need help feeling placebo effect

[blutoski]

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)

Understood, but you're asking a leading question. There's little evidence that suggestion has any clinically significant effect, blinded or otherwise. It's not useful to ask about "its hold" &c without an "hold" to investigate.

 

[quarky]

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.

now we're getting somewhere.

 

[shuttlt]

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.

My spirit guide walked off with my homeopathic sleeping tablets before I took any. Is this an overdose?

 

[The Man]

My spirit guide walked off with my homeopathic sleeping tablets before I took any. Is this an overdose?

Could be, have you seen your spirit guide since then? Was your sprit guide sullen and despondent when last you meet, sleeping most of the day or constantly speaking of the uselessness in guiding you, perhaps even going so far as to suggest that it might have been better if you had never envisioned it. You need to go on a vision quest immediately to locate you spirit guide and ensure that it has not attempted something drastic. In the future if you want to keep your sprit guide healthy and productive you need to spend some quality time together, don’t just wait for some troubling issue, go on a vision quest just say hello or play a game. Also it is important to make your sprit guide feel useful, do not criticize it for vague guidance like “be more productive” or “endeavor to persevere”, but let it know that its guidance is important to you “I almost gave up the other day but then I remembered your guidance so I endeavored then I persevered”. Also throw your sprit guide a bone (or whatever depending on the guide) from time to time and ask for some guidance on some simpler issues occasionally “do you think this shirt goes with these pants” or “who would you pick in Sundays game”. Of course you should not over do it and make your guide feel trivialized or marginalized, sometimes you have to throw it a bone with some meat on it then give your guide the credit for a successful outcome regardless of the results “Well I didn’t get the job but it is just as well I do not think I would have liked that job anyway and it is only with your help that I see that now”. Your sprit guide can be as healthy and rewording as any of your real pets, but it can only be what you make of it.

 

[quarky]

I see now that I shouldn't have castrated my spirit guide. He's copped an 'attitude' ever since.

 

[Baby Nemesis]

There was a television programme on once about alternative medicine, that concluded that the reason faith healing and spiritual healing often works is probably due to the placebo effect. They went to a Benny Hinn meeting and interviewed someone who'd actually got out of a wheelchair.

They interviewed some other people who said expectation seemed to be important in the creation of the conditions that would make the placebo effect more effective, something Benny Hinn did well at his meetings, because there was a big build-up to the actual part of each meeting where he said healings were taking place.

If expectations are higher when taking medical drugs than with herbs because they're thought to be more powerful, that might make the placebo effect more powerful with drugs, in some cases.

On the programme, they also interviewed someone who said he'd once carried out an experiment where he'd given a group of people a cup of coffee. Within five minutes, they were all feeling more lively; but actually, it was decaffeinated coffee.

They even said that some people with arthritis in their knees had recovered after they'd had sham surgery.

And they interviewed someone who said he'd noticed the placebo effect working with people who had Parkinson's disease, after he'd given some of his patients dopamine injections and others dummy injections, and noticed that some of the ones given dummy injections actually produced more dopamine in their brains than those given dopamine injections. So he started speculating that dopamine had something to do with the placebo effect in everyone - if such a feel-good chemical was released because people expected something positive so they were feeling more upbeat, that would increase their sense of well-being.

It may also be that if people feel more positive because they think progress is being made because they're doing something about their problem, that could reduce stress and tension so they feel better as well. Stress/tension can exacerbate a lot of physical complaints or cause pains all on its own, and when people have low serotonin levels, they can apparently feel pain more intensely; so feeling more relaxed and cheerful can actually reduce physical pain sometimes.

 

[Baby Nemesis]

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?

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

Here you are. See, for example: New pitch for placebo power - placebo effect of antidepressant drugs studied - Behavior - Brief Article

This is how they do it: It's apparently been known that some drug companies have done a preliminary trial for depression medications, and those people who have responded strongly to the placebo pill have been dropped from the test, and then the trial is done again. With less people in the trial responding to the placebo pill, it means the figures are massaged to look as if the drug has a much higher success rate than the placebo effect.

