Musing on the placebo effect

[gurugeorge]

Suppose whatever peculiar mind-body interaction is responsible for the effectiveness of the placebo effect is also responsible for a lot of positive testimonials about all sorts of woo-woo stuff (from alternative therapies to obscure mystical biophysical exercises like Tummo, conscious control of the body's temperature)?

Then surely what becomes interesting is that very mind-body interaction?

Yet oddly, medical science doesn't seem very interested in it at all. Either it's just too difficult and they're humbly shelving the question of what's responsible for the placebo effect untill we know more, or, more sinisterly, the scientific/medical establishment as a whole is either consciously or unconsciously avoiding something that treads on their "turf". After all, if we could all self-heal consciously, what would be the point of a goodly part of the institutions and traditions of modern medicine?

But then neither do the "alternative" types, the New Agers, the serious end of the woo-woo crowd - neither do they show any positive interest in the real possibility of replicable effects coming from something in the mind-body interaction in itself. Which is peculiar, given how highly holism is rated in such circles. It seems to be the case that, granted some kind of mind-body interaction responsible for the power of what I am calling here the "placebo effect", New Agers, etc., would prefer that it betokened some kind of power of "mind over matter", and when it looks too boringly ordinary and biological (like an actual effect in the brain, something in our physiology and biology, that allows us to self-heal when we believe strongly enough), they lose interest.

To me, it seems likely that there are all sorts of untapped potentials even in the human body and brain just as they are (even without the various kinds of augmentation possible), and that occasional accidental irruptions of, or obscurely trained accesses to those potentials, provide a rational basis for what might be a kernel of truth in the woo-woo (eliminative explanations - "they're all basically stupid" - I find unpersuasive).

(Once the usual suspects have been eliminated (error, fraud, various kinds of self or mass hypnosis), I see several possible sources of little-understood human potential that have given rise to much of the mythology of the woo-woo: the placebo effect, as above outlined; the phenomena of "astral travel"/"lucid dreaming"'; certain kinds of mystical experience that involve insight into the insubstantiality of the self (as explored by recent research on experienced meditators); the kinds of magnetic effects explored by Persinger.)

 

[Dr Adequate]

Yet oddly, medical science doesn't seem very interested in it at all.

This is a sweeping statement. Have you looked?

Unless you've had a good look through the medical literature for scientific approaches to the placebo effect, on what basis do you say that medical science isn't interested?

Maybe the problem is that you haven't been sufficiently interested in medical science.

I've not looked into it too deeply myself, but I do remember seeing a research paper showing that the placebo effect was stronger if the placebo was an unusual shape or color, so it is not the case that no research is being done.

I notice that googling on the phrase "research into the placebo effect" gets 315 hits. Perhaps you should read some of them.

Either it's just too difficult and they're humbly shelving the question of what's responsible for the placebo effect untill we know more...)

... or, as I've pointed out, they are researching it...

Or, as you pointed out, maybe there is a "sinister" conspiracy among all the medical scientists in the world to remain ignorant of this aspect of medical science even though as individuals their jobs, status, and funding are contingent on them finding stuff out about medical science.

Your explanation for why they should maintain this conspiracy is quite bizarre. If medical scientists were trying to hush up the fact that we can "self-heal", why did they tell us about, e.g. the immune system, the regeneration of the liver, the mechanisms of DNA repair, and the placebo effect?

It is, after all, medical science that tells us that the placebo effect exists. A quick look at PubMed reveals more than a hundred thousand articles containing the word "placebo". And you think they're trying to hush it up?

You wouldn't even know it existed if it wasn't for medical science.

Worst.
Conspiracy.
Theory.
Ever.

 

[ysabella]

While you're at it, I recommend looking up "nocebo." That's also a very interesting concept.

 

[gurugeorge]

This is a sweeping statement. Have you looked?

(Apologies for lateness of reply - I'd clean forgotten about this post here!) Ok, it was a sweeping statement, there isn't no research at all, but I don't think the research that does exist is of a sufficient level to show the degree of interest I believe should be shown, for reasons outlined in my post.

IIRC the placebo effect, for a long time, has not been presented in terms of the body's self-healing ability (like the immune system), but as a mere curiosity. As to the immune system and other aspects of the body's regenerative capabilities, of course science will present things like that whenever it discovers them. What I'm saying is that there's no great drive (so far as I can see) to discover anything in that area.

