11 ms·

A new hypothesis in medicine: give patients drugs they know don’t work

62 points by pella 9y ago

deleted 9y ago
[deleted]
anotheryou 9y ago
I wonder how far you can go with this. I mean, there is a huge scale from homeopathy ("I know this does not work, but some believe in it"), things labeled placebo and administered by a doctor, smarties in a pill bottle and buying someone a candy bar and saying "here, that will make you feel better". I'm pretty sure I know a few cases of self-administered placebos. When you are sick everyone has the wondercure, be it healthy food, some natural bee-wax-antibiotic, homepathy, "it's all just psychosomatic"/"there is allways a deeper reason for a sickness" or what not. They probably all just need someone to bring camilla tea and a wet cloth for on the forehead :)
- jbmorgado 9y ago
  The thing is, homeopathy claims to heal all kinds of illness (cancer for instance), while the author of this study leaves it very, very clearly that it only works on the perception of illness by the mind. He clearly states that the placebo won't work in quantifiable illnesses because those quantifiable effects don't depend on the perception from your brain.
nraynaud 9y ago
Maybe that's what I need, I have residual headaches after a stroke (CVT). It seems to be a common issue and it doesn't come from the head pressure.
- maxerickson 9y ago
  What sorts of treatment do doctors suggest for that?
  - nraynaud 9y ago
    Just pain-killer or nothing if the pain is low enough. It looks like it is a source of pain-killer overuse, and psychiatric issues. In my case the pain responds very well, so I just treat it with paracetamol, but I have used just 8 doses in 3 weeks. To put it in context, tho, it is an extremely rare kind of stroke (5/1,000,000 per year), so the select people having had this stroke might have pain medicine issues, but it is not a contributor of anything in the grand scheme of things.
amelius 9y ago
> People on no treatment got about 30 percent better. And people who were given an open-label placebo got 60 percent improvement in the adequate relief of their irritable bowel syndrome. There's a few differences between these groups: - People on the placebo pill were reminded about their illness at least once a day (when they took the pill), and can be expected to have special attention for their illness. - People on the placebo pill were seeing a doctor, and had the prospect of going back to the doctor to evaluate their progress. - For people NOT on the placebo pill, all hope was basically lost. So perhaps "hope" (however small) is the underlying psychological effect causing this, or perhaps it's the attention from self.
- Jill_the_Pill 9y ago
  This echoes the negative effect of praying for the sick. Those who were prayed for feared their conditions were serious enough to warrant prayer and lost some hope. Perhaps if you are given a sugar pill, and are told it's only a sugar pill, you also relax about the threat of your condition -- well, it can't be that bad!
  - _Microft 9y ago
    I can't find a reference for the following at the moment but there was something about the perceived health being a far better indicator for life expectancy/longevity than the actual health. The mindset of the patient seems to matter a lot!
golergka 9y ago
That's exactly why I take homeopathy medicine. I know that the science behind it is pseudo; but I also know that placebo effect works regardless. At least, on my particular sample size of one it definitely does.
- michaelmrose 9y ago
  This is truly terrible advice and you ought to feel bad for promoting it here. http://whatstheharm.net/homeopathy.html http://whatstheharm.net/homeopathy.html
  - vhhhggv 9y ago
    > you ought to feel bad for promoting it here. But see, he doesn't, he's taking homeopathic medicines for that.
  - lisper 9y ago
    But he's not offering advice. He's offering a data point. There's nothing wrong with that.
    - michaelmrose 9y ago
      http://whatstheharm.net/homeopathy.html http://whatstheharm.net/homeopathy.html
      - deleted 9y ago
        [deleted]
      - qb45 9y ago
        I could swear I have already seen this link somewhere /s Plus this article is a fraud. The people it lists were killed by ignorance, neglect or their own informed choice, not by homeopathy. I don't think anybody has yet died of drinking a small amount of water and the guy you are harassing said nothing about giving up other treatments, just using homeopathy as placebo.
HillaryBriss 9y ago
> Thinking you’re going to get better is not what makes you better. That’s the mind-cure idea: It doesn’t happen. It’s not the way it is ... I’m a little bit of a standard deviation or two out from consensus. This surprised me. I've been under the impression that the body's immune system could be modulated by the brain. The science has changed underneath my feet, I guess.
HillaryBriss 9y ago
