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The Placebo Phenomenon

harvardmagazine.com

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Re: The Placebo Phenomenon

#21

Post by lutusp »

tokenadult wrote: post #2

From the article: "Kaptchuk . . . doesn’t argue that you can simply 'think yourself better.' 'Sham treatment won’t shrink tumors or cure viruses,' he says." That's an honest statement and an important point, because many publications with Kaptchuk's name on them are overinterpreted to reach the conclusion that there is a "real" placebo effect that can actually cure disease. In fact, there is no strong evidence of tha…

> To sum up, despite claims to the contrary that are often covered by the lay press, the best-considered view among medical practitioners with clinical experience is that the placebo response has no ethical clinical application.

Of course I agree with this view, but when interpreted in its widest sense, it argues against the legitimacy of religion. It also occurs to me that few will notice the connection.

On a more practical level, it argues against most psychological treatments, which research shows cannot reliably be distinguished from a placebo effect. Few will notice this connection either.

Re: The Placebo Phenomenon

#22

Post by 31reasons »

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.

>That's not a controlled study

Just wondering, how could you get rid of the placebo effect in the placebo experiment?

Re: The Placebo Phenomenon

#23

Post by aufreak3 »

> Companies spend millions of dollars and often decades testing drugs; every drug must outperform placebos if it is to be marketed. “If we can identify people who have a low predisposition for placebo response, drug companies can preselect for them,” says Winkler. “This could seriously reduce the size, cost, and duration of clinical trials…bringing cheaper drugs to the market years earlier than before.”

Wat? Is that a typo? Shouldn't it be "preselect against them"? .. or better still, include predisposition to placebo response as a variable?

Re: The Placebo Phenomenon

#24

Post by psykotic »

31reasons wrote: post #22
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.

>That's not a controlled study Just wondering, how could you get rid of the placebo effect in the placebo experiment?

Fair point. I was using "controlled" as a shorthand for the usual qualities (double blind, randomized, sufficiently many test subjects, etc) you'd associate with good experimental design.

Re: The Placebo Phenomenon

#25

Post by haxplorer »

aufreak3 wrote: post #23

> Companies spend millions of dollars and often decades testing drugs; every drug must outperform placebos if it is to be marketed. “If we can identify people who have a low predisposition for placebo response, drug companies can preselect for them,” says Winkler. “This could seriously reduce the size, cost, and duration of clinical trials…bringing cheaper drugs to the market years earlier than before.” Wat? Is that…

I think what he means to convey there is that a person with a low predisposition would be affected by the actual content in the drug than just taking any pill.

Including predisposition to placebo as a variable would just increase the number of experiments needed. Instead, if you could eliminate a variable from the system by preselecting for people for whom the variable doesn't apply, it would reduce the time to experiment

Re: The Placebo Phenomenon

#26

Post by lutusp »

31reasons wrote: post #22
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.

>That's not a controlled study Just wondering, how could you get rid of the placebo effect in the placebo experiment?

> ... how could you get rid of the placebo effect in the placebo experiment?

That's easy -- give one group a real placebo, give the other an imitation.

Re: The Placebo Phenomenon

#27

Post by StavrosK »

lutusp wrote: post #21
tokenadult wrote: post #2

From the article: "Kaptchuk . . . doesn’t argue that you can simply 'think yourself better.' 'Sham treatment won’t shrink tumors or cure viruses,' he says." That's an honest statement and an important point, because many publications with Kaptchuk's name on them are overinterpreted to reach the conclusion that there is a "real" placebo effect that can actually cure disease. In fact, there is no strong evidence of tha…

> To sum up, despite claims to the contrary that are often covered by the lay press, the best-considered view among medical practitioners with clinical experience is that the placebo response has no ethical clinical application. Of course I agree with this view, but when interpreted in its widest sense, it argues against the legitimacy of religion. It also occurs to me that few will notice the connection. On a more p…

This research invalidated the only reason I had for not minding homeopathy. It was at least healing people by the placebo effect.

Now it doesn't even do that. Good riddance.

Re: The Placebo Phenomenon

#28

Post by iskander »

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?

Some related studies:

'Partial antagonism of placebo analgesia by naloxone' (http://www.ncbi.nlm.nih.gov/pubmed/6308540) -- no actual morphine was ever adminstered, only a regimen of saline injections, whose placebo effect is apparently achieved by the release of endogenous opioids.

'A comprehensive review of the placebo effect'(http://pharmacology.ucsd.edu/graduate/courseinfo/placebartic...): "placebos have actual biological effects on the brain and body and are more than response biases."

Re: The Placebo Phenomenon

#29

Post by iskander »

tokenadult wrote: post #2

From the article: "Kaptchuk . . . doesn’t argue that you can simply 'think yourself better.' 'Sham treatment won’t shrink tumors or cure viruses,' he says." That's an honest statement and an important point, because many publications with Kaptchuk's name on them are overinterpreted to reach the conclusion that there is a "real" placebo effect that can actually cure disease. In fact, there is no strong evidence of tha…

Huh, your extensive research doesn't square with much of what I learned as a neuroscience undergrad. We read a few papers that demonstrated non-trivial physiological responses due to 'sham' treatments.

In particular, placebo treatments have a well established impact on pain by causing release of endogenous opioids (see http://webusers.astro.umn.edu/~larry/CLASS/NOTHING/READINGS/... and http://pharmacology.ucsd.edu/graduate/courseinfo/placebartic...).

More generally, it would be shocking if beliefs and perceptions didn't have (both beneficial and harmful) medical effects. Mental states have physical consequences. For example, stressful thoughts cause measurable differences in levels of various hormones and neurotransmitters. Over time, particular patterns of thinking can even cause changes in the morphology of the brain. The strong assertion of a mind/body split seems simplistic and outdated, there's simply too much evidence of a complex entangled relationship between the two.

Re: The Placebo Phenomenon

#30

Post by wisty »

thirdtruck wrote: post #5
revelation wrote: post #3

I get very uneasy reading articles that start to pitch "value of caring" and someone who "didn't doubt the value of acupuncture" against "western medicine" and "western doctors" who are portrayed as stubborn and close-minded.

Agreed. "Western medicine" only exists as half of a false dichotomy. If the doctors so labeled really were stubborn and close-minded, then we would still perform blood-lettings and chew tree mark (instead of just the active ingredient). Instead, these doctors are more open to new information; they're just willing to also incorporate the evidence against efficacy so often ignored by "alternative medicine" practitioner…

That's not 100% true. It's only really the case in patent protected medicines.

New drugs undergo testing, to get FDA approval. New surgical treatments don't. New (and old) surgical treatments and old drugs aren't lucrative enough to warrant real testing. Surgeons will claim it's for ethical reasons, or because they just know better, or that they are artists who can't be constrained by the laws of statistics, but it's simply a lack of regulations and / or incentives.

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