Non-Existent Placebo Effect

[SezMe]

I got drawn into a discussion of medical science today with someone who made a rather remarkable assertion...at least it was to me. He asserted there was no such thing as the placebo effect. As evidence, he cited a study in the (British, I think) journal (or magazine?) Science (It was noisy in the pizza joint) within the last year that a study had been conducted to determine if there was such a thing as the placebo effect...and the result was, no, there is no such thing.

After that, everytime I tried to argue against crap medicine and the need for DBPC studies, he would just simply respond, "There is no such thing as a placebo effect."

I have tried googling about but I cannot find anything that is directly relevant. Plus, I probably wouldn't understand a detailed study if I found one, being the dumb layman that I am in the area of medical science.

Can any of you confirm or help me confront this assertion?

Thanks.

 

[Donks]

Can any of you confirm or help me confront this assertion?

Thanks.

I can point you towards the study, is that good enough?
2001 study: here
By same authors, 2004: here

 

[Paul C. Anagnostopoulos]

I had read about the original study.

So what does it mean when someone tests a new drug and it does "better than placebo?" Perhaps we should now have two control groups, one on placebo and one doing nothing at all. The two control groups should have similar results, right? If we can show this is true, we can do away with placebo controls and just compare the drug to untreated patients.

How does this jibe with all the research showing the power of suggestion in medicine?

~~ Paul

 

[Paul C. Anagnostopoulos]

Well, looky here:

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=15827993&query_hl=3

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=15788014&query_hl=3

~~ Paul

 

[Dr. Imago]

Measurement, recall, and reporting bias can create the perception that a placebo, when tested in an adequate and well-controlled (AWC) trial (i.e., the DPBC methodology as one example of such an AWC trial) is working, when there is in reality no measurable treatment effect. These are all forms of human error that DBPC trials help to minimize, but can create the perception that the placebo is "working", which is not at all what the placebo effect intimates.

As an example, when I worked in epilepsy research we used to use a 4-week "lead-in" period where we asked patients to measure and record the number of seizures they had on their current medication. Patients were then randomized in a double-blind fashion to either receive the active medication versus a placebo. Over the next 12 weeks, their response was recorded (at home) by themselves and compared to the number of seizures they had during the 4 weeks preceding the study. Invariably, patients receiving the placebo would report (and that is the critical word here) fewer seizures during the active treatment phase, although it was still far more (statistically significantly so) more than those actually receiving the active medication. In that sense, one explanation is that the patient bias was to report fewer seizures on the study, and if they had been hospitalized and observed during the entire sixteen-week period (the four-week lead-in time and the 12-week active study period) and observed and recorded by a separate blinded investigator, we might anticipate that the actual number of seizures would be lower in the lead-in period and higher in the treatment period. Of course, this phenomemon effects both the active and placebo study arms, but the treatment effect still separates out between the two arms so the overall reporting bias is minimized (i.e., a prime example why we do DBPC trials).

So, the "placebo effect" is real despite the fact that the placebo itself contains no active, biological ingredients and cannot possibly cause a direct physiological effect in and of itself. In that regard, we cannot in any way assume that this means that the placebo is working. But, it amply measures the imperfect human effect of being in a clinical trial and deeply desiring for a treatment to work.

I think this is the misconception of the term "placebo effect" in the lay public to which a lot of people take objection. When we observe the "placebo effect" phenomonenon, much as we do with homeopathic remedies (and the like), we should not accept any explanation that dismisses other reasons for the observatios and in any way purports that there is specific activity of that sham medication. In other words, while placebos offer us the unique opportunity to perhaps gain insight into the "mind over matter" phenomenon, we shouldn't forget to look for simpler explanations such as various types of study bias. Likewise, the "fuzzier" (i.e., more subjective) the study endpoint you are measuring, the greater the placebo effect you're going to see.

In that sense, SezMe, your friend may be partially correct in that what we call the "placebo effect" might be nothing more than an easy, catch-all term that describes various types of hard-to-discern bias that unwittingly get into clinical trials, a few of which I've described here.

-TT

 

[kk2796]

Exactly what TT said - I've always thought the placebo was meant to offset confirmation bias... People who think they're being treated generally focus on the positives of their condition, while people not being treated tend to focus on the negatives of their condition.

Thus, *any* form of treatment for a condition with symptoms with *any* level of subjectivity has a good chance of "success". Enter: blood-letting, homeopathy, touch-therapy, magnetic bracelets, crystal therapy, etc., etc.

In my mind, this is the placebo effect. I'm surprised at the number of people who think there is more to it, but it seems the British study went to great lengths to refute the notion that there is any positive impact of placebos on objectively measurable symptoms.

In summary, the statement "There is no placebo effect" is only true in a limited context. SezMe, I would tell your friend to read this thread (particularly TT's post), or email the contents to him.

