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The Placebo Effect Doesn’t Apply Just to Pills

nytimes.com

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Re: The Placebo Effect Doesn’t Apply Just to Pills

#41

Post by acornax »

nitid_name wrote: post #38
beagle3 wrote: post #17

Earlier quoted context omitted.

No. Because people know they could be taking a placebo, then having undeniable effect (psychoactive, redness, soreness, etc.) tells them that they are not using the placebo. Conversely, having no undeniable side effects lets them know that they are using the placebo. Thus, placebo usage is undermined. "Active placebo" has an undeniable effect, but not the compound being tested, so that the test subjects cannot tell i…

Couldn't that raise the question of if the side effects themselves are a source of benefit?

Not if they're already understood not to be...

Re: The Placebo Effect Doesn’t Apply Just to Pills

#42

Post by refurb »

Alex3917 wrote: post #39
taeric wrote: post #35

Earlier quoted context omitted.

I'm not sure I understand the first scenario. If they are tested against drugs which have already been shown to be better than a placebo, doesn't basic logic show they would be, as well? Or is there a case where one could "pass" this test, but still "lose" against a placebo? For the rest, I didn't realize there was a difference between inert and active placebos.

> Or is there a case where one could "pass" this test, but still "lose" against a placebo? The main issue is that a lot of the existing drugs aren't better than placebos: - Some were never required to be tested for efficacy by the FDA before approval. - Some were tested for whatever reason., but the methodology used by testing was flawed for whatever reason. - In many the data was blatantly faked or manipulated by th…

Some were never required to be tested for efficacy by the FDA before approval

Yes they were used before the FDA had a formal approval process, but your comments doesn't make sense.

If the current standard of care is a drug and you test against it, aren't you showing it's more effective?

Re: The Placebo Effect Doesn’t Apply Just to Pills

#43

Post by pella »

DanBC wrote: post #21
matkam wrote: post #2

Any idea how placebos work so well, what they are, and if we're doing anything to take advantage of the effect?

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974... > We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with…

"Nevertheless, it is important to mention that according to an influential 2001 meta-analysis comparing placebo-treatment arms with no treatment, placebos make no clinical difference.[20] However, the methodological difficulties of combining diverse conditions in a single meta-analysis are serious, and the authors’ updated meta-analysis includes more nuanced conclusions.[21] Furthermore, the meta-analyses implicitly assume the biological reductionist definition of placebo, ignoring the psychosocial context of sickness and health. The subjects in those studies were entered into a research programme and received attention and care. Therefore, in the way that the studies of the meta-analysis were actually conducted, there was plenty of room for the placebo effect without the placebo, which would spuriously suggest that the placebo was no more effective than no treatment, though in fact both had the potential to produce a placebo effect."

from "The moral case for the clinical placebo"

http://jme.bmj.com/content/40/4/219.full

Re: The Placebo Effect Doesn’t Apply Just to Pills

#44

Post by refurb »

Alex3917 wrote: post #11
viewer5 wrote: post #10

Earlier quoted context omitted.

> antidepressants and ADHD drugs on the market even the though research shows they are actually worse than taking no drug at all What do you mean?

http://www.amazon.com/gp/product/0307452425/ref=s9_simh_gw_p... http://www.amazon.com/gp/product/0465022006/ref=s9_simh_gw_p...

Rather than linking to a book on Amazon, could you link to some peer-reviewed journal articles?

Re: The Placebo Effect Doesn’t Apply Just to Pills

#45

Post by taeric »

Alex3917 wrote: post #39
taeric wrote: post #35

Earlier quoted context omitted.

I'm not sure I understand the first scenario. If they are tested against drugs which have already been shown to be better than a placebo, doesn't basic logic show they would be, as well? Or is there a case where one could "pass" this test, but still "lose" against a placebo? For the rest, I didn't realize there was a difference between inert and active placebos.

> Or is there a case where one could "pass" this test, but still "lose" against a placebo? The main issue is that a lot of the existing drugs aren't better than placebos: - Some were never required to be tested for efficacy by the FDA before approval. - Some were tested for whatever reason., but the methodology used by testing was flawed for whatever reason. - In many the data was blatantly faked or manipulated by th…

Ok, so it is less about them not specifically testing against a placebo, and more that they just do shoddy tests in the first place. I think that makes sense.

