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What can the placebo effect do?

In trials, critically ill patients are not used. They tend to look for the standard that can be easily measured, such as raised BP. People with cancer would rarely be entered into something like this.
 
Mojo said:
The point is that, certainly as far as the patient's perceptions are concerned, a placebo intervention does do something. This is why it is necessary to give the control group in a trial of a therapy a convincing placebo, rather than simply not treating them.
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Remember that it is also so that the observing doctors don't know who gets the drug and who does not, so that they can not unintentionaly bais the results either. There is a reason it is called double blind.
 
asthmatic camel said:
I've wondered for some time about the ethics of using placebos in tests, particularly when the patient is seriously, perhaps fatally, ill. Here's a case I chose at random.

I find it most worrying that doctors are willing to prescribe placebos in these circumstances; are there any known cases where a placebo has cured cancer? (No woo sites, please.)
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The reason it that you need to know what the drug does and you need to make it so that the administering doctor also can not introduce a bias.

You need something to measure the effect against and that is what placebos do.
 
Deetee said:
A lot of alternative therapies employ what I term the "Ineffective Comparator" principle to tout how wonderful they are:e.g:

"Crystal therapy! As good as Dycomycin chemotherapy for leukaemia!"
[Well of course it is as good, since dycomycin trials show it is useless, but the general public go away thinking - "Wow! as good as chemotherapy, huh? Must be great!"]
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Sounds a lot like a poster they had in the window of our local "health" shop, made up to look like newspaper headline, and which said something like "arnica gel is as effective as ibuprofen gel, say scientists". Needless to say, I couldn't find anything published, or anything about the tests other than the scientists in question were Swiss and employed by a manufacturer of arnica gel. No mention of to the purpose for which the arnica gel was as effective as ibuprofen gel: for all I know thay could have been using it for wallpaper paste.
 
Here is an interesting historical intro to the subject from the National Library of Medicine exhibition, including a bit about doctors prescribing "cebocap" and "Obecalp".
 
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From the National Library of Medicine article:

A long-standing tradition of mental self-help, not directed by physicians and concentrating on overt and positive rather than covert and negative feelings, began in the late nineteenth century and was still strong in the 1950s and 1960s. This tradition had consistently focused attention on proactive ways people could become more positive and optimistic about life, master their moods, and fix their physical ills without taking medications
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I'd argue that the movement started well before the late 19th century. In the 1830s, non-doctor Sylvester Graham was recommending preserving health based on diet and cheerfulness, and the Grahamites morphed into the hygienic movement in the mid-19th century.

Dr. Isaac Jennings was famous for his placebo use, which he began in 1822, only revealing the secret twenty years late. An 1862 speech advocating the hygienic system and describing Jennings' influence, is online here http://www.soilandhealth.org/02/0201hyglibcat/020120trall.html There's the section about Jennings (emphasis added)

Who has not heard of Dr. Jennings, now of Oberlin, Ohio? Some years ago he practiced medicine in Derby, Conn. Being a close observer and a very conscientious man, and, withal, something of a philanthropist, he became a "reformer," and what all true reformers must be in the world's estimation, a "radical," an "ultraist," a "one-idealist," a "fanatic," etc. He became fully convinced that the system of drug medication was all wrong; that drugs, instead of curing persons, or aiding Nature to cure them, really hindered the cure, or changed the primary malady to a drug disease as bad or worse; and to put the matter to the proof, he practiced for several years without giving a particle of medicine of any kind. But his patients did not know it. The people did not mistrust that they were humbugged out of their diseases; cheated into health; deceived into saving the greater part of their doctor's bills, all of their apothecary's bills, and the better part of their constitutions. Under Dr. Jennings' administration, diseases seemed to have lost all of their malignancy and danger, and to have assumed a singularly mild and manageable form, type, and diathesis. He gave harmless placebos--colored water, sugar pellets, and starch powders, to keep up confidence and furnish the mind with some charm of mysteriousness to rest its faith upon and then he directed such attention to Hygienic conditions as would enable Nature to work the cure in the best possible manner and in the shortest possible time.

His success was remarkable. His fame extended far and wide. The praises of his wonderful skill were heard in all the region roundabout. In a few years, having conclusively demonstrated the principle involved, he disclosed to his medical brethren the secret of his extraordinary success. And do you not think that they were all swift to adopt the no-medicine plan of Dr. Jennings? Not quite--no, not one of them
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I guess it is possible to attribute many things to the placebo effect. However, as Blutoski rightly says:

I qualify this by saying that my definition of 'placebo effect' is the difference in outcome between the placebo group and the non-treatment group.
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Thus how do we define the same effect in the real world. We all know that homeopathy is just placebo effect but can we really call it placebo when there is no control group present.

