{"id":5931,"date":"2022-01-21T06:00:00","date_gmt":"2022-01-21T06:00:00","guid":{"rendered":"https:\/\/www.mojemedunka.cz\/?p=5931"},"modified":"2022-01-19T19:10:12","modified_gmt":"2022-01-19T19:10:12","slug":"z-lednove-medunky-placebo-nocebo-a-jejich-ucinky","status":"publish","type":"post","link":"https:\/\/www.mojemedunka.cz\/index.php\/2022\/01\/21\/z-lednove-medunky-placebo-nocebo-a-jejich-ucinky\/","title":{"rendered":"Z lednov\u00e9 MEDU\u0147KY: Placebo, nocebo a jejich \u00fa\u010dinky"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Hlavn\u00ed t\u00e9ma lednov\u00e9ho \u010d\u00edsla Medu\u0148ky je v\u011bnov\u00e1no SAMOL\u00c9\u010c\u00cdC\u00cdM SCHOPNOSTEM NA\u0160EHO ORGANISMU. Na\u0161e t\u011blo je toti\u017e \u00fa\u017easn\u00fd syst\u00e9m, kter\u00fd m\u00e1 svou moudrost a z\u00e1le\u017e\u00ed jen na n\u00e1s, jestli budeme tutuo moudrost vn\u00edmat a naslouchat j\u00ed.<br>V t\u00e9matu lednov\u00e9ho \u010d\u00edsla se na\u0161i auto\u0159i v\u011bnuj\u00ed \/krom\u011b jin\u00e9ho) tak\u00e9 r\u016fzn\u00fdm mo\u017enostem a metod\u00e1m, jak podpo\u0159it na\u0161e samol\u00e9\u010d\u00edc\u00ed schopnosti a upozor\u0148uj\u00ed na nesm\u00edrn\u011b d\u016fle\u017eitou roli psychiky. Tentokr\u00e1t vyb\u00edr\u00e1me uk\u00e1zlu z \u010dl\u00e1nku MUDr. Ludmily Elekov\u00e9 o p\u016fsoben\u00ed placeba a noceba. Na\u0161i p\u0159\u00ed\u00e9znivci u\u017e v\u011bd\u00ed, \u017ee Medu\u0148ku je mo\u017en\u00e9 st\u00e1le koupit n aobvykl\u00fdch prodejn\u00edch m\u00edstech a pokud v\u00e1m v\u00edce vyhovuje elektronick\u00e1 verze, koukn\u011bte na <a href=\"https:\/\/www.mojemedunka.cz\/index.php\/2020\/03\/18\/elektronickou-verzi-medunky-sezenete-na-emedunka-cz\/\" data-type=\"post\" data-id=\"2535\">emedunka.cz<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Uk\u00e1zka z \u010dl\u00e1nku:<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Placebo efekt je zlep\u0161en\u00ed zdravotn\u00edho stavu \u010dlov\u011bka na z\u00e1klad\u011b pouh\u00e9ho p\u0159esv\u011bd\u010den\u00ed, \u017ee je \u00fa\u010dinn\u011b l\u00e9\u010den, a\u0165 ji\u017e pod\u00e1n\u00edm biologicky ne\u00fa\u010dinn\u00e9 l\u00e1tky m\u00edsto \u00fa\u010dinn\u00e9ho l\u00e9ku, nebo p\u0159edst\u00edr\u00e1n\u00edm operace \u010di jin\u00e9ho zdravotnick\u00e9ho v\u00fdkonu. Nocebo efekt je naopak zhor\u0161en\u00ed zdravotn\u00edho stavu \u010dlov\u011bka n\u00e1sledkem negativn\u011b p\u016fsob\u00edc\u00edho placeba.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Slovo placebo poch\u00e1z\u00edz prvn\u00edho slova 9. ver\u0161e ze 116. \u017ealmu, kter\u00fd zp\u00edvali duchovn\u00ed p\u0159i ud\u011blov\u00e1n\u00ed sv\u00e1tosti um\u00edraj\u00edc\u00edm:&nbsp;<em>Placebo Domino in regione vivorum\u2026<\/em>&nbsp;(<em>Zal\u00edb\u00edm se P\u00e1nu v zemi \u017eiv\u00fdch\u2026<\/em>). Stav mnoha nemocn\u00fdch se po modlitb\u011b zna\u010dn\u011b zlep\u0161il.<br>Placebo efekt medic\u00edna vyu\u017e\u00edvala od starov\u011bku. P\u0159i nedostatku \u00fa\u010dinn\u00e9 l\u00e9\u010dby se l\u00e9ka\u0159i, l\u00e9\u010ditel\u00e9, bylink\u00e1\u0159ky a porodn\u00ed b\u00e1by sna\u017eili jakkoli povzbudit samol\u00e9\u010debn\u00e9 schopnosti organismu nemocn\u00e9ho. R\u016fzn\u00e9 ritu\u00e1ly doprov\u00e1zej\u00edc\u00ed l\u00e9\u010dbu, d\u016fraz na posv\u00e1tnost l\u00e9\u010dby, exkluzivitu l\u00e9\u010debn\u00e9ho prost\u0159edku nebo procedury, v\u00fdjime\u010dn\u00e9 schopnosti l\u00e9\u010ditele a dal\u0161\u00ed postupy zvy\u0161ovaly \u00fa\u010dinnost l\u00e9\u010dby.