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How do skeptics account for the placebo effect?

Moochie

Philosopher
Moochie
Joined
Aug 12, 2005
Messages
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Australia
Hello,

It seems to me that the apparent success of much of the woo-woo crowd hinges on the placebo effect.

How do skeptics account for this?

How shall we explain the often dramatic results achieved by placebos to people steeped in religious doctrine and the like?

Can "placebo" be explained in religious terms?

Cheers,

Moochie
 
Could you clarify what you mean by the placebo effect?

Placebo effects and other confounding factors are the explanation for why so much alternative medicine appears to work.

The placebo effect is an entirely natural, psychological response to treatment. There’s nothing magical or mystical about it.
 
Moochie said:

It seems to me that the apparent success of much of the woo-woo crowd hinges on the placebo effect.

How do skeptics account for this?

How shall we explain the often dramatic results achieved by placebos to people steeped in religious doctrine and the like?

Can "placebo" be explained in religious terms?
Click to expand...

There seems little need to explain the placebo effect in religious terms per se; much of the placebo effect can be explained in terms of simply psychology.

First, people have an inherent confirmation bias; they notice things that they want to believe, and tend not to notice the rest. So if you are suffering intermittent pain, and I give you a sugar pill and tell you you will be feeling less pain, you will notice the times that you feel less pain more, and notice the times you are feeling more pain less. Ergo, you "think" you are feeling less pain and will report pain relief.

This confirmation effect can even apply to third parties as well; if I can convince you that your pet is, in fact, feeling better, you will notice an improvement. Ask any vet (I suggest Rolfe, on this forum).

Second, there is a very real mind-over-matter effect in people's abilities to control their bodies. Just as a quick example -- can you get angry "on command," by thinking of something that makes you angry? Most people can -- and the effects of this anger (pulse, blood pressure, respiration, adrenalin levels, &c) are quite "real."

Any doctor will tell you that they don't cure people; what modern medicine does is allow people to cure themselves through the body's natural healing processes. If I can give you a sugar pill and put you in a mental state that enhances healing, your healing will be enhanced.
 
Re: Re: How do skeptics account for the placebo effect?

new drkitten said:
If I can give you a sugar pill and put you in a mental state that enhances healing, your healing will be enhanced.
Click to expand...
I thought Rolfe posted some studies that showed tht this wasn't actually true - that your healing is the same regardless of mental state (obviously not including the negative effects of emotional states such as stress which have real negative physical impact).

Placebo dosn't have any real curative effect, it merely alters how we perceive sensations - pain might feel alleviated, breathing might seem easier etc.
And any physical change in symptoms that might have occured naturally may be falsely associated with the placebo.

I wasn't under the impression that there were any real measurable effects from taking a placebo, other than those that could be psychologically induced.
 
Wasn't there a reference on here recently to the release of endorphins being produced by placebos?
To me, that would imply classical conditioning, where effective painkillers would be the unconditioned stimuli and the sight, feel and act of swallowing the pill conditioned stimuli.
 
Jeff Corey said:
Wasn't there a reference on here recently to the release of endorphins being produced by placebos?
To me, that would imply classical conditioning, where effective painkillers would be the unconditioned stimuli and the sight, feel and act of swallowing the pill conditioned stimuli.
Click to expand...

It would. Man, much of psychology is sooooo basic, isn't it?
 
Coincidental recovery. Wishful thinking (rose-coloured spectacles, if you like). That's about your lot.

The rest is nothing but marginal and mostly imaginary scratching round the edges of oh look, I stuck an acupuncture needle in this guy's hand and a bit of his brain lit up on fMRI. Well, duh!

Consider that (subjectively, I can't prove this) the placebo effect seems to work if anything even better in animals. Why? Well, because it's a lot easier to smile through those rose-coloured glasses if it's not you personally who's feeling the pain!

Another thing. The placebo treatments that seem to persist all have a high input from a guru of some sort. When the public is simply sold something that's supposed to be a cure-all, and left to get on with it (Perkinism, for example), it tends not to last, as without someone explaining how to interpret subsequent events in the light of the assertion that the treatment is doing something, people usually start to notice that the alleged treatment isn't actually having a consistent effect. But add in a homoeopath (or a homoeopathy book) or an acupuncturist, telling the patient how much better he looks, or how this "aggravation" is great because it shows the remedy is "really" working, and frankly the nonsense gets swallowed hook, line, sinker and rowboat.

Try this article for a slightly different take on it. Also this thread about the article, with an excellent (unprinted) letter from BSM near the bottom.