>We have great drugs, but they don’t often treat symptoms that well. What really bothers people are the symptoms. The symptoms are things they can perceive that are modulated by the brain. so, Kaptchuk's open-label placebo therapy appears to be centered on and limited to a person's subjective experience of their illness. that's all this is?
- DanBC 9y ago
  > that's all this is? But those things can be debilitating, so anything that helps without causing harm is pretty important.
hannob 9y ago
This isn't so new, a major study lots of this is based on was published in 2010. Here's a skeptical look at that study: https://sciencebasedmedicine.org/placebo-effects-without-deception-well-not-exactly/ https://sciencebasedmedicine.org/placebo-effects-without-dec...
- HillaryBriss 9y ago
  Yeah, I think maybe Vox is sensationalizing a bit with that article title. Back in 1995, Dr. Andrew Weil wrote: It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. [Spontaneous Healing] I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before? It seems to me Kaptchuk has varied one aspect of the experiment (eliminate double blindness, and even single blindness). Does that make it a radically new hypothesis?
  - hannob 9y ago
    > I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before? Well, Kaptchuk at least tries to do science. Andrew Weil is a full-blown crank.
    - HillaryBriss 9y ago
      Ah. Ok. Got it. Maybe if I rephrase it slightly it will be more useful: Back in 1995, a full-blown crank wrote: It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. I'm not saying that this full-blown crank describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?
msandford 9y ago
I know a lady who was managing a convenience store / pharmacy who eventually quit and became a reiki healer. Prior to this kind of study any real scientist would know it's total garbage. But somehow she makes a living doing it. Is it all duping? I suspected not. In my mind what people who paid her were getting was something that they almost universally can't get inside the traditional medicine system here in the US at least, someone who cares. Most encounters with doctors here in the US are 10 minutes or less at least for an office visit. If you have a lot of symptoms or back-story or whatever the doc might cut you off and ask questions and keep directing the conversation rather than hear you out. That might be an efficient use of their time, but it's not good for the placebo effect to work because part of that seems to be caring, wanting the patient to get better, doing things (even things we know won't work) to help. This lady has I think only hour long appointments which are totally unheard of in the traditional system. It's not surprising that if the placebo effect is real that seeing someone who can really only care (or at least pretend to) could be effective.
- tathougies 9y ago
  Auto immune diseases are all untreatable and severely reduce quality of life in some cases. One thing proven to slow their progress is stress reduction. As you can imagine, being less stressed is really hard when you have a chronic illness. This is exacerbated by doctors ignoring you. Having anyone spend an hour to help you in any way is such a relief. I wouldn't be surprised if this played a large role. As another example, my wife and I have had six miscarriages. We're 25 and both healthy and the many doctors we've seen agree. Well if the doctors don't have a diagnosis, they don't wanna see you. When it comes to recurrent miscarriage, there is no treatment. They suspect there are likely auto immune diseases we don't know about. Indeed, this seems likely. Most studies on potential treatments cannot be reliably replicated. The only thing that has been shown to reduce miscarriage risk in future pregnancies is tender loving care-- having a doctor who will talk with you for hours whenever you want, and being taken care of. So now we see a new matronly obstetrician. She's a bit quirky but we feel like she won't abandon us like the other doctors did. Her appointments are multiple hours long, and she's happy being paged in the middle of the night when we've found out we're pregnant again. At 5 am when you find out you're pregnant after five miscarriages, nothing is more calming than a soothing voice on the telephone This doctor has also encouraged us to seek out alternate practitioners, like acupuncturists and massage. She doesn't believe in their treatments working per se (she's an md and is happy providing real treatments), but I think she understands they these practitioners will at least make you feel calm and taken care of. Whereas I used to laugh at people who would see them before, I get it now. When you have a medical condition that is chronic and there's no end in sight and no cure available, you need a friend more than a doctor, and unfortunately, there's not much overlap between the two
pella 9y ago