<br><strong>Modern\u00ed medic\u00edna na placebo efekt hled\u00ed svrchu a pova\u017euje ho sp\u00ed\u0161 za n\u011bco, co komplikuje klinick\u00e9 studie l\u00e9k\u016f a znehodnocuje \u00fa\u010dinek \u201eskute\u010dn\u00fdch l\u00e9k\u016f\u201c<\/strong>. Povinnost l\u00e9ka\u0159e informovat pacienta o jeho stavu a p\u0159esun od l\u00e9k\u016f vyr\u00e1b\u011bn\u00fdch v&nbsp;l\u00e9k\u00e1rn\u011b k l\u00e9k\u016fm vyr\u00e1b\u011bn\u00fdm hromadn\u011b ve farmaceutick\u00fdch podnic\u00edch tak\u00e9 zna\u010dn\u011b z\u00fa\u017eily mo\u017enosti vyu\u017eit\u00ed placeba v&nbsp;medic\u00edn\u011b. D\u0159\u00edve l\u00e9ka\u0159i m\u011bli mo\u017enost zejm\u00e9na psychosomaticky nemocn\u00fdm p\u0159edepsat placebo ve form\u011b v&nbsp;l\u00e9k\u00e1rn\u011b vyr\u00e1b\u011bn\u00fdch l\u00e9k\u016f. Jde to samoz\u0159ejm\u011b i dnes, ale kdo se toho odv\u00e1\u017e\u00ed?<br>P\u0159itom jde o efekt nezanedbateln\u00fd, v&nbsp;pr\u016fm\u011bru se uv\u00e1d\u00ed kolem 30 %. Tedy a\u017e 30 % nemocn\u00fdch se zlep\u0161\u00ed nebo dokonce uzdrav\u00ed na z\u00e1klad\u011b pouh\u00e9 v\u00edry, \u017ee u\u017e\u00edvaj\u00ed \u00fa\u010dinn\u00fd l\u00e9k nebo podstupuj\u00ed \u00fa\u010dinn\u00fd medic\u00ednsk\u00fd z\u00e1krok. N\u011bkter\u00e9 studie zjistily i vy\u0161\u0161\u00ed procento \u00fa\u010dinku placeba. Pr\u00e1v\u011b proto l\u00e9ka\u0159i nemaj\u00ed placebo efekt v&nbsp;l\u00e1sce, proto\u017ee n\u011bkter\u00e9 studie dokonce zjistily, \u017ee p\u0159i porovn\u00e1n\u00ed s&nbsp;placebem mnoh\u00e9 l\u00e9ky (nap\u0159. n\u011bkter\u00e1 antidepresiva), ale dokonce i v\u00fdkony jako operace (!) nemaj\u00ed v\u016fbec \u017e\u00e1dn\u00fd efekt.<br>R\u016fzn\u00ed jedinci jsou k&nbsp;placebo efektu r\u016fzn\u011b citliv\u00ed. Byly dokonce objeveny geny, kter\u00e9 jejich nositele \u010din\u00ed k&nbsp;\u00fa\u010dinku placeba v\u00fdrazn\u011b vn\u00edmav\u011bj\u0161\u00edm. Placebo efekt byl v&nbsp;posledn\u00ed dob\u011b podrobn\u011b zkoum\u00e1m a objevily se zaj\u00edmav\u00e9 poznatky. Nap\u0159\u00edklad se uk\u00e1zalo, \u017ee barevn\u00e9, drah\u00e9 a bolestiv\u00e9 placebo \u00fa\u010dinkuje podstatn\u011b l\u00e9pe ne\u017e placebo oby\u010dejn\u00e9, levn\u00e9 a nebolestiv\u00e9. Injekce nebo inf\u00faze je \u00fa\u010dinn\u011bj\u0161\u00ed ne\u017e tableta. Divadlo, sehran\u00e9 kolem pod\u00e1n\u00ed placeba zdravotn\u00edkem, kter\u00fd ho pod\u00e1v\u00e1, m\u00e1 tak\u00e9 v\u00fdznamn\u00fd vliv.<br><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>P\u0159\u00edklady z praxe<\/strong><br>Pod\u00e1n\u00ed placeba vede k&nbsp;vyplaven\u00ed endorfin\u016f, je schopno ulevit od bolesti i u stav\u016f, kde bychom to ne\u010dekali. Existuj\u00ed \u010detn\u00e9 p\u0159\u00edpady, kdy v&nbsp;p\u0159\u00edpad\u011b nouze bylo m\u00edsto analgetika pod\u00e1no placebo, a pacient pak bolest nec\u00edtil. Byly to p\u0159\u00edpady zuba\u0159sk\u00fdch a chirurgick\u00fdch z\u00e1krok\u016f, pop\u00e1lenin a podobn\u011b. Jedna moje star\u0161\u00ed kolegyn\u011b mi vypr\u00e1v\u011bla svou zku\u0161enost s&nbsp;placebem u pacientky s&nbsp;\u00fapornou bolest\u00ed zad. \u0160lo o pan\u00ed st\u0159edn\u00edho v\u011bku, kter\u00e1 v&nbsp;jednom obdob\u00ed velmi \u010dasto p\u0159ich\u00e1zela do ordinace. Byla kompletn\u011b vy\u0161et\u0159ena, vyzkou\u0161elo se