Questions about the placebo effect.

[Fluffy]

I don't have a clue what the placebo effect is, or how it works.

I read articles below, after Geni mentioned it in another thread. I don't understand how the placebo effect works. Why it is allowed to be administered by the medical professionals. Why do scientists seem to accept the effect, and yet ridicule other such similar unknowns.

The dummy pills work a strange kind of magic. There is in fact a great body of evidence to suggest that placebo or dummy treatments can sometimes work as well or even better than real medicines. Patients on placebos can even experience side-effects that mimic real drugs

Which article

In another it says,

The action of placebos emphasises the power of suggestion. A history of Freudian psychoanalysis is the rejection of the suggestion of hypnosis for the transference of the analysis. Frank postulated that all treatments comprised a specific element and a non-specific placebo element aimed at counteracting demoralisation

placebo deception

The power of suggestion, is this the same effect that the shops use? Like that of having freshly baked bread smells pumping through the shops to make you buy more? Or the smell of fresh coffee when you view a home to buy?

Dummy treatments used in clinical trials of cancer treatments can produce positive effects - but are unlikely to have a direct impact on tumours, research has found.

cancer patients given placebo pills.

Now if people are being deceived into taking fake medicines believing they are being cured isn't that unethical?

As noted earlier, higher levels of NPY in the prefrontal cortex are associated with greater stress tolerance and lower anxiety. Considering all the evidence, it therefore seems likely that the prefrontal cortex plays an important role in mind-body health, as well as in the etiology of disorders such as CFS which appear to be the result of a breakdown in this system

Mind and body

This will sound ridiculous but it is what I thought it was suggesting. From the last quote, the author seemed to point out that a part of the brain heals the body or at least kick starts it to heal. If this is so, does any medicine really work or is it really needed?

Could homeopathy, although only water with fancy differing names, be classed as a placebo effect? Just like the placebo effect, and not actually be proved or disproved.

 

[Rolfe]

Placebo itself just means "something to keep the patient happy". In other words, keep the patient and his friends and family occupied while nature itself effects a cure.

Also, people are frequently motivated to reinterpret circumstances so as to imagine they are better, once they start taking medicine. Wishful thinking, really.

Also, the feeling that everything is under control, someone has dealt with the situation, and you are being helped, can lessen stress enough to make people feel genuinely better.

The point about drug trials is that you have to allow for these effects - pilltaking as such is known to predispose patients to report feeling better. So you make sure that both your test group and your control group are treated in exactly the same way, down to the pill-taking and the belief that they are (or may be) taking the real drug), with the only difference being whether or not the pill contais the active ingredient. This is the only way you can tell whether the active ingredient is really doing something.

This is of coures the point where any alleged effects of homoeopathy pack up and leave.

Rolfe.

PS. Yes, any beneficial effects reported for homoeopathy are the same thing as "placebo effect". Patients prescribed a pill tend to report feeling better.

 

[Brian the Snail]

Does the placebo effect work with animals? I'm guessing that it wouldn't, but I would also suspect that it's difficult to test for. Has any studies been done on this at all?

 

[Hellbound]

While I am something of a layman, I can try and give a better description of placebo effect.

Placebo effect is, basically, how you think you feel. Think about having the flu. Even though the physical symptoms may remain the same (i.e.-fever is the same, still throwing up, etc), there is a difference in how you feel depending on whether you are home by yourself suffering or you have a family that is caring for you and looking after you.

Placebo effect is similar to this. Many illnesses can be caused by non-physical factors, stress being high among them. Effects related to stress are headache, nausea, malaise, backache, and lethargy, just to name a few. Stress is caused by change, and often the highest stress is produced when a person feels they are not in control of the change.

Placebos work because the person believes they are medicinal. This gives them a feeling of control, a feeling of doing something, and can therefore reduce stress. This can alleviate many of the stress induced symptoms, and basically improves outlook, making other symptoms easier to bear.

