This is nicely done — clear and comprehensible. I also very much like the statement that doctors have an obligation to state the truth.
Pharyngula
Evolution, development, and random biological ejaculations from a godless liberal
This is nicely done — clear and comprehensible. I also very much like the statement that doctors have an obligation to state the truth.
Another good bit from Ben, and surprisingly well-focused on the positive side of things.
Too bad it doesn’t say absolutely anynothing about the actual mechanism of the placebo effect, just the manifestation.
That’s the crucial aspect: sooner or later lying to patients will undermine the authority of medical science.
That elegantly explains the niche into which Homeopathy has inserted itself.
Some very good friends of mine believe in the curing power of homeopathy, and I am a bit unsure about how much I should try to talk them out of it. They are otherwise sensible atheists, and this quirk seems to be their only dip into the “alternative”.
On one hand, homeopathic … preparations does work (in the placebo sense of the word), causes minimal harm (even placebo has reported side-effects including drowsiness, dizziness and nausea), and it isn’t anything that’s ruining them finansially, and so far they aren’t using it for anything serious, mostly heyfever, headaches and common cold (where placebo works wonders).
On the other it is a sham, and they are giving money to some highly unethical people.
While it is a doctor’s responsibility to come clean that the placebo isn’t working, what is my responsibility, seing as it doesn’t seem to cause any harm (except to my sense of justice)?
@Tronzu
Isn’t that because no one knows how it works?
Another way to use placebo effects is to prescribe psychotherapy much more often. A wide variety of conditions can benefit from psychotherapy, even apparently “somatic” conditions like ulcers, diabetes, migraine….
We also should be studying the mechanism of placebo effects to determine what actually is going on in the brain and body. Is it just a change in perception? Is it a change in behavior? Is it actually a physiological change, e.g. in endocrine systems?
Doesn’t the NHS cover homeopathy?
Placebos are amazing things. Watching a child announce that she now feels better, thanks, two seconds after swallowing an antibiotic or analgesic is a mothering high. Obviously, at that point, the medicine would be just as affective if it were a placebo. Except that I believed it was real, and that believe was transmitted to the child.
You could give placebos without lying. You could say, “Try these pills and see if they help.” Deception, yes, but not a full-blown lie.
And oddly, you can tell people that life is too complicated to have arisen “naturally,” so God must have made it, and that can be understood as an actual explanation.
I’m not just ragging on various types of creationists, I’m saying that the effects of saying “the Designer did it” and “these (sugar) pills will help you” seem to both invoke causal effects within the mind that are similar to each other.
Glen D
http://tinyurl.com/mxaa3p
Vilding, I would say your responsibility as a friend is to tell them honestly what you think. If they do not use homeopathy as a replacement for proper medical care, then the only harm is financial, and the question as to whether that harm is sufficient to be considered significant rests on a personal value judgement – how much is one willing to pay for a placebo effect, and the feel-good psychological reassurance of thinking one is doing something constructive?
Physicians (real doctors) take advantage of the placebo effect whenever they succeed in establishing a good patient-doctor relationship. Some, of course, are better at this than others.
@4
I feel the same way about homeopathy. Part of me is itching to tell the person that it’s complete nonsense, and the other part is thinking that I’d be removing a valuable placebo from their arsenal.
The thing is, real medicine also has a placebo affect, as I’ve shown with my anecdote above.
Still, it’s a tricky situation. I wouldn’t want to spend money on a worthless treatment, and I assume most people feel the same way. On the other hand, I don’t want to be belligerent about it.
You really can’t generalize like that. Do you know the official US legal definition of homeopathic medicine? It’s anything that is listed in the Homeopathic Pharmacopoeia of the United States. This does not guarantee that there are not potentially dangerous levels of active ingredients, and it bypasses clinical trials that actual drugs need to go through.
Zicam is classified as homeopathic. It did not require clinical trials a normal drug would take. It has high levels of Zinc. Tentative trials show that it can cause permanent loss of sense of smell (and the mechanism is plausible, Zinc is known to cause loss of sense of smell, and that is why “homeopathy” would use it to treat a cold, which can more temporarily cause loss of sense of smell).
@8 Yup, I remember that effect from my childhood. 2 or 3 seconds after downing an aspirin I felt a lot better.
Citations, please.
As a child, I suffered badly from respiratory allergies. My doctor assured us that the condition was “psychosomatic”, right up until the first antihistamines came on the market. Suddenly, it wasn’t “psychosomatic” any more. Similarly, many of the ulcers that used to be attibuted to “stress” are now easily treated with antibiotics, because they are caused by Helicobacter pylori.