Surely figuring out what it is that produces this kind of mentally/emotionally controlled self-healing, enhancing it, making it more powerful, is more important than testing medicines whose effect is (in many cases) only slightly better statistically than the placebo effect?

My personal opinion isn't that there's a "conspiracy" at all, it's just an unconscious tendency to avoid what's deeply not in the interests of the institutions involved, combined with (as I said) an understandable unwillingness to tackle something may be too difficult at this stage. Again, what I'm saying isn't coming from a Commie perspective or a Hippy perspective or something of that nature, I'm just noting a possible mechanism for (what looks to me like) avoidance.

 

[Cynric]

IIRC the placebo effect, for a long time, has not been presented in terms of the body's self-healing ability (like the immune system), but as a mere curiosity. As to the immune system and other aspects of the body's regenerative capabilities, of course science will present things like that whenever it discovers them. What I'm saying is that there's no great drive (so far as I can see) to discover anything in that area.

Two comments on this: first, the placebo effect is really quite difficult to research. However, there is plenty of research being done. A recent review in Nature Neuroscience (2005), Vol 6; p 545-552:

PLACEBOS AND PAINKILLERS: IS MIND AS REAL AS MATTER?

Luana Colloca & Fabrizio Benedetti

Abstract

Considerable progress has been made in our understanding of the neurobiological mechanisms of the placebo effect, and most of our knowledge originates from the field of pain and analgesia. Today, the placebo effect represents a promising model that could allow us to shed new light on mind–body interactions. The mental events induced by placebo administration can activate mechanisms that are similar to those activated by drugs, which indicates a similarity between psychosocial and pharmacodynamic effects. These new neurobiological advances are already changing our conception of how clinical trials and medical practice must be viewed and conducted.


I'm afraid the full text is subscription only, but good libraries should have it.

The second point is that the placebo effect (and nocebo) are not viewed as curiosities - they're one of the biggest problems in conducting clinical research. Not just for the confounding effect on trial results, but for ethical reasons. If placebos help patients feel better (which they do) should they be given - i.e. should a doctor lie to a patient? Most "Western" doctors would say no. Mystics may differ.

Edited for spelling

 

[Amapola]

Since you are interested in the placebo effect, and you are speaking of the body healing itself, I wonder if you can tell me if the placebo effect has actually healed a broken bone in say, a day or a week? I have only heard of the placebo effect "working" (if that is what you want to call it) in instances where the malady is pretty subjective, like a headache. In other words, I have only heard of the placebo effect working on things that can't be measured scientifically. Since it can't be measured scientifically, that can make it pretty hard to study. (I have only heard anecdotal stories of someone actually having a serious illness "cured" by placebo, without any sort of controls in place so that there is assurance the person did not simply go into remission naturally. But if you are aware of different studies, please let me know so I can read about them.)

Now, if you could prove that you mended your broken arm in a day with a placebo, you would really have something there! That would be something tangible that would really get everyone interested. There would be a LOT of studies if that were to happen.

 

[blutoski]

Since you are interested in the placebo effect, and you are speaking of the body healing itself, I wonder if you can tell me if the placebo effect has actually healed a broken bone in say, a day or a week? I have only heard of the placebo effect "working" (if that is what you want to call it) in instances where the malady is pretty subjective, like a headache. In other words, I have only heard of the placebo effect working on things that can't be measured scientifically. Since it can't be measured scientifically, that can make it pretty hard to study. (I have only heard anecdotal stories of someone actually having a serious illness "cured" by placebo, without any sort of controls in place so that there is assurance the person did not simply go into remission naturally. But if you are aware of different studies, please let me know so I can read about them.)

Now, if you could prove that you mended your broken arm in a day with a placebo, you would really have something there! That would be something tangible that would really get everyone interested. There would be a LOT of studies if that were to happen.

My impression is that there are two types of improvement attributed to 'placebo effect':

• Real effects, which involve systems known to interact with human emotions. eg: blood pressure reduction, which can be associated with being less anxious.
  
• Imaginary effects, which are arbitrarily reported by patients. Objective measurements show the patients are mistaken.

Both real and imaginary effects can be positive (placebo) or negative (nocebo).

