Neither psychological nor neuroscientific investigations have been able to fully explain the para... more Neither psychological nor neuroscientific investigations have been able to fully explain the paradox that placebo is designed to be inert in randomized controlled trials (RCTs), yet appears to be effective in evaluations of clinical interventions in all fields of medicine and alternative medicine. This article develops the Neuroplasticity Placebo Theory, which posits that neuroplasticity in fronto-limbic areas is the unifying factor in placebo response (seen in RCTs) and placebo effect (seen in clinical interventions) where it is not intended to be inert. Depression is the disorder that has the highest placebo response of any medical condition and has the greatest potential for understanding how placebos work: recent developments in understanding of the pathophysiology of depression suggest that fronto-limbic areas are sensitized in depression which is associated with a particularly strong placebo phenomenon. An innovative linkage is made between diverse areas of the psychology and the translational psychiatry literature to provide supportive evidence for the Neuroplasticity Placebo Theory. This is underpinned by neuro-radiological evidence of frontolimbic change in the placebo arm of antidepressant trials. If placebo stimulates neuroplasticity in fronto-limbic areas in conditions other than depression-and results in a partially active treatment in other areas of medicine-there are far reaching consequences for the day-today use of placebo in clinical practice, the future design of RCTs in all clinical conditions, and existing unwarranted assertions about the efficacy of antidepressant medications. If fronto-limbic neuroplasticity is the common denominator in designating placebo as a partially active treatment, the terms placebo effect and placebo response should be replaced by the single term "placebo treatment."
Consent Quotations a, b, and c are from a 'live' GP whistleblower case and are used with the full... more Consent Quotations a, b, and c are from a 'live' GP whistleblower case and are used with the full knowledge and consent of the person concerned.
The recent White Paper Choosing Health: making healthy choices easier highlights the need for com... more The recent White Paper Choosing Health: making healthy choices easier highlights the need for community and primary health-care teams to develop motivational skills so that they can help families develop healthy habits and enhance the self-care of chronic diseases.1 This ...
European Journal of Cardiovascular Prevention & Rehabilitation, 2011
To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering d... more To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering drugs in Polish primary care between the years 2004 and 2006; (2) the characteristics of patients that are associated with attainment of these goals. Cross-sectional study in randomly selected Polish primary care practices. 5248 patients aged over 30 years in 2004 and 5386 patients in 2006, who were taking cholesterol-lowering treatment took part in the study. Physicians recorded demographic and medical history data using a standardized questionnaire, including weight and height, and collected blood samples of patients to determine their cholesterol level. 18.5% of patients attained their optimal goals of therapy (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C) in 2004 compared to 25.2% in 2006 (p < 0.001). In both 2004 and 2006, more patients achieved their target levels for LDL-C than for TC and statins were the most commonly used medication (85% and 91%, respectively). Male sex, smoking, and higher education were the strongest correlates of the therapeutic outcome. The odds ratio of achieving cholesterol therapy goals in men, non-smokers, and university graduates was estimated at 1.51, 0.70, 1.38 in 2004 and 1.50, 0.73, 1.34 in 2006, respectively. There was a measurable improvement in the effectiveness of hypercholesterolaemia treatment between 2004 and 2006 but the majority of patients remain inadequately treated, with goals not being achieved. There is a need to raise the standard of lipid-lowering management in Poland.
General practice The wizard and the gatekeeper: of castles and contracts Barbara Herd, consultant... more General practice The wizard and the gatekeeper: of castles and contracts Barbara Herd, consultant physician, a Andrew Herd, general practitioner, b Nigel Mathers, senior lecturer c
The wizards and the gatekeepers were unhappy. There were many reasons for their unhappiness. They... more The wizards and the gatekeepers were unhappy. There were many reasons for their unhappiness. They worked hard but felt that too much was being demanded of them. The poorly people's charter was resulting in unrealistic expectations, and changes in the apprenticeship for wizards were putting great strain on their mentors. The wizards enjoyed their work less and less, and it was getting difficult to find new gatekeepers. On the other hand, the way the system worked meant that there had to be plenty of goblins and the number ofscrolls that had to be filled in was rising sharply. The wizards and gatekeepers tried to point out ways to improve things that would ensure that poorly people were better treated, but there was no easy solution. With the ominous sign that the recruitment of wizards and gatekeepers was becoming more difficult, an answer was neededand soon.
