need help feeling placebo effect

[quarky]

Let's use anti-oxidants as my woo example in a possible phenomena I'd like to explore:

In a double blind test, the participants are aware of their chances of getting the placebo. They have good reason to doubt that they should fell anything.
Perhaps we could even give the doubt a number, like 50% doubt.

Even so, some people feel a positive effect from the sugar pill...up to 30% in some tests.

There is also an anti-placebo effect...some of the people that got the real stuff assume they got sugar; some of them are prone to negative outcomes regardless; some actually don't respond well to the new drug (or supplement) being tested.

I would suggest that deciding to take a woo product (anti-oxidants) is fundamentally different than being in a double blind experiment.
For one thing, the 50% reasonable doubt is not there. You aren't thinking you may get a placebo, even if that's what it is.

Furtharmore, the anti-placebo effect is also removed in such self-experiments...and, hopefully, the legitimate side effects that often occur in tests of new drugs.

All this would point to a much larger potential placebo effect in pure woo than that which would be expected in a typical double blind study.

so,

how wrong am I this time?

 

[Modified]

Most people I know who believe in unproven effects of vitamins or herbs feel that those effects are subtle and that "drugs" have much stronger effects.

 

[Mojo]

Most people I know who believe in unproven effects of vitamins or herbs feel that those effects are subtle and that "drugs" have much stronger effects.

I've seen it suggested that the placebo effect works more strongly in "orthodox medical pills" because of advertising:

But the main thrust of Goldacre's argument is the role of the "placebo effect". Yes, this works. And, yes, it is without doubt present in every homeopathic intervention; but it is far more powerfully present in orthodox medical pills because they are advertised so widely in billion-dollar campaigns.

 

[fls]

Let's use anti-oxidants as my woo example in a possible phenomena I'd like to explore:

In a double blind test, the participants are aware of their chances of getting the placebo. They have good reason to doubt that they should fell anything.
Perhaps we could even give the doubt a number, like 50% doubt.

Study participants are often asked whether or not they think they've been given the placebo. Your number is too high. Usually more than half (like 70 percent) think they've received the active drug.

Even so, some people feel a positive effect from the sugar pill...up to 30% in some tests.

Yes, some people notice an improvement in their subjective symptoms.

There is also an anti-placebo effect...some of the people that got the real stuff assume they got sugar; some of them are prone to negative outcomes regardless; some actually don't respond well to the new drug (or supplement) being tested.

That isn't "anti-placebo", in that people don't feel worse than they would otherwise, they simply don't report that they feel better.

I would suggest that deciding to take a woo product (anti-oxidants) is fundamentally different than being in a double blind experiment.
For one thing, the 50% reasonable doubt is not there. You aren't thinking you may get a placebo, even if that's what it is.

For one thing, your 50% reasonable doubt is an over-estimate. For another, expectations in a double blind experiment are going to be higher than they are for taking an anti-oxidant. You may doubt a bit less, but your initial expectations are going to be much less. I don't know how that will balance out, but I suspect it's not in the direction you hope for.

Furtharmore, the anti-placebo effect is also removed in such self-experiments...and, hopefully, the legitimate side effects that often occur in tests of new drugs.

The "anti-placebo effect" is simply a lack of placebo effect, so you've already accounted for this. You are now cheating by deducting it twice.

The lack of legitimate side effects is relevant. Although, while they may make people feel worse, they also increase expectations, since people are able to recognize that they are receiving something 'powerful'.

All this would point to a much larger potential placebo effect in pure woo than that which would be expected in a typical double blind study.

The placebo effect you are talking about is expectation. To what extent do people expect to feel a bit better when they are participating in a double-blind study vs. taking some vitamin supplements? To what extent do people taking anti-oxidants (or whatever other woo treatment you want to consider) think they are taking something which will have a powerful effect? We already know from surveys it won't be all of them. It might not even be most of them.

Linda

 

[Ivor the Engineer]

Let's not forget positive feedback.

For example, if I take a pain killer which does have an effect above placebo, then the "real" reduction in my sensation of pain makes me believe that it works, thus any placebo effects are boosted, which further reduce my perception of pain, which reinforces my belief that it works, which...

 

[Mojo]

Let's not forget positive feedback.

