Lost & Found

I’m in Scotland, and I lost my hat. The one that was supposed to do for me what my father repeatedly suggested to me when I was young: “Get your head screwed on boy!” I took it kindly. It was an encouragement towards mindfulness, or core strength. And now, the screwing entails some deduction: by now, if I’d left my hat in the cab, the Glaswegian taxi driver would have turned it in to the Convention Center where he dropped me off, so I must have left it at the ticket counter at the Queen St. Railway Station. Two days after losing it, I’m here, hopeful, making a precise description of a non-descript black hat to the lady at the station’s Lost and Found desk. She disappears for an intolerable number of seconds into a room full of lost things, then re-appears with .… that’s it! We smile at the hat.

And now I’m sitting on the West Highlands train, rolling headlong into the mountains, delighted how things come around. The ferry connection will get me to a lodging gracefully called a “caravan,” Scottish for a corrugated rectangle containing some of the comforts of home.

corrugated-box

the caravan

view-from-the-box

view from the caravan

 

Surrounding the caravan, the Isle of Canna, which may be too small to be a Hebride, though I shouldn’t second guess it. It has, in any case, a similar density of sheep, lichen, and off-shore seals embracing its polygonal coast.

The weather in Scotland, like in Vermont, strikes one pose after another.

wester-highlands

 

Maybe it was the fog blurring their horizons that made the Scots such persuasive, persistent scale makers, meting out this spectral, mysterious world in numbers and categories, all the way back to Lord Kelvin with his Absolute Zero Temperature scale. More recently, the head trauma cases coming in from the local highways gave neurosurgeons Teasdale & Jennett the idea for the Glasgow Coma Scale.

I have a bit of that ornery, Scottish measurer/categorizer in me, and come by it honestly, from the McQueens and McPhedrans in my ancestry. (McPhedran—in fact it’s not the name for a Scottish herbal stimulant.) I felt their presence when I stood at the microphone with a question for the speaker in a large, dark Glasgow auditorium, and the moderator was about to pass me over for a second time. “Hellow!” blurted my inner Scot. The moderator heard the W, and promptly apologized.

“Do you think the disposition to placebo and nocebo response resides in the same person? Or are they in different people, as though we’re either optimists or pessimists?” I don’t remember the response, which probably means it was 65 seconds of polysyllabic gesticulating, academic for “I don’t know.” Aykhh. When it comes to reviewing medication side effects, clinicians would like to know which among their patients is prone to side-effect-by-suggestion, nocebo.

I used to think I’d avoided “social infections,” but since I’ve attended the “European Headache & Migraine Trust Conference,” I’m not so sure. Here, a social infection is something like what the Italian experimentalist Benedetti caused when he sent over a hundred students, clambering guinea pigs, up a 10,000 foot Alp. And now, the bad magic, the sorcery: simply by whispering into the ear of one of the climbers “You will very likely get a headache during the climb; it’s from the high altitude, …” Benedetti increased the headache rate at the mountain top from 52% to 86%. That’s social primates for you, spoiling the picnic with a contagious headache, algesia-by-suggestion. I wanted to ask if Benedetti, like any good experimentalist, ran the study twice, to reproduce his results. Recruitment could be a problem … But I forgot to ask him, as I was missing my hat at the time.

The nice thing is, it seems you can save the picnic with a placebo, though only the nocebo headaches respond to it; it won’t touch those original, 52% of headaches. There is a way, however, to fortify a placebo. It’s all about expectation: tell the consumer that there’s a very low chance—one in ten instead of the usual 50-50—that he’s swallowing a placebo. He thinks, correctly, “this is most likely the real stuff,” and so, even when it’s a fake, it works, better than a work-a-day, 50-50 placebo; or Prozac; or molasses.

Wrangling expectations can be a social thing. Or not. Now that I’ve got my hat again, I’ll carry it in my hand, and ask my expectations to be nice. They’re bound to listen.

 

what-we-dont-know

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