Tronzu | February 10, 2010 12:19 PM:
Each of us has within ourselves hundreds of billions of neurons, tens of trillions of synapses, and hundreds of billions of glial cells – the dark matter of the brain. In all these structures, the operation of proteins is key. Proteins can fold in multitudinous complex ways, resulting in enormous numbers of different shapes – each shape with its particular function. The folding of proteins – and thus their function – is strongly influenced by quantum mechanics. Through quantum mechanics, in the dark matter of the brain, our bodies are influenced. Quantum mechanics is capable of coherence, of spooky action at a distance, and of many strange twists of probability. These strange twists of probability connect the dark matter of our brains across the spooky distances to other beings, creating ley lines along which the energies of other consciousnesses flow, connecting us to the whole and to our community and to the one. Through these energies come wishes of wellness, power of health, and deep body cleansing. This powerful cleansing flushes the toxins out of our bodies, enabling us to sprout sweet butterflies of health from every pore, strengthened and renewed.
I’m reading his book “Bad Science” right now, and it rocks pretty hard. As a chemist I get pretty sick of media scare mongering and scientific charlatans, so it’s a very refreshing read, and also comforting to know there’s at least one writer in a popular newspaper telling the truth.
I calling loki on #16.
Has anyone realized that eating a meal also has a kind of placebo effect? You feel satisfied immediately, long before the food has had a chance to be digested. Of course this has been selected for, otherwise we’d all eat ourselves to death (no comment on the current plague of obesity in the US).
Vilding, I think it’s irresponsible *not* to tell your friends the truth about homeopathy. The purveyors of that scam are criminals who are committing fraud, and you shouldn’t worry about sounding too “belligerent.” What kind of so-called atheist believes in crap like this in the first place? Homeopaths also claim to treat *any* kind of condition, including serious ones which definitely require genuine medical intervention. Faith healing sometimes works too, but not for things like cancer!
And it’s really disgusting how our own government has been hornswoggled into a hands-off treatment of almost anything labeled as alternative or supplemental just because enough voters demand it. Scientific knowledge is not determined by popular vote!
I don’t know the details, and I could be wrong here, but I’m pretty sure that Sen. McCain is pushing a bill to force supplement manufacturers to list their ingredients and for some more regulation. It’s a reaction to sports and steroids etc.. but I think it would apply to all supplements.
I’ll have to check up on it and see what it says.
Newage troll alert on #16!!
My previous post ought to teach me not to change my wording mid sentence (“I call loki” ~> “I’m calling loki”).
#9, Glen: So you think deception isn’t lying, huh? I think you should buy this bridge. I heard it’s for sale. :)
@16 Brilliant satire! The very essence of woo.
I don’t think there is a moral obligation to alert your friend to their foolish use of alternative medicine. If they planned to use herbs to cure a brain tumor – Yes, jump in with both feet, call all available evidence to the front and go in with guns blazing. But life is shades of grey. Or more accurately, multi-colored in various shades. And if your friends allergies are better because they ate the local bee barf… Is anyone really hurt and as you say, the placebo affect is gone.
Life is situational. Do you risk your friendship over herbal remedies for a cold? I wouldn’t.
hznfrst #19
That’s because your stomach, which was previously empty, is now full.
Curious. And something that should be required. But not really helping with respect to the issue I mentioned. Listing ingredients doesn’t tell people whether they are harmful or not. Being able to sell supplements that contain potentially harmful active ingredients without proper testing, simply because they got added to the list of “officially homeopathic” medications, is an atrocity. People take “homeopathic” medications because they believe they work. If the manufacturer does not believe they work, but advertises/sells them claiming they do, it’s fraud. If they believe they do but do not test them to ensure no harmful side effects (or to at least catalogue the possible ones to allow informed decision), they are negligent.
Right I understand that but it’s better than what we currently have. Especially if more regulation on the ingredients and what they are / do comes into play.
@llewelly:
wrong wrong wrong. you aren’t supposed to use bold type to highlight words. you’re supposed to use CAPITAL LETTERS.
Agree. Makes me miss the days when I could see McCain as an honest politician, instead of being forever tainted by being willing to throw his country under the bus for a few points in the presidential race.