For example, if I take a pain killer which does have an effect above placebo, then the "real" reduction in my sensation of pain makes me believe that it works, thus any placebo effects are boosted, which further reduce my perception of pain, which reinforces my belief that it works, which...

No, no, no, it's because of the advertising I tell you, otherwise the homoeopathic interventions Dr. Roy was on about would have just as powerful a placebo effect as the real drugs because homoeopathy is so effective ... er, ... right?

 

[quarky]

People seeking a positive effect through a woo med would experience a greater likelihood of perceived benefit than if they had been in a double blind test?

 

[Mojo]

People seeking a positive effect through a woo med would experience a greater likelihood of perceived benefit than if they had been in a double blind test?

Almost certainly, because they will be absolutely certain that they have received the real treatment, and they will be using it at least in the hope that it will work, and probably in the belief that it will work. This will not necessarily be the case for all those involved in a properly randomised trial.

 

[Starthinker]

I thought you didn't tell the participants there were placebos at all. You tell them all they are taking the real drug. Don't mention the possibility that there are placebos involved.

 

[Mojo]

I thought you didn't tell the participants there were placebos at all. You tell them all they are taking the real drug. Don't mention the possibility that there are placebos involved.

Wouldn't it be unethical to recruit patients to a trial without telling them?

 

[Dancing David]

People seeking a positive effect through a woo med would experience a greater likelihood of perceived benefit than if they had been in a double blind test?

Let's use anti-oxidants as my woo example in a possible phenomena I'd like to explore:

In a double blind test, the participants are aware of their chances of getting the placebo. They have good reason to doubt that they should fell anything.
Perhaps we could even give the doubt a number, like 50% doubt.

Even so, some people feel a positive effect from the sugar pill...up to 30% in some tests.

There is also an anti-placebo effect...some of the people that got the real stuff assume they got sugar; some of them are prone to negative outcomes regardless; some actually don't respond well to the new drug (or supplement) being tested.

I would suggest that deciding to take a woo product (anti-oxidants) is fundamentally different than being in a double blind experiment.
For one thing, the 50% reasonable doubt is not there. You aren't thinking you may get a placebo, even if that's what it is.

Furtharmore, the anti-placebo effect is also removed in such self-experiments...and, hopefully, the legitimate side effects that often occur in tests of new drugs.

All this would point to a much larger potential placebo effect in pure woo than that which would be expected in a typical double blind study.

so,

how wrong am I this time?

As in most discussion here, we have to define the critter before we discuss it. What is the placebo effect?

In most cases it is a positive clinical outcome with no treatment. IE an infection clears up with no treatment.

However in many cases it is something else, a statistical effect of no meaning.


Now I think the effect that you are addressing would be the 'doing something effect', in double blind studies this can be addressed through a number of means, the administration of a placebo, the use of shampuncture or in good clinical studies, the exact recreation of a setting but not the 'treatment'. So in case involving saying 'meditation' you have a test group who arrives at the site, sits in the waiting area but reads a book instead of doing the meditation.

So you can hopefully control for the 'doing something' effect. The other one that has been mentioned in the 'power of suggestion' effect. That something taken that is told to you has an effect will change your experience. And this again can be controlled for as well.

However what I think you are addressing here is something other than is what is often called the 'placebo' effect. I think you are getting into 'confirmation bias', 'selective memory', 'behavioral association of unrelated events' and many other also interesting critters.

 

[fls]

People seeking a positive effect through a woo med would experience a greater likelihood of perceived benefit than if they had been in a double blind test?

People who are participating in a clinical trial have high expectations. People who are trying an alt-med substance tend to have a fair bit of doubt. So it's probably the other way around.

Linda

 

[quarky]

Aren't some double blind tests arranged to eliminate those most prone to placebo effect?
I've have heard so, in regards to ssri's. If that is so, it would imply a higher batting average for the placebo in the general population.

I don't see how the expectations can be higher in a clinical trial if you know the odds of getting a sugar pill. In trying out a woo med, there is little reason to suspect that you aren't getting what you bought.

I'm trying to figure out if woo works better when it isn't put to a double blind test.
Does this make any sense?