other interesting articles: Changing Mindsets to Enhance Treatment Effectiveness JAMA. 2017 May 23;317(20):2063-2064. doi: 10.1001/jama.2017.4545. https://mbl.stanford.edu/sites/default/files/crum_zuckerman_jama_2017.pdf https://mbl.stanford.edu/sites/default/files/crum_zuckerman_... == You can train your body into thinking it’s had medicine ( 09 February 2016 ) Jo Marchant asks if we can harness the mind to reduce side-effects and slash drug costs. https://mosaicscience.com/story/medicine-without-the-medicine-how-to-train-your-immune-system-placebo https://mosaicscience.com/story/medicine-without-the-medicin... == The Vodka-Red-Bull Placebo Effect People take more risks when downing caffeine-and-alcohol cocktails—but only if they know what they’re drinking. https://www.theatlantic.com/science/archive/2017/06/caffeine-and-alcohol-placebo/529641/?single_page=true https://www.theatlantic.com/science/archive/2017/06/caffeine... == Howe, L. Goyer, P., & Crum, A. (2017). Harnessing the Placebo Effect: Exploring the Influence of Physician Characteristics on Placebo Response. Health Psychology. https://mbl.stanford.edu/sites/default/files/howegoyercrum_harnessingtheplaceboeffect.pdf https://mbl.stanford.edu/sites/default/files/howegoyercrum_h... == Crum, A., Phillips, D., Higgins, T. (2016). Transforming Water: Social Influence Moderates Psychological, Physiological, and Functional Response to a Placebo Product. PLOS One, 11(11). https://mbl.stanford.edu/sites/default/files/crumetal_transformingwater.pdf https://mbl.stanford.edu/sites/default/files/crumetal_transf... == Crum, A. & Phillips, D. (2015). Self-Fulfilling Prophesies, Placebo Effects, and the Social-Psychological Creation of Reality. In R. Scott and S. Kosslyn (Eds.), Emerging Trends in the Social and Behavioral Sciences. Hoboken, NJ: John Wiley and Sons. https://mbl.stanford.edu/sites/default/files/crumphillips_emergingtrends2015.pdf https://mbl.stanford.edu/sites/default/files/crumphillips_em...
- msnower 9y ago
  Those seem to back up this quote by the doctor from the article: "What’s going on in the patient’s [mind] is that the rituals of medicine... activates specific quantifiable and relevant brain regions that release these neurotransmitters. And they modulate symptoms." For minor ailments for which there are no real cure (and are probably entirely psychological) building a new habit covers up the old one and subsequently cures the patient's pain.
anonymous2017 9y ago
A data point from my personal experience: 15 years ago I started developing acute dysphagia (difficulty swallowing) which eventually got so severe I went to see a doctor about it. It was diagnosed as acid reflux, and I was prescribed proton pump inhibitors. That seemed to help for a long time, but a few years ago the symptoms started to return. They got so bad that I went back to the doctor, and this time was diagnosed with a newly discovered malady called eosinophilic esophagitis (EOE -- http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis http://www.aaaai.org/conditions-and-treatments/related-condi...). EOE is an allergic reaction in the esophagus, which made sense because the initial symptoms appeared shortly after we got pets -- a dog and a cat -- for the first time, and I'm allergic to both. Case closed, or so I thought. A few months ago, despite the fact that both or dog and cat had long since died, my symptoms started to come back worse than ever. Things got so bad that at one point I was actually heading to the emergency room (I never made it because before we got there I threw up, which fixed the immediate problem). But that episode scared me enough that I made another doctors appointment. There followed a truly bizarre confluence of circumstances: first, my wife fell down and broke her arm. Then my doctors office called to confirm my appointment, but my wife picked up the phone and thought it was her doctors office calling about her arm. She thought the appointment was for her, but she hadn't made an appointment, so she told them the appointment was a mistake an they should cancel it, which they did. I called to reschedule, and that delayed it for another few weeks. The day of my new appointment, my doctors office called and said they were running hours behind because of computer problems and needed to reschedule again. Bottom line: it has been several months now and I still haven't been able to see a doctor. But here's the punch line: in the intervening time, my symptoms have completely disappeared. If I had been able to see a doctor, I would almost certainly have ascribed this positive outcome to any intervention she would have done. And yet there has been no intervention, but only because of these weird twists of fate that kept me from seeing my doctor. Moreover, I know there has been no intervention. And yet I suddenly feel better than I have in 15 years. It's really weird.
- xherberta 9y ago
  "The great secret, known to internists and learned early in marriage by internists wives, but still hidden from the general public, is that most things get better by themselves. Most things, in fact, are better by morning." - Lewis Thomas, The Lives of a Cell (Among other achievements, he was dean of Yale Medical School and president of Sloan-Kettering. This collection of essays was published in 1974 and is absolutely prescient and fascinating - he offers profound thoughts on the nature of science, computing, and medicine that have stood the test of time astonishingly well.)