Objectives To explore patient experiences of living with, and receiving treatment for, PMR. Metho... more Objectives To explore patient experiences of living with, and receiving treatment for, PMR. Methods Semi-structured qualitative interviews, with 22 patients with PMR recruited from general practices in South Yorkshire. Thematic analysis using a constant comparative method, ran concurrently with the interviews and was used to derive a conceptual framework. Results 5 key themes emerged highlighting the importance of: 1) pain, stiffness and weakness, 2) disability, 3) treatment and disease course, 4) experience of care, 5) psychological impact of PMR. Patients emphasised the profound disability experienced that was often associated with fear and vulnerability, highlighting how this was often not recognised by health care professionals. Patients symptom, the use of morning stiffness as a measure of disease activity and the myth of full resolution of symptoms with steroid treatment. Treatment decisions were complex, with patients balancing glucocorticoid side effects against persistent symptoms. Conclusions Patients often described their experience of PMR in terms of disability rather than focussing on localised symptoms. The associated psychological impact was significant. Practice implications Recognising this is key to achieving shared understanding, reaching the correct diagnosis promptly, and formulating a patient-centred management plan.
Background. Women from BME backgrounds are less likely to attend for regular smears1. Recent new ... more Background. Women from BME backgrounds are less likely to attend for regular smears1. Recent new waves of immigration from Eastern Europe are presenting new difficulties in engaging with women eligible to have smears. Many of these countries have no established screening programme2, 3. The Roma constitute one of the largest minorities in Europe (estimate 5 -10 million) and have historically been marginalized and subsequently large parts of the population have low educational status and high levels of unemployment and deprivation. Roma life expectancy is 10 years lower than other EU citizens4.
Complementary Therapies in Clinical Practice, Feb 1, 2012
To pilot the delivery of shiatsu in primary care and investigate the non-clinical impact on the g... more To pilot the delivery of shiatsu in primary care and investigate the non-clinical impact on the general practice, its patients and staff. Ten patients, referred by four GPs, were each offered six shiatsu treatments with a qualified practitioner. An inner-city general practice in Sheffield, England. 36 semi-structured interviews, evaluated with Interpretative Phenomenological Analysis and practitioner research including a reflective journal. GPs welcomed having more options of care, especially for patients with complex, chronic symptoms, and patients appreciated the increased time and holistic, patient-centred approach during shiatsu consultations. Participants claimed the clinic increased equality of access to complementary medicine, improved perceptions of the general practice, reduced consultation and prescription rates, enhanced GP-patient relationships and the working practices of the GPs and shiatsu practitioner. The study successfully integrated a shiatsu clinic into a general practice and offers a model for future research on complementary medicine in primary care.
Neither psychological nor neuroscientific investigations have been able to fully explain the para... more Neither psychological nor neuroscientific investigations have been able to fully explain the paradox that placebo is designed to be inert in randomized controlled trials (RCTs), yet appears to be effective in evaluations of clinical interventions in all fields of medicine and alternative medicine. This article develops the Neuroplasticity Placebo Theory, which posits that neuroplasticity in fronto-limbic areas is the unifying factor in placebo response (seen in RCTs) and placebo effect (seen in clinical interventions) where it is not intended to be inert. Depression is the disorder that has the highest placebo response of any medical condition and has the greatest potential for understanding how placebos work: recent developments in understanding of the pathophysiology of depression suggest that fronto-limbic areas are sensitized in depression which is associated with a particularly strong placebo phenomenon. An innovative linkage is made between diverse areas of the psychology and the translational psychiatry literature to provide supportive evidence for the Neuroplasticity Placebo Theory. This is underpinned by neuro-radiological evidence of frontolimbic change in the placebo arm of antidepressant trials. If placebo stimulates neuroplasticity in fronto-limbic areas in conditions other than depression-and results in a partially active treatment in other areas of medicine-there are far reaching consequences for the day-today use of placebo in clinical practice, the future design of RCTs in all clinical conditions, and existing unwarranted assertions about the efficacy of antidepressant medications. If fronto-limbic neuroplasticity is the common denominator in designating placebo as a partially active treatment, the terms placebo effect and placebo response should be replaced by the single term "placebo treatment."
Consent Quotations a, b, and c are from a 'live' GP whistleblower case and are used with the full... more Consent Quotations a, b, and c are from a 'live' GP whistleblower case and are used with the full knowledge and consent of the person concerned.
The recent White Paper Choosing Health: making healthy choices easier highlights the need for com... more The recent White Paper Choosing Health: making healthy choices easier highlights the need for community and primary health-care teams to develop motivational skills so that they can help families develop healthy habits and enhance the self-care of chronic diseases.1 This ...