Now, about those
often dramatic results achieved by placebos to people steeped in religious doctrine
Click to expand...
How about some evidence that any such results have ever happened? I'm religious myself, and I think this is baloney.

Also, some evidence for
the release of endorphins being produced by placebos
Click to expand...
would also be nice. I've never seen any reliable data on that. I could be wrong, I'm open to correction, but the way it seems to have gone is this. Some placebo treatments (like acupuncture) actually interact with the body. So it's not such a huge leap of faith to imagine that maybe there's the possibility of an actual effect. Phew, gasps the timid sceptic, here's a methodology that I might actually not have to slag off, if I can make some case for it actually doing something. This will get me so many Brownie points with that vocal alt-med mob, who currently hate my guts because I just pointed out how it's totally impossible that homoeopathy or radionics could have any effect! OK, maybe it could work, because maybe it might induce endorphin secretion!

And before you know where you are, you have the altmeddlers declaring that medical science has confirmed that acupuncture is effective because it promotes endorphin secretion.

Never been a single publication even trying to demonstrate the pesky things though, so far as I know.

Rolfe.
 
Surely it is obvious to all, that to some degree emotion, particularly stress, has significant effects upon health and disease Or are skeptics now in denial over this or do they believe stress is temporary unpleasant sensation that the body handles just as well as no stress? :)

The placebo effect is more than just patient delusion. However the beneficial placebo effect is usually lower than ideal (i.e. less than a cure) and usually beaten by a drug (to get on the market), which is usually less than a complete cure too although better.

Some skeptics believe the placebo is only useless component. To do this they claim a placebo is all spontaneous remission, regression to the mean , symptom detection ambiguity, etc. …. …and no doubt these are occurring factors to some degree ........ however I believe a real beneficial placebo effect is also occurring even if often masked by the misinterpretation of other explanations (just like real PSI! which I also believe is a real but weak effect, often mixed in with sensory clues, most believers miss the sensory clues and most skeptics by focusing on sensory clues misses the real weaker psi effect (e.g. parapsychology trials with suggestions of unproven sensory leakage) …. But I will not wander off topic further :) )

As posted earlier, just some suggestive evidence of placebos potentially being of benefit. .........

~~~~~~~~


(1) http://www.jneurosci.org/cgi/content/full/23/10/4315

(2) A. Steptoe, 'Placebo responses: An experimental study of psychophysiological processes in asthmatic volunteers,' British Journal of Clinical Psychology, 1986, 25, 173-183.

(3) 'Effects of suggestion and conditioning on the action of chemical agents in human subjects: The pharmacology of placebos/ Journal of Clinical Investigation, 1950, 29,100-109.

……………………………..

An interesting theory concerning placebo effect is based on ‘neuropeptides’

( C. B. Pert, M. R. Ruff, R. J. Weber, and M. Herkenham, 'Neuropeptides and their receptors: A psychosomatic network/ /. Immunol., 1985, 35(2), 820s-826s.)

Neuropeptides can trigger emotion .... but of more significance to understanding the placebo effect emotion can produce neuropeptides (mind/body bi-directional process) ....... neuropeptides are involved in a whole array of different bodily functions, from hormone regulation, to protein manufacture, to cellular repair upon injury, to memory storage, to pain management.

...... neuropeptides have receptors all over the body…… the whole body therefore is psychosomatically wired to emotion to some degree?

PET Scans have showed placebo triggered neuropeptides in the brain. (Science 2002, 295, 1737-1740)

Also of possible emerging interest is …… ‘Psychosocial Genomics’
http://www.ernestrossi.com/about_ps..._expression.htm


~~~~~~~~

If skeptics will forgive me for saying so, I do think they prefer to diminish the placebo effect to just a worthless psychological effect because they often are campaigning against alternative/complimentary medicines that are probably making use of placebo like effects to significant extent. If they acknowledge the placebo as somewhat beneficial, even if lacking or small, the campaign against alternative therapies is somewhat less effective?

If we take an antidepressant (e.g. Prozac) it hardly beats a placebo ….. a meta-analysis of published clinical trials of antidepressants indicated that 75 percent of the response to antidepressants is duplicated by placebo. Either that means antidepressants are not really doing anything much or a placebo is also nearly as effective against depression ...... either way it works effectively on patients. Placebos (e.g. salt water) in some trials have also done well in comparison to some painkillers in past .. again .. according to news report http://www.detnews.com/2005/health/0508/28/C01-291098.htm

Perhaps it would be fairer in trials to compare a drug to not just a placebo but also to no treatment at all so we can watch the placebo out perform no treatment? This is actually important as a safe check too, whereas an antidepressant fractionally beating an effective placebo works, another drug for another condition beating a very ineffective placebo fractionally may render the drug result rather useless in practical terms.