I also share surprise with gurugeorge's suggestion that "Medical science doesn't seem interested at all." It's one of the most explored research phenomena, and heavily tied into anti-confounding research. There are people whose careers are dedicated to the design and manufacture of better placebos. A quick scan of PubMed shows almost 2400 hits for "placebo effect".

I do believe there is a difference between the scientific approach to placebo studies, versus the altmed approach to placebo studies: scientists consider it a research phenomenon, but altmed people consider it an easy explanation for a cure with no plausible mechanism.

 

[Jeff Corey]

The mind over matter stuff is nonsense. It's all matter. There are some interesting sudies out there that I can't give you a link for that strongly suggest that the release of endophines can be triggered by administration of a placebo. Classical Pavlovian conditioning.

 

[gurugeorge]

The mind over matter stuff is nonsense. It's all matter. There are some interesting sudies out there that I can't give you a link for that strongly suggest that the release of endophines can be triggered by administration of a placebo. Classical Pavlovian conditioning.

OK, I'll reply to this as a part reply to some of the above as well. Your position here seems to me to sort of encapsulate something of the attitude I've been criticising. I wouldn't actually have much objection to what you are saying in one sense - in a sense, yes, it's all just matter. But in terms of "it's all just matter", there's an aspect, or sub-system, of matter (in this case the body), that we call "mind", that has (as demonstrated by the placebo/nocebo effect) a pretty strong influence on other aspects of the matter that is the body.

And if the mind can (say) have an influence on endorphins that produces effects that are (as I said above) in many cases statistically just about as strong as the effects of a drug under test, then understanding and harnessing that influence is what MOST medical research should be channeled into investigating. (Clearly, also, what's called "spontaneous remission" may be connected with this phenomenon in many cases.) (Note: of course we're getting a bit tangled here because there are at least two things going on here, medical science as pure investigation and medical science as a foundation of medicine - I'm thinking more of the latter.)

IOW, surely harnessing this effect ought to be the very foundation of medicine, and not a morally troublesome curiosity, or a late-investigated adjunct? Surely this kind of paradigm shift (to use that horribly overused term) would have a greater impact on the vast majority of day-to-day mental/physical suffering than the production of any number of invasive, trivially effective drugs? (I appreciate people pointing out to me that there is more interest in it nowadays - that's good.)

Not only that, but (as I said in my first post, which has essence of what I started this thread about) this effect actually points to a way in which some common aspects of the "woo" can be understood as not actually irrational, but (to a limited extent) reasonable - if things "work", then it's quite understandable that people believe they "work", even if they may be wrong about why they "work". They're not necessarily idiots, because there is an effect, a strong effect, that's improving the quality of their life (or whatever) - they're just wrong about the mechanism.

But perhaps this kind of sympathetic understanding of some "woo" folks is going too far for some rationalists - after all, what would they do without their demons?

 

[MRC_Hans]

Placebo means, literally "I please". Placebo makes people feel better, report feeling better. It does not make them objectively better except in the cases where their subjective well-being (or lack of same) is part of the disease. This was tested on cancer patients, where a lot of "positive thinking" experiments have been carried out during the last few decades. Positive thinking improves the quality of life for a lot of patients, but it does not improve their chance of cure.

In the context of placebo controlled trials, the term placebo effect covers all effects observed in the control group. This includes lifestyle changes, other forms of treatment than the one under test, plus the above-mentioned subjective improvements in well-being.

There is, however, no apparant self-curing power that depends on the administering on placebo medicine.

Hans

 

[Dr Adequate]

And if the mind can (say) have an influence on endorphins that produces effects that are (as I said above) in many cases statistically just about as strong as the effects of a drug under test, then understanding and harnessing that influence is what MOST medical research should be channeled into investigating.

Your conclusion would follow from your premise only if the problem of providing short-term relief for manageable pain was more important than all the other challenges in medicine put together.

 

[Complexity]

Suppose whatever peculiar mind-body interaction...

There is no mind-body interaction in the popular sense. 'Mind' is what we call the behaviour of the brain.

 

[NeilC]

You have no way of knowing what form consciousness and the mind in general takes. The brain is part of the body. The mind remains a mystery.

We can, for example, explain how visual information enters the flesh and blood of the brain but we have no idea how there is a conscious entity in there noticing it happening or what is really is.