na n\u00ed leccos, ale \u00fa\u010dinek ve\u0161ker\u00fd \u017e\u00e1dn\u00fd. L\u00e9ka\u0159ka m\u011bla podez\u0159en\u00ed, \u017ee bolest je do zna\u010dn\u00e9 m\u00edry psychosomatick\u00e1 a vyzkou\u0161ela placebo. D\u016fle\u017eit\u00e9 je, \u017ee se tento p\u0159\u00edb\u011bh odehr\u00e1val v&nbsp;hlubok\u00e9m socialismu, n\u011bkdy b\u011bhem 70. let minul\u00e9ho stolet\u00ed. Jednoho dne pacientka p\u0159i\u0161la do ordinace a byla uv\u00edt\u00e1na slovy: \u201ePan\u00ed Nov\u00e1kov\u00e1, to je dob\u0159e, \u017ee jste tady!\u201c. Pan\u00ed se lehce zarazila, proto\u017ee posledn\u00ed dobou se s&nbsp;takov\u00fdm uv\u00edt\u00e1n\u00edm u\u017e nesetk\u00e1vala. L\u00e9ka\u0159ka pokra\u010dovala: \u201eM\u00e1te velk\u00e9 \u0161t\u011bst\u00ed. P\u0159edstavte se, pan \u0159editel (polikliniky) dostal n\u011bkolik balen\u00ed \u00fapln\u011b nov\u00e9ho \u0161v\u00fdcarsk\u00e9ho l\u00e9ku a dal po jednom do ka\u017ed\u00e9 ordinace, abychom ho pou\u017eili na opravdu pot\u0159ebn\u00e9 pacienty. Hned jsem si vzpomn\u011bla na v\u00e1s, tak jestli chcete, my v\u00e1m ty \u0161v\u00fdcarsk\u00e9 injekce nap\u00edch\u00e1me.\u201c Kdo by necht\u011bl v&nbsp;socialistick\u00e9m zdravotnictv\u00ed speci\u00e1ln\u00ed nov\u00fd \u0161v\u00fdcarsk\u00fd l\u00e9k, a nav\u00edc v&nbsp;injekc\u00edch! Pan\u00ed souhlasila a 2x t\u00fddn\u011b p\u0159ich\u00e1zela na injekce fyziologick\u00e9ho roztoku, tedy slan\u00e9 vody. Nedost\u00e1vala ani \u017e\u00e1dn\u00fd vitamin, jen slanou vodu. \u00da\u010dinek byl p\u0159\u00edmo z\u00e1zra\u010dn\u00fd, od injekce k&nbsp;injekci se zlep\u0161ovala, l\u00e9\u010dbu si n\u00e1ramn\u011b pochvalovala, po jej\u00edm skon\u010den\u00ed p\u0159\u00edmo vytan\u010dila z&nbsp;ordinace, kde ji pak hodn\u011b dlouho nevid\u011bli. Kudy chodila, tudy pan\u00ed doktorku a jej\u00ed z\u00e1zra\u010dn\u00e9 \u0161v\u00fdcarsk\u00e9 injekce chv\u00e1lila.<br>Bylo to dokonal\u00e9 placebo: vz\u00e1cn\u00e9, drah\u00e9, bolestiv\u00e9, aplikovan\u00e9 v&nbsp;r\u00e1mci ritu\u00e1lu. N\u011bkdo se m\u016f\u017ee pohor\u0161ovat, \u017ee to byl podvod. Kdybychom ale t\u00e9 pacientce m\u011bli mo\u017enost ud\u011blat funk\u010dn\u00ed magnetickou rezonanci mozku, uk\u00e1zala by \u00fapln\u011b stejn\u00e9 zm\u011bny jako u pacienta, kter\u00fd by dostal skute\u010dn\u00fd l\u00e9k. Tak co ji vyl\u00e9\u010dilo? Jej\u00ed vlastn\u00ed mozek.<br><strong>Uva\u017ete, jak\u00fd efekt m\u00e1 na nemocn\u00e9ho l\u00e9k podan\u00fd s&nbsp;t\u00edmto slovn\u00edm doprovodem: \u201eJe to skv\u011bl\u00e9, pou\u017e\u00edv\u00e1m to \u010dasto, ka\u017ed\u00e9mu to pom\u016f\u017ee, s\u00e1m to ob\u010das beru, ned\u00e1m na to dopustit\u201c, nebo s&nbsp;t\u00edmto: \u201eNo tak zkus\u00edme tohle, snad to n\u011bco ud\u011bl\u00e1\u2026\u201c<\/strong> Z&nbsp;placeba lze ale snadno ud\u011blat nocebo (novotvar vyu\u017e\u00edvaj\u00edc\u00ed ko\u0159en latinsk\u00e9ho nocere \u2013 \u0161kodit), co\u017e je n\u011bco, co u\u0161kod\u00ed, nemocn\u00e9mu stav zhor\u0161\u00ed. Bohu\u017eel nocebo efekt v&nbsp;sou\u010dasn\u00e9 medic\u00edn\u011b p\u0159eva\u017euje, \u010d\u00e1ste\u010dn\u011b jsem o tom psala minule. Upozor\u0148ov\u00e1n\u00ed na ne\u017e\u00e1douc\u00ed \u00fa\u010dinky p\u0159edem, shazov\u00e1n\u00ed o\u010dek\u00e1v\u00e1n\u00ed ohledn\u011b l\u00e9\u010dby i l\u00e9k\u016f, ve studi\u00edch upozorn\u011bn\u00ed, \u017ee podan\u00e1 l\u00e1tka bude m\u00edt negativn\u00ed \u00fa\u010dinky.