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Placebo effect
Posted: 09 August 2010 02:56 PM   [ Ignore ]
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I think I’m about as immune to the placebo effect as the rest of the sceptics here. But what about those who aren’t and might benefit from alternative medicine?

Stephen

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Posted: 09 August 2010 03:15 PM   [ Ignore ]   [ # 1 ]
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The point is that the placebo effect is not an objective benefit. It does not result in the patient’s needing fewer painkillers, less medicine or anything else objectively measurable. What it amounts to is that the patient is more likely to say he or she feels better when asked on a certain kind of test. That’s basically it.

And you are probably not immune to its effects, such as they are.

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Posted: 09 August 2010 03:42 PM   [ Ignore ]   [ # 2 ]
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I’m and old dinosaur of a nurse, who likes to think she practices science based medicine…and I KNOW I’m not immune. Steven Novella will probably tell you the same thing. (for instance) I have allergies, when I take an antihistamine during a bout of hay fever, I immediately begin to feel better. The medication takes about 30 minutes to take effect, so it causes an initial placebo effect.

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Posted: 09 August 2010 03:45 PM   [ Ignore ]   [ # 3 ]
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StephenLawrence - 09 August 2010 02:56 PM

I think I’m about as immune to the placebo effect as the rest of the sceptics here. But what about those who aren’t and might benefit from alternative medicine?

Stephen

This statement is worded kind of wierdly.  We skeptics are not immune to it at all, which means that you are as immune as we are . . .

And are you talking about only the placebo effect benefit, or other benefits?

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Posted: 09 August 2010 04:23 PM   [ Ignore ]   [ # 4 ]
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I promise you, Stephen, you are not immune to the placebo effect. None of us are. It is a fundamental artefact of how our brains make cause-effect conslusions. However, I also think implicit in your question is the notion that the “placebo effect” is a real phenomenon, not just an artefact, and that it has real and possibly significant effects on health. I don’t think this is true.

Part of the confusion is in what the term really means. It is usually a catchall used to lump together many psychological and methodological factors that affect the outcome of clinical trials. People tend to think it simply means that believing something is helpful actually makes you better, mind-over-matter and that sort of thing. But it really encompasses much more than that. People getting a medical intervention may appear to get better for many reasons, and without the proper controls (which are rare in medical studies and completely absent in real life), it is impossible to distiguish which are the real causes of perceived improvement in a given case and how much role, if any, psychological factors such as belief or expectancy play. A few examples (from Quackwatch, Why Bogus Therapies Often Seem to Work):

1. The disease may have run its natural course. Many diseases are self-limiting. If the condition is not chronic or fatal, the body’s own recuperative processes usually restore the sufferer to health. Thus, to demonstrate that a therapy is effective, its proponents must show that the number of patients listed as improved exceeds the number expected to recover without any treatment at all (or that they recover reliably faster than if left untreated). Without detailed records of successes and failures for a large enough number of patients with the same complaint, someone cannot legitimately claim to have exceeded the published norms for unaided recovery.

2. Many diseases are cyclical. Such conditions as arthritis, multiple sclerosis, allergies, and gastrointestinal problems normally have “ups and downs.” Naturally, sufferers tend to seek therapy during the downturn of any given cycle. In this way, a bogus treatment will have repeated opportunities to coincide with upturns that would have happened anyway.

3. The placebo effect may be responsible. Through suggestion, belief, expectancy, cognitive reinterpretation, and diversion of attention, patients given biologically useless treatments often experience measurable relief. Some placebo responses produce actual changes in the physical condition; others are subjective changes that make patients feel better even though there has been no objective change in the underlying pathology.

4. People who hedge their bets credit the wrong thing. If improvement occurs after someone has had both “alternative” and science-based treatment, the fringe practice often gets a disproportionate share of the credit.

5. The original diagnosis or prognosis may have been incorrect. Scientifically trained physicians are not infallible. A mistaken diagnosis, followed by a trip to a shrine or an “alternative” healer, can lead to a glowing testimonial for curing a condition that would have resolved by itself. In other cases, the diagnosis may be correct but the time frame, which is inherently difficult to predict, might prove inaccurate.

6. Temporary mood improvement can be confused with cure. Alternative healers often have forceful, charismatic personalities. To the extent that patients are swept up by the messianic aspects of “alternative medicine,” psychological uplift may ensue.

