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Medical Placebos Work In the Absence of Deception

  1. Jul 2, 2012 #1
    http://www.psychologytoday.com/collections/201201/the-placebo-effect/wising-dummy-pills

    The actual study:
    http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015591

     
  2. jcsd
  3. Jul 2, 2012 #2

    Curious3141

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    You know, I didn't want to get embroiled in your "nice" discussion on how you thought modern psychiatry is pseudoscience, and where you defended (the rest of) Medicine as not being pseudoscience. I'm not going to mention anything more about psych here so as not to derail the thread (I just mentioned it to highlight your interesting stance), but I will say this: as a medical doctor, I think the rest of Medicine also has a lot of baggage that might be called pseudoscience.

    The placebo (and nocebo) effect is chief among them. It's ill-defined - is deception crucial to the definition of a proper placebo? Does this have to be "active" deception, i.e. do you have to tell the patient this is a wonder drug? Or can it be a "passive" deception, which is the form used in controlled clinical trials, where the patient is told they will not know whether they are getting active compound or placebo. I don't think anyone has previously considered this sort of "no deception" placebo, which is why this study is useful, but again, the fact that almost noone has thought about this very clearly till now is a bit depressing (though there was a BMJ letter in 1994 that mentioned Shapiro's definition of the placebo and distinguished briefly between "intentional" and "inadvertent" placebos). And of course, the mechanism of action is not well-elucidated at all, with lots of handwaving about neural pathways. The plethora of different postulated mechanisms that seem curiously unfalsifiable does not make for a proper scientific theory.
     
  4. Jul 2, 2012 #3
    Interesting definition of no deception. No one fully understands the placebo effect, the precise role of regression to the mean versus psychological priming to respond etc. So telling the patients to expect benefit by a particular mechanism is a form of deception. What the study does support is that the mechanism is related to psychological priming rather than regression to the mean.
    The difficult bit is excluding a negative impact of "no treatment" - however the quality of interaction is controlled - this remains by definition an unblinded observation with a soft end point. The second issue is the patients were recruited for a study of placebo' so this may have attracted a biased study population.
     
  5. Jul 2, 2012 #4
    I take this to mean that, since the placebo effect is not completely understood, you find it pseudoscientific that every drug is tested against a placebo?
     
  6. Jul 2, 2012 #5
    So they told participants that taking placebos would make them feel better, and then the participants felt better? That seems like pretty standard placebo effect to me.
     
  7. Jul 2, 2012 #6
    Yes, the "without deception" is deceptive. I'd be interested in seeing the participants interviewed and having them explain in detail what “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes” means to them, what they heard by it. The psychological priming of "that have been shown in clinical studies to produce significant improvement" is almost certainly what they all found salient, and they rationalized the rest away if they had any doubts about it.
    Not sure what this means.
    IBS patients, in particular, had already been shown to be 'placebo friendly':
     
  8. Jul 2, 2012 #7

    Evo

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    My doctor told me that IBS cannot actually be diagnosed. When the patient has bowel problems and all tests come back negative, then they use the "IBS" label, meaning no cause found.

    IBS can be due to anxiety or diet, in which case, a placebo could work because it's not a disease.

    http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#diagnostic
     
  9. Jul 2, 2012 #8

    Curious3141

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    Not at all. The placebo effect is well-documented (even it it's not well-defined in most statements). Studies are meaningless without controls, so one needs to include a control group of some sort. In a double-blinded placebo-controlled trial, the control is the placebo, and it should be indistinguishable from the active study compound by both subject and researcher, and exactly the same instructions should be given to the subject no matter what they're on (which is easy when it's double-blind). I'm not disputing any of this. If this were not done, most prospective studies would be invalid, too.

    What I *am* saying is that, to date, the placebo effect has been observed without a serious, concerted effort to elucidate its mechanisms. What really causes it? Do the instructions matter? How about "suggestibility" of the subject (which in itself needs to be better defined)? And are all placebos equal? Would a bitter-tasting placebo be more or less effective than a neutral or sweet tasting one? How about colours and textures of pills?

    The problem is that the placebo effect has been entirely empirically studied to date, and even that has left something to be desired. Lots of the observations are subjective, in that they are reported by the patient, without a measurable correlate (e.g. pain scores, although certain measures like blood-pressure and heart rate can be objectively measured). There has been very little laid by way of biochemical or physiological foundation. This is, I believe, similar to the issue you had with psychiatry - where lots of things are empirically studied (and subjectively "measured") but there's been no convincing biochemical foundation. Although, personally, I'd say there's far more evidence for neurotransmitter involvement in psychiatric illness than there is for any brain chemistry change in the placebo effect. That makes a lot of psychiatry less "pseudoscientific" than the "placebo effect" (which is simply accepted in mainstream Medicine).
     
  10. Jul 2, 2012 #9

    Curious3141

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    Placebos have been documented to produce effect in diseases with well-defined organic causes as well. So it's not quite right to state that something has to not be a(n organic) disease for placebo to work. :smile:
     
  11. Jul 2, 2012 #10

    Pythagorean

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    There was actually a neuroscience paper a couple of years ago claiming to have "found" the placebo effect (neuroanatomically speaking) I made a thread about it here.

    Will dig it, or the paper up once I get to a real keyboard (if someone doesn't beat me to it).
     
  12. Jul 2, 2012 #11

    Pythagorean

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  13. Jul 2, 2012 #12

    Evo

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    I was specifically addressing the use of placebos with "IBS", yeah, looking at my post, I can see how it could be taken to mean that it can't aleviate syptoms where disease is present.

    I agree that placebos can influence how a patient feels and self reports perceived improvements. I was thinking more of actually eliminating symptoms of IBS since it's not disease based, AFAIK.
     
  14. Jul 2, 2012 #13

    Curious3141

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    Although physiological mechanisms (pertaining to the "enteric nervous system") have been proposed and largely accepted, e.g. see: http://www.ncbi.nlm.nih.gov/pubmed/15798484
     
  15. Jul 2, 2012 #14
    I found this article while I was googling placebos, which reports they're getting a lot more serious attention than they used to:
    http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all
    I'm tempted, but don't want to derail my own thread.
     
  16. Jul 2, 2012 #15
    I read over the whole page you linked to. It does make it look very psycho-somatic, but I wouldn't be surprised if it turned out to be a hypothalamus problem. A quick google tells me people are looking into this:

    http://www.ncbi.nlm.nih.gov/pubmed/16472586
     
  17. Jul 2, 2012 #16

    Curious3141

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  18. Jul 3, 2012 #17
    Yes and there's this "secret" research underway, as well:

    And a few of your questions were answered:
     
  19. Jul 3, 2012 #18
    Where can I buy placebos? Do they come in different doses? If they'll work on IBS without active ingredients I'll be they'll work on all kinds of ailments.

    Actually, this might vindicate homeopathy where there's maybe 1 molecule of an active ingredient if you're lucky.
     
  20. Jul 3, 2012 #19
    This site sells "Universal Placebos". $20 a bottle:

    http://www.placebo.com.au/
     
  21. Jul 3, 2012 #20
    Interesting: I just discovered this same test of non-deceptive placebo administration was carried out on "neurotics" in the 1960's:

    http://www.leecrandallparkmd.net/researchpages/placebo1.html

    They seem to have done a more thorough job of telling the patients they would just be getting sugar pills, but the confident attitude of the doctors that the pills would work, and their inability to understand why they would be given inactive pills, lead some to conclude they were being deceived about them being sugar:

    Other patients vascillated over whether they were getting placebos or not:

     
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