 

[quarky]

Thanks for the link. I'm terrible at linking. I had read that there is some sort of filtering of test subjects that inadvertently makes the med being tested score better than in an average cross section of people. Maybe it was jive. Might have been in the book "Talking back to Prozac".

The point I'm arguing is subtle; maybe even non-existent.

 

[Baby Nemesis]

I had read that there is some sort of filtering of test subjects that inadvertently makes the med being tested
score better than in an average cross section of people.

It isn't inadvertent - it's deliberate, to make the drug seem more effective than it is.

I expect whether non-medical treatments have a bigger or smaller placebo effect than drugs varies considerably according to circumstances. For instance, it might vary according to the condition the person has and how much it's amenable to the placebo effect; whether they're using a non-medical treatment as a last resort or whether they're using it because it's been hyped up as something wonderful by people advertising it, and so on.

 

[quarky]

yes,

It is difficult to define all the non drug effects, though it seems logical that the placebo, as well as the non-placebo are equally effected by these subtleties.

And that these effects favor the placebo in a non-double blind study; as in, the general psuedo-science experiment.

Similarly, the dynamic of the double blind experiment favors the odds for the non-placebo.

And if it turns out that the non-placebo is mostly a placebo, yet sells well, it's placebo power would increase, due to the less doubt; because taking it would no longer be a double blind experiment.

The subjective aspects of feeling better would be greater, overall, if a placebo was marketed as a well tested new medicine. Which could only happen through criminal intent. Why would anyone bother? But if they did, and it flew, said drug would acheive a stronger placebo effect % than the same placebo in a double blind study.

crud. Is this comprehensible?

 

[blutoski]

yes,

It is difficult to define all the non drug effects, though it seems logical that the placebo, as well as the non-placebo are equally effected by these subtleties.

And that these effects favor the placebo in a non-double blind study; as in, the general psuedo-science experiment.

Similarly, the dynamic of the double blind experiment favors the odds for the non-placebo.

And if it turns out that the non-placebo is mostly a placebo, yet sells well, it's placebo power would increase, due to the less doubt; because taking it would no longer be a double blind experiment.

The subjective aspects of feeling better would be greater, overall, if a placebo was marketed as a well tested new medicine. Which could only happen through criminal intent. Why would anyone bother? But if they did, and it flew, said drug would acheive a stronger placebo effect % than the same placebo in a double blind study.

crud. Is this comprehensible?

I understand what you're getting at, but I reiterate that it's misguided. Specifically, these 30% improvement rates are not really attributable to the suggestion element of placebos - they're just the placebo group's overall improvement rate. In studies that compare placebo to nontreatment, we find that the nontreated group also improves by 30%, which makes the placebo 'effect' flatly zero.

Or - to put this another way - the nontreatment group knows they have a zero percent chance of getting the treatment, but they don't fare differently than a hyped-up placebo suggestion in most studies that attempt to measure a difference. The literature suggests that there is no 'there' 'there' to worry about.

There are a few indications such as pain and joint range of motion that seem to be influenced by suggestion, but the results are temporary and very rarely clinically significant.

Pending further evidence, I believe there is no good reason to talk about 'placebo effect' and 'plausible treatment' in the same conversation.

 

[quarky]

I dig what you're saying, but I must also chuckle about the placebo/nothing test you mention. In my above hypothesis, this test would favor the nothing.

The only real way to test what I'm suggesting, would be by an unethical experiment, with professional lying and cheating. Lurid ads and testimonials; fda approval; that kind of stuff.

I'm not saying that is happening. I'm wondering how well it would 'work', if it did happen.