7. Psychological needs can distort what people perceive and do. Even when no objective improvement occurs, people with a strong psychological investment in “alternative medicine” can convince themselves they have been helped. According to cognitive dissonance theory, when experiences contradict existing attitudes, feelings, or knowledge, mental distress is produced. People tend to alleviate this discord by reinterpreting (distorting) the offending information. If no relief occurs after committing time, money, and “face” to an alternate course of treatment (and perhaps to the worldview of which it is a part), internal disharmony can result. Rather than admit to themselves or to others that their efforts have been a waste, many people find some redeeming value in the treatment. Core beliefs tend to be vigorously defended by warping perception and memory. Fringe practitioners and their clients are prone to misinterpret cues and remember things as they wish they had happened. They may be selective in what they recall, overestimating their apparent successes while ignoring, downplaying, or explaining away their failures. The scientific method evolved in large part to reduce the impact of this human penchant for jumping to congenial conclusions. In addition, people normally feel obligated to reciprocate when someone does them a good turn. Since most “alternative” therapists sincerely believe they are helping, it is only natural that patients would want to please them in return. Without patients necessarily realizing it, such obligations are sufficient to inflate their perception of how much benefit they have received.

The job of distinguishing real from spurious causal relationships requires well designed studies and logical abstractions from large bodies of data. Many sources of error can mislead people who rely on intuition or informal reasoning to analyze complex events. Before agreeing to any kind of treatment, you should feel confident that it makes sense and has been scientifically validated through studies that control for placebo responses, compliance effects, and judgmental errors. You should be very wary if the “evidence” consists merely of testimonials, self-published pamphlets or books, or items from the popular media.


There is also a New England Journal of Medicine review which suggests that the common belief placebos have real, significant effects even on symptoms, much less underlying diseases processes, is unfounded.


Ultimately, if someone does something harmless and then feels better, I don’t strongly object to that. But I think the devil is in the details, and the details include unknown risks from therapies presumed to be harmless, avoidance of truly effective therapies as a consequence of the same beliefs that may have a placebo benefit, the ethical concerns about doctors an others selling inert therapies as if they were real therapies, and many others. Rather than an untapped resource for better health, I think the placebo effect is simply an artefact of our epistemological systems which interferes with making accurate judgements about medical interventions, and what benefits it may have are rarely enough to balance the harm done by the effects of such an artefact.

For more info, see:
The Placebo Effect

The Placebo Myth

Studying Placebo Effects

Skeptic’s Dictionary Placebo Entry

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Posted: 09 August 2010 04:31 PM   [ Ignore ]   [ # 5 ]
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StephenLawrence - 09 August 2010 02:56 PM

I think I’m about as immune to the placebo effect as the rest of the sceptics here. But what about those who aren’t and might benefit from alternative medicine?

So your mommy’s kisses never helped to heal your booboos faster?  A mere “there there” never made it all better? 

That said, I’d like to see a placebo stop a gushing wound faster than a tourniquet. 

Placebos help cope, as it was said earlier, but won’t cure.

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Posted: 09 August 2010 06:41 PM   [ Ignore ]   [ # 6 ]
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While I don’t know if a sugar pill disguised as my normal antihistamine would give the same result, common sense tells me not to consider a placebo (or homeopathic ‘remedy’) in the event of an anaphylactic reaction.

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Posted: 09 August 2010 07:09 PM   [ Ignore ]   [ # 7 ]
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asanta - 09 August 2010 06:41 PM

While I don’t know if a sugar pill disguised as my normal antihistamine would give the same result, common sense tells me not to consider a placebo (or homeopathic ‘remedy’) in the event of an anaphylactic reaction.

You know when I was in my 20s and I found out my younger son also got migraines just as I do and have since I was a child, I heard feverfew tea helped with migraines.  Since he was too young to take the meds for migraines I did, I tried feverfew tea.  It didn’t help him any at all.  So, placebos don’t work, not matter the form.

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Posted: 09 August 2010 08:27 PM   [ Ignore ]   [ # 8 ]
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Hey, when I had severe muscle from statins, chewing a half a hydrocodone gave me instant relief.  Just knowing I had taken something that would wipe out the pain in about a half hour made me feel so much better that I probably didn’t need the hydrocodone.  smile

Occam/E

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Posted: 09 August 2010 08:28 PM   [ Ignore ]   [ # 9 ]
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Emerson - 09 August 2010 08:27 PM

Hey, when I had severe muscle from statins, chewing a half a hydrocodone gave me instant relief.  Just knowing I had taken something that would wipe out the pain in about a half hour made me feel so much better that I probably didn’t need the hydrocodone.  smile

Occam/E

I knew it didn’t help my son when he continued to have the headache and puked.  Told me it got worse, not better, which is the way most untreated migraines go.