bfirsh 9y ago
Also, more expensive sugar pills work better than cheaper sugar pills. (And bigger ones, colourful ones, etc). Presumably this means something like homeopathy could work better than sugar pills. It's easy to ridicule homeopathy, and it certainly shouldn't be used for illnesses that are easy to treat. But, perhaps it could be a valid treatment for chronic, hard to treat conditions. It's certainly very elaborate and expensive.
- _Microft 9y ago
  The bad thing with homeopathy is not that they're fooling people to take substances that have no effect on their own and only work via the placebo-effect. It's the "making a lot of money from sick people by selling expensive placebos"-part that's despicable.
carapace 9y ago
In the late 70's there were a couple of guys who tried to bring placebo pills to market. They had a bottle of sugar pills and a little booklet that listed all the various things placebos had worked for along with the percentage effectiveness. If you had something that the placebos weren't that effective for, well, you just took more... The FDA wouldn't go for it.
gehwartzen 9y ago
From the actual trial: "Patients were randomized to either open-label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes” or no-treatment controls with the same quality of interaction with providers." Sounds like they didn't give them pills that the patients "know don't work" as the Vox title states, but instead told the patients that trials showed that these pills did work just not through a chemically induced action.
- comex 9y ago
  But that's the truth, isn't it? From a scientific perspective, it might be interesting to see how well the placebo effect holds up if patients literally think it won't work, e.g. by selecting participants who haven't heard of the placebo effect, and not informing them. But from the perspective of helping people, if the placebo effect is to some extent caused by knowledge of the placebo effect, so much the better; there's no deception in that.
fragsworth 9y ago
If a licensed professional gives you a placebo for your illness, they're also effectively saying it's not that important to worry about, which changes the psychology of the patient.
- kem 9y ago
  ... this is like walking through a minefield, but here it goes. A lot of the illnesses they're talking about in the article, like IBS, lower back pain, and CFS have a strong psychosomatic component to it for a lot of people. They essentially say this in the article--something like "this won't work for malaria, but it will work for pain." This can be a really controversial position, and it gets really twisted by a lot of people. No I'm not advocating mind-body dualism. What I'm saying is that there's top-down influences on physical symptom perception and that probably influences bottom-up processes, leading to some sort of vicious circle. I think a lot of these psychosomatic conditions are really explained by the same processes involved in the nocebo effect. There have been studies to support this, showing that psychosomatic patients report more nocebo effects in control conditions than other patients and controls. The idea you're discussing--reassurance effects--is interesting and actually really understudied I think. However, I think there's an equally plausible hypothesis, that you're kind of fighting negative psychosomatic effects with positive psychosomatic effects in certain situations. I don't think that's all of the placebo effect, but I do think there's some broader causal system involved that encompasses placebo effects, nocebo effects, and psychosomatic illnesses and effects, including more psychosomatic psychiatric conditions (e.g., conversion disorder, psychogenic seizures, etc.), as well as psychological effects on disease process (e.g., stress effects on inflammation). I kind of wish this area of research didn't get so bogged down with political infighting, which invariably happens. Patients start insisting that we're being dismissive by discussing psychosomatic processes, some researchers will spuriously start criticizing other researchers for advocating Cartesian dualism, as political smear tactic, when the real issues pertain to emergent processes and top-down mutual influences. It's a very interesting area of research with lots of potential, but tends to get oversimplified really quickly to score political points.
ajanuary 9y ago
I don't have the resources right now to condense the arguments or cite the evidence, but the Skeptics with a K podcast [1] has recently done a whole series on why the article and pretty much every other study mentioned in the comments so far is not any evidence of "the mysterious power of the placebo" but actually misuse of analysis on experimental biases. Well worth a listen. [1] http://www.merseysideskeptics.org.uk/category/podcast/skeptics-with-a-k/ http://www.merseysideskeptics.org.uk/category/podcast/skepti...