European Journal of Cardiovascular Prevention & Rehabilitation, 2011
To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering d... more To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering drugs in Polish primary care between the years 2004 and 2006; (2) the characteristics of patients that are associated with attainment of these goals. Cross-sectional study in randomly selected Polish primary care practices. 5248 patients aged over 30 years in 2004 and 5386 patients in 2006, who were taking cholesterol-lowering treatment took part in the study. Physicians recorded demographic and medical history data using a standardized questionnaire, including weight and height, and collected blood samples of patients to determine their cholesterol level. 18.5% of patients attained their optimal goals of therapy (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C) in 2004 compared to 25.2% in 2006 (p < 0.001). In both 2004 and 2006, more patients achieved their target levels for LDL-C than for TC and statins were the most commonly used medication (85% and 91%, respectively). Male sex, smoking, and higher education were the strongest correlates of the therapeutic outcome. The odds ratio of achieving cholesterol therapy goals in men, non-smokers, and university graduates was estimated at 1.51, 0.70, 1.38 in 2004 and 1.50, 0.73, 1.34 in 2006, respectively. There was a measurable improvement in the effectiveness of hypercholesterolaemia treatment between 2004 and 2006 but the majority of patients remain inadequately treated, with goals not being achieved. There is a need to raise the standard of lipid-lowering management in Poland.
General practice The wizard and the gatekeeper: of castles and contracts Barbara Herd, consultant... more General practice The wizard and the gatekeeper: of castles and contracts Barbara Herd, consultant physician, a Andrew Herd, general practitioner, b Nigel Mathers, senior lecturer c
The wizards and the gatekeepers were unhappy. There were many reasons for their unhappiness. They... more The wizards and the gatekeepers were unhappy. There were many reasons for their unhappiness. They worked hard but felt that too much was being demanded of them. The poorly people's charter was resulting in unrealistic expectations, and changes in the apprenticeship for wizards were putting great strain on their mentors. The wizards enjoyed their work less and less, and it was getting difficult to find new gatekeepers. On the other hand, the way the system worked meant that there had to be plenty of goblins and the number ofscrolls that had to be filled in was rising sharply. The wizards and gatekeepers tried to point out ways to improve things that would ensure that poorly people were better treated, but there was no easy solution. With the ominous sign that the recruitment of wizards and gatekeepers was becoming more difficult, an answer was neededand soon.
Objectives To explore patient experiences of living with, and receiving treatment for, PMR. Metho... more Objectives To explore patient experiences of living with, and receiving treatment for, PMR. Methods Semi-structured qualitative interviews, with 22 patients with PMR recruited from general practices in South Yorkshire. Thematic analysis using a constant comparative method, ran concurrently with the interviews and was used to derive a conceptual framework. Results 5 key themes emerged highlighting the importance of: 1) pain, stiffness and weakness, 2) disability, 3) treatment and disease course, 4) experience of care, 5) psychological impact of PMR. Patients emphasised the profound disability experienced that was often associated with fear and vulnerability, highlighting how this was often not recognised by health care professionals. Patients symptom, the use of morning stiffness as a measure of disease activity and the myth of full resolution of symptoms with steroid treatment. Treatment decisions were complex, with patients balancing glucocorticoid side effects against persistent symptoms. Conclusions Patients often described their experience of PMR in terms of disability rather than focussing on localised symptoms. The associated psychological impact was significant. Practice implications Recognising this is key to achieving shared understanding, reaching the correct diagnosis promptly, and formulating a patient-centred management plan.
Background. Women from BME backgrounds are less likely to attend for regular smears1. Recent new ... more Background. Women from BME backgrounds are less likely to attend for regular smears1. Recent new waves of immigration from Eastern Europe are presenting new difficulties in engaging with women eligible to have smears. Many of these countries have no established screening programme2, 3. The Roma constitute one of the largest minorities in Europe (estimate 5 -10 million) and have historically been marginalized and subsequently large parts of the population have low educational status and high levels of unemployment and deprivation. Roma life expectancy is 10 years lower than other EU citizens4.
Complementary Therapies in Clinical Practice, Feb 1, 2012
To pilot the delivery of shiatsu in primary care and investigate the non-clinical impact on the g... more To pilot the delivery of shiatsu in primary care and investigate the non-clinical impact on the general practice, its patients and staff. Ten patients, referred by four GPs, were each offered six shiatsu treatments with a qualified practitioner. An inner-city general practice in Sheffield, England. 36 semi-structured interviews, evaluated with Interpretative Phenomenological Analysis and practitioner research including a reflective journal. GPs welcomed having more options of care, especially for patients with complex, chronic symptoms, and patients appreciated the increased time and holistic, patient-centred approach during shiatsu consultations. Participants claimed the clinic increased equality of access to complementary medicine, improved perceptions of the general practice, reduced consultation and prescription rates, enhanced GP-patient relationships and the working practices of the GPs and shiatsu practitioner. The study successfully integrated a shiatsu clinic into a general practice and offers a model for future research on complementary medicine in primary care.
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Papers by Nigel Mathers