Likewise, the reverse is also true. A person taking a placebo, thinking it to be an actual drug, can experience "side effects". This is often related to stress levels and belief, and again the side effects produced by placebo tend to be stress-type effects (as listed above-headache, nausea, etc). Almost all the effects helped and harmed by placebo are subjective...things the patient has to tell us rather than things we can directly measure. A persons outlook, whether they expect to be sick or expect to be well, can make a big difference in subjective measures.

Another example might be a trip to an amusement park. If your son decides they don't want to go with the family to Disney Antarctica, for example, chances are he will not have fun, simply because he already decided he would not. However, the same child, in a better mood, might actually describe it as "the happiest place on Earth". It's all abour perception.

When a new drug is tested, there are at least two groups involved. Group A would get the actual drug, while Group B would be told they were getting the actual drug, but in reality would recieve a placebo (usually sugar pills). For a drug to be considered as effective, it must show a better performance than the placebo. So hopefully this will answer the question about whether drugs are needed. If a drug shows an effect that is no greater than that shown by the placebo, it is considered an ineffective treatment.

As to placebos being given to patients, generally they are not being given to patients as cures. Placebos, when given medicinally, tend to be for treatment of subjective things: pain, lethargy, malaise, nausea, and so forth. They are never given as a "cure", but as a symptomatic treatment. They can make someones symptoms more tolerable, but only if the person truly believes they are recieving medication. So, no, I don;t think it is unethical unless they are being sold as actual cures, rather than what they are (homeopathy sells placebo as cure, medicine does not).

The placebo effect is accepted because it is well-known, well-studied, and has been proved. It is not unproveable. We KNOW that people can experience effects from placebo.

Now, the reason homeopathy is ridiculed and placebo is not basically goes back to the ethical question. Scientists know that placebo effect exists, and its limitations are fairly well-known. Homeopathic medicine is identical to placebo in that it is a non-medicinally active substance (water or sugar pills). The problem is that homeopaths claim these placebos can cure, and can perform better than real medicines. This is the idea that is ridiculed. A doctor might give aplacebo to someone suffering from stress-related lethargy, or to a chemotherapy patient to help reduce nausea. However, the homeopath would claim the placebo would cure the cancer and remove the stress. This is beyond any measured effect of placebo (see the third link you posted..."unlikely to have a direct impact on tumors").

It's not the idea that the mind can help in healing, this is well known. The problem is that homeopaths misrepresent both the "treatments" they give (which contain no active ingredients), the effects of those treatments (which have never been shown to be greater than placebo), and at the same time urge patients not to be treated by real medicine (thus preventing treatment that can actually cure the disease or relieve the effects of it, if incurable).

 

[King of the Americas]

I think...

...therefore I am.

All the great apes suffer from this affliction, as demonstrated when they gave chimps and gorillas white asprine to aleviate headaches and joint pain. When given a white dummy pill, they suffered from the same recovery.

Humans alike are subect to their thoughts and perceptions as shaping their very being.

The yang to this yin is that "doubt" came be just as destructive as faith. Doubt in a solid procedure can be catastrophic.

It is an odd thing this "placebo", but it works...sometimes, and in most studies it works about half the time.

You think, therefore you are...or might be.

 

[John Bentley]

Whistler,

I don't understand how the placebo effect works.

I haven't done a lot of reading on the subject, but as far as I know, no one knows how the placebo effect works, but there are lots of theories. Most people studying the effect seem to think that it has something to do with lowering anxiety and increasing tolerance to pain, nausea, etc. In other words, it basically makes people think that their symptoms are getting better, whether they are or not. As far as causing side effects, these seem to be subjective side effects of the type like headaches, nausea, itching, etc., that may only be due to heightened awareness of normal "background" body complaints that are normally ignored. For instance, as I sit here at the computer and really take an inventory of my body, I realize that my lower back is hurting a little because I'm slouching, I have a slight headache, etc. I wasn't really aware of these things until I forced myself to take notice. I could be dead wrong on this, so anyone with better sources to cite, please do so.

Why it is allowed to be administered by the medical professionals.

It is not allowed to be administered by medical professionals as a substitute for needed medication, except as part of scientific study.

