The Placebo Phenomenon • Hacker News Board

Re: The Placebo Phenomenon

#11

Post by confluence » Sun, Dec 23, 2012, 12:38 AM UTC

The placebo/nocebo effect appears to be simply an example of the confirmation bias, a couple of other psychological biases and various other known statistical effects.

> False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. These factors are still prevalent in modern placebo literature. The placebo topic seems to invite sloppy methodological thinking. Therefore awareness of Beecher's mistakes and misinterpretations is essential for an appropriate interpretation of current placebo literature.

Beecher retrospectively attributed the improvements in the placebo groups to effects of the placebo administration. However, on the basis of the published data, in all of these trials the reported outcome in the placebo groups can be fully, plausibly, and easily explained withoutpresuming any therapeutic placebo effect. The published data of these trials make it quite obvious that there were a variety of reasons for the reported results, such as spontaneous improvements, additional treatments, methodological artifacts, etc. In some of the original trial publications even the authors themselves had explicitly written that there were no placebo effects.

Source: The powerful placebo effect: fact or fiction?, GS Kienle, H Kiene, Journal of clinical epidemiology, 1997 (http://ukpmc.ac.uk/abstract/MED/9449934/reload=0;jsessionid=...)

Placebo interventions were again not found to have important clinical effects in general but may influence patient-reported outcomes in some situations

Source: http://en.wikipedia.org/wiki/Placebo#Clinical_utility

The effect, apparently, doesn't exist.

Re: The Placebo Phenomenon

#12

Post by tqs » Sun, Dec 23, 2012, 12:56 AM UTC

petercooper wrote: post #7

On a tangent, I think some of these massive open online courses going around nowadays might act as a form of what Rory Sutherland terms "placebo education". Education where you don't necessarily learn things but that gives you the impression that you did, resulting in extra confidence leading to extra success later on ;-)

Along these lines: placebo buttons, e.g. walk buttons at crosswalks, elevator door close buttons

http://en.wikipedia.org/wiki/Placebo_button

Re: The Placebo Phenomenon

#13

Post by seiji » Sun, Dec 23, 2012, 1:17 AM UTC

Placebo in a nutshell: inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain.

The whole "people believing X so X happens" is a perverse co-opting of the placebo title.

And, just for fun, if you give a patient naloxone (opiate blocker) before giving them the saline, their brains won't interpret it as morphine. naloxone blocks placebo response. in case you missed that, read it again: naloxone blocks placebo response. (and once more: placebo means a very narrow thing. it means your body responds as if it biologically received the medicine it had been receiving -- it does not mean any new age "think your way to better health" mumbo jumbo).

Re: The Placebo Phenomenon

#14

Post by psykotic » Sun, Dec 23, 2012, 1:43 AM UTC

seiji wrote: post #13

Placebo in a nutshell: inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain. The whole "people believing X so X happens" is a perverse co-opting of the placebo title. And, just for fun, if you give a patient naloxone (opiate blocker) before giving them the saline, the…

> inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain.

I must admit I have a very hard time believing this exact claim as written. Do you have any sources?

Re: The Placebo Phenomenon

#15

Post by seiji » Sun, Dec 23, 2012, 1:50 AM UTC

psykotic wrote: post #14

seiji wrote: post #13

Placebo in a nutshell: inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain. The whole "people believing X so X happens" is a perverse co-opting of the placebo title. And, just for fun, if you give a patient naloxone (opiate blocker) before giving them the saline, the…

> inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain. I must admit I have a very hard time believing this exact claim as written. Do you have any sources?

A talky explanation is included in http://www.youtube.com/watch?v=gQS0tdIbJ0w

As for other sources, just type random related words into a search engine until something reliable pops out. You'll mostly find pop science articles including the word placebo though.

Re: The Placebo Phenomenon

#16

Post by lutusp » Sun, Dec 23, 2012, 1:56 AM UTC

psykotic wrote: post #14

seiji wrote: post #13

Placebo in a nutshell: inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain. The whole "people believing X so X happens" is a perverse co-opting of the placebo title. And, just for fun, if you give a patient naloxone (opiate blocker) before giving them the saline, the…

> inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain. I must admit I have a very hard time believing this exact claim as written. Do you have any sources?

> I must admit I have a very hard time believing this exact claim as written. Do you have any sources?