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Studie pracuj\u00edc\u00ed sou\u010dasn\u011b s&nbsp;placebo i nocebo efektem jsou jedny z&nbsp;nejzaj\u00edmav\u011bj\u0161\u00edch.<\/strong> P\u0159edstavte si, \u017ee pacientovi podaj\u00ed n\u011bco, co mu m\u00e1 ulevit, ale \u0159eknou mu, \u017ee se t\u00edm jeho stav zhor\u0161\u00ed \u2013 a on se zhor\u0161\u00ed. Plat\u00ed to i obr\u00e1cen\u011b. Podali nap\u0159. l\u00e1tku vyvol\u00e1vaj\u00edc\u00ed zvracen\u00ed lidem s&nbsp;nevolnost\u00ed, ale \u0159ekli jim, \u017ee je to l\u00e9k a jim se ulevilo. Naopak dali n\u011bco zcela ne\u0161kodn\u00e9ho \u00fa\u010dastn\u00edk\u016fm studie a \u0159ekli jim, \u017ee jim po tom bude \u0161patn\u011b \u2013 a bylo. V&nbsp;jin\u00e9 studii dali lidem alergick\u00fdm na \u0161kumpu na jednu ruku \u0161kumpu a na druhou n\u011bco ne\u0161kodn\u00e9ho, ale \u0159ekli jim, \u017ee to je obr\u00e1cen\u011b. H\u00e1dejte, kde se jim vysela vyr\u00e1\u017eka? Tam, kde m\u011bli ne\u0161kodnou mast, ale ruka namazan\u00e1 \u0161kumpou se neosypala.<br>Byl pops\u00e1n dokonce p\u0159\u00edpad nemocn\u00e9ho s&nbsp;depres\u00ed, kter\u00fd u\u017e\u00edval nov\u00e9 antidepresivum v&nbsp;r\u00e1mci klinick\u00e9 studie. P\u0159i akutn\u00edm zhor\u0161en\u00ed stavu se rozhodl sp\u00e1chat sebevra\u017edu p\u0159ed\u00e1vkov\u00e1n\u00edm l\u00e9ku. Kdy\u017e se mu p\u0159it\u00ed\u017eilo, lekl se a zavolal si z\u00e1chranku. M\u011bl symptomy otravy, upadal do bezv\u011bdom\u00ed. Kdy\u017e zdravotn\u00edci zjistili, \u017ee u\u017e\u00edval experiment\u00e1ln\u00ed l\u00e9k, zavolali supervizorovi studie, kter\u00fd v\u011bd\u011bl, kdo dost\u00e1val l\u00e9k a kdo placebo. Supervizor jim \u0159ekl, \u017ee tento pacient byl na placebu. Jakmile se to pacient dozv\u011bd\u011bl, p\u0159estal um\u00edrat na otravu l\u00e9ky.<br>Existuj\u00ed zdokumentovan\u00e9 dramati\u010dt\u011bj\u0161\u00ed p\u0159\u00edpady. Pacient s&nbsp;lymfomem dostal experiment\u00e1ln\u00ed l\u00e9k, kter\u00fd vypadal velmi slibn\u011b, a z\u00e1zra\u010dn\u011b se uzdravil. Po n\u011bkolika m\u011bs\u00edc\u00edch se v&nbsp;tisku za\u010daly objevovat zpr\u00e1vy, \u017ee se \u00fa\u010dinek l\u00e9ku nakonec neprok\u00e1zal a \u017ee l\u00e9k tedy nebude schv\u00e1len. Pacient m\u011bl okam\u017eit\u011b recidivu a lymfom se vr\u00e1til. Na\u0161t\u011bst\u00ed se dostal do nemocnice op\u011bt k&nbsp;l\u00e9ka\u0159i, kter\u00fd mu p\u016fvodn\u011b aplikoval experiment\u00e1ln\u00ed l\u00e9k. L\u00e9ka\u0159 reagoval duchap\u0159\u00edtomn\u011b a pacientovi \u0159ekl, \u017ee nem\u016f\u017ee v\u011b\u0159it n\u011bjak\u00e9mu \u010dl\u00e1nku v&nbsp;novin\u00e1ch, \u017ee l\u00e9k mezit\u00edm vylep\u0161ili a po\u0159\u00e1d skv\u011ble funguje a pou\u017e\u00edv\u00e1 se. Pacientovi dali s\u00e9rii inf\u00faz\u00ed s&nbsp;vitaminy a on se op\u011bt z\u00e1zra\u010dn\u011b uzdravil. Bohu\u017eel po \u010dase vy\u0161ly dal\u0161\u00ed \u010dl\u00e1nky informuj\u00edc\u00ed o tom, \u017ee l\u00e9k je opravdu ne\u00fa\u010dinn\u00fd, pacient se to dozv\u011bd\u011bl, lymfom se mu vr\u00e1til a on zem\u0159el. V&nbsp;kontextu b\u011b\u017en\u00e9 komunikace onkolog\u016f s&nbsp;pacienty, kdy pou\u017e\u00edvaj\u00ed (doufejme jen nev\u011bdom\u011b) nocebo efekt, je to varovn\u00fd p\u0159\u00edklad&#8230; &nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Cel\u00fd \u010dl\u00e1nek si p\u0159e\u010dtete