(Some unpleasant side effects would need to be added, to overcome people's puritanical sense)

 

[fls]

Here you are. See, for example: New pitch for placebo power - placebo effect of antidepressant drugs studied - Behavior - Brief Article

This is how they do it: It's apparently been known that some drug companies have done a preliminary trial for depression medications, and those people who have responded strongly to the placebo pill have been dropped from the test, and then the trial is done again. With less people in the trial responding to the placebo pill, it means the figures are massaged to look as if the drug has a much higher success rate than the placebo effect.

Thanks for providing something a little more specific.

I think you misunderstand the purpose of dropping highly suggestible people from the study, though. It's a way to reduce noise when trying to understand efficacy (studying the effect of the drug under relatively ideal circumstances). Both efficacy and effectiveness (studying the effect under more realistic conditions) are useful to study, but both require somewhat contrived conditions in order to extract valuable information from which conclusions can be drawn.

It is well-recognized (although not always emphasized), that clinical trials have higher internal validity than external validity (generalizability).

Linda

 

[fls]

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.

Certainly.

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)

We should be clear that the bulk of the placebo effect has nothing to do with expectation. It is, as you mention, simply the waxing and waning of symptoms on their own and other factors unrelated to whether or not someone actually takes a treatment that they expect to help. There is very little difference found between 'no treatment' and placebo. There is no difference in any relatively objective measure of the disease process (there's no extra healing on a placebo), and there's no difference in whether or not subjective symptoms go away or not. What difference can be found is in the relative weight given to various subjective symptoms - most strongly to pain, which does seem to have a corresponding physiologic mechanism (endogenous opiate release). So your nausea doesn't go away on placebo, but you will report it as less disturbing. This is the effect of expectation.

I agree that if you ran an open trial (everyone gets the drug) vs. a DBRCT, that the 'placebo effect' will likely be stronger in the group where everyone knows they are taking the drug vs. the group where only half are getting the real drug and the rest placebo. I just think that this difference, which is the effect of expectation, will be dwarfed by the other factors that contribute to the placebo effect. And that in the real world, expectation (as has been discussed in this thread) is highly variable and depends upon the circumstances.

The hold that CAM therapy seems to have is that everything that happens after the therapy is given is attributed to the therapy. This happens with conventional medicine as well, but it is tempered by the evidence on which recommendations are based. Without evidence, CAM therapies don't have anything holding them back. Also, outcomes are usually measured solely by those few things that are amenable to the effect of expectation - some variation in the strength of their symptoms.

Linda

 

[quarky]

Thanks, Linda.
That was well put.

 

[blutoski]

I dig what you're saying, but I must also chuckle about the placebo/nothing test you mention. In my above hypothesis, this test would favor the nothing.

? - Maybe I'm confused, but are you saying that a pt told he is not being treated would perform better than a pt told he has a 50% chance of being treated?

The only real way to test what I'm suggesting, would be by an unethical experiment, with professional lying and cheating. Lurid ads and testimonials; fda approval; that kind of stuff.

I'm not saying that is happening. I'm wondering how well it would 'work', if it did happen.

(Some unpleasant side effects would need to be added, to overcome people's puritanical sense)

Mm. Well, I think you're assuming that placebos are not designed with the same undesireable side effects of the medication in question. This is pretty common practice, as it ensures proper blinding. That's not a new proposal.

What you're testing is whether there's a difference between a pt being told he's in a study with a chance of getting placebo vs a pt in a study where he's told there's no chance of getting placebo. ie: does not telling the pt they are in a placebo study increase their reporting of benefit.

The reason I brought up the baseline studies that compare medication to placebo to nontreatment is that since there is no noticeable difference between the pt who is told they are getting zero chance of treatment and the one who is enrolled in a placebo group for the same indication, there doesn't seem to be good reason to expect a significant improvement by taking the additional step of telling the placebo arm they are getting treatment.

 

[quarky]

Thanks, Blutoski. I may be starting to understand.
I'll be back if/when my confusion arises again.