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Placebos work, even when patients are in the know, study finds

Not really.

The 'placebo effect' is thought to be the cumulative effect of lots of things, including getting attention from a doctor/waiting for a doctor in a waiting room/lots and lots of other things. Removing one factor of many shouldn't make it all fall down.

Something I know less about is that there is an argument that the placebo effect is not real outside of statistics, or something. That is, there is no subjective improvement in a person's self-assessment. Perhaps somebody else could present that accurately.
 
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No. Really.

In the Gold Standard double-blind testing every effort is made to keep secret the knowledge of which tablet is real and which is the phony.

The effects of believing a placebo is "real" are both subjective and real.
 
The other aspects of the placebo effect are controlled for as well in double-blind tests, not just the (for example) tablet. That the tablet is not the sole/main cause of whatever placebo effect there may be won't have an effect on double-blinded research based on placebos, as far as I can see.

Or I could have misunderstood since I am a bit distracted. I'll wait and see the study to see what things were taken into account.
 
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It is a matter of investment. You make an investment, i.e. time and effort to take pills. Therefor you have a vested interest in thinking (or is that stating?) that it works. Of course what would be of interest is if there was some objective way to measure how much of an improvement there was. I predict that would say none.
 
I think the biggest part of this is that Irritable Bowel Syndrome is a highly variable disease that is best managed by changes in the patient's diet and stress levels. So maybe just the fact that they are participating in a study about IBS was enough to help these patients. The study says 59% of the fake-pill-recievers got better and 35% of the ones who got no treatment got better. Those are both pretty high numbers for two groups of people who essential got the same treatment (none!).

I'd like to see a study with something more concrete like Crohn's Disease. If a placebo can be shown to treat Crohn's Disease, then we're on to something.
 
Gord_in_Toronto said:
Placebos work, even when patients are in the know, study finds



Surprising news.

Really surprising news.

:jaw-dropp
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No. If you look at the actual study, the patients were misled as to the effects of placebo. They were repeatedly given specific information that placebos were effective due to the effects of mind-body self-healing processes and were told that placebos were powerful. This set-up ensures that the expectations in the placebo group were similar to the expectations in a regular placebo-controlled drug trial anyway.

Then, if we look at the outcomes, we see just what we'd predict from the effects of expectation. The primary outcome measure was subjective and continuous, and the secondary measures were also subjective and continuous, except for one which was dichotomous. We already know that expectation will lead to small differences on these kinds of measures.

This was sort of a wasted study, considering that it failed to address the issue which was purportedly the purpose of the study - can placebos be useful without deceit?

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015591#pone.0015591-Finniss1

Linda
 
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The results didn’t surprise me when I saw them yesterday.

As fls reported, the demand characteristics all but guaranteed sweet returns from the participants who received the placebo. Patient compliance, expectations, and a host of other factors (many unknown) apparently contribute to the placebo effect.

From the study http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015591#pone.0015591-Finniss1

Our results challenge “the conventional wisdom” that placebo effects require “intentional ignorance.” [29] Our data suggest that harnessing placebo effects without deception is possible in the context of 1) an accurate description of what is known about placebo effects, 2) encouragement to suspend disbelief, 3) instructions that foster a positive but realistic expectancy, and 4) directions to adhere to the medical ritual of pill taking. It is likely our study also benefited from ongoing media attention giving credence to powerful placebo effects.
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To me, that was stacking the deck.

rjh01 said:
It is a matter of investment. You make an investment <snip>
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We are bringing Cognitive Dissonance in here. Yes.

Alan said:
Not really.

The 'placebo effect' is thought to be the cumulative effect of lots of things <snip>
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Yes. Sorry for snipping so much.

xjx388 said:
I think the biggest part of this is that Irritable Bowel Syndrome is a highly variable disease that is best managed by changes in the patient's diet and stress levels. So maybe just the fact that they are participating in a study about IBS was enough to help these patients. The study says 59% of the fake-pill-recievers got better and 35% of the ones who got no treatment got better. Those are both pretty high numbers for two groups of people who essential got the same treatment (none!).

I'd like to see a study with something more concrete like Crohn's Disease. If a placebo can be shown to treat Crohn's Disease, then we're on to something.
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Well, the placebo treatment actually is something, which is why controls are put in place during clinical trials. There was a significant difference between the control group and the placebo group (the treatment group) in this study. I’d assume research on ulcerative colitis or Chron’s Disease would also be placebo controlled b/c placebos would be deemed as potentially contributing some effect.

For a good primer on placebo, you can check out The Skeptic’s Dictionary entry.