For those worried about telling their friends the truth about homeopathy and thus destroying a valuable placebo for them…don’t worry. They won’t believe you. I know because I’ve told people many a time. You’ll hear “I know that it works from personal experience,” or “It doesn’t matter what large studies say, what matters is that it works for me,” or “I can’t believe you’d say there’s no mechanism for it working when it clearly works; it’s just like saying bumblebees can’t fly.”
So go ahead and tell people that traditional homeopathy doesn’t work. And ask them to look at the ingredients: in many cases the homeopaths apparently don’t believe in homeopathy, so they put actual medicinal agents in there. At that point, mention that there’s no regulation of homeopathic remedies. That might get them thinking sensible. However, if they demonstrate their selective paranoia by telling you that homeopathic companies are made of sweetness and light and only make safe products because they care about healing people, you’ll know your friends are too far gone and you can just give up on them.
Saw this guy on Nerdstock the other day. Great stuff..see it here: http://www.youtube.com/watch?v=O1Q3jZw4FGs
Great video by the good doctor (errr… should that be “bad” doctor?). I wonder though if I have somehow surpassed the placebo effect? I have become so jaded and distrustful in our overly-commercialized society that I no longer expect even real medicine to work as advertised. I go in with an attitude that “this stuff is over-hyped and probably won’t work”. And of course, like any good self-fulfilling prophecy, it doesn’t work anywhere near as well as it might. Pain medicine doesn’t relieve pain, cough medicine doesn’t relieve coughing, anti-itch cream doesn’t relieve the itch, and so on. Cursed by my skepticism. Sigh…
I can’t see the video, so maybe what I’m about to ask is covered there, but isn’t the placebo “effect”, just noise in the statistics? That is, what might also be called “false positive”; meaning the patient got better without treatment. What I am asking is, have there been studies where one group was not given any medication (nor placebo), the other group was given the placebo and there was a significant difference in recovery between the two?
I also think one has to distinguish between a “real” (medical) effect and the effect of just relieving anxiety about a condition. What I mean is that while I don’t think I am really a hypochondriac I do tend to get anxious when a new pain seems to not be “going away” and so a visit to my PCP who tells me there’s nothing to worry about seems to instantly “cure” whatever it was, simply because at that point the anxiety was worse than the pain itself. I think the same is true of the little kids instant response to the antibiotic. It is more about the emotions around the condition than the condition itself. The placebo relieves the emotions if not the disease.
@33
No, the crazy thing about placebo is that it actually, properly works.
It gives a boost in recovery rates on a number of diseases, that are actually objectively verifiable, not just how the patient feels.
Of course there are limits to what you can ethically study: Many illnesses you can’t actually take people off real drugs and give them placebo instead.
I’ve noticed that at least some of my friends who take so-called alternative medicine are not the least bit fazed to be told that these nostrums are placebos. That’s because they seriously overestimate the power and importance of the placebo effect, translating it into a mind-body connection that is practically magical. You can cure yourself of anything, they think, if you just have the right attitude. If that attitude involves a false belief, then so be it: it’s not a false belief, if it “works.”
All things are possible, if you believe it strongly enough. This gets into “The Secret” and Choprawoo territory.
Alties also don’t seem to think there’s anything dishonest about giving placebos, as long as you have good intentions (which is why it’s still wrong when money-grubbing pharmaceutical companies do it). If you believe in woo, and manage to re-frame the placebo effect as the Quantum Healing Power of the Cosmic Consciousness (hat tip to llewelly at #16), then there’s no moral problem anymore. Sincerity, excuses anything. Small improvement, is better than none at all.
They don’t seem to realize that big improvement — scientific progress in genuinely understanding and curing diseases and disorders — is simply not going to be on the radar in a culture which lies to itself for the short-term gain of the temporary, superficial fix. For people who babble on about being ‘holistic’ and ‘innovative,’ they’re sure entrenched in appearances and tradition.
When we say placebo gives a boost to recovery rates, aren’t we actually saying some people do better and some people don’t (which is still the larger number?), rather than everyone will do somewhat better? So, while there “is” a placebo effect, it is apparently not present in all patients. Have studies been done to try to ascertain what kinds of people (rather than what kind of beliefs) are amenable to placeboes?
BTW – #16 is classic woo. Victor Stenger’s “Quantum Gods” completely cured me of that stuff.
I wonder if the degree of placebo effect depends on the nature of the medical condition at issue. I seriously doubt any “placebo insulin” would keep a Type I diabetic alive for very long. However, with respect to chronic pain, or even high blood pressure, I assume there would be a more significant placebo effect.