Also have placebo effects being properly researched? It would be logical to assume the active ingredients of a drug will give it a great difference over placebo in the short term but have the long term trials been properly done? For example if today you were to eat a lot of junk food, perhaps due to guilt, you would feel much worse - we could perhaps dismiss that as a psychological placebo like (i.e. nocebo like) effect? Yet few today would argue that a long term change of diet is not of vital importance (at least 1/3 of cancers are diet related according to one leading cancer research charity ... and this viewpoint has increased over the years, could it be higher still?). Very long term trials comparing placebo to drug, no treatment or change of diet have rarely been done properly, since the pharmaceutical company goal is one to show the effectiveness (or failure) of the drug against the seemingly useless placebo.

Then there is an ethical consideration, if the placebo effect within complimentary medicine is beneficial even to a small degree, skeptics claiming placebos have no benefit is actually creating a nocebo like effect upon those trying complimentary medicine? ;) Hmm .... .... who knows yet ...... perhaps old snake oil doesn’t work anymore because we no longer believe it can possibly work anymore? :) In one trial placebo effectiveness varied with colour of pill.
 
I would agree that in conditions where there is a significant contribution of anxiety in the presentation, then soothing the patient down by making them believe they are being helped may provide a real benefit. However, this is only going to be inasmuch as the lessening of the anxiety response may affect the way the patient feels. It can't possibly do anything for a real physical illness where anxiety isn't a contributory factor.

One thing I think argues against this as a major explanation, though. The frequent claims that "it works on animals".

No matter how much you may soft-soap an animal's owner, and tell them how effective this remedy is, and how much better the pet is looking, and all the usual waffle, this is only going to affect the owner, not the animal. Some have suggested subliminal effects of decreasing owner anxiety on the well-being of pets, but that is so tenuous you really can't get it to fly.

When you examine alternative medicine for animals, it's very clear that the effect is on the owner. In fact it's easier to make this work by proxy as it were, as it's easier to believe there's been an improvement if it's not you personally who is ill. What I'm saying is, if all this removing of anxiety were having a significant physical effect on the patient, rather than just changing their outlook on the situation, then you'd expect it to go away when applied to animals. It doesn't. Which suggests that the effects are entirely acting on the subjective impressions of the person paying the bill.

Maybe you can argue that anything that makes a human patient declare that he or she feels better is a good thing, because by definition the patient does feel better. My point is that manipulating the perceptions of animal owners so that they're convinced the animal is better when it isn't, may rake in the money, but it doesn't do a damn thing for the poor bloody animal.

Rolfe.
 
Open Mind said:


If skeptics will forgive me for saying so, I do think they prefer to diminish the placebo effect to just a worthless psychological effect because they often are campaigning against alternative/complimentary medicines that are probably making use of placebo like effects to significant extent. If they acknowledge the placebo as somewhat beneficial, even if lacking or small, the campaign against alternative therapies is somewhat less effective?
Click to expand...

I don't see how this follows at all. Most of the campaign against "alternative medicine" is based on fraud on the part of the proponent -- they claim that their treatment is effective against a particular disease or syndrome, when it is demonstrably no better than a placebo, and usually substantially more expensive (how much does a sucrose tablet cost? How much does a homeopathic tablet of anything cost?)

Alternative medicine is fraud, pure and simple.

If the alternative medicine proponents were selling "Placebenol -- proven to be exactly as effective as a placebo," there would be a lot less campaign against the snake oil peddlers and a lot more clamouring for public education about exactly what "placebo" meant.
 
Moochie said:
Hello,

It seems to me that the apparent success of much of the woo-woo crowd hinges on the placebo effect.

How do skeptics account for this?

How shall we explain the often dramatic results achieved by placebos to people steeped in religious doctrine and the like?

Can "placebo" be explained in religious terms?

Cheers,

Moochie
Click to expand...

I suggest you look here for a detailed explanation: http://www.quackwatch.org/04ConsumerEducation/placebo.html

The Placebo Effect, simply, is the result of "feeling better" after having received no treatment that could account for it. There are a couple of reasons that this can happen like spontaneous remission (most diseases will get better all by themselves) and the patient's belief that he feels better.

Placebos are used as controls in testing. They are not intended to have any healing properties whatsoever. But, in drug testing in particular, some of the control patients will show improvement despite not having had any treatment. In order for a treatment to be shown effective, it must perform significantly better than the control group. The term "placebo effect", when attributed to a treatment, is essentially the same as saying "no effect attributable to the treatment". In other words, the same effect could be acheived by not doing anything at all. There is no significant difference in effect between taking the medicine and not taking it.