Anne
 
Gord_in_Toronto said:
No. Really.

In the Gold Standard double-blind testing every effort is made to keep secret the knowledge of which tablet is real and which is the phony.

The effects of believing a placebo is "real" are both subjective and real.
Click to expand...

I'm not even sure what this means.

The "placebo effect" covers a lot of things, many of which are not affected by state of mind. For example, people get better all by themselves, which means you need to account for the number of people who would improve naturally over the course of the study; that gets lumped into the placebo effect, since the people are given placebos also improve naturally.

Similarly, even where people don't 'get better,' they typically regress to the mean; if you start out with a group of sick volunteers, they'll usually improve to average over the course of a study. Again, this applies to the control group, too, so it gets lumped under the placebo effect.

And, of course, people lie about whether or not they feel better, regardless of what they were dispensed. People who get placebos are no less likely to tell lies than the experimental group.

So, there's really nothing new here.
 
Percent said:
Well, the placebo treatment actually is something, which is why controls are put in place during clinical trials. There was a significant difference between the control group and the placebo group (the treatment group) in this study. I’d assume research on ulcerative colitis or Chron’s Disease would also be placebo controlled b/c placebos would be deemed as potentially contributing some effect.

For a good primer on placebo, you can check out The Skeptic’s Dictionary entry.

Anne
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I understand placebo effect. My point is that if a study similar to the one in question showed that the fake-pill-getters had clinically significant healing of their Crohn's disease, it would be more impressive. IBD often resolves through reducing stress which is exactly what this study might have done. CD does not respond to reduction of stress and requires meds or surgery to treat.
 
Could the fact that people self-selected to be in a study that informed them they would not be offered any active medication be a source of bias?
 
xjx388 said:
I understand placebo effect. My point is that if a study similar to the one in question showed that the fake-pill-getters had clinically significant healing of their Crohn's disease, it would be more impressive. IBD often resolves through reducing stress which is exactly what this study might have done. CD does not respond to reduction of stress and requires meds or surgery to treat.
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From The Mayo Clinic site on Crohn's disease:

Crohn's disease: Lifestyle and Home Remedies

Stress
Although stress doesn't cause Crohn's disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.

When you're stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acid. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.

Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:

* Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.
* Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. You're then taught how to produce these changes without feedback from the machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.
* Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
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Maybe stress reduction could be of some use. I'm not "that type of Dr." and I'm not claiming to know about Crohn's Disease. Sorry for any misunderstanding. :)

Anne
 
fls said:
No. If you look at the actual study, the patients were misled as to the effects of placebo. They were repeatedly given specific information that placebos were effective due to the effects of mind-body self-healing processes and were told that placebos were powerful. This set-up ensures that the expectations in the placebo group were similar to the expectations in a regular placebo-controlled drug trial anyway.

Then, if we look at the outcomes, we see just what we'd predict from the effects of expectation. The primary outcome measure was subjective and continuous, and the secondary measures were also subjective and continuous, except for one which was dichotomous. We already know that expectation will lead to small differences on these kinds of measures.

This was sort of a wasted study, considering that it failed to address the issue which was purportedly the purpose of the study - can placebos be useful without deceit?

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015591#pone.0015591-Finniss1

Linda
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Damn. Trust me to trust a newspaper and not search out the original paper. I usually make an effort to do that before posting. I'll blame pre-Christmas consumption of "spiced" eggnog. Move along folks. Nothing to see here. :o
 
I wonder if anyone could or would market a placebo pill for over-the-counter. Call it Placebo. List the active ingedient as whatever sugar is typically used. Give warnings for anyone who shouldn't ingest that sugar. Boldly state that it isn't any kind of genuine medication. Say something like, "You know this isn't medicine, but 20% of you will get better after taking this placebo anyway. We aren't entirely sure why some of you get better - but those who do get better do get better. There is nothing fancy in this pill. Only buy this if you really want to buy this. We recommend consulting your doctor."
 
How do we know that the placebos weren't contaminated with a molecule or two of a homeopathic remedy? That would explain things.
 
In some cultures, the 'doctor' prescribes a meaningless and illogical ceremony, such as bringing squash to the base of a certain tree at a specific time, for 10 days in a row.
The 'doctor' pretends that the gesture is gravely significant in its own right, knowing that its purpose was to distract the mental rut the patient had gotten into.

Even taking a placebo, in a test, is something that would slightly alter or upset the normal routine. A symbolic gesture can be legitimate and sincere, and quite possibly beneficial, though one would expect that the 'doctor' would study the patient before prescribing the healing woo, and fine-tune the prescription for the individual.
 
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