Anybody know of any studies that look at this?
Anyone interested in “the” placebo effect and its mechanism should consult Dr. Novella, e.g. here:
http://www.theness.com/neurologicablog/?p=1130
********************
Warning: OFF TOPIC:
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If you’re bored…please upload new product photos of “Nothing”…on Amazon.com.
OK. I’ll start. Here’s one of PZ.
http://www.amazon.com/This-Test-Product-Nothing-Will/dp/B000ZING44
Look under “See all XX customer images”
Yawn.
The part about four sugar pills being a more effective treatment than two sugar pills blew my mind. I had no idea that the placebo effect worked that way.
Here’s the “fake surgery” I’d like to see for the placebo effect: Do surgery on two people with the same kind of cancer, but only take out the tumor in one of them. Think it’ll affect the survival rates?
I think the only difference is that, before it spreads too much farther, the person who still has the tumor will still think they feel fine.
Ecorona–
“It works but not for everybody” isn’t an argument that there’s no such thing as the placebo effect, because it applies to most medical interventions. Antibiotics won’t cure all infections; aspirin doesn’t bring down all fevers; measles vaccines don’t produce 100% protection; and so on.
But it matters whether the doctor or nurse (or layperson in a white lab coat, or parent) who gives someone a pill says “This will cure your cough” or “This will bring down the fever.” It also matters whether they sound sure of themselves: “This pill cures sore throat” is better than “This might help your throat” or than someone saying “This will cure your sore throat” in tones that suggest that they don’t believe it. That part is the placebo effect. Yes, it matters whether a person with a cough is given codeine or a sugar pill, but that’s not the only thing that matters.
Wrong!
Also wrong (in part). Most people don’t realize that the stomach and duodenum are endocrine organs and are also outfitted with a whole array of chemosensory abilities (for example, the intestinal lining expresses some of the same chemosensory proteins as taste buds and olfactory receptors–they’re just not hooked up to the conscious part of the brain to which “you” have access.)
When you eat a meal, stretch receptors and chemoreceptors in the stomach wall sense distension (“stomach full of something”) and protein (“new meal coming in”) and signal other stomach cells to stop secreting the “hunger hormone” ghrelin and to start secreting the “stomach full” hormone gastrin. Then, when acidic chyme (great Scrabble word, btw) enters the duodenum, it releases the hormone CCK. These hormones have many effects (all of which make perfect sense), including on the brain.
Ain’t no placebo. Just physiology.
Sven @43
or, to translate, “we know how this effect works, now.” One day I expect the placebo effect to be “just physiology” too.
(PS would the adjective associated with chyme be “chymal”?)
So 4 suger pills a day cures gastric ulcers faster than 2 suger pills a day. How do we know that this is just a placebo effect and not some sort of suger actually cures gastric ulcers effect?
Glen D: “You could give placebos without lying. You could say, “Try these pills and see if they help.” Deception, yes, but not a full-blown lie.”
No, if you’re a doctor, that’s a lie.
Leo111:
Easy, there’s a paper on it.
@Joffan
No…. There’s a fairly clear difference between a pharmacological effect and a placebo effect. I don’t think you understand what placebos are.
I’m relieved to find others expressing this.
I also find myself thinking “whoa…” : surely there must be a limit to what the placebo effect can achieve, and it’s only responsible to point this out. He gives the ulcers as an example of an organic illness where the patient’s condition can be improved by placebos, but that must be an exception, and the effect is normally only palliative. Will it cure cancer (apart from alleviating the symptoms)? Does the palliative effect even work with every patient? I can see people running too far with this.
#49 said “I can see people running too far with this.”
I could not agree more. One thing that jumped out at me was his statement that 4 sugar pills a day are more effective than 2 sugar pills a day and that a shot of saline solution is even more effective yet. Are 8 sugar pills a day more effective than 4? How are they truly quantifying this type of conclusion.
As an example, maybe the people receiving the shot feel more pressure to say it worked, even if they don’t feel a benefit.
No, it’s a good parody.
Check out the link in it.