v lednov\u00e9 Medu\u0148ce<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hlavn\u00ed t\u00e9ma lednov\u00e9ho \u010d\u00edsla Medu\u0148ky je v\u011bnov\u00e1no SAMOL\u00c9\u010c\u00cdC\u00cdM SCHOPNOSTEM NA\u0160EHO ORGANISMU. Na\u0161e t\u011blo je toti\u017e \u00fa\u017easn\u00fd syst\u00e9m, kter\u00fd m\u00e1 svou moudrost a z\u00e1le\u017e\u00ed jen na n\u00e1s, jestli budeme tutuo moudrost vn\u00edmat a naslouchat j\u00ed.V t\u00e9matu lednov\u00e9ho \u010d\u00edsla se na\u0161i auto\u0159i v\u011bnuj\u00ed \/krom\u011b jin\u00e9ho) tak\u00e9 r\u016fzn\u00fdm mo\u017enostem a metod\u00e1m, jak podpo\u0159it na\u0161e samol\u00e9\u010d\u00edc\u00ed schopnosti a upozor\u0148uj\u00ed na nesm\u00edrn\u011b d\u016fle\u017eitou roli psychiky. Tentokr\u00e1t vyb\u00edr\u00e1me uk\u00e1zlu z \u010dl\u00e1nku MUDr. Ludmily Elekov\u00e9 o p\u016fsoben\u00ed placeba a noceba. Na\u0161i p\u0159\u00ed\u00e9znivci u\u017e v\u011bd\u00ed, \u017ee Medu\u0148ku je mo\u017en\u00e9 st\u00e1le koupit n aobvykl\u00fdch prodejn\u00edch m\u00edstech a pokud v\u00e1m v\u00edce vyhovuje elektronick\u00e1 verze, koukn\u011bte na emedunka.cz Uk\u00e1zka z \u010dl\u00e1nku: Placebo efekt je zlep\u0161en\u00ed zdravotn\u00edho stavu \u010dlov\u011bka na z\u00e1klad\u011b pouh\u00e9ho p\u0159esv\u011bd\u010den\u00ed, \u017ee je \u00fa\u010dinn\u011b l\u00e9\u010den, a\u0165 ji\u017e pod\u00e1n\u00edm biologicky ne\u00fa\u010dinn\u00e9 l\u00e1tky m\u00edsto \u00fa\u010dinn\u00e9ho l\u00e9ku, nebo p\u0159edst\u00edr\u00e1n\u00edm operace \u010di jin\u00e9ho zdravotnick\u00e9ho v\u00fdkonu. Nocebo efekt je naopak zhor\u0161en\u00ed zdravotn\u00edho stavu \u010dlov\u011bka n\u00e1sledkem negativn\u011b p\u016fsob\u00edc\u00edho placeba. Slovo placebo poch\u00e1z\u00edz prvn\u00edho slova 9. ver\u0161e ze 116. \u017ealmu, kter\u00fd zp\u00edvali duchovn\u00ed p\u0159i ud\u011blov\u00e1n\u00ed sv\u00e1tosti um\u00edraj\u00edc\u00edm:&nbsp;Placebo Domino in regione vivorum\u2026&nbsp;(Zal\u00edb\u00edm se P\u00e1nu v zemi \u017eiv\u00fdch\u2026). Stav mnoha nemocn\u00fdch se po modlitb\u011b zna\u010dn\u011b zlep\u0161il.Placebo efekt medic\u00edna vyu\u017e\u00edvala od starov\u011bku. P\u0159i nedostatku \u00fa\u010dinn\u00e9 l\u00e9\u010dby se l\u00e9ka\u0159i, l\u00e9\u010ditel\u00e9, bylink\u00e1\u0159ky a porodn\u00ed b\u00e1by sna\u017eili jakkoli povzbudit samol\u00e9\u010debn\u00e9 schopnosti organismu nemocn\u00e9ho. R\u016fzn\u00e9 ritu\u00e1ly doprov\u00e1zej\u00edc\u00ed l\u00e9\u010dbu, d\u016fraz na posv\u00e1tnost l\u00e9\u010dby, exkluzivitu l\u00e9\u010debn\u00e9ho prost\u0159edku nebo procedury, v\u00fdjime\u010dn\u00e9 schopnosti l\u00e9\u010ditele a dal\u0161\u00ed postupy zvy\u0161ovaly \u00fa\u010dinnost l\u00e9\u010dby.Modern\u00ed medic\u00edna na placebo efekt hled\u00ed svrchu a pova\u017euje ho sp\u00ed\u0161 za n\u011bco, co komplikuje klinick\u00e9 studie l\u00e9k\u016f a znehodnocuje \u00fa\u010dinek \u201eskute\u010dn\u00fdch l\u00e9k\u016f\u201c. Povinnost l\u00e9ka\u0159e informovat pacienta o jeho stavu a p\u0159esun od l\u00e9k\u016f vyr\u00e1b\u011bn\u00fdch v&nbsp;l\u00e9k\u00e1rn\u011b k l\u00e9k\u016fm vyr\u00e1b\u011bn\u00fdm hromadn\u011b ve farmaceutick\u00fdch podnic\u00edch tak\u00e9 zna\u010dn\u011b z\u00fa\u017eily mo\u017enosti vyu\u017eit\u00ed placeba v&nbsp;medic\u00edn\u011b. D\u0159\u00edve l\u00e9ka\u0159i m\u011bli mo\u017enost zejm\u00e9na psychosomaticky nemocn\u00fdm p\u0159edepsat