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Mriana
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Posted: 09 August 2010 09:57 PM   [ Ignore ]   [ # 10 ]
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Mriana - 09 August 2010 08:28 PM

I knew it didn’t help my son when he continued to have the headache and puked.  Told me it got worse, not better, which is the way most untreated migraines go.

How old was your son, the placebo effect has a more limited effect on children. It is more effective when the parents are convinced/convincing the treatment will work(kissing a scraped knee).

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Posted: 09 August 2010 09:59 PM   [ Ignore ]   [ # 11 ]
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Emerson - 09 August 2010 08:27 PM

Hey, when I had severe muscle from statins, chewing a half a hydrocodone gave me instant relief.  Just knowing I had taken something that would wipe out the pain in about a half hour made me feel so much better that I probably didn’t need the hydrocodone.  smile

Occam/E

My guess is that the pain relief would last no where near as long as the vicodin.

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Posted: 09 August 2010 10:07 PM   [ Ignore ]   [ # 12 ]
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mckenzievmd - 09 August 2010 04:23 PM

I promise you, Stephen, you are not immune to the placebo effect. None of us are. It is a fundamental artefact of how our brains make cause-effect conslusions. However, I also think implicit in your question is the notion that the “placebo effect” is a real phenomenon, not just an artefact, and that it has real and possibly significant effects on health. I don’t think this is true.

Ok, thanks, I think that answers the question.

By immune I just meant that going to “Peter the healer” yes there is such a chap, could not work for me because I think it’s mumbo jumbo.

Whilst I was thinking it might work for someone who believed.

I was thinking of the placebo effect as a real effect, so the mind and body could respond to the belief it was getting cured favourably in such a way that the person really was physically improved.

And so I was thinking that perhaps we shouldn’t ignore this real benefit to some people.

Stephen

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Posted: 10 August 2010 08:24 AM   [ Ignore ]   [ # 13 ]
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StephenLawrence - 09 August 2010 10:07 PM

And so I was thinking that perhaps we shouldn’t ignore this real benefit to some people.
Stephen

It sort of depends. The placebo effect works best on mild to moderate pain or sedation. If I were to operate on you, no amount of salt water could convince you that you were getting morphine. The placebo effect also does not cure. If I had a cancer, some quack may be able to convince me that it is gone via placebo mumbo jumbo, but this would not affect the cancer presence or growth…I’d still have the cancer.

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Posted: 10 August 2010 08:36 AM   [ Ignore ]   [ # 14 ]
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asanta - 09 August 2010 09:57 PM
Mriana - 09 August 2010 08:28 PM

I knew it didn’t help my son when he continued to have the headache and puked.  Told me it got worse, not better, which is the way most untreated migraines go.

How old was your son, the placebo effect has a more limited effect on children. It is more effective when the parents are convinced/convincing the treatment will work(kissing a scraped knee).

Oh about 8 to 10 years old. Somewhere in there.  I had no clue if it would work or not.  It was purely experimental and I had researched it enough to know it wouldn’t do him harm, but the question remained, “Would it help him?”  So, I had the “I don’t know” attitude.  I could not confirm or deny it’s effectiveness.  All I could say was, “I heard this helps with migraines and it won’t hurt you.  Would you like to try it and see if it works?”  I gave him the choice of trying it without any promises.  He chose to try it after I informed him of all the information I had on it, because he was in so much pain.  Part of it might have been my fault because I’ve always educated my sons, esp on what they put in their bodies, at least with all the knowledge I had on said product.  In the end, I allowed them to make their own choices about such things.

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Posted: 10 August 2010 11:39 AM   [ Ignore ]   [ # 15 ]
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I’m not really all that aware of how strong the placebo effect is in me.  I don’t really ever take anything.  I take a couple aspirin for headaches once in a while, but those usually take a while to kick in and I’m never really sure whether it’s the aspirin working or just my headache going away on its own. 

I’d assume it would work on me, but I’d be terrible for research as I’d assume I would receive the sugar pill going into it.

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