I couldn’t figure out how to make this an official reply, but this is @InfraredEyes, post 15:
Diabetes: http://www.pep-web.org/document.php?id=PAQ.015.0262B
Migraine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1966930/
Ulcers: http://www.psychosomaticmedicine.org/cgi/reprint/56/5/440.pdf
Note that I am NOT saying that these conditions are purely psychological. I am saying that psychotherapy can help alleviate them, in part by changing people’s behavior and lowering their level of chronic stress. Some of these comments are utter nonsense that assert things about quantum physics without having even a basic understanding of quantum physics. (A good heuristic: If you can’t solve the Infinite Well Problem, you should shut up about quantum physics.) That’s not what I’m saying; I’m saying that how you think affects how you feel, how you feel affects how your endocrine system works, and how your endocrine system works affects your health.
In fact, I think we are much too dismissive of psychological conditions as if they were just something you can snap out of. I suffer from depression, and whether you consider it psychological or somatic (under identity materialism, what exactly is the difference?), it’s very difficult to deal with.
Perhaps, but his comment about the use of gastric ulcers for the study suggested that they were measuring effectiveness by actually looking at the stomach lining with a camera, and not relying on the patients’ reports of how they were feeling.
Nice one, Llewelly! More CAPS and the odd spelling error would help, though it seems you suckered a few despite linking to orac.
Nice one, Llewelly! More CAPS and the odd spelling error would help, though it seems you suckered a few despite linking to orac.
I always find myself pondering the possibilities when hearing things like this. Just how much control do we have over our bodies? Do we tap into even a small percentage of our potential on a daily basis?
latsot
What if you say, “I’d be interested in whether you find these pills effective,” with the intent of explanation later on?
Ben devotes an entire chapter of his book (Bad Science) to the placebo effect. It’s an excellent book: buy it, read it, then lend it to your woo friends.
Is it my imagination, or does he look older than usual in this video? He looks almost old enough to leave school!
‘Tis #25, I should have mentioned that I also feel more energetic right away as well (if I don’t overdo it, in which case I feel like sleeping it off) – now that has to be a placebo effect.
But then Sven #43 comes along with the real explanation, explaining this lifelong mystery for me. Thanks for that, Sven.
A friend’s tagline on h2g2 used to be “Ben Goldacre’s cat is my nutritionist”. The Bad Science blog is excellent, as is the book. I’ve lent my copy to my mother.
TRiG.
Seems like it comes down to stress. I’ve heard quite a bit about the physically debilitating effects of stress. Soldiers with PTSD are known to have all kinds of health problems …head aces, ulcers, hair falling out, …etc. And heart disease (the #1 killer), has been linked to stress.
Doesn’t the placebo effect just reduce stress by giving one a more positive mind set, or is there more to it.?
Book recommendation:
Predictably Irrational by Dan Ariely
He talks about the price of medication having an effect on the results garnered by them, and a bunch of other interesting stuff about how we think.
@latsot
I don’t think you understand my comment. Unless you believe that we will never know the physiological mechanisms of placebo effects.
Huffpost has a new article pimping for homeopathy and defending it from “skeptics” with what they call “evidence”.
Funny stuff:
http://www.huffingtonpost.com/dana-ullman/the-case-for-homeopathic_b_451187.html
I second SPEEDdemon’s book recommendation.
Also, another part of the placebo effect is telling the patient it’s a new drug. The thought process here is: if it’s new, it must work better than older meds.
Another interesting thing about the placebos is that narcotic competitive antagonists like naloxone ccan block the effect.
What this means is that placebos are capable of activating the endorphin system the same way an opiate does.
The experiment, as I recall, was to induce some sort of pain and treat it with morphine. After several repetitions of this saline is substituted for morphine. The subject could not tell the difference. But when naloxone was substituted the pain no longer goes away.
I have to say I’m glad I wasn’t one of the volunteers for this particular experiment though.
here’s a fictional example of how the relationship with the caregiver and how the information is presented makes a difference – one of Tony Hillerman’s novels included an anecdote about a Navajo elder who had been diagnosed with type 2 diabetes. his physician prescribed exercise, weight loss, and diet change – none of which the elder did. his shaman told him to climb a nearby hilltop every day to greet the dawn god with an offering of corn pollen. the elder complied with this advice and successfully managed his type 2 diabetes…by getting exercise and losing weight (there might have been something in the story about diet, too, but I’ve forgotten that part).
@ # 66
“I have to say I’m glad I wasn’t one of the volunteers for this particular experiment though.”
In any group of a hundred folks or so, there will be a few that actually enjoy pain….they might be perfect subjects for an experiment like this.
# 53 said: “Perhaps, but his comment about the use of gastric ulcers for the study suggested that they were measuring effectiveness by actually looking at the stomach lining with a camera, and not relying on the patients’ reports of how they were feeling.”