placebo ve form\u011b v&nbsp;l\u00e9k\u00e1rn\u011b vyr\u00e1b\u011bn\u00fdch l\u00e9k\u016f. Jde to samoz\u0159ejm\u011b i dnes, ale kdo se toho odv\u00e1\u017e\u00ed?P\u0159itom jde o efekt nezanedbateln\u00fd, v&nbsp;pr\u016fm\u011bru se uv\u00e1d\u00ed kolem 30 %. Tedy a\u017e 30 % nemocn\u00fdch se zlep\u0161\u00ed nebo dokonce uzdrav\u00ed na z\u00e1klad\u011b pouh\u00e9 v\u00edry, \u017ee u\u017e\u00edvaj\u00ed \u00fa\u010dinn\u00fd l\u00e9k nebo podstupuj\u00ed \u00fa\u010dinn\u00fd medic\u00ednsk\u00fd z\u00e1krok. N\u011bkter\u00e9 studie zjistily i vy\u0161\u0161\u00ed procento \u00fa\u010dinku placeba. Pr\u00e1v\u011b proto l\u00e9ka\u0159i nemaj\u00ed placebo efekt v&nbsp;l\u00e1sce, proto\u017ee n\u011bkter\u00e9 studie dokonce zjistily, \u017ee p\u0159i porovn\u00e1n\u00ed s&nbsp;placebem mnoh\u00e9 l\u00e9ky (nap\u0159. n\u011bkter\u00e1 antidepresiva), ale dokonce i v\u00fdkony jako operace (!) nemaj\u00ed v\u016fbec \u017e\u00e1dn\u00fd efekt.R\u016fzn\u00ed jedinci jsou k&nbsp;placebo efektu r\u016fzn\u011b citliv\u00ed. Byly dokonce objeveny geny, kter\u00e9 jejich nositele \u010din\u00ed k&nbsp;\u00fa\u010dinku placeba v\u00fdrazn\u011b vn\u00edmav\u011bj\u0161\u00edm. Placebo efekt byl v&nbsp;posledn\u00ed dob\u011b podrobn\u011b zkoum\u00e1m a objevily se zaj\u00edmav\u00e9 poznatky. Nap\u0159\u00edklad se uk\u00e1zalo, \u017ee barevn\u00e9, drah\u00e9 a bolestiv\u00e9 placebo \u00fa\u010dinkuje podstatn\u011b l\u00e9pe ne\u017e placebo oby\u010dejn\u00e9, levn\u00e9 a nebolestiv\u00e9. Injekce nebo inf\u00faze je \u00fa\u010dinn\u011bj\u0161\u00ed ne\u017e tableta. Divadlo, sehran\u00e9 kolem pod\u00e1n\u00ed placeba zdravotn\u00edkem, kter\u00fd ho pod\u00e1v\u00e1, m\u00e1 tak\u00e9 v\u00fdznamn\u00fd vliv. P\u0159\u00edklady z praxePod\u00e1n\u00ed placeba vede k&nbsp;vyplaven\u00ed endorfin\u016f, je schopno ulevit od bolesti i u stav\u016f, kde bychom to ne\u010dekali. Existuj\u00ed \u010detn\u00e9 p\u0159\u00edpady, kdy v&nbsp;p\u0159\u00edpad\u011b nouze bylo m\u00edsto analgetika pod\u00e1no placebo, a pacient pak bolest nec\u00edtil. Byly to p\u0159\u00edpady zuba\u0159sk\u00fdch a chirurgick\u00fdch z\u00e1krok\u016f, pop\u00e1lenin a podobn\u011b. Jedna moje star\u0161\u00ed kolegyn\u011b mi vypr\u00e1v\u011bla svou zku\u0161enost s&nbsp;placebem u pacientky s&nbsp;\u00fapornou bolest\u00ed zad. \u0160lo o pan\u00ed st\u0159edn\u00edho v\u011bku, kter\u00e1 v&nbsp;jednom obdob\u00ed velmi \u010dasto p\u0159ich\u00e1zela do ordinace. Byla kompletn\u011b vy\u0161et\u0159ena, vyzkou\u0161elo se na n\u00ed leccos, ale \u00fa\u010dinek ve\u0161ker\u00fd \u017e\u00e1dn\u00fd. L\u00e9ka\u0159ka m\u011bla podez\u0159en\u00ed, \u017ee bolest je do zna\u010dn\u00e9 m\u00edry psychosomatick\u00e1 a vyzkou\u0161ela placebo. D\u016fle\u017eit\u00e9 je, \u017ee se tento p\u0159\u00edb\u011bh odehr\u00e1val v&nbsp;hlubok\u00e9m socialismu, n\u011bkdy b\u011bhem 70. let minul\u00e9ho stolet\u00ed. Jednoho dne pacientka p\u0159i\u0161la do ordinace a byla uv\u00edt\u00e1na slovy: \u201ePan\u00ed Nov\u00e1kov\u00e1, to je dob\u0159e, \u017ee jste tady!\u201c. Pan\u00ed se lehce zarazila, proto\u017ee posledn\u00ed dobou se s&nbsp;takov\u00fdm uv\u00edt\u00e1n\u00edm u\u017e nesetk\u00e1vala. L\u00e9ka\u0159ka pokra\u010dovala: \u201eM\u00e1te velk\u00e9 \u0161t\u011bst\u00ed. P\u0159edstavte se, pan \u0159editel (polikliniky) dostal n\u011bkolik balen\u00ed \u00fapln\u011b nov\u00e9ho \u0161v\u00fdcarsk\u00e9ho l\u00e9ku a dal po jednom do ka\u017ed\u00e9 ordinace, abychom ho pou\u017eili na opravdu pot\u0159ebn\u00e9 pacienty. Hned jsem si vzpomn\u011bla na v\u00e1s, tak jestli chcete, my v\u00e1m ty \u0161v\u00fdcarsk\u00e9 injekce nap\u00edch\u00e1me.