Now if people are being deceived into taking fake medicines believing they are being cured isn't that unethical?

In these studies, subjects are told beforehand that they will receive either a medication or a placebo, but that they will not be told which one they receive. They are made fully aware that they may receive a placebo, and they give their consent to that before the test is begun. I can think of at least two cases off the top of my head where subjects were not told beforehand that they may receive a placebo and in both cases, there was a big scandal involved after the facts came out. In many cases, if the medication is proving far superior to the placebo, the test is halted so that the placebo group can receive the benifits of the medication, even if that means the scientific study is not publishable. I would bet that many general practitioners give placebos to patients that they believe to be hypochondriacs. These people imagine they are ill, usually in order to get attention from friends, family members, doctors, etc. They aren't being cynical, they truly believe they are ill, but it is "all in their head" as the saying goes. However, this is not a good practice and the doctor better be darned sure that he hasn't missed something before going that route, as prescribing and charging for a placebo medication can get your license yanked.

Why do scientists seem to accept the effect, and yet ridicule other such similar unknowns.

They accept the effect because it has been proven to exist in carefully controlled, double blind studies.

Could homeopathy, although only water with fancy differing names, be classed as a placebo effect?

If any effect is seen from homeopathy, it is undoubtedly a placebo effect. However, homeopathists themselves fervently deny that this is so. It is interesting to note that placebo effects do not occur in animals as far as I know. I could be wrong about that, but would be willing to question any study that purports otherwise, as it seems that the placebo effect requires the conscious perception that the medication you are receiving will help your problem. Homeopathists continually claim that their preparations work in animals so it can't be a placebo effect. Of course, no carefully controlled, double blind study has ever shown that homeopathic remedies work, but that doesn't stop the claims.

 

[geni]

Does the placebo effect work with animals? I'm guessing that it wouldn't, but I would also suspect that it's difficult to test for. Has any studies been done on this at all?

Yes and no. Soem of the effects atributed to the placebo effectgs still exist such as observer bias, greater care being taken of the animal and the animal getiing more attention.

 

[Fluffy]

Does the placebo effect work with animals? I'm guessing that it wouldn't, but I would also suspect that it's difficult to test for. Has any studies been done on this at all?

That was what I just wondered about. Also with the current trend for some vets to also prescribe homeopathic remedies, its disconcerting.

As animals can't say ick this is making me come out in hives. I consider it cruel for animals to be given these water all cures. What suffering might be going on undetected?

Apologies to all, I am becoming quite an animal activist (word use?) of late.

 

[Rolfe]

Does the placebo effect work with animals? I'm guessing that it wouldn't, but I would also suspect that it's difficult to test for. Has any studies been done on this at all?

Basically when you rely on the owner to decide how the patient feels, you are putting another observer in the system, and one who is not personally experiencing the illness but is indeed subject to suggestibility. This makes it even easier for imaginary improvements to be reported.

Woo-woo (confidently): yes, he's a lot better, isn't he!
Owner (doubtfully): well, maybe....
Woo-woo (enthusiastically): oh yes, look at that damp nose, that shining eye, and look, he's wagging his tail!
Owner (becoming more convinced): oh, isn't that wonderful!
Dog: I feel terrible, you freaking morons!

When doing drug trials with animals you still have to do the placebo group and blind all the participants.

I saw a fascinating study of a woo-woo treatment for arthritis in the dog. They had an objective measurement of lameness (force plates), and they asked both the owners and the treating veterinary surgeons to assess response subjectively. By chance, the treating veterinary surgeons were unblinded to some extent as to which dogs had been treated, but the owners almost certainly weren't. Guess what. No significant difference on the force plate measurements, or on the owners' subjective assessments, but the treating veterinary surgeons' assessments came in positive for the snake-oil at p<0.05.

Blinding is most important where assessments are subjective. If the assessment is strictly objective, say a machine measurement that the operator can't influence, then even if you know which group's which there's little you can do about it.

Rolfe.

 

[Prester John]

I think that with animals the placebo effect is on the human involved, that is the human percieves the animal as showing indications of treatment, even tho' the animal might recieve a placebo (as with homeopathic treatments).