Re: The Placebo Effect Doesn’t Apply Just to Pills

#46

Post by wiredfool »

Alex3917 wrote: post #29
harvestmoon wrote: post #26

Earlier quoted context omitted.

While there is a good amount of controversy around the efficacy of antidepressants, first-line ADHD medications (the stimulants) work in roughly 70% of cases, which is much superior to placebo. For those with ADHD, treatment can make a large quality of life improvement. Source - memory from having written a book on adult ADHD

> first-line ADHD medications (the stimulants) work in roughly 70% of cases What do you mean by 'work'? The research cited by Anatomy of an Epidemic shows that there is no affect on grades or other academic outcomes. And that while concentration itself improves somewhat in the short term, after 2+ years it is worse than if the person were never given the drugs to begin with. See also: http://online.wsj.com/news/artic…

Academic performance doesn't seem to be an optimal measure for Adult ADHD.

Re: The Placebo Effect Doesn’t Apply Just to Pills

#47

Post by Alex3917 »

nitid_name wrote: post #38
beagle3 wrote: post #17

Earlier quoted context omitted.

No. Because people know they could be taking a placebo, then having undeniable effect (psychoactive, redness, soreness, etc.) tells them that they are not using the placebo. Conversely, having no undeniable side effects lets them know that they are using the placebo. Thus, placebo usage is undermined. "Active placebo" has an undeniable effect, but not the compound being tested, so that the test subjects cannot tell i…

Couldn't that raise the question of if the side effects themselves are a source of benefit?

This is what the book The Emperor's New Drugs is about. The idea of the book is that there was some well-known research showing that anti-depressants are effective for severe depression, but not mild or moderate cases. But if you actually only look at studies that used active placebos as controls, then there is no evidence clinical efficacy even for severe depression. Meaning that the nominal benefit for anti-depressants for severe depression that's seen in many studies is in fact probably due to people thinking they are better due to the side effects of the drug, rather than due to true drug benefits.

Re: The Placebo Effect Doesn’t Apply Just to Pills

#48

Post by Alex3917 »

refurb wrote: post #42
Alex3917 wrote: post #39

Earlier quoted context omitted.

> Or is there a case where one could "pass" this test, but still "lose" against a placebo? The main issue is that a lot of the existing drugs aren't better than placebos: - Some were never required to be tested for efficacy by the FDA before approval. - Some were tested for whatever reason., but the methodology used by testing was flawed for whatever reason. - In many the data was blatantly faked or manipulated by th…

Some were never required to be tested for efficacy by the FDA before approval Yes they were used before the FDA had a formal approval process, but your comments doesn't make sense. If the current standard of care is a drug and you test against it, aren't you showing it's more effective?

> If the current standard of care is a drug and you test against it, aren't you showing it's more effective?

The main issue is that a drug can be more effective than an older drug but still be less effective than taking no drug at all.

But given all the problems, both theoretical and practical, with current drug trials, there is pretty much no guarantee of anything. Just because something makes sense on paper doesn't mean that it's actually true. There are a number of books about the issues with drug trials... Bad Pharma by Ben Goldacre, The Truth About Drug Companies by Marcia Angell, Overdosed America, etc. All of these books cover largely different issues, so imho it's worth reading them all.

Re: The Placebo Effect Doesn’t Apply Just to Pills

#50

Post by Dylan16807 »

DigitalJack wrote: post #23
skinnybatch wrote: post #15

Earlier quoted context omitted.

I'd argue this is a psychological benefit...

So you think there is nothing physical about mood? Interesting.

There is a distinction, though it's tricky to word. It's about what is a direct effect, and what is an indirect effect.

There is a feedback loop between abstract thoughts and effects on the body, so to make a proper distinction you want to ignore the feedback loop and look at where the inputs are.

A placebo's direct effect is not physical. The direct effect is that first thought that you are receiving treatment, before it even has a chance to affect your mood.

A kidney transplant's direct effect is mostly physical. It's filtering your blood at a rapid pace.

So technically mood has physical effects but by the time you reach that stage you've destroyed the meaning of the term "physical benefit" into meaning just "benefit". Feel free to suggest better terms, but please don't muddle the waters.

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