I commented on his statement that a saline shot was more effective than sugar pills at reducing *pain*.
@pnrjulius, thanks for the references. I don’t have access to the full text, but based on the abstract, I’m not sure that the reference on diabetes actually says that the disease is helped by psychotherapy. Plus, a sample size of “about eight” is going to be of limited value, statistically speaking.
Here is an interesting article about the opposite of the placebo effect – the nocebo effect – where believing you are ill can make you ill. Make up your own minds.
http://www.newscientist.com/article/mg20227081.100-the-science-of-voodoo-when-mind-attacks-body.html
This is driving me out of my mind.
If I can believe Ben Goldacre, he’s claiming a real, measurable effect that demonstrates that there is a real mind-body connection with regard to health.
I’ve heard this claimed before, and this is what drives me crazy: if it is real, why isn’t half the &*!$# medical establishment hard at work focusing on trying to pin down and understand the mechanism behind it?! Why isn’t a HUGE fraction of the enormous NIH budget dedicated to understanding this effect on a molecular level?! It strikes me that this could easily lead to a medical breakthrough as big as vaccines, if not bigger. I mean, using placebo-based results to “improve” the performance of existing treatments is just pussyfooting around, like you’ve been handed a very advanced tool or device and then you use it as a hammer to bang in nails on a board.
Another reason, it drives me nuts is the studies I’ve seen of drug efficacy which dutifully list success/failures of the test drug along with placebo control tests that are sometimes nearly as big as those of the drug, for which an effect is nevertheless claimed. How can anybody honestly claim a real effect when the background (placebo) is nearly as big and IS NOT UNDERSTOOD AT ALL?!
Am I the only one that thinks this? That understanding the placebo effect should be a major focus of medical research? By LEAVING this as some sort of unexplained mystery, the medical establishment IS practicing f&*!ing WOO! It should be hit with scientific analysis and it should be hit hard! People should be running MRIs, PET scans, enzyme screens etc. etc etc all those things that they do, until they get to the bottom of it.
I like to think that a thorough scientific knowledge of the placebo effect can actually help make up for the “broken spell” that results from such knowledge. Namely, simply knowing that so many ailments are self-limited should go some way towards speeding up that limiting, no? Whereas someone who waits for a pill before subconsciously giving themselves “permission” to get better didn’t have much confidence in their own immune system, I would think. Maybe?
(That’s something I’ve said before about alties — in contrast to their rhetoric, they really think the body’s natural healing potential is zilch, and thus in need of their woo. A rationalist, on the other hand, should be able to tell herself, “My body, fueled by food, water, and rest, is plenty capable of beating what I’ve got”, assuming it’s a self-limiting condition.)
What I’m basically saying is, shouldn’t the placebo effect be somewhat replicable with sheer willpower? Or are skeptics with back pain (or whatever) just plain screwed? It’s kind of a mindfuck thing if you think about it too hard — it’s like playing The Game (and I’m sorry you just lost).
It is being looked into. I don’t know why you think it isn’t. For pain, it increases the body’s natural pain killer, endorphins.
Nerd of Redhead @74 – thank you, that helps me calm down. I actually AM very ignorant of the research so maybe I shouldn’t rant at all and I probably should have researched the budgets more thoroughly before exploding like that, but there’s “looking into” and there’s taking a more serious attitude nationally – this announcement is a bit old and maybe not typical
http://grants.nih.gov/grants/guide/rfa-files/RFA-AT-02-002.html
but a few million is chump change, compared to the couple of billion dollar NCI budget, for example, which is focused on one malady only (a bad one that afflicts a lot of people to be sure)
So please let me rephrase (and also can you or anybody correct me with a number which is much bigger than a few million? I realize the above could be only a small bit of the pie) But if thats all it is, then why isn’t it more -much, much more? I mean, its not just pain treatment in the picture, the placebo effect works in LOTS of ailments and maladies, no?
Sean, the Wiki article is a good starting point for a further look. Near the bottom is a list of diseases that have been looked at, along with some links to the research papers.
So regarding the research into the placebo effect, I’ve got a question. To what degree is it being done? I mean.. the bit about sugar pills and ulcers says that the placebo effect can result in full on physical changes, not simply an endorphin release. Perhaps this is an extraordinary case, perhaps the ulcers were stress related and the placebo effect was able to tackle the stress issue.