As it happens, one of the original placebo observations took place in a battlefield hospital that had run out of morphine. A physician began injecting saline, hoping the switch wouldn't cause too much psychological stress. To his surprise, many of his patients continued to report pain relief. Source:

http://www.brainfacts.org/sensing-thinking-behaving/mood/art...

"While treating wounded American soldiers during World War II, Henry Beecher ran out of pain-killing morphine. Desperate, he decided to continue telling the soldiers that he was giving them morphine, although he was actually infusing them with a saline solution. Amazingly, 40 percent of the soldiers reported that the saline treatment eased their pain."

Re: The Placebo Phenomenon

#17

Post by psykotic » Sun, Dec 23, 2012, 2:03 AM UTC

lutusp wrote: post #16

psykotic wrote: post #14

Earlier quoted context omitted.

> inject someone in pain with morphine. do it repeatedly over time. once, without telling them, inject them with saline instead. their brain will respond as if it was morphine and continue to block the pain. I must admit I have a very hard time believing this exact claim as written. Do you have any sources?

> I must admit I have a very hard time believing this exact claim as written. Do you have any sources? As it happens, one of the original placebo observations took place in a battlefield hospital that had run out of morphine. A physician began injecting saline, hoping the switch wouldn't cause too much psychological stress. To his surprise, many of his patients continued to report pain relief. Source: http://www.brai…

That's not a controlled study, plus the effect claimed is much weaker than what I was addressing. I can believe that placebo provides some pain relief--I was addressing the claim that they provided identical levels of relief. All the studies I could find on PubMed comparing morphine to placebo for treating various kinds of pain have morphine as the undisputed winner.

Re: The Placebo Phenomenon

#18

Post by seiji » Sun, Dec 23, 2012, 2:10 AM UTC

psykotic wrote: post #17

lutusp wrote: post #16

Earlier quoted context omitted.

> I must admit I have a very hard time believing this exact claim as written. Do you have any sources? As it happens, one of the original placebo observations took place in a battlefield hospital that had run out of morphine. A physician began injecting saline, hoping the switch wouldn't cause too much psychological stress. To his surprise, many of his patients continued to report pain relief. Source: http://www.brai…

That's not a controlled study, plus the effect claimed is much weaker than what I was addressing. I can believe that placebo provides some pain relief--I was addressing the claim that they provided identical levels of relief. All the studies I could find on PubMed comparing morphine to placebo for treating various kinds of pain have morphine as the undisputed winner.

It's not morphine or salt water. It's morphine->morphine->morphine->morphine->salt water.

Pharmaceutical studies of only using drug or not-drug have different characteristics.

Re: The Placebo Phenomenon

#19

Post by psykotic » Sun, Dec 23, 2012, 2:14 AM UTC

seiji wrote: post #18

psykotic wrote: post #17

Earlier quoted context omitted.

That's not a controlled study, plus the effect claimed is much weaker than what I was addressing. I can believe that placebo provides some pain relief--I was addressing the claim that they provided identical levels of relief. All the studies I could find on PubMed comparing morphine to placebo for treating various kinds of pain have morphine as the undisputed winner.

It's not morphine or salt water. It's morphine->morphine->morphine->morphine->salt water. Pharmaceutical studies of only using drug or not-drug have different characteristics.

I got that from your original post. Unfortunately, I wasn't able to find any studies with that experimental setup, hence my earlier question to you.

Re: The Placebo Phenomenon

#20

Post by lutusp » Sun, Dec 23, 2012, 2:17 AM UTC

psykotic wrote: post #17

lutusp wrote: post #16

Earlier quoted context omitted.

> I must admit I have a very hard time believing this exact claim as written. Do you have any sources? As it happens, one of the original placebo observations took place in a battlefield hospital that had run out of morphine. A physician began injecting saline, hoping the switch wouldn't cause too much psychological stress. To his surprise, many of his patients continued to report pain relief. Source: http://www.brai…

That's not a controlled study, plus the effect claimed is much weaker than what I was addressing. I can believe that placebo provides some pain relief--I was addressing the claim that they provided identical levels of relief. All the studies I could find on PubMed comparing morphine to placebo for treating various kinds of pain have morphine as the undisputed winner.

> I can believe that placebo provides some pain relief--I was addressing the claim that they provided identical levels of relief.

I doubt that any serious researcher will make that claim. Such studies are, after all, based on self-reporting, notoriously unreliable and difficult to accurately quantify.

This is not to say that psychologists won't make claims like that. But psychological science is only peripherally related to the other kind of science -- the real kind.