Script: Placebo Effect Matt Biggers, Amelia Hulbert, Kathryn Valchar

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1 Script: Placebo Effect Matt Biggers, Amelia Hulbert, Kathryn Valchar Cast of Characters Scene 1 Doctor Ruth Cannon Patient 1 Mark Bridges Patient 2 Stella Brody Doctor Doris Bradley Open on a doctor s office Doctor Cannon: Hello, I m Dr. Ruth Cannon. Welcome to the drug trial for AMK-32, a new anti-depressant. You have been selected for the trial of this new drug. Over the next few visits, we will be testing its effects. I just need you to answer a few questions. This is the pill that you both will be taking. It needs to be taken four times a day with food, for seven days. After seven days, you will need to come back to my office for a follow up appointment, where we will assess the drug s effects. Now, let s start with you sir, please tell me your name. Patient 1: Mark Bridges Doctor: Age? Mark: 30 Doctor: What symptoms are you experiencing? Mark: I m having trouble sleeping, I can t eat, and I always feel hopeless, like there s a dark cloud following me around. Doctor: When would you say you started experiencing these symptoms? Mark: I ve been having these feelings for a while, but they really got bad about 3 months ago. Doctor: Well Mark, it sounds like you might be experiencing depression. Now, depression can be very serious, and it is actually much more common than most people think. It can be caused by chemical imbalances in your brain, possibly caused by a smaller hippocampus, a section of your brain that deals with serotonin, the chemical that makes you feel happy. Pause to see a diagram of the brain, with voicethread to point out where the hippocampus is.

"Learning and Emotion." 7 July 2006. CTER. 21 November 2010 <http://wik.ed.uiuc.edu/index.php/learning_and_emotion>. Mark: Geez, I hope my brain is okay. I m willing to try anything.

2 "Learning and Emotion." 7 July CTER. 21 November 2010 < Mark: Geez, I hope my brain is okay. I m willing to try anything. I just want to feel happy again. Doctor: Well Mark, this new drug should increase your levels of serotonin and should make you feel much better. Mark: Okay. Thank you. I hope that this will help. Doctor: Now, would you please tell me your name, miss. Patient 2: Stella Brody. Doctor: Your age? Stella: 23 Doctor: What are your symptoms? Stella: I can t get out of bed in the morning. I think I m getting enough sleep, but I m always so tired. I m more irritable than I used to be, and I find it really hard to concentrate.

3 Doctor: How long have you been experiencing these symptoms? Stella: For the past six weeks or so. Doctor: Well Stella, it sounds like you may also be suffering from depression. But don t be discouraged, this new drug should really help with your problems. Stella: Thanks a lot Doc. I hope I feel better soon. Scene 2 Break room: Doctor is seen talking to a colleague. Doctor Bradley: So how s the depression trial going? Doctor Cannon: It s going well. I met with two patients recently who seem to have the same level of depression. I gave one our new drug, AMK-32, and the other one got the placebo, the inert pill. I m really excited to see how the drug does against the placebo and if the patients respond equally or not. This new drug really could be a breakthrough for us. Bradley: So, does the placebo pill look the same as the anti-depressant? Cannon: Yes, they look exactly the same. The placebo is a control for the AMK- 32. Hopefully, the drug will fair better than the placebo pill, so that we can put it on the market. Scene 3 Doctor s office a week later, follow up appointment with both patients Doctor Cannon: It s so nice to see you again, welcome back. Mark: grinning Thank you so much! It s wonderful to see you, I feel great! My dark cloud is gone! Stella: Me too! I ve felt so rested this past week and I can concentrate again! Doctor: That s great you guys! But, please fill out this detailed questionnaire so we can specifically monitor your improvement. After you re done with that, you are free to leave, although we will be having another follow up appointment in one month. Please continue taking your pills as previously instructed. See you then! Scene 4 Break room with colleagues. Doctor Cannon: UGH, these results are terrible! The placebo effect has ruined my drug trial! The results are the same for the placebo pill and for the actual drug! I don t understand how it can be so powerful!

Bradley: What did the pill look like, and how many times a day is it taken? Cannon: It s green, round, big, and normal looking, with a stamp of the drug name on it. It s taken four times a day.

4 Bradley: What did the pill look like, and how many times a day is it taken? Cannon: It s green, round, big, and normal looking, with a stamp of the drug name on it. It s taken four times a day. Bradley: Actually, it has been shown that the color of the drug can influence the results. Green pills reduce anxiety through the placebo effect, and the more times you take the pill per day, the more you believe it s working. Cannon: I don t even really know how the placebo effect works! Bradley: Often being told that you will get better is enough to make it so. It has been found that the placebo effect is controlled by opioids, which are neurotransmitters that the brain produces, which are released when the body is stressed. Neurotransmitters are chemicals that transfer signals from a neuron to a target cell across a synapse. Voicethread: circle brain areas on diagram Various regions of the brain are affected, such as the basal ganglia, anterior cingulate cortex, and the corsolateral prefrontal cortex. But we re still not really sure how these regions are specifically signaled. Brainwave Mind Voyages November 2010 < Bradley: We ve begun research on the biological impacts through neuroimaging, where we can study the brain s activity when under a placebo. In a Parkinson s disease trial, the neuroimaging scan shows the specific areas of the brain that are activated

5 by the placebo, and they are the same areas responsible for the release of dopamine, which Parkinson s disease patients lack. Switch to voicethread voiceover with picture In the picture, the more red an area, the more dulled, so as you see in the after placebo image, those areas that are less red have been activated. These patients begin to feel better from a placebo due to the known psychological implications as well as these new biological findings. Lidstone, S. C., & Stoessl, J. A. (2007). Understanding the Placebo Effect: Contributions From Neuroimaging. Molecular Imaging and Biology, Cannon: Oh, well I guess we are going to have to redesign our drug trial! I didn t realize the placebo effect was such a problem for drug companies.

QUESTIONS ANSWERED BY

Module 16 QUESTIONS ANSWERED BY BERNIE SIEGEL, MD 2 Q How do our thoughts and beliefs affect the health of our bodies? A You can t separate thoughts and beliefs from your body. What you think and what