Placebo effect

[saizai]

Why try to keep it out of medicine? If anything, I think that it should be studied *more* (as its actual mechanism is not understood, being a subset of the mind-body problem which is itself unsolved) and applied.

Doctors don't (AFAIK) prescribe placebos even when that might be the wisest course (eg for hypochondriacs). They take almost no efforts to increase the placebo effect of what they do prescribe, even though that would increase the effectiveness and cure more people.

Of course I agree that one must avoid:
* research that doesn't control against placebo effect (because otherwise you won't know the relative utility of the treatment) and
* placebo effect ONLY applications in ways that exclude more effective medicine, for serious conditions (eg homeopathy alone for cancer treatment)

But I don't see why one should avoid giving it in ADDITION to standard treatment, if the point is to produce more cures.

The only issue, IMO, is that the ethics are a bit gray in that one needs to oversell the treatment... but doing so does in fact increase the treatment effectiveness at least somewhat. Ironic, that.

 

[brodski]

Why try to keep it out of medicine? If anything, I think that it should be studied *more* (as its actual mechanism is not understood, being a subset of the mind-body problem which is itself unsolved) and applied.

Doctors don't (AFAIK) prescribe placebos even when that might be the wisest course (eg for hypochondriacs). They take almost no efforts to increase the placebo effect of what they do prescribe, even though that would increase the effectiveness and cure more people.

Of course I agree that one must avoid:
* research that doesn't control against placebo effect (because otherwise you won't know the relative utility of the treatment) and
* placebo effect ONLY applications in ways that exclude more effective medicine, for serious conditions (eg homeopathy alone for cancer treatment)

But I don't see why one should avoid giving it in ADDITION to standard treatment, if the point is to produce more cures.

The only issue, IMO, is that the ethics are a bit gray in that one needs to oversell the treatment... but doing so does in fact increase the treatment effectiveness at least somewhat. Ironic, that.

A few points, firstly we have not yet established that placebo is anything more than a failure of accurate observation.

Secondly using placebos runs into problem regarding "informed consent", if you tell a patient that the treatment that you are giving them has no active ingredient then there will be no observed placebo effect, even if the placebo effect is "real", you could only "benefit" from placebo by lying to patients.

and thirdly, when treatments are tested for efficacy, they are tested for efficacy ABOVE placebo, so when you use a conventional, proven treatment, you are getting benefits (if any) of the placebo effect as well as real medical help.

 

[Mojo]

But I don't see why one should avoid giving it in ADDITION to standard treatment, if the point is to produce more cures.

The placebo effect works just as much with effective treatments as it does with ineffective ones.

Nobody tries to keep the placebo effect out of medicine. Have you ever known a doctor to say "take these pills; they'll do you no good whatsoever"?

 

[saizai]

The placebo effect works just as much with effective treatments as it does with ineffective ones.

That's what I was talking about.

Nobody tries to keep the placebo effect out of medicine. Have you ever known a doctor to say "take these pills; they'll do you no good whatsoever"?

That would be an anti-placebo; not what I meant.

What I was saying (and think is true) is that doctors generally don't bother *trying* to intentionally increase the placebo effects of the treatments they prescribe; they're sorta neutral about it IME. "Here's this drug; have fun, call me back in a month."

Perhaps medicine could use some more theatrics.

 

[brodski]

That's what I was talking about.



That would be an anti-placebo; not what I meant.

What I was saying (and think is true) is that doctors generally don't bother *trying* to intentionally increase the placebo effects of the treatments they prescribe; they're sorta neutral about it IME. "Here's this drug; have fun, call me back in a month."

Perhaps medicine could use some more theatrics.

The trouble is, in order to increase the "theatrics" it becomes necessary to mislead patients about just how effective a treatment is, and as I said before, informed consent goes out the window.

 

[Dave1001]

Perhaps medicine could use some more theatrics.

You mean like calling the healer a special title like "doctor", and having the healer wears special garments such as a white coat?

I think this is a non-trivial point. The theatrics/aesthetics of medicine should be studied empirically for ways to increase healing efficacy. I'm not sure of the degree to which it is already done.

 

[Dave1001]

The trouble is, in order to increase the "theatrics" it becomes necessary to mislead patients about just how effective a treatment is, and as I said before, informed consent goes out the window.

Not necessarily. There are probably shamanistic theatrics that don't involve making direct or implied lies to the patient about healing efficacy.

 

[ponderingturtle]

Not necessarily. There are probably shamanistic theatrics that don't involve making direct or implied lies to the patient about healing efficacy.

