strength. Studies have found that taking more pills would strengthen the effect. Besides, capsules appear to be more influential than pills, and injections are even stronger than capsules.

Some studies have investigated the use of placebos where the patient is fully aware that the treatment is inert, known as an open-label placebo. A meta-analysis found some evidence that open-label placebos may have positive effects in comparison to no treatment, which may open new avenues for treatments, but noted the trials were done with a small number of participants and hence should be interpreted with "caution" until further better controlled trials are conducted.

If the person dispensing the placebo shows their care towards the patient, is friendly and sympathetic, or has a high expectation of a treatment's success, then the placebo would be more effectual.

Symptoms and conditions

A 2010 Cochrane Collaboration review suggests that placebo effects are apparent only in subjective, continuous measures, and in the treatment of pain and related conditions.

Pain

Placebos are believed to be capable of altering a person's perception of pain. "A person might reinterpret a sharp pain as uncomfortable tingling."

One way in which the magnitude of placebo analgesia can be measured is by conducting "open/hidden" studies, in which some patients receive an analgesic and are informed that they will be receiving it (open), while others are administered the same drug without their knowledge (hidden). Such studies have found that analgesics are considerably more effective when the patient knows they are receiving them.

Depression

In 2008, a controversial meta-analysis led by psychologist Irving Kirsch, analyzing data from the FDA, concluded that 82% of the response to antidepressants was accounted for by placebos. However, there are serious doubts about the used methods and the interpretation of the results, especially the use of 0.5 as cut-off point for the effect-size. A complete reanalysis and recalculation based on the same FDA data discovered that the Kirsch study suffered from "important flaws in the calculations". The authors concluded that although a large percentage of the placebo response was due to expectancy, this was not true for the active drug. Besides confirming drug effectiveness, they found that the drug effect was not related to depression severity.

Another meta-analysis found that 79% of depressed patients receiving placebo remained well (for 12 weeks after an initial 6–8 weeks of successful therapy) compared to 93% of those receiving antidepressants. In the continuation phase however, patients on placebo relapsed significantly more often than patients on antidepressants.

Negative effects

A phenomenon opposite to the placebo effect has also been observed. When an inactive substance or treatment is administered to a recipient who has an expectation of it having a negative impact, this intervention is known as a nocebo (Latin nocebo = "I shall harm"). A nocebo effect occurs when the recipient of an inert substance reports a negative effect or a worsening of symptoms, with the outcome resulting not from the substance itself, but from negative expectations about the treatment.

Another negative consequence is that placebos can cause side-effects associated with real treatment. Failure to minimise nocebo side-effects in clinical trials and clinical practice raises a number of recently explored ethical issues.

Withdrawal symptoms can also occur after placebo treatment. This was found, for example, after the discontinuation of the Women's Health Initiative study of hormone replacement therapy for menopause. Women had been on placebo for an average of 5.7 years. Moderate or severe withdrawal symptoms were reported by 4.8% of those on placebo compared to 21.3% of those on hormone replacement.

Ethics

In research trials

Knowingly giving a person a placebo when there is an effective treatment available is a bioethically complex issue. While placebo-controlled trials might provide information about the effectiveness of a treatment, it denies some patients what could be the best available (if unproven) treatment. Informed consent is usually required for a study to be considered ethical, including the disclosure that some test subjects will receive placebo treatments.

The ethics of placebo-controlled studies have been debated in the revision process of the Declaration of Helsinki. Of particular concern has been the difference between trials comparing inert placebos with experimental treatments, versus comparing the best available treatment with an experimental treatment; and differences between trials in the sponsor's developed countries versus the trial's targeted developing countries.

Some suggest that existing medical treatments should be used instead of placebos, to avoid having some patients not receive medicine during the trial.

In medical practice

The practice of doctors prescribing placebos that are disguised as real medication is controversial. A chief concern is that it is deceptive and could harm the doctor–patient relationship in the long run. While some say that blanket consent, or the general consent to unspecified treatment given by patients beforehand, is ethical, others argue that patients should always obtain specific information about the name of the drug they are receiving, its side effects, and other treatment options. This view is shared by some on the grounds of patient autonomy. There are also concerns that legitimate doctors and pharmacists could open themselves up to charges of fraud or malpractice by using a placebo. Critics also argued that using placebos can delay the proper diagnosis and treatment of serious medical conditions.

Despite the abovementioned issues, 60% of surveyed physicians and head nurses reported using placebos in an Israeli study, with only 5% of respondents stating that placebo use should be strictly prohibited. A British Medical Journal editorial said, "that a patient gets pain relief from a placebo does not imply that the pain is not real or organic in origin ...the use of the placebo for 'diagnosis' of whether or not pain is real is misguided." A survey in the United States of more than 10,000 physicians came to the result that while 24% of physicians would prescribe a treatment that is a placebo simply because the patient wanted treatment, 58% would not, and for the remaining 18%, it would depend on the circumstances.

Referring specifically to homeopathy, the House of Commons of the United Kingdom Science and Technology Committee has stated:

In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice—which the Government claims is very important—as it means patients do not have all the information needed to make choice meaningful. A further issue is that the placebo effect is unreliable and unpredictable.

In his 2008 book Bad Science, Ben Goldacre argues that instead of deceiving patients with placebos, doctors should use the placebo effect to enhance effective medicines. Edzard Ernst has argued similarly that "As a good doctor you should be able to transmit a placebo effect through the compassion you show your patients." In an opinion piece about homeopathy, Ernst argues that it is wrong to support alternative medicine on the basis that it can make patients feel better through the placebo effect. His concerns are that it is deceitful and that the placebo effect is unreliable. Goldacre also concludes that the placebo effect does not justify alternative medicine, arguing that unscientific medicine could lead to patients not receiving prevention advice.