62 points by pella 9y ago

deleted 9y ago

[deleted]

I wonder how far you can go with this. I mean, there is a huge scale from homeopathy ("I know this does not work, but some believe in it"), things labeled placebo and administered by a doctor, smarties in a pill bottle and buying someone a candy bar and saying "here, that will make you feel better". I'm pretty sure I know a few cases of self-administered placebos. When you are sick everyone has the wondercure, be it healthy food, some natural bee-wax-antibiotic, homepathy, "it's all just psychosomatic"/"there is allways a deeper reason for a sickness" or what not. They probably all just need someone to bring camilla tea and a wet cloth for on the forehead :)

jbmorgado 9y ago
The thing is, homeopathy claims to heal all kinds of illness (cancer for instance), while the author of this study leaves it very, very clearly that it only works on the perception of illness by the mind. He clearly states that the placebo won't work in quantifiable illnesses because those quantifiable effects don't depend on the perception from your brain.

nraynaud 9y ago

Maybe that's what I need, I have residual headaches after a stroke (CVT). It seems to be a common issue and it doesn't come from the head pressure.

maxerickson 9y ago
What sorts of treatment do doctors suggest for that?
- nraynaud 9y ago
  Just pain-killer or nothing if the pain is low enough. It looks like it is a source of pain-killer overuse, and psychiatric issues. In my case the pain responds very well, so I just treat it with paracetamol, but I have used just 8 doses in 3 weeks. To put it in context, tho, it is an extremely rare kind of stroke (5/1,000,000 per year), so the select people having had this stroke might have pain medicine issues, but it is not a contributor of anything in the grand scheme of things.

amelius 9y ago

> People on no treatment got about 30 percent better. And people who were given an open-label placebo got 60 percent improvement in the adequate relief of their irritable bowel syndrome. There's a few differences between these groups: - People on the placebo pill were reminded about their illness at least once a day (when they took the pill), and can be expected to have special attention for their illness. - People on the placebo pill were seeing a doctor, and had the prospect of going back to the doctor to evaluate their progress. - For people NOT on the placebo pill, all hope was basically lost. So perhaps "hope" (however small) is the underlying psychological effect causing this, or perhaps it's the attention from self.

Jill_the_Pill 9y ago
This echoes the negative effect of praying for the sick. Those who were prayed for feared their conditions were serious enough to warrant prayer and lost some hope. Perhaps if you are given a sugar pill, and are told it's only a sugar pill, you also relax about the threat of your condition -- well, it can't be that bad!
- _Microft 9y ago
  I can't find a reference for the following at the moment but there was something about the perceived health being a far better indicator for life expectancy/longevity than the actual health. The mindset of the patient seems to matter a lot!

golergka 9y ago

That's exactly why I take homeopathy medicine. I know that the science behind it is pseudo; but I also know that placebo effect works regardless. At least, on my particular sample size of one it definitely does.

michaelmrose 9y ago
This is truly terrible advice and you ought to feel bad for promoting it here. http://whatstheharm.net/homeopathy.html http://whatstheharm.net/homeopathy.html
- vhhhggv 9y ago
  > you ought to feel bad for promoting it here. But see, he doesn't, he's taking homeopathic medicines for that.
- lisper 9y ago
  But he's not offering advice. He's offering a data point. There's nothing wrong with that.
  - michaelmrose 9y ago
    http://whatstheharm.net/homeopathy.html http://whatstheharm.net/homeopathy.html
    - deleted 9y ago
      [deleted]
    - qb45 9y ago
      I could swear I have already seen this link somewhere /s Plus this article is a fraud. The people it lists were killed by ignorance, neglect or their own informed choice, not by homeopathy. I don't think anybody has yet died of drinking a small amount of water and the guy you are harassing said nothing about giving up other treatments, just using homeopathy as placebo.

HillaryBriss 9y ago

> Thinking you’re going to get better is not what makes you better. That’s the mind-cure idea: It doesn’t happen. It’s not the way it is ... I’m a little bit of a standard deviation or two out from consensus. This surprised me. I've been under the impression that the body's immune system could be modulated by the brain. The science has changed underneath my feet, I guess.