So there can be a perculiar mind-body interaction.

 

[Jekyll]

IIRC the placebo effect, for a long time, has not been presented in terms of the body's self-healing ability (like the immune system), but as a mere curiosity. As to the immune system and other aspects of the body's regenerative capabilities, of course science will present things like that whenever it discovers them.

I thought the link between stress and the immune system was well understood and nothing more than the body prioritizing resources according to demand.

 

[Z]

You have no way of knowing what form consciousness and the mind in general takes. The brain is part of the body. The mind remains a mystery.

We can, for example, explain how visual information enters the flesh and blood of the brain but we have no idea how there is a conscious entity in there noticing it happening or what is really is.

So there can be a perculiar mind-body interaction.

Ghost in the machine, Splossy. The conscious entity IS the brain. There's nothing 'in there' noticing anything.

Common idealist/dualist mistake.

 

[blutoski]

But perhaps this kind of sympathetic understanding of some "woo" folks is going too far for some rationalists - after all, what would they do without their demons?

I think the disagreement is about what, exactly, is "there" to be studied. The placebo effect, again I reiterate, is two things with the same name. The first thing is entirely imaginary. The second is real, but trivial and not of medical interest because it doesn't have any obvious benefits.

Think of the placebo effect as you would a statistical outlier. They're both usually artefacts of an experiment, not a representation of an underlying reality. Most experiments have no measureable placebo effect. Keep that in mind.

Also, you're throwing in spontaneous remission with placebo effect. The placebo effect is only measureable by distinguishing it from spontaneous remission, and anyway, spontaneous remission has ordinary medical explanations.

I've attached a diagram to illustrate that placebo effect is a mathematical difference between the untreated group and the placebo group.

 

[Jeff Corey]

OK, I'll reply to this as a part reply to some of the above as well. Your position here seems to me to sort of encapsulate something of the attitude I've been criticising. I wouldn't actually have much objection to what you are saying in one sense - in a sense, yes, it's all just matter. But in terms of "it's all just matter", there's an aspect, or sub-system, of matter (in this case the body), that we call "mind", that has (as demonstrated by the placebo/nocebo effect) a pretty strong influence on other aspects of the matter that is the body....

No, "we" don't call it "mind". If it's a matter of classically conditioned release of endorphines, that's what it is. The term "mind" adds nothing to the discussion.

 

[gurugeorge]

No, "we" don't call it "mind". If it's a matter of classically conditioned release of endorphines, that's what it is. The term "mind" adds nothing to the discussion.

If consciousness and emotion are involved, then you can call the phenomenon mind. Whatever belief is, if that is involved in people altering their medical condition (as it seems to be in both placebo/nocebo), then mind is involved. It's a nice philosophical question whether and to what extent materialist reductionism is tenable, to what extent mind is reducible to dispostions of matter, etc., but those points have to be argued for separately, you can't just assume the term away (well you can, but you risk making yourself look ridiculous).

 

[gurugeorge]

I think the disagreement is about what, exactly, is "there" to be studied. The placebo effect, again I reiterate, is two things with the same name. The first thing is entirely imaginary. The second is real, but trivial and not of medical interest because it doesn't have any obvious benefits.

Think of the placebo effect as you would a statistical outlier. They're both usually artefacts of an experiment, not a representation of an underlying reality. Most experiments have no measureable placebo effect. Keep that in mind.

Also, you're throwing in spontaneous remission with placebo effect. The placebo effect is only measureable by distinguishing it from spontaneous remission, and anyway, spontaneous remission has ordinary medical explanations.

I've attached a diagram to illustrate that placebo effect is a mathematical difference between the untreated group and the placebo group.

You're taking an odd-looking (to me) position on this, and I don't think most of the other people I'm arguing with here would take it (most of them seem to more or less agree with the way I'm talking about the effect - as a phenomenon that is clearly partly a result of belief and emotion). If you don't mind I'll bow out of going down this line of arguments with you.

 

[gurugeorge]

Ghost in the machine, Splossy. The conscious entity IS the brain. There's nothing 'in there' noticing anything.

Common idealist/dualist mistake.

I actually agree with this, and the last sentence would also be uncontroversial for certain schools of Buddhism, Daoistm, Hindu Advaita, and that ilk.