But is there an attempt to intentionally harness this effect without using deception? I mean beside Ben’s example of creating a positive environment to administer the treatment. The message of the placebo effect is that the mind can make the effect real. So is there work under way to try to see if people can intentionally do this, to use their mind to heal their body without devolving into the sort of woo that such a statement would seem to suggest?
I kind of wonder if I’m wandering into the “nocebo” realm myself. I routinely suffer from headaches and have found that many typical OTC remedies don’t work. I’m down to maybe two regulars that usually work, I’m under the effects of one right now, Excedrine Migrain. My tendency is perhaps to expect the drug to not work except for my regulars, so am I making them less effective? On the other hand the sense of relief I feel, especially from the Excedrine, sometimes borders on euphoria, or at least pleasure. I’ve got a little of that going right now too. Perhaps I’m triggering a little endorphin release as well?
If you read the Wiki article linked above, it doesn’t work for everything. And it doesn’t work for everybody. Which makes it difficult to study, since it is very inconsistent. When I had the shingles, I needed my Naproxin every 6 hours for a month. A sugar pill wouldn’t have worked.
Re the discussion about research into the placebo effect. A possible reason that it is maybe not well researched is because no drug company stands to make any money out of the research findings.
What’s interesting is what effects on sports performance placebos could have. Here’s a bit about it at New Scientist.
You’ve got the usual question of the ethics of lying (or otherwise deceiving) about treatment, plus the question of whether it’s ethical to use the placebo effect to decrease an athlete’s susceptibility to pain.
Glen D
http://tinyurl.com/mxaa3p
“Quantum mechanics is capable of coherence, of spooky action at a distance, and of many strange twists of probability.”
(Llewelly in no. 16)
“‘You haven’t a real appreciation of Newspeak, Winston,’ he said almost sadly. ‘Even when you write it you’re still thinking in Oldspeak.'”
(Orwell in Nineteen Eighty-Four)
“I speak Esperanto like a native.”
(Spike Milligan somewhere)
You’re fluent in Woospeak, Llewelly, but you don’t have the quirks, the evasions, the internal conflictedness and intellectual dead zones that mark a native speaker. It’s off to Room 101 with you.
I’m actually surprised that all here seem so accepting without criticism the idea that placebos even work to begin with.
sure there are a lot of studies published, but have any of you actually taken a close look at them? Did you look to see if the trials controlled for other explanatory variables or not?
I recalled a paper in 2001 I had in my collection that reviewed the status of around 130 published studies that had concluded there was a placebo effect. discarding the few that had actually had no relevant outcome, they were left with 114 studies.
after analyzing all these papers…
so, umm, why does everyone here seem so convinced of the placebo effect?
read the review paper yourself:
http://content.nejm.org/cgi/content/abstract/344/21/1594
re 16 and 81: I’m pretty sure that, like Feynman said, quantum mechanics is not very capable of coherence…
at least, it’s incoherent to me.
Nice … but it could be misleading. Dr. Goldacre doesn’t emphasize that the placebo effect is not significant (if present at all) in *many* circumstances. For example, if you’re exposed to a large enough dosage of the rabies virus, placebo will do jack shit. Whenever anyone mentions “mind over matter” (except for magicians) I cringe. In another example, in the treatment of cancer a placebo may help a patient feel better (pain management) but that does jack shit for controlling the disease (though there may be a lot of wishy-washy “oh but maybe a more relaxed patient will fight the disease better” – well, ‘better’ isn’t good enough if the disease isn’t beaten).
http://www.blognow.com.au/sciencesays/247013/Are_We_still_Buying_From_the_Snake_Oil_Salesman.html
That’s my take on homeopathy in detail.
In Australia, the natives used to punish offenders with the old “bone curse”. If their shahman pointed the bone at an individual who was to be cursed they’d die of pneumonia a few days later.
Once, one was taken to hospital with a severe pneumonia like illness. Use of anti-schizophrenia drugs treated it and he made a full recovery. It was all in the mind of the believer.
http://en.wikipedia.org/wiki/Kurdaitcha
MadScientist, have you seen the Mindfreak episode on body suspension? If that’s not mind over matter, I don’t know what is. Of course, that is a magician using the phrase, but he’s not doing any magic there.
Minor quibble : Didn’t like him saying “shows the power of the mind over the body” or something to that intent at the beginning of the video.
Placebos don’t work “in the mind”, since the mind is something our brain generates in the first place.
But like the brain can be fooled to perceive an artificial hand as one’s own, so it can be fooled to perceive a sugar pill or fake operation as having an actual effect.It’s all quite amazing.