HillaryBriss 9y ago

>We have great drugs, but they don’t often treat symptoms that well. What really bothers people are the symptoms. The symptoms are things they can perceive that are modulated by the brain. so, Kaptchuk's open-label placebo therapy appears to be centered on and limited to a person's subjective experience of their illness. that's all this is?

DanBC 9y ago
> that's all this is? But those things can be debilitating, so anything that helps without causing harm is pretty important.

hannob 9y ago

This isn't so new, a major study lots of this is based on was published in 2010. Here's a skeptical look at that study: https://sciencebasedmedicine.org/placebo-effects-without-deception-well-not-exactly/ https://sciencebasedmedicine.org/placebo-effects-without-dec...

HillaryBriss 9y ago
Yeah, I think maybe Vox is sensationalizing a bit with that article title. Back in 1995, Dr. Andrew Weil wrote: It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. [Spontaneous Healing] I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before? It seems to me Kaptchuk has varied one aspect of the experiment (eliminate double blindness, and even single blindness). Does that make it a radically new hypothesis?
- hannob 9y ago
  > I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before? Well, Kaptchuk at least tries to do science. Andrew Weil is a full-blown crank.
  - HillaryBriss 9y ago
    Ah. Ok. Got it. Maybe if I rephrase it slightly it will be more useful: Back in 1995, a full-blown crank wrote: It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. I'm not saying that this full-blown crank describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?

msandford 9y ago

I know a lady who was managing a convenience store / pharmacy who eventually quit and became a reiki healer. Prior to this kind of study any real scientist would know it's total garbage. But somehow she makes a living doing it. Is it all duping? I suspected not. In my mind what people who paid her were getting was something that they almost universally can't get inside the traditional medicine system here in the US at least, someone who cares. Most encounters with doctors here in the US are 10 minutes or less at least for an office visit. If you have a lot of symptoms or back-story or whatever the doc might cut you off and ask questions and keep directing the conversation rather than hear you out. That might be an efficient use of their time, but it's not good for the placebo effect to work because part of that seems to be caring, wanting the patient to get better, doing things (even things we know won't work) to help. This lady has I think only hour long appointments which are totally unheard of in the traditional system. It's not surprising that if the placebo effect is real that seeing someone who can really only care (or at least pretend to) could be effective.

tathougies 9y ago
Auto immune diseases are all untreatable and severely reduce quality of life in some cases. One thing proven to slow their progress is stress reduction. As you can imagine, being less stressed is really hard when you have a chronic illness. This is exacerbated by doctors ignoring you. Having anyone spend an hour to help you in any way is such a relief. I wouldn't be surprised if this played a large role. As another example, my wife and I have had six miscarriages. We're 25 and both healthy and the many doctors we've seen agree. Well if the doctors don't have a diagnosis, they don't wanna see you. When it comes to recurrent miscarriage, there is no treatment. They suspect there are likely auto immune diseases we don't know about. Indeed, this seems likely. Most studies on potential treatments cannot be reliably replicated. The only thing that has been shown to reduce miscarriage risk in future pregnancies is tender loving care-- having a doctor who will talk with you for hours whenever you want, and being taken care of. So now we see a new matronly obstetrician. She's a bit quirky but we feel like she won't abandon us like the other doctors did. Her appointments are multiple hours long, and she's happy being paged in the middle of the night when we've found out we're pregnant again. At 5 am when you find out you're pregnant after five miscarriages, nothing is more calming than a soothing voice on the telephone This doctor has also encouraged us to seek out alternate practitioners, like acupuncturists and massage. She doesn't believe in their treatments working per se (she's an md and is happy providing real treatments), but I think she understands they these practitioners will at least make you feel calm and taken care of. Whereas I used to laugh at people who would see them before, I get it now. When you have a medical condition that is chronic and there's no end in sight and no cure available, you need a friend more than a doctor, and unfortunately, there's not much overlap between the two