\u201c Kdo by necht\u011bl v&nbsp;socialistick\u00e9m zdravotnictv\u00ed speci\u00e1ln\u00ed nov\u00fd \u0161v\u00fdcarsk\u00fd l\u00e9k, a nav\u00edc v&nbsp;injekc\u00edch! Pan\u00ed souhlasila a 2x t\u00fddn\u011b p\u0159ich\u00e1zela na injekce fyziologick\u00e9ho roztoku, tedy slan\u00e9 vody. Nedost\u00e1vala ani \u017e\u00e1dn\u00fd vitamin, jen slanou vodu. \u00da\u010dinek byl p\u0159\u00edmo z\u00e1zra\u010dn\u00fd, od injekce k&nbsp;injekci se zlep\u0161ovala, l\u00e9\u010dbu si n\u00e1ramn\u011b pochvalovala, po jej\u00edm skon\u010den\u00ed p\u0159\u00edmo vytan\u010dila z&nbsp;ordinace, kde ji pak hodn\u011b dlouho nevid\u011bli. Kudy chodila, tudy pan\u00ed doktorku a jej\u00ed z\u00e1zra\u010dn\u00e9 \u0161v\u00fdcarsk\u00e9 injekce chv\u00e1lila.Bylo to dokonal\u00e9 placebo: vz\u00e1cn\u00e9, drah\u00e9, bolestiv\u00e9, aplikovan\u00e9 v&nbsp;r\u00e1mci ritu\u00e1lu. N\u011bkdo se m\u016f\u017ee pohor\u0161ovat, \u017ee to byl podvod. Kdybychom ale t\u00e9 pacientce m\u011bli mo\u017enost ud\u011blat funk\u010dn\u00ed magnetickou rezonanci mozku, uk\u00e1zala by \u00fapln\u011b stejn\u00e9 zm\u011bny jako u pacienta, kter\u00fd by dostal skute\u010dn\u00fd l\u00e9k. Tak co ji vyl\u00e9\u010dilo? Jej\u00ed vlastn\u00ed mozek.Uva\u017ete, jak\u00fd efekt m\u00e1 na nemocn\u00e9ho l\u00e9k podan\u00fd s&nbsp;t\u00edmto slovn\u00edm doprovodem: \u201eJe to skv\u011bl\u00e9, pou\u017e\u00edv\u00e1m to \u010dasto, ka\u017ed\u00e9mu to pom\u016f\u017ee, s\u00e1m to ob\u010das beru, ned\u00e1m na to dopustit\u201c, nebo s&nbsp;t\u00edmto: \u201eNo tak zkus\u00edme tohle, snad to n\u011bco ud\u011bl\u00e1\u2026\u201c Z&nbsp;placeba lze ale snadno ud\u011blat nocebo (novotvar vyu\u017e\u00edvaj\u00edc\u00ed ko\u0159en latinsk\u00e9ho nocere \u2013 \u0161kodit), co\u017e je n\u011bco, co u\u0161kod\u00ed, nemocn\u00e9mu stav zhor\u0161\u00ed. Bohu\u017eel nocebo efekt v&nbsp;sou\u010dasn\u00e9 medic\u00edn\u011b p\u0159eva\u017euje, \u010d\u00e1ste\u010dn\u011b jsem o tom psala minule. Upozor\u0148ov\u00e1n\u00ed na ne\u017e\u00e1douc\u00ed \u00fa\u010dinky p\u0159edem, shazov\u00e1n\u00ed o\u010dek\u00e1v\u00e1n\u00ed ohledn\u011b l\u00e9\u010dby i l\u00e9k\u016f, ve studi\u00edch upozorn\u011bn\u00ed, \u017ee podan\u00e1 l\u00e1tka bude m\u00edt negativn\u00ed \u00fa\u010dinky. Studie pracuj\u00edc\u00ed sou\u010dasn\u011b s&nbsp;placebo i nocebo efektem jsou jedny z&nbsp;nejzaj\u00edmav\u011bj\u0161\u00edch. P\u0159edstavte si, \u017ee pacientovi podaj\u00ed n\u011bco, co mu m\u00e1 ulevit, ale \u0159eknou mu, \u017ee se t\u00edm jeho stav zhor\u0161\u00ed \u2013 a on se zhor\u0161\u00ed. Plat\u00ed to i obr\u00e1cen\u011b. Podali nap\u0159. l\u00e1tku vyvol\u00e1vaj\u00edc\u00ed zvracen\u00ed lidem s&nbsp;nevolnost\u00ed, ale \u0159ekli jim, \u017ee je to l\u00e9k a jim se ulevilo. Naopak dali n\u011bco zcela ne\u0161kodn\u00e9ho \u00fa\u010dastn\u00edk\u016fm studie a \u0159ekli jim, \u017ee jim po tom bude \u0161patn\u011b \u2013 a bylo. V&nbsp;jin\u00e9 studii dali lidem alergick\u00fdm na \u0161kumpu na jednu ruku \u0161kumpu a na druhou n\u011bco ne\u0161kodn\u00e9ho, ale \u0159ekli jim, \u017ee to je obr\u00e1cen\u011b. H\u00e1dejte, kde se jim vysela