I work in Air Conditioning. We have occassionally placed fake thermostats (a placebo thermostat, if you will) in areas where the occupants are complaining about the temperature[1]. It has stopped some of the complaints, but the conditions that it does work are very specific. In all cases, there isn't actually a problem with the air conditioning. In most cases, the occupant is complaining because he feels he lacks control, not because he is uncomfortable temperature-wise. And, in some cases, the "placebo" works for about a week by which time the occupant has figured out that it doesn't really do anything. It helps if there are no temperature indicators in the room (out of sight, out of mind). But, in all cases, it is "treating" a problem with the occupant, not the air conditioning.

A placebo thermostat will not fix a temperature control problem.

The same effect can probably be observed by using placebos as a treatment in medicine[2]. I would imagine that if it was to be effective there would be a number of conditions that would have to be met. What they are, exactly, I can't say. But I highly doubt a patient could be cured of a real disease like cancer or tuberculosis simply because he believes he is being treated. Mind over matter may allow you to ignore pain from muscle strain in your arm, but I doubt it's going to kill off an infection.

As far as "dramatic results achieved by placebos to people steeped in religious doctrine and the like", I'm not aware of any short of anecdotes.

[1] These are areas that are temperature controlled, but the thermostat for that area is in another room off the same unit. The placebo thermostat is a real thermostat but isn't connected to anything.

[2] There are certainly a good number of anecdotes claiming this, but I have no idea if it's actually been studied (episodes of MASH don't count).
 
There's a lot of misunderstanding about this though. The page I linked to above contains a daft post from a girl bemoaning that homoeopathy cured her friend's eczema, by the placebo effect of course, and isn't it a bummer that it wouldn't work for her because she doesn't believe in it.

Total kookiness. Wrong end of the stick, grasped in a death-grip. But a lot of people seem to hold this view.

Rolfe.
 
Perhaps it would be fairer in trials to compare a drug to not just a placebo but also to no treatment at all so we can watch the placebo out perform no treatment? This is actually important as a safe check too, whereas an antidepressant fractionally beating an effective placebo works, another drug for another condition beating a very ineffective placebo fractionally may render the drug result rather useless in practical terms.
Click to expand...

I confused about this. Isn't the whole point of the placebo in controlled testing that it's a way of doing nothing without the subjects knowing who is or isn't getting the real deal? Don't they usually already have baseline statistics on incubation periods, survival rates, duration of symptoms, healing times, etc before starting a DBT? How would you evaluate any results if you didn't have baseline stats as well?
 
Rolfe said:
There's a lot of misunderstanding about this though. The page I linked to above contains a daft post from a girl bemoaning that homoeopathy cured her friend's eczema, by the placebo effect of course, and isn't it a bummer that it wouldn't work for her because she doesn't believe in it.

Total kookiness. Wrong end of the stick, grasped in a death-grip. But a lot of people seem to hold this view.

Rolfe.
Click to expand...

But is it really 'kookiness' ? It may well be the case that placebos are far more effective on just some people than others, as drugs also seem to be more effective on some people than others? For example people with similar levels of blood pressure may need a lower level of active drug than others?

Also when drugs are compared to placebos in trials, as far as I know (and I am open to correction) pharmaceutical companies do not supply a list of possible side effects (that is supplied with medicine when finally put on market). So there could be an nocebo (counteracting) effect upon drugs total effectiveness that is absent from original trials declared effectiveness, that just cannot apply to placebos (or homeopathy) since these are inactive substances ;) Is the gap further reduced in real life practise than in trials?

Now, if a drug is more prone to produce a side effect than a placebo, could supplying a list of possible side effects in trials for both the active drug and inactive placebo, increase the side effects of the drug more than the placebo? :eek: :)

I take the viewpoint, perhaps we should have positive expectation from our pills even in conventional medicine, every little helps, perhaps greater still over the long term,
 
Blondin said:
I confused about this. Isn't the whole point of the placebo in controlled testing that it's a way of doing nothing without the subjects knowing who is or isn't getting the real deal? Don't they usually already have baseline statistics on incubation periods, survival rates, duration of symptoms, healing times, etc before starting a DBT? How would you evaluate any results if you didn't have baseline stats as well?
Click to expand...

I think the question is whether a placebo also beats these estimations, yet trials are aborted when a drug effectiveness is proven to be siginifcantly beyond placebo or other rival drug being compared. The trials are seldom designed to test how well the placebo is actually doing ... and as you suggest it is complex to do so.
 
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