 

[richardm]

Originally posted in The Onion:

"That's the beauty, and the mystery, of placebo.
It's all-purpose. Think of it like aspirin, but without any of the analgesic properties."

 

[Rolfe]

I would bet that many general practitioners give placebos to patients that they believe to be hypochondriacs.

Or in the veterinary world, an injection of vitamin B<SUB>12</SUB> for the dog does make the client feel they've got more than words for their consultation fee....

Rolfe.

 

[John Bentley]

As animals can't say ick this is making me come out in hives. I consider it cruel for animals to be given these water all cures. What suffering might be going on undetected?

Don't worry about that. If homeopathy has anything going for it, it's that you're basically giving the animal water. That won't cause the animal to break out in hives, and at least it keeps them hydrated.

 

[John Bentley]

Or in the veterinary world, an injection of vitamin B<SUB>12</SUB> for the dog does make the client feel they've got more than words for their consultation fee....

Rolfe.

I don't want to come off sanctimonious, but I still consider that a rather dubious practice unless you aren't charging for it. Charging for something you know to be worthless is just not ethical.

Edited to include:

I re-read my own post and just had to include this. I really don't think it's ethical to give the shot at all if it's not indicated medically, regardless of whether you charge for it or not. I know lots of vets who do this, and I have always thought it was very deceptive.

 

[Rolfe]

I really don't think it's ethical to give the shot at all if it's not indicated medically, regardless of whether you charge for it or not. I know lots of vets who do this, and I have always thought it was very deceptive.

I agree with you, I agree with you, I agree with you..... But we all know people who do it, and when I were a raw young graduate, who knows what I did....?

Rolfe.

 

[Rolfe]

Don't worry about that. If homeopathy has anything going for it, it's that you're basically giving the animal water. That won't cause the animal to break out in hives, and at least it keeps them hydrated.

I don't think they give them enough to make any difference to the fluid balance, and half the time they give them dehydrated magic sugar pills anyway.

Just not enough to make any difference to any coincidental hypoglycaemia....

Rolfe.

 

[John Bentley]

I agree with you, I agree with you, I agree with you..... But we all know people who do it, and when I were a raw young graduate, who knows what I did....?

Rolfe.

Yes, the people who do it are generally easy to spot. They drive big cars, send their sons and daughters to the best of schools, have houses on the waterfront, etc. It is very discouraging and I see the allure. After all, it really doesn't hurt the animal. The dark side is truly powerfully seductive and rewards its adherents well.

One of the largest vet clinics in my area gives vaccines for diseases that even the vaccine manufacturer admits are not known to cause clinical disease, or can cause deadly side effects, or are for diseases that have never been shown to be prevalent in our area of the country. They have been known to promote homeopathic products as well. I repeat -- they are one of the largest clinics in my area. Very discouraging.

 

[jj]

Simply put, a placebo creates a thought in the mind of the person getting it. If this reduces tension (for instance) this has, because of the physical thought (I'm a materialist, remember?) causing the lowering of stress (a physical effect brought about by a physical effect), this may indeed help the person.

Placebos do work, due to the person causing something good to happen to themselves.

Things like the placebo effect (but not directly a placebo) are commonly demonstrated in various kinds of psychometric testing like audio tests, video tests, etc.

 

[Soapy Sam]

It may be easier for some to imagine the opposite of the placebo effect.

Every time I get on an aircraft (which is much too often) I am seriously stressed. Partly this is fear of falling. (Not flying, falling. Trust me), partly it is fear of fear: I know I will be scared and that stresses me before I even get on the thing. Positive feedback. Cortisol levels in the stratosphere.

Now suppose I could just remove the fear, by clutching Dumbo's magic feather? How much happier would I be? How much healthier would I be?

That is a placebo effect.

By the way, does anyone know why coffee on aircraft causes turbulence?

 

[John Bentley]

By the way, does anyone know why coffee on aircraft causes turbulence?

You did not propitiate my God -- Murphy.