How? You need to convince the patient that something is going to be effective when you know it will do nothing. That is the placebo effect. So you need to convince them of something that is untrue intentionaly and not be dishonnest? How?

 

[brodski]

Not necessarily. There are probably shamanistic theatrics that don't involve making direct or implied lies to the patient about healing efficacy.

So, when the patient asks "why are you sacrificing that goat" or "so, does it matter if I step outside of this circle of salt you have just pored whilst you where Calling the Quarters?" what does the doctor tell them?

 

[Dave1001]

So, when the patient asks "why are you sacrificing that goat" or "so, does it matter if I step outside of this circle of salt you have just pored whilst you where Calling the Quarters?" what does the doctor tell them?

Funny stuff. I assume you don't expect a serious reply to that though.

 

[blutoski]

Why try to keep it out of medicine? If anything, I think that it should be studied *more* (as its actual mechanism is not understood, being a subset of the mind-body problem which is itself unsolved) and applied.

As mentioned, there is an assumption being made that there actually is a placebo effect. When we can demonstrate one, medicine might consider it.

Doctors don't (AFAIK) prescribe placebos even when that might be the wisest course (eg for hypochondriacs). They take almost no efforts to increase the placebo effect of what they do prescribe, even though that would increase the effectiveness and cure more people.

Well, in that particular situation - hypochondria - placebos are specifically contraindicated, as they make the condition worse. It's called "facilitating," and that's how a psychiatrist loses his licence.

But I don't see why one should avoid giving it in ADDITION to standard treatment, if the point is to produce more cures.

The only issue, IMO, is that the ethics are a bit gray in that one needs to oversell the treatment... but doing so does in fact increase the treatment effectiveness at least somewhat. Ironic, that.

Not ironic, no. Just immoral.

 

[Dave1001]

How? You need to convince the patient that something is going to be effective when you know it will do nothing. That is the placebo effect. So you need to convince them of something that is untrue intentionaly and not be dishonnest? How?

Not necessarily. Placebo effect due to theatrics doesn't have to involve deliberately telling a patient that a medication will be effective when you empirically it is unlikely to be. I think elements of it can be done through ritual rather than lying. For example, there are already probably theatrical elements to the practice of medicine, including what I mentioned earlier, the ritual of calling physicians "doctor" and encountering them in a distinctive costume (the white lab coat). I think that it's worth more detailed study and experimentation determine the decree to which we maximize patient benefit from this stuff.

 

[brodski]

Funny stuff. I assume you don't expect a serious reply to that though.

Well, my tongue was planted firmly in my cheek, but I did have a serious point. I can't see what "shamanistic" approaches you could suggest which wouldn't raise some questions from many patients. How should doctors answer those questions?

 

[Dave1001]

Well, my tongue was planted firmly in my cheek, but I did have a serious point. I can't see what "shamanistic" approaches you could suggest which wouldn't raise some questions from many patients. How should doctors answer those questions?

I think they're obligated to answer the questions honestly, should they arise. Unless the patients are part of some study where they agreed beforehand to this type deception (similarl to patients in studies that make use of placebos).

 

[andyandy]

Why try to keep it out of medicine? If anything, I think that it should be studied *more* (as its actual mechanism is not understood, being a subset of the mind-body problem which is itself unsolved) and applied.

Doctors don't (AFAIK) prescribe placebos even when that might be the wisest course (eg for hypochondriacs). They take almost no efforts to increase the placebo effect of what they do prescribe, even though that would increase the effectiveness and cure more people.

Of course I agree that one must avoid:
* research that doesn't control against placebo effect (because otherwise you won't know the relative utility of the treatment) and
* placebo effect ONLY applications in ways that exclude more effective medicine, for serious conditions (eg homeopathy alone for cancer treatment)

But I don't see why one should avoid giving it in ADDITION to standard treatment, if the point is to produce more cures.

The only issue, IMO, is that the ethics are a bit gray in that one needs to oversell the treatment... but doing so does in fact increase the treatment effectiveness at least somewhat. Ironic, that.

Have you thought about entering the JREF million dollar prize?
I was going to post exactly the same OP - with regards to how vehicles for placebo should be embraced by the health service.... I'd just gone into SMMT to write it now....about how homeopathy could be co-opted by the health service as an effective placebo delivery system which has 3 benefits;
1) Lots of people already believe in it
2) It's seen as an "alternative" treatment - ie more easily embraced by those people who are suspicious of mainline medicine
3) It's just water! Thus no bad side effects and it's incredibly cheap...

but it's already been said.....you should really look into the psychic thing

 

[Rasmus]

Why try to keep it out of medicine?

