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LEFT The hormone cortisol, seen here in a microscope image taken with polarised light, is released in response to stress. High levels over long periods of time have a negative e ect on health THE ETHICS OF PLACEBO SURGERY US. In the research, she discovered that those who are the most optimistic have roughly 15 per cent longer lifespans than those who are the least optimistic. In part, it is thought that differences in longevity like this are down to the fact that those with positive attitudes tend to do more exercise and smoke less. But it is not just that. “People with higher levels of positive emotions do a better job of managing stress,” explains Kubzansky. “So a lot of the stress-activated biochemical processes, like higher levels of cortisol that are circulating and driving inflammation, are less likely to occur.” Reduced stress also reduces ‘allostatic load’ – a medical term for the general wear and tear on the body, such as strain on the internal organs, that takes place under long-term stress. 74% 51% But, says Kubzansky, this is likely to just be part of the picture – there will be other biochemical processes within our cells that are influenced by our positivity that we’re not aware of yet. Part of the problem is that medical research has been understandably focused on getting to grips with what’s going on in our bodies when we’re ill, rather than when we’re feeling well and things are going right. “We’re not very good at looking at the biology of good functioning, we mostly just look at the biology of normal or bad,” she says. “But the time for positive biology has come.” One of Kubzansky’s priorities now is to look at how our microbiome – the bacteria and other microorganisms that live inside our bodies, particularly in the gut – are influenced by how positive we are. “There is some preliminary research that links depression to alterations in the gut microbiome, so it’s logical to speculate that you might get effects in the other direction,” says Kubzansky. The effect of our mental state on the microbes inside us is a big deal because the health and make-up of these microbes has been linked to several aspects of our physical health, such as whether or not we’re overweight. The percentage of studies where patients improve a er placebo surgery The percentage of trials where placebo surgery is as e ective as the real thing I B R A R Y LP H O T O I E N C E S C TRICKING THE TELOMERES There’s already evidence that the way we think can influence our DNA. For more than a decade now, the laboratory of molecular biologist Dr Elizabeth Blackburn at University of California, San Francisco, has been investigating the inf luence of our state of mind on our telomeres – the chunks of DNA that act as protective caps at the end of chromosomes. Telomeres get shorter each time a cell divides and if they get too short, the cells in which they are located no longer divide and so they die. Short telomeres have been associated with everything f rom heart disease to lung conditions. Blackburn was awarded the Nobel Prize in 2009 for her research on telomeres and telomerase, which is an enzyme that fights against the tendency of 2 The mind has a big role to play in how e ective surgery is. One in uential study, published in the prestigious British Medical Journal (BMJ), pulled together the results of more than 50 surgical trials that compared a widely used surgical technique, such cleaning out painful knee joints with salt water, with a placebo surgery. It showed that in 74 per cent of the studies, patients who just had the placebo surgery showed signs of improvement, such as reductions in pain. In fact, in 51 per cent of the trials, placebo surgery was as e ective as the real thing. There are few who would doubt the importance of using placebo surgery to test out existing surgical techniques. But given that placebo surgeries do seem to work, isn’t there an argument for using them as a treatment in their own right? “Fake surgery is not benign, it’s not a sugar pill,” says Dr Ted Kaptchuk, a leading placebo researcher at Harvard Medical School. “It has real costs and dangers.” It means placebo surgery can’t be justified ethically, he says. However ‘open-label placebo’ medication, where patients are told that their treatment – whether it’s a pill, medicine or cream – doesn’t contain an active ingredient is justifiable, he says. The other ethical approach to harnessing the power of the brain, says Kaptchuk, is to use ‘conditioning’. Here the body is tricked by pairing a known treatment, such as the painkiller morphine, with something that has no e ect, like saline solution. If the two are injected together, eventually when the saline is injected on its own, it acts like a painkiller. 63

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