pella 9y ago

other interesting articles: Changing Mindsets to Enhance Treatment Effectiveness JAMA. 2017 May 23;317(20):2063-2064. doi: 10.1001/jama.2017.4545. https://mbl.stanford.edu/sites/default/files/crum_zuckerman_jama_2017.pdf https://mbl.stanford.edu/sites/default/files/crum_zuckerman_... == You can train your body into thinking it’s had medicine ( 09 February 2016 ) Jo Marchant asks if we can harness the mind to reduce side-effects and slash drug costs. https://mosaicscience.com/story/medicine-without-the-medicine-how-to-train-your-immune-system-placebo https://mosaicscience.com/story/medicine-without-the-medicin... == The Vodka-Red-Bull Placebo Effect People take more risks when downing caffeine-and-alcohol cocktails—but only if they know what they’re drinking. https://www.theatlantic.com/science/archive/2017/06/caffeine-and-alcohol-placebo/529641/?single_page=true https://www.theatlantic.com/science/archive/2017/06/caffeine... == Howe, L. Goyer, P., & Crum, A. (2017). Harnessing the Placebo Effect: Exploring the Influence of Physician Characteristics on Placebo Response. Health Psychology. https://mbl.stanford.edu/sites/default/files/howegoyercrum_harnessingtheplaceboeffect.pdf https://mbl.stanford.edu/sites/default/files/howegoyercrum_h... == Crum, A., Phillips, D., Higgins, T. (2016). Transforming Water: Social Influence Moderates Psychological, Physiological, and Functional Response to a Placebo Product. PLOS One, 11(11). https://mbl.stanford.edu/sites/default/files/crumetal_transformingwater.pdf https://mbl.stanford.edu/sites/default/files/crumetal_transf... == Crum, A. & Phillips, D. (2015). Self-Fulfilling Prophesies, Placebo Effects, and the Social-Psychological Creation of Reality. In R. Scott and S. Kosslyn (Eds.), Emerging Trends in the Social and Behavioral Sciences. Hoboken, NJ: John Wiley and Sons. https://mbl.stanford.edu/sites/default/files/crumphillips_emergingtrends2015.pdf https://mbl.stanford.edu/sites/default/files/crumphillips_em...

msnower 9y ago
Those seem to back up this quote by the doctor from the article: "What’s going on in the patient’s [mind] is that the rituals of medicine... activates specific quantifiable and relevant brain regions that release these neurotransmitters. And they modulate symptoms." For minor ailments for which there are no real cure (and are probably entirely psychological) building a new habit covers up the old one and subsequently cures the patient's pain.

anonymous2017 9y ago

A data point from my personal experience: 15 years ago I started developing acute dysphagia (difficulty swallowing) which eventually got so severe I went to see a doctor about it. It was diagnosed as acid reflux, and I was prescribed proton pump inhibitors. That seemed to help for a long time, but a few years ago the symptoms started to return. They got so bad that I went back to the doctor, and this time was diagnosed with a newly discovered malady called eosinophilic esophagitis (EOE -- http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis http://www.aaaai.org/conditions-and-treatments/related-condi...). EOE is an allergic reaction in the esophagus, which made sense because the initial symptoms appeared shortly after we got pets -- a dog and a cat -- for the first time, and I'm allergic to both. Case closed, or so I thought. A few months ago, despite the fact that both or dog and cat had long since died, my symptoms started to come back worse than ever. Things got so bad that at one point I was actually heading to the emergency room (I never made it because before we got there I threw up, which fixed the immediate problem). But that episode scared me enough that I made another doctors appointment. There followed a truly bizarre confluence of circumstances: first, my wife fell down and broke her arm. Then my doctors office called to confirm my appointment, but my wife picked up the phone and thought it was her doctors office calling about her arm. She thought the appointment was for her, but she hadn't made an appointment, so she told them the appointment was a mistake an they should cancel it, which they did. I called to reschedule, and that delayed it for another few weeks. The day of my new appointment, my doctors office called and said they were running hours behind because of computer problems and needed to reschedule again. Bottom line: it has been several months now and I still haven't been able to see a doctor. But here's the punch line: in the intervening time, my symptoms have completely disappeared. If I had been able to see a doctor, I would almost certainly have ascribed this positive outcome to any intervention she would have done. And yet there has been no intervention, but only because of these weird twists of fate that kept me from seeing my doctor. Moreover, I know there has been no intervention. And yet I suddenly feel better than I have in 15 years. It's really weird.

