The Placebo Effect Doesn’t Apply Just to Pills

This article brings up a very important point, and I'm grateful that it was submitted here. The professor of pediatrics who wrote the article is onto some important issues, and I was especially glad he cited some of the research literature with direct links. Reading a review he cited,[1] I see that one of the problems here is the vagueness of what he calls "improvement" in many medical studies. Is the treatment endpoint of a knee operation patients moving better than they used to, as measured by trained observers watching the patients do standardized movements? Or is "improvement" a patient self-report of less pain? Several of the examples the author writes about are examples of treatments indicated to relieve pain (angina, which is chest pain, or lower back pain, and it looks like most of the knee surgery he mainly focuses on was also done to relieve patient-reported pain). Patient self-reported pain is a symptom, a matter important to the patient, but it is not a diagnostic sign that can be objectively observed by anyone else (as, for example, blood pressure or white cell count can be objectively observed).

Too many medical studies, and almost all "alternative medicine" testimonials, are based on soft endpoints (patient self-reports of improvement) rather than on "hard endpoints" (longer healthier life after reduction in all-cause mortality, or resuming walking after being paralyzed, or something observable objectively and lastingly important).

Pretty much all studies by all authors of whatever researcher background that appear to show a "placebo effect" show that only for patient-reported subjective symptoms that are usually temporary anyway like pain and nausea. Nobody asks for a placebo treatment for a broken leg or a life-threatening infection. The medical researchers who look at the issue with proper study designs and statistical controls know that placebos are essentially useless, as they at most have influence just on self-reported subjective symptoms, not on any sign that affects the progression of a disease or maintenance of good health.[2]

Findings on placebo effects by researchers who have considered the issue carefully include

"Despite the spin of the authors – these results put placebo medicine into crystal clear perspective, and I think they are generalizable and consistent with other placebo studies. For objective physiological outcomes, there is no significant placebo effect. Placebos are no better than no treatment at all."[3]

"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 low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed."[4]

So, yes, let's make sure that studies of surgical techniques include studies of sham surgery. (Studies of acupuncture had better always have sham acupuncture arms in which "real" acupuncture points are disregarded or other aspects of supposedly ancient Chinese technique are intentionally omitted without the patient knowing that.) This will improve the evaluation of safety and effectiveness of new surgical techniques. Just don't assume that ANY placebo is ever good for ANYTHING that you couldn't achieve just by giving yourself a good pep talk.

[1] http://www.bmj.com/content/348/bmj.g3253

[2] http://www.sciencebasedmedicine.org/michael-specter-on-the-p...

http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-plac...

[3] http://theness.com/neurologicablog/index.php/the-rise-and-fa...

[4] http://www.ncbi.nlm.nih.gov/pubmed/20091554

BTW, if you haven't seen it already, you should check out his YT channel, Healthcare Triage:

https://www.youtube.com/user/thehealthcaretriage

He does a great job covering a variety of subjects & explaining research to the layman.

> "Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective."

You seem to be taking that demonstrate efficacy, when what they're actually saying is more like 'there is no evidence that this works, but if nothing works then why the hell not.' It's no different than doctors giving patients the go ahead to use alternative medicine or whatever when the doctors know the patient is already going to die from cancer regardless.

placebo paradoxon- different teams - different conclusions :)

I agree with this:

"It is evident that placebo effects are real and that they have therapeutic potential. Laboratory evidence supports the existence of numerous placebo mechanisms and effects in both healthy volunteers and patients with a variety of medical conditions. Furthermore, clinically relevant evidence demonstrates that placebo effects can have meaningful therapeutic effects, by virtue of magnitude and duration, in different patient populations. Although substantial progress has been made in understanding placebo effects, considerable scientific work remains to be done in both laboratory experiments and translational clinical trial research, ---> with the ultimate aim of harnessing placebo effects to improve patient care."

Damien G Finniss,corresponding author Ted J Kaptchuk, Franklin Miller, and Fabrizio Benedetti

"Placebo Effects: Biological, Clinical and Ethical Advances"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/

I didn't say that. I believe that there are psychological benefits that have physical implications, and physical effects with psychological implications… As in depression can result in physical pain, and chronic pain can result in depression.