 

[JihadJane]

I've seen it suggested that the placebo effect works more strongly in "orthodox medical pills" because of advertising:

I've seen it suggested that that the placebo effect works more strongly in "orthodox medical pills" because of the side effects.

I've also seen it suggested that people who have written "woo" more than a thousand times lose the power of critical thought.

 

[fls]

Aren't some double blind tests arranged to eliminate those most prone to placebo effect?

Huh? How would you go about doing that? Try to hypnotise everyone and go with those who fail?

I've have heard so, in regards to ssri's. If that is so, it would imply a higher batting average for the placebo in the general population.

You're going to have to give some references as to what you're talking about.

I don't see how the expectations can be higher in a clinical trial if you know the odds of getting a sugar pill. In trying out a woo med, there is little reason to suspect that you aren't getting what you bought.

Forget the odds for a moment. I'm saying that your expectations are higher that some fabulous, new, cutting-edge, high-tech pill is going to do the trick than you are that some over-the-counter, doctors-don't-think-it-works-but-what-the-heck-i'll-try-it-anyway pill.

I'm trying to figure out if woo works better when it isn't put to a double blind test.
Does this make any sense?

What do you means by "works"?

Linda

 

[fls]

I've seen it suggested that that the placebo effect works more strongly in "orthodox medical pills" because of the side effects.

Yup, maybe even in the 4th post in this thread.

I've also seen it suggested that people who have written "woo" more than a thousand times lose the power of critical thought.

What number are you up to, now?

Linda

 

[The Man]

need help feeling placebo effect

Check the expiration date on your placebo’s if they have not expired then you probably just need to take more of the placebo, but just be careful not to overdose.

 

[JihadJane]

Yup, maybe even in the 4th post in this thread.

Oh yes, I knew I'd seen it somewhere!

What number are you up to, now?

Linda

14.

 

[blutoski]

Let's use anti-oxidants as my woo example in a possible phenomena I'd like to explore:

In a double blind test, the participants are aware of their chances of getting the placebo. They have good reason to doubt that they should fell anything.
Perhaps we could even give the doubt a number, like 50% doubt.

Even so, some people feel a positive effect from the sugar pill...up to 30% in some tests.

There is also an anti-placebo effect...some of the people that got the real stuff assume they got sugar; some of them are prone to negative outcomes regardless; some actually don't respond well to the new drug (or supplement) being tested.

I would suggest that deciding to take a woo product (anti-oxidants) is fundamentally different than being in a double blind experiment.
For one thing, the 50% reasonable doubt is not there. You aren't thinking you may get a placebo, even if that's what it is.

Furtharmore, the anti-placebo effect is also removed in such self-experiments...and, hopefully, the legitimate side effects that often occur in tests of new drugs.

All this would point to a much larger potential placebo effect in pure woo than that which would be expected in a typical double blind study.

so,

how wrong am I this time?

You're trying to assign 'thinking' activities to an effect that doesn't have a lot of thinking in its mechanism.

I also think you're conflating the different mechanisms involved in placebo effect. My impression is that the mechanism that generates the most influence is simply the condition following its course. Patients misattribute this natural improvement to the placebo.

 

[quarky]

There are certainly many factors in play when a person experiences a positive effect from a meaningless gesture, like taking anti-oxidants, and attributes the improvement to the pill.
I have mistakenly lumped it under placebo effect.

Yet, isn't it also true that some % of the percieved improvements attributed to conventional treatments are actually these other effects, like the illness pasing on its own, as well as confirmation bias...and placebo effect, whatever that is.

Its also possible that the doubt factor one has when going for the woo is not as great as it would be with the conventional treatment...if said person was coming off a bad experience with 'real' meds and drs, and had a strong incentive to try something 'different", it would be 'empowered' somewhat. I suspect that lots of people that are drawn to woo treatments have had bad times with Doctors.

My point is that it is possible that bogus med's perceived benefit is stronger when not in a double blind placebo test. Who would fly to Peru to see a famous healer, if there was a 50% chance Joe Schmoe would be there instead?

People can add meaning to a meaningless gesture...with legitimate benefits.
This might be a factor in some apparently sucessful conventional treatment, as well as the bogus treatment.

(sorry about the difficult writing; I'm not promoting woo; trying to understand its hold, and the nature of its claimed victories)