vyr\u00e1\u017eka? Tam, kde m\u011bli ne\u0161kodnou mast, ale ruka namazan\u00e1 \u0161kumpou se neosypala.Byl pops\u00e1n dokonce p\u0159\u00edpad nemocn\u00e9ho s&nbsp;depres\u00ed, kter\u00fd u\u017e\u00edval nov\u00e9 antidepresivum v&nbsp;r\u00e1mci klinick\u00e9 studie. P\u0159i akutn\u00edm zhor\u0161en\u00ed stavu se rozhodl sp\u00e1chat sebevra\u017edu p\u0159ed\u00e1vkov\u00e1n\u00edm l\u00e9ku. Kdy\u017e se mu p\u0159it\u00ed\u017eilo, lekl se a zavolal si z\u00e1chranku. M\u011bl symptomy otravy, upadal do bezv\u011bdom\u00ed. Kdy\u017e zdravotn\u00edci zjistili, \u017ee u\u017e\u00edval experiment\u00e1ln\u00ed l\u00e9k, zavolali supervizorovi studie, kter\u00fd v\u011bd\u011bl, kdo dost\u00e1val l\u00e9k a kdo placebo. Supervizor jim \u0159ekl, \u017ee tento pacient byl na placebu. Jakmile se to pacient dozv\u011bd\u011bl, p\u0159estal um\u00edrat na otravu l\u00e9ky.Existuj\u00ed zdokumentovan\u00e9 dramati\u010dt\u011bj\u0161\u00ed p\u0159\u00edpady. Pacient s&nbsp;lymfomem dostal experiment\u00e1ln\u00ed l\u00e9k, kter\u00fd vypadal velmi slibn\u011b, a z\u00e1zra\u010dn\u011b se uzdravil. Po n\u011bkolika m\u011bs\u00edc\u00edch se v&nbsp;tisku za\u010daly objevovat zpr\u00e1vy, \u017ee se \u00fa\u010dinek l\u00e9ku nakonec neprok\u00e1zal a \u017ee l\u00e9k tedy nebude schv\u00e1len. Pacient m\u011bl okam\u017eit\u011b recidivu a lymfom se vr\u00e1til. Na\u0161t\u011bst\u00ed se dostal do nemocnice op\u011bt k&nbsp;l\u00e9ka\u0159i, kter\u00fd mu p\u016fvodn\u011b aplikoval experiment\u00e1ln\u00ed l\u00e9k. L\u00e9ka\u0159 reagoval duchap\u0159\u00edtomn\u011b a pacientovi \u0159ekl, \u017ee nem\u016f\u017ee v\u011b\u0159it n\u011bjak\u00e9mu \u010dl\u00e1nku v&nbsp;novin\u00e1ch, \u017ee l\u00e9k mezit\u00edm vylep\u0161ili a po\u0159\u00e1d skv\u011ble funguje a pou\u017e\u00edv\u00e1 se. Pacientovi dali s\u00e9rii inf\u00faz\u00ed s&nbsp;vitaminy a on se op\u011bt z\u00e1zra\u010dn\u011b uzdravil. Bohu\u017eel po \u010dase vy\u0161ly dal\u0161\u00ed \u010dl\u00e1nky informuj\u00edc\u00ed o tom, \u017ee l\u00e9k je opravdu ne\u00fa\u010dinn\u00fd, pacient se to dozv\u011bd\u011bl, lymfom se mu vr\u00e1til a on zem\u0159el. V&nbsp;kontextu b\u011b\u017en\u00e9 komunikace onkolog\u016f s&nbsp;pacienty, kdy pou\u017e\u00edvaj\u00ed (doufejme jen nev\u011bdom\u011b) nocebo efekt, je to varovn\u00fd p\u0159\u00edklad&#8230; &nbsp; Cel\u00fd \u010dl\u00e1nek si p\u0159e\u010dtete v lednov\u00e9 Medu\u0148ce<\/p>\n","protected":false},"author":3,"featured_media":5865,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,1,31,33,10],"tags":[],"class_list":["post-5931","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-alternativni-medicina","category-medunka","category-pro-inspiraci","category-rady-a-tipy","category-zdravi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/5931","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/comments?post=5931"}],"version-history":[{"count":2,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/5931\/revisions"}],"predecessor-version":[{"id":5933,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/5931\/revisions\/5933"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media\/5865"}],"wp:attachment":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media?parent=5931"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/categories?post=5931"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/tags?post=5931"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}