 

[Kumar]

I think "placebo effect" can be related to "self healing effect" or "by self immune strength". Stress effects our immune strength, higher stress can weaken the immune strength so on the opposite side, it can be thought that lower the stress or relaxing conditions may strengthen the immune power. Faith, belief, spritual practices, natural lifestyle & environments, good music, yogas & breathing exercises, homeopathic remedies or other alternative means which can cause relaxing conditions or lower the stresses can improve our immune strenght resulting into better "self healing effect". The main purpose of alternative means can be "to trigger, initiate & relieve specific stresses" unabling immune system to work better in natural style.

However, immune system can also be initiated/triggered or disease causing agents can be directly poisioned or disorders can be directly treated, by some strong means(alike hunter/beating to a horse to initiate him to run) by some concentrated non-traditional/non-adapted/non-habituated chemicals to us, presenting somewhat alike "shocking/non-adapted/non-traditional/unnatural/non-habituated effects.

The former can be slow & steady natural effects with least adverse/toxic effects or other adversities, whereas later can be fast/strong/unnatural effects with adverse/toxic effects or with other adversities. It is not sure to me that, if measurable results of studies are real healing effects or real effects+adversities--which one can try to understand. It is understoodable that concentrated chemicals with advesities can present more apparent measurable effects--real or real+adverse/toxic. The difference can be "by natural means" with more natural effects or "by unnatural means" with more unnatural effects. Placebo seems to be a name given to it.

Moreover, we can't think any change/effect in our body--psycholosical or physiological, placebo or real, quantum or chemical, micro or macro.....can happen without any chemical/quantum/mechanical change/activity in our body. What it will be called; A person interacting with other person, photo or object & getting some effects without any chemical exchage in between them?

 

[Donks]

I think "placebo effect" can be related to "self healing effect" or "by self immune strength". Stress effects our immune strength, higher stress can weaken the immune strength so on the opposite side, it can be thought that lower the stress or relaxing conditions may strengthen the immune power. Faith, belief, spritual practices, natural lifestyle & environments, good music, yogas & breathing exercises, homeopathic remedies or other alternative means which can cause relaxing conditions or lower the stresses can improve our immune strenght resulting into better "self healing effect". The main purpose of alternative means can be "to trigger, initiate & relieve specific stresses" unabling immune system to work better in natural style.

However, immune system can also be initiated/triggered or disease causing agents can be directly poisioned or disorders can be directly treated, by some strong means(alike hunter/beating to a horse to initiate him to run) by some concentrated non-traditional/non-adapted/non-habituated chemicals to us, presenting somewhat alike "shocking/non-adapted/non-traditional/unnatural/non-habituated effects.

The former can be slow & steady natural effects with least adverse/toxic effects or other adversities, whereas later can be fast/strong/unnatural effects with adverse/toxic effects or with other adversities. It is not sure to me that, if measurable results of studies are real healing effects or real effects+adversities--which one can try to understand. It is understoodable that concentrated chemicals with advesities can present more apparent measurable effects--real or real+adverse/toxic. The difference can be "by natural means" with more natural effects or "by unnatural means" with more unnatural effects. Placebo seems to be a name given to it.

Kumar, if you had taken the time to read any of the links posted in the thread, or ThirdTwin's excellent post, you would have realized that you were wrong. Also, we wouldn't have been subjected to another of your "I think" posts, which by default are always wrong.

 

[Kumar]

Kumar, if you had taken the time to read any of the links posted in the thread, or ThirdTwin's excellent post, you would have realized that you were wrong. Also, we wouldn't have been subjected to another of your "I think" posts, which by default are always wrong.

Pls explain in detail, what is wrong in my post which you are claiming?

 

[Donks]

Pls explain in detail, what is wrong in my post which you are claiming?

I'm not explaining anything to you anymore, remember? Just try to "think profoundly and dynamically" and see what's wrong with this phrase:

I think "placebo effect" can be related to "self healing effect" or "by self immune strength".

 

[Kumar]

I'm not explaining anything to you anymore, remember? Just try to "think profoundly and dynamically" and see what's wrong with this phrase:

When you are claiming that I am wrong & as you commonly say that it is the duty of .....to prove. So pls explain in detail & prove that I am wrong.

 

[Donks]

When you are claiming that I am wrong & as you commonly say that it is the duty of .....to prove. So pls explain in detail & prove that I am wrong.

Oh so now you're a stickler for where the onus lies, huh? Ok, I'll play your little game. Your statement, again:

I think "placebo effect" can be related to "self healing effect" or "by self immune strength".

I'm not going to make you read anything outside of this thread, ust ThirdTwin's post. Contrast your thought with this:

Measurement, recall, and reporting bias can create the perception that a placebo, when tested in an adequate and well-controlled (AWC) trial (i.e., the DPBC methodology as one example of such an AWC trial) is working, when there is in reality no measurable treatment effect. These are all forms of human error that DBPC trials help to minimize, but can create the perception that the placebo is "working", which is not at all what the placebo effect intimates.