I recently encountered a chap who sold some magnetic bull crap that you put on the fuel pipe of your car. This is supposed to make your car run more efficently. I suggested this was placebo effect because I proved that people observe the same effect when the device is on the car as when it is not. However, it is not correct to use the term placebo as there was no placebo used.

I believe the correct term in that instance is 'power of suggestion'
 
Pup said:
Dr. Isaac Jennings was famous for his placebo use, which he began in 1822, only revealing the secret twenty years late. An 1862 speech advocating the hygienic system and describing Jennings' influence, is online here http://www.soilandhealth.org/02/0201hyglibcat/020120trall.html There's the section about Jennings (emphasis added)
Who has not heard of Dr. Jennings, now of Oberlin, Ohio? Some years ago he practiced medicine in Derby, Conn. Being a close observer and a very conscientious man, and, withal, something of a philanthropist, he became a "reformer," and what all true reformers must be in the world's estimation, a "radical," an "ultraist," a "one-idealist," a "fanatic," etc. He became fully convinced that the system of drug medication was all wrong; that drugs, instead of curing persons, or aiding Nature to cure them, really hindered the cure, or changed the primary malady to a drug disease as bad or worse; and to put the matter to the proof, he practiced for several years without giving a particle of medicine of any kind. But his patients did not know it. The people did not mistrust that they were humbugged out of their diseases; cheated into health; deceived into saving the greater part of their doctor's bills, all of their apothecary's bills, and the better part of their constitutions. Under Dr. Jennings' administration, diseases seemed to have lost all of their malignancy and danger, and to have assumed a singularly mild and manageable form, type, and diathesis. He gave harmless placebos--colored water, sugar pellets, and starch powders, to keep up confidence and furnish the mind with some charm of mysteriousness to rest its faith upon and then he directed such attention to Hygienic conditions as would enable Nature to work the cure in the best possible manner and in the shortest possible time.

His success was remarkable. His fame extended far and wide. The praises of his wonderful skill were heard in all the region roundabout. In a few years, having conclusively demonstrated the principle involved, he disclosed to his medical brethren the secret of his extraordinary success. And do you not think that they were all swift to adopt the no-medicine plan of Dr. Jennings? Not quite--no, not one of them
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All sounds a bit like homoeopathy, apart from the fact that homoeopaths have yet to admit that they are only offering placebos.

The reason for his apparent success is probably, like that of Hahnemann, that the "orthodox" medicine of the time was pretty awful. At least he wasn't actually harming his patients.
 
To go back to the OP. I remember reading something a while back on the New Scientist website regarding the placebo effect, so I did a quick google and found the article again. Unfortunately I can't post links yet, so you'll have to cut and paste.. (add www to the front!)..

13 things that don't make sense (#1 being the placebo effect):
newscientistspace.com/article.ns?id=mg18524911.600

Also look here (placebo triggers an opioid hit in the brain):
newscientist.com/article.ns?id=dn7892

So it seems the placebo effect does indeed cause an objectively measurable effect to a persons biochemistry, and is not purely "psychological" (but then again, if a psychological effect doesn't involve a change in neurochemistry, then what do we mean by "psychological"!!)
 
There's also another type of effect that has been observed particularly in relaxation techniques. For example, trying to lower your blood pressure or heart rate by using biofeedback or to control your own pain by shifting your focus or creating mental images. Not strictly placebo, but nobody can dismiss the possibility that some placebo recipients are more "active" than others in their belief that the drug will work.
 
asthmatic camel said:
I've wondered for some time about the ethics of using placebos in tests, particularly when the patient is seriously, perhaps fatally, ill. Here's a case I chose at random.

I find it most worrying that doctors are willing to prescribe placebos in these circumstances; are there any known cases where a placebo has cured cancer? (No woo sites, please.)
Click to expand...

Generally, if someone has a fatal disease that has a known treatment (even if it is not very good) then a placebo will not be given. Giving a drug with a 5% success rate is better than giving nothing at all. Trials that cannot be carried out on less severe cases are usually compared only with existing treatment and not with a placebo.
 
dogbite666 said:
I guess it is possible to attribute many things to the placebo effect. However, as Blutoski rightly says:



Thus how do we define the same effect in the real world. We all know that homeopathy is just placebo effect but can we really call it placebo when there is no control group present.

I recently encountered a chap who sold some magnetic bull crap that you put on the fuel pipe of your car. This is supposed to make your car run more efficently. I suggested this was placebo effect because I proved that people observe the same effect when the device is on the car as when it is not. However, it is not correct to use the term placebo as there was no placebo used.

I believe the correct term in that instance is 'power of suggestion'
Click to expand...

The Hawthorne Effect is relevant here. You pay more attention to your fuel-mileage and so may well driving differently, and, bingo, fuel economy improves.

http://www.nwlink.com/~donclark/hrd/history/hawthorne.html
 
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