Obviously the placebo effect doesnt cure everything (or even most things). It mainly deals with pain or conditions that the bodies defences will destroy anyway.
I don’t think anyone is arguing the placebo effect will cure cancer but it may make it less painful (until medicine destroys the cancer or the cancer kills you).
I assume the body is capable of curing gastric ulcers in some cases on its own placebo or not but the placebo in some cases can speed it up
This makes sense. I like the truth obligation, too!
I’m extremely skeptical of the placebo effect. And watching Goldacre’s video just sounds like the crap we hear from the alt-med nutjobs. Do we have any evidence whatsoever of a mechanism for “mind over body?”
Every time I see something about the placebo effect, I read the data as just statistical randomness. Some people just get better because it happens. There are spontaneous remissions of cancers, and are we going to claim it’s placebos, or homeopathic water or even acupuncture.
As soon as we begin this journey that there is some magical process of the body which is induced by placebos, then the homeopathic nutjobs can claim “see, our stuff taps into this magic.”
A lot of what I’m reading here is pseudoscience. In fact, I cannot believe what I’m reading.
#82 Ichthyic and #90 Michael W Simpson:
It’s true that the placebo effect does initially sound like so much woo… but a fair amount of studies suggest there’s something to it, although it may indeed turn out to have been a red herring. (Check out health management system for one solidly materialistic hypothesis for the effect — one that could be total bullshit, I admit!)
We must be careful not to rule out something solely because of its connotation of woo; some skeptics ignore evidence for global warming, because it brings to mind treehuggers saying New-Agey things about Gaia, and their bullshit-detectors overreact. I’m not accusing anyone here of that, though, just pointing out the risk. (I’m susceptible to it too.)
Ah, but very few homeopaths are actually willing to admit their stuff is placebo — that would mean all that “succussing” was for nothing. And as has been posted here before, the effect is only good for self-limiting conditions. You can’t use it to cure, for example, malaria, in contrast to the oldest homeopathic claim of them all.
(To me, the counterintuitive thing about placebo is that it doesn’t make one sicker — that is, “You will get better” becoming a self-denying prophecy, because the body “thinks” it doesn’t have to do anything to fight whatever it’s got.)
The placebo effect is very real, its one of the big reasons we have double blind tests.
Its not woo merely the fact that the relationship between the mind/brain and body is poorly understood. No one is saying there are any external spirit forces
I’m extremely skeptical of the placebo effect. And watching Goldacre’s video just sounds like the crap we hear from the alt-med nutjobs. Do we have any evidence whatsoever of a mechanism for “mind over body?”
A teenage male arrived at A&E with partial and full-thickness burns to a hand and knee. On injection of saline the pain disappeared. On being informed that the injection was saline the pain reappeared again and then disappeared on injection of morphine.
It’s an anecdote but the placebo effect is definitely real.
The mechanistic hypothesis I’ve heard is that believing yourself to be getting better stimulates endorphin release which blocks pain, no evidence for that though.
Plenty. Just go over to PubMed and you’ll find plenty of studies on the effect. In fact, all drug trials are predicated on the placebo effect being real, since the drug has to be proven more effective than the placebo to even be considered for further trials.
One thing that I think most people (and doctors) miss from the placebo effect is that the body is quite capable of healing itself. All drugs and treatments do is to induce the body to begin a healing process, possibly in a directed manner. Without the body’s cooperation, any treatment would be ineffective. This also means that sometimes a “wait and see” approach is more appropriate than aggressive treatment for conditions that take time to develop.
I truly believe that one of the reasons healthcare costs continue to increase is that aggressive treatments (brought on by doctors being afraid of negligence lawsuits) have eroded the beneficial placebo effect of doctors being confident in the body’s ability to heal itself. That’s not to say that doctors should withhold treatment, but perhaps there are cases when a “wait and see” approach might have been the more effective form of treatment. Maybe one day I’ll perform that study, if it hasn’t already been done…
Plenty. Just go over to PubMed and you’ll find plenty of studies on the effect.
please, this defense is little more than an argumentum ad populum.
I highly recommend you read the meta-reviews of the many studies you just noted.
many of them have fatal flaws, either in design or statistical analysis.
To conclude that the placebo effect is broadly applicable is simply not supported by the evidence at hand.
pain, being a subjective scale to begin with, or other medical conditions in which patients use their own subjective scales DO support there being a placebo effect, and that is not unexpected.
as to the rest?
nope.