In that regard, we cannot in any way assume that this means that the placebo is working. But, it amply measures the imperfect human effect of being in a clinical trial and deeply desiring for a treatment to work.

...your friend may be partially correct in that what we call the "placebo effect" might be nothing more than an easy, catch-all term that describes various types of hard-to-discern bias that unwittingly get into clinical trials...

So, if you bother reading these snippets, you'll see that the placebo effect is not a magical state by which the body can cure any and all illnesses just by wishing it to be so. It does not relate to "self healing effect" or "by self immune strength" because there is no measurable effect there, just the illusion of one, caused by a variety of biases and errors.

ETA: Oh, and now that you have played the burden of proof card, you have now shown that you know that the person making the claims has to provide the evidence. As a result, in the future you can shove your BS about it being our duty to explain the theories you present (like you just did in the other thread) up your ass. Right next to your head.

 

[Kumar]

Donks,

I usually use non-absolute words. See my signature. But when you use & claim "somewhat absolute", you need to prove it. You can ask me when I am "absolute" in any of my post otherwise not.

 

[Donks]

Donks,

I usually use non-absolute words. See my signature. But when you use & claim "somewhat absolute", you need to prove it. You can ask me when I am "absolute" in any of my post otherwise not.

More BS. No Kumar, that's not how it works. I don't care what your signature says, or how ambiguous and confusing you intentionally make your language. If you make a claim, I may ask you to back it up (that's if I'm still responding to your giberish). If you don't back it up, I'll consider your claim to be null and void.

Edit: Oh, and sorry SezMe for derailing your thread. I won't respond to Kumar in this thread anymore, unless he has something to add to the topic.

Edit2: SezMe: It's your turn to post a pic in the name that place thread

 

[SezMe]

Edit2: SezMe: It's your turn to post a pic in the name that place thread

It is there, Donks. I hope you're challenged.

More on this thread after I have read the links and digest the material more. But ahead of that, thank you very much.

 

[Mojo]

Kumar, if you had taken the time to read any of the links posted in the thread, or ThirdTwin's excellent post, you would have realized that you were wrong.

For Ed's sake, if Kumar just bothered to read what he posts himself he'd realise he's wrong!

 

[Donks]

For Ed's sake, if Kumar just bothered to read what he posts himself he'd realise he's wrong!

Well, yeah but we can't really expect anyone to read Kumarese, can we?

 

[treble_head]

my only thought here involves Kumar. There is such a thing as keeping your mind so far open your brain falls out.

 

[Kumar]

I have posted my views, if these don't suit you due to any of your reason or if you don't want to understand alike it, it is your problem. Anything which can cause any interaction/effect/change in us may not be without any chemical/quantum/mechnical/biological...or scientific change--just I think. Is it not true? If true, then why placebo? To injure anyone by words/abuses or by slapping or by weapen or by chemicals or by radiations---may not mean placebo effect as all these can bring scientific changes in the body--just I feel. Is it not ok?

 

[Vim Razz]

Stress effects our immune strength, higher stress can weaken the immune strength so on the opposite side, it can be thought that lower the stress or relaxing conditions may strengthen the immune power.

Chronic stress does supress the immune system; this is not the same as saying that all stress supresses the immune system.

At the onset of the stress response (glucocorticids being the relevant trigger) the immune system is stimulated. Continued glucocorticid then supresses the immune system to bring it bsk down to "normal." (This is an important self-regulating function. If the immune system does not get supressed you run the risk of auto-immune disorders -- where the overly agressive immune system begins to attack normal body tissues.)

A problem arises when it comes to chronic stresses (which are a very recent challenge in our evolutionary history -- fretting about bills, deadlines and such) and glucocorticid release does not stop for extended periods of time. This continues to supress the immune system until it's below "normal" healthy levels and messes with the triggering mechanism in such a way that interferes with it's ability to respond properly to the next threat.

So you're not entirely wrong, Kumar, although much of your post is inacurate and/or unclear to me.



Glucocorticids do not only affect they immune system. They trigger a variety of stress reponses throughout the body -- mostly "fight or flight" responses that sacrifice long term heath in favor of short term survival -- and there are additional complications when glucocorticid levels remain high for a prolonged period of time.

In relation to the placebo effect, if an individual's primary source of anxiety is the condition that they believe they are treating with the placebo, then removing that source of anxiety (because they think the situation is now under control) can alow the stress funtions to shut off and thus return the body to "recovery mode."

This variety of plabebo does not, in itself, cause healing, but it does stop "fight or flight" functions that are inhibiting the healing process.




My source -- highy recomended, it's a great read. Any errors in this post are my own.