Mechanisms

Expectation plays a clear role. A placebo presented as a stimulant may trigger an effect on heart rhythm and blood pressure, but when administered as a depressant, the opposite effect.

Psychology

The "placebo effect" may be related to expectations

In psychology, the two main hypotheses of placebo effect are expectancy theory and classical conditioning.

In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different. According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Similarly, the appearance of effect can result from classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. Both conditioning and expectations play a role in placebo effect, and make different kinds of contribution. Conditioning has a longer-lasting effect, and can affect earlier stages of information processing. Those who think a treatment will work display a stronger placebo effect than those who do not, as evidenced by a study of acupuncture.

Additionally, motivation may contribute to the placebo effect. The active goals of an individual changes their somatic experience by altering the detection and interpretation of expectation-congruent symptoms, and by changing the behavioral strategies a person pursues. Motivation may link to the meaning through which people experience illness and treatment. Such meaning is derived from the culture in which they live and which informs them about the nature of illness and how it responds to treatment.

Placebo analgesia

Functional imaging upon placebo analgesia suggests links to the activation, and increased functional correlation between this activation, in the anterior cingulate, prefrontal, orbitofrontal and insular cortices, nucleus accumbens, amygdala, the brainstem periaqueductal gray matter, and the spinal cord.

It has been known that placebo analgesia depends upon the release in the brain of endogenous opioids since 1978. Such analgesic placebos activation changes processing lower down in the brain by enhancing the descending inhibition through the periaqueductal gray on spinal nociceptive reflexes, while the expectations of anti-analgesic nocebos acts in the opposite way to block this.

Functional imaging upon placebo analgesia has been summarized as showing that the placebo response is "mediated by "top-down" processes dependent on frontal cortical areas that generate and maintain cognitive expectancies. Dopaminergic reward pathways may underlie these expectancies". "Diseases lacking major 'top-down' or cortically based regulation may be less prone to placebo-related improvement".

Brain and body

In conditioning, a neutral stimulus saccharin is paired in a drink with an agent that produces an unconditioned response. For example, that agent might be cyclophosphamide, which causes immunosuppression. After learning this pairing, the taste of saccharin by itself is able to cause immunosuppression, as a new conditioned response via neural top-down control. Such conditioning has been found to affect a diverse variety of not just basic physiological processes in the immune system but ones such as serum iron levels, oxidative DNA damage levels, and insulin secretion. Recent reviews have argued that the placebo effect is due to top-down control by the brain for immunity and pain. Pacheco-López and colleagues have raised the possibility of "neocortical-sympathetic-immune axis providing neuroanatomical substrates that might explain the link between placebo/conditioned and placebo/expectation responses". There has also been research aiming to understand underlying neurobiological mechanisms of action in pain relief, immunosuppression, Parkinson's disease and depression.

Dopaminergic pathways have been implicated in the placebo response in pain and depression.

Confounding factors

Placebo-controlled studies, as well as studies of the placebo effect itself, often fail to adequately identify confounding factors. False impressions of placebo effects are caused by many factors including:

  • Regression to the mean (natural recovery or fluctuation of symptoms)
  • Additional treatments
  • Response bias from subjects, including scaling bias, answers of politeness, experimental subordination, conditioned answers;
  • Reporting bias from experimenters, including misjudgment and irrelevant response variables.
  • Non-inert ingredients of the placebo medication having an unintended physical effect

History

A quack treating a patient with Perkins Patent Tractors by James Gillray, 1801. John Haygarth used this remedy to illustrate the power of the placebo effect.

The word placebo was used in a medicinal context in the late 18th century to describe a "commonplace method or medicine" and in 1811 it was defined as "any medicine adapted more to please than to benefit the patient". Although this definition contained a derogatory implication it did not necessarily imply that the remedy had no effect.

It was recognized in the 18th and 19th centuries that drugs or remedies often worked best while they were still new:

We know that, in Paris, fashion imposes its dictates on medicine just as it does with everything else. Well, at one time, pyramidal elm bark had a great reputation; it was taken as a powder, as an extract, as an elixir, even in baths. It was good for the nerves, the chest, the stomach — what can I say? — it was a true panacea. At the peak of the fad, one of Bouvard’s [sic] patients asked him if it might not be a good idea to take some: "Take it, Madame", he replied, "and hurry up while it [still] cures." [dépêchez-vous pendant qu’elle guérit]

— Gaston de Lévis quoting Michel-Philippe Bouvart in the 1780s

Placebos have featured in medical use until well into the twentieth century. In 1955 Henry K. Beecher published an influential paper entitled The Powerful Placebo which proposed idea that placebo effects were clinically important. Subsequent re-analysis of his materials, however, found in them no evidence of any "placebo effect".

Placebo-controlled studies

The placebo effect makes it more difficult to evaluate new treatments. Clinical trials control for this effect by including a group of subjects that receives a sham treatment. The subjects in such trials are blinded as to whether they receive the treatment or a placebo. If a person is given a placebo under one name, and they respond, they will respond in the same way on a later occasion to that placebo under that name but not if under another.

Clinical trials are often double-blinded so that the researchers also do not know which test subjects are receiving the active or placebo treatment. The placebo effect in such clinical trials is weaker than in normal therapy since the subjects are not sure whether the treatment they are receiving is active.

Butane

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