xherberta 9y ago
"The great secret, known to internists and learned early in marriage by internists wives, but still hidden from the general public, is that most things get better by themselves. Most things, in fact, are better by morning." - Lewis Thomas, The Lives of a Cell (Among other achievements, he was dean of Yale Medical School and president of Sloan-Kettering. This collection of essays was published in 1974 and is absolutely prescient and fascinating - he offers profound thoughts on the nature of science, computing, and medicine that have stood the test of time astonishingly well.)

bfirsh 9y ago

Also, more expensive sugar pills work better than cheaper sugar pills. (And bigger ones, colourful ones, etc). Presumably this means something like homeopathy could work better than sugar pills. It's easy to ridicule homeopathy, and it certainly shouldn't be used for illnesses that are easy to treat. But, perhaps it could be a valid treatment for chronic, hard to treat conditions. It's certainly very elaborate and expensive.

_Microft 9y ago
The bad thing with homeopathy is not that they're fooling people to take substances that have no effect on their own and only work via the placebo-effect. It's the "making a lot of money from sick people by selling expensive placebos"-part that's despicable.

carapace 9y ago

In the late 70's there were a couple of guys who tried to bring placebo pills to market. They had a bottle of sugar pills and a little booklet that listed all the various things placebos had worked for along with the percentage effectiveness. If you had something that the placebos weren't that effective for, well, you just took more... The FDA wouldn't go for it.

gehwartzen 9y ago

From the actual trial: "Patients were randomized to either open-label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes” or no-treatment controls with the same quality of interaction with providers." Sounds like they didn't give them pills that the patients "know don't work" as the Vox title states, but instead told the patients that trials showed that these pills did work just not through a chemically induced action.

comex 9y ago
But that's the truth, isn't it? From a scientific perspective, it might be interesting to see how well the placebo effect holds up if patients literally think it won't work, e.g. by selecting participants who haven't heard of the placebo effect, and not informing them. But from the perspective of helping people, if the placebo effect is to some extent caused by knowledge of the placebo effect, so much the better; there's no deception in that.

fragsworth 9y ago

If a licensed professional gives you a placebo for your illness, they're also effectively saying it's not that important to worry about, which changes the psychology of the patient.

kem 9y ago
... this is like walking through a minefield, but here it goes. A lot of the illnesses they're talking about in the article, like IBS, lower back pain, and CFS have a strong psychosomatic component to it for a lot of people. They essentially say this in the article--something like "this won't work for malaria, but it will work for pain." This can be a really controversial position, and it gets really twisted by a lot of people. No I'm not advocating mind-body dualism. What I'm saying is that there's top-down influences on physical symptom perception and that probably influences bottom-up processes, leading to some sort of vicious circle. I think a lot of these psychosomatic conditions are really explained by the same processes involved in the nocebo effect. There have been studies to support this, showing that psychosomatic patients report more nocebo effects in control conditions than other patients and controls. The idea you're discussing--reassurance effects--is interesting and actually really understudied I think. However, I think there's an equally plausible hypothesis, that you're kind of fighting negative psychosomatic effects with positive psychosomatic effects in certain situations. I don't think that's all of the placebo effect, but I do think there's some broader causal system involved that encompasses placebo effects, nocebo effects, and psychosomatic illnesses and effects, including more psychosomatic psychiatric conditions (e.g., conversion disorder, psychogenic seizures, etc.), as well as psychological effects on disease process (e.g., stress effects on inflammation). I kind of wish this area of research didn't get so bogged down with political infighting, which invariably happens. Patients start insisting that we're being dismissive by discussing psychosomatic processes, some researchers will spuriously start criticizing other researchers for advocating Cartesian dualism, as political smear tactic, when the real issues pertain to emergent processes and top-down mutual influences. It's a very interesting area of research with lots of potential, but tends to get oversimplified really quickly to score political points.

ajanuary 9y ago

I don't have the resources right now to condense the arguments or cite the evidence, but the Skeptics with a K podcast [1] has recently done a whole series on why the article and pretty much every other study mentioned in the comments so far is not any evidence of "the mysterious power of the placebo" but actually misuse of analysis on experimental biases. Well worth a listen. [1] http://www.merseysideskeptics.org.uk/category/podcast/skeptics-with-a-k/ http://www.merseysideskeptics.org.uk/category/podcast/skepti...