Whoever would do such a thing - and how would they go about it?

If anything, I think that it should be studied *more* (as its actual mechanism is not understood, being a subset of the mind-body problem which is itself unsolved) and applied.

I don't think you need to get into any mind-body-problematic here. But then again, I also think there's as much studying going on as practical application.

Doctors don't (AFAIK) prescribe placebos even when that might be the wisest course (eg for hypochondriacs).

You are, quite simply, mistaken.

They take almost no efforts to increase the placebo effect of what they do prescribe, even though that would increase the effectiveness and cure more people.

I, too, would be interested to learn how you would go about that without intentionally lying to your patient about the treatment you are giving them.

Of course I agree that one must avoid:
* research that doesn't control against placebo effect (because otherwise you won't know the relative utility of the treatment) and
* placebo effect ONLY applications in ways that exclude more effective medicine, for serious conditions (eg homeopathy alone for cancer treatment)

please, let us stay with one subject. Don't go dragging homoeopathy into a subject like placebo treatment. Nobody uses homoeopathy as placebo. People use it like exorcisms and voodoo.

But I don't see why one should avoid giving it in ADDITION to standard treatment, if the point is to produce more cures.

Because it might be a bad idea to make patients believe that they require lots of medication, when they really just need a little. That would suggest that they are not as healthy as they really are. For example.

The only issue, IMO, is that the ethics are a bit gray in that one needs to oversell the treatment... but doing so does in fact increase the treatment effectiveness at least somewhat. Ironic, that.

You are mistaken. Placebo treatment is possible and is being performed with informed and consenting patients.

Overselling a treatment is unethical. How can a patient make in informed descision about the treatment if the doctor lies about its efficiency?

 

[brodski]

Have you thought about entering the JREF million dollar prize?
I was going to post exactly the same OP - with regards to how vehicles for placebo should be embraced by the health service.... I'd just gone into SMMT to write it now....about how homeopathy could be co-opted by the health service as an effective placebo delivery system which has 3 benefits;
1) Lots of people already believe in it
2) It's seen as an "alternative" treatment - ie more easily embraced by those people who are suspicious of mainline medicine
3) It's just water! Thus no bad side effects and it's incredibly cheap...

but it's already been said.....you should really look into the psychic thing

You do know that the NHS already has 3 fully funded homeopathic only hospitals don't you?

 

[Mojo]

You do know that the NHS already has 3 fully funded homeopathic only hospitals don't you?

And how about this from yesterday's Times?

The UCLH haematology unit claims that Buxton-King and her two colleagues are the only paid spiritual healers to work in an NHS hospital ward. Buxton-King joined the UCLH haematology unit, which treats patients with leukaemia, as well as lymphomas, myelomas and sickle-cell disease, in 1999 as an unpaid volunteer, working one day a week. Since 2001 she has a been fully-paid, part-time staff member, who manages a team of six complementary therapists, as well as treating about ten patients a week.

Toby Murcott tries hard to put a positive spin on the evidence:

Angie Buxton-King’s belief that each of us is surrounded by an energy field into which she can channel energy has no support in conventional science. But there is evidence that this therapy can help patients with pain relief.

In a 2004 study of 35 cancer patients, published in the European Journal of Oncology Nursing, subjects showed significant improvement in pain and discomfort, and improvement in depression and anxiety, after energy healing.

I managed to find an abstract of the study. It starts:

An uncontrolled, preliminary evaluation...

 

[ponderingturtle]

Not necessarily. Placebo effect due to theatrics doesn't have to involve deliberately telling a patient that a medication will be effective when you empirically it is unlikely to be. I think elements of it can be done through ritual rather than lying. For example, there are already probably theatrical elements to the practice of medicine, including what I mentioned earlier, the ritual of calling physicians "doctor" and encountering them in a distinctive costume (the white lab coat). I think that it's worth more detailed study and experimentation determine the decree to which we maximize patient benefit from this stuff.

THe point is you are intentionaly missleading them. So doctors need to make their patients fraudulently think that something will help but not actualy lie, but why is that ethicaly different from lieing?

 

[saizai]

How? You need to convince the patient that something is going to be effective when you know it will do nothing. That is the placebo effect. So you need to convince them of something that is untrue intentionaly and not be dishonnest? How?

That's not what I'm suggesting (except for hypochondriacs).

Placebo effect, as pointed out above, is additive to the 'base' effect of the treatment. I'm suggesting that it be increased - not that patients not be given standard, effective medicine.