17 ms·

What if the Placebo Effect Isn’t a Trick?

347 points by sajid 8y ago

joaomacp 8y ago
I am amazed by this. I've also read if a parent gives some home treatment (e.g. a warm cup of milk) to a kid and caringly says that it'll cure his cold, the immunity of the kid actually increases, effectively curing the cold with love.
mannykannot 8y ago
"What if the placebo effect isn't a trick?" - then it will surely be patented.
- yitchelle 8y ago
  Nice idea - Those who is paying a royalty for it is literally paying for nothing.
jonawesomegreen 8y ago
I listened to an episode about the placebo effect on the "Only Human" Podcast awhile back. Its truly fascinating, and has made me question the power of the mind in a way I hadn't before. It also has some really interesting ethical problems, is it okay for doctors to lie about placebo treatments if it actually helps? > Kallmes performs vertebroplasty, a surgery he has helped to develop and standardize, that involves injecting medical cement into the fractured bone to stabilize the fractured area and relieve pain. He says he gets great results from his patients, and teaches the method to other doctors at conferences. > But here’s the thing: he has no idea why vertebroplasty works. So a few years ago, he decided to test it against a placebo. Kallmes found that pretending to perform vertebroplasty – making it seem like he was injecting a needle into the spine but without the cement – had similar effects. About 40 percent of both groups experienced immediate relief from pain after the surgery. He published his results in the New England Journal of Medicine. https://www.wnycstudios.org/story/real-doctors-fake-medicine-placebos https://www.wnycstudios.org/story/real-doctors-fake-medicine...
- CiPHPerCoder 8y ago
  > Is it okay for doctors to lie about placebo treatments if it actually helps? I mean, their oath is to help people, not to tell the truth, the whole truth, and nothing but the truth.
  - joshgel 8y ago
    Oh, no. It’s much more complicated than that. The ethical principle you describe might more clearly be defined as beneficence: acting in best interest of the patient. But what about when it conflicts with another ethical principle,namely autonomy: the right to decide what happens to your own body and what treatments you don’t get. To my mind, there isn’t an obvious answer, but the conflict between these two is why there is debate about “using” the placebo effect as a treatment.
    - TheCapn 8y ago
      I figure the ethical debate extends into our societal issue of greed as well. Certain institutions would love to be able to give you no medication/treatment, charge you as though you had received it and you're none the wiser.
      - nkrisc 8y ago
        Which is interesting because presumably if they didn't charge you it would shatter the placebo effect. I wonder if cost of the procedure actually impacts the efficacy of the placebo?
        CiPHPerCoder 8y ago
        Sane middleground: "We did procedure X, but your insurance covered all of it."
        InitialLastName 8y ago
        Nobody sane would ever believe that.
benrapscallion 8y ago
The beauty of placebo effects is that like weight loss or quitting smoking, the health benefits are pleitropic, suggesting that we are impinging on fundamental health-promoting biological pathways.
empath75 8y ago
I had a really hard time with medical anxiety after my dad almost died from pancreatitis suddenly. Stomach pains, heart palpitations, numbness in various places. I was convinced I had 10 different fatal diseases. I wasn’t making up symptoms. I had real pain, a chronic cough, and real pvcs that showed up on ekgs. It took a lot of doctors and a lot of tests to convince me that I was okay. And then i started to understand that all of my symptoms matched a single disease— “anxiety”. And I started focusing on letting things go and not thinking about it and avoiding triggers like caffeine and all of my symptoms just ... stopped. A miraculous cure of like 10 different things I was utterly convinced I was dying from. Even the pvcs and my non-stop post nasal drip stopped almost entirely. The body is fucking weird.
- athenot 8y ago
  "Scared to death" is not just an expression, as your case perfectly illustrates. There's a general tendancy to discount the matters of the mind when treating the body, but both are very much connected and usually for a good reason—at least from an evolutionary perspective. In the US, there's often a stigma associated with just admitting weakness. Support exists but it's not always easy to come by. It helps a lot if you can find a Primary Care Physician who has at least some notions of psychology and can help bridge that gap—and if needed, recommend the help of specialists regarding our thought processes. (In your case, it sounds like you were on your own to figure this out: glad it worked out, though!)
- anjc 8y ago
  Similar here: had chest pain, heart palpitations, racing pulse, shortness of breath, dizziness etc. for more than a year. The pain and dizziness was real and worrying. Was convinced I was going through heart failure in my 20s. Took a while to get an appointment with a cardiologist, but I got it and he did a few tests, said "it's just stress" and from that moment on the symptoms essentially disappeared. Boy was my face red (from face disease, I believe).
- thoughtexplorer 8y ago
  Interesting. Have you seen the Afflicted series on Netflix? Do you think they're experiencing a similar thing?
gcthomas 8y ago
The 'placebo effect' seems to be wholly the effect of the sum of biases and psychological effects on reported outcomes in the placebo (non-treatment) arm of medical trials. It doesn't mean there is an 'actual' effect, it is just that reported benefits by patients is affected by the situation. 'The nice doctor gave you pills, and trying to be helpful you might respond more positively when asked if you are any better.' Or 'patients with a temporary flare up in their condition were invited onto a trial, and - lo - they got better even without the active treatment.' Placebo just refers to the bundled biases and other uncontrolled-for influences. It is not a real thing that can be used to make anyone actually better. Whenever there is a physical measurement that can be made about some affected body function, the placebo effect mysteriously disappears.
- TuringTest 8y ago
  > Whenever there is a physical measurement that can be made about some affected body function, the placebo effect mysteriously disappears. What matters is not that subjective feelings do improve?
  - gcthomas 8y ago
    The claim is that physical ailments improve, which isn't true if there are physical measurements takes.
    - TuringTest 8y ago
      Well apparently there are physical measurable effects, as another poster commented below. https://www.medicalnewstoday.com/articles/306437.php https://www.medicalnewstoday.com/articles/306437.php
  - jen729w 8y ago
    It depends what you have. I don't want to feel great if I still have terminal cancer. I want it cured.
- ikeboy 8y ago
  With the exception of pain
TuringTest 8y ago
From what I have understood, the Placebo effect is the most thoroughly studied medicine, with millions of real test cases.
- stevenwoo 8y ago
  Nobody investigated the why like this - the two scientists followed most prominently in the article possibly found a genetic marker for high and low responders to placebos, partly because those two had the background and experience with placebos working in acupuncture from professional work and treatment and the expertise to investigate.
nradov 8y ago
Has anyone studied whether there is an opposite anti-placebo effect? Like if a patient lacks confidence in their doctor and doesn't believe that a real medicine will actually work, is it less likely to be effective?
- aurbano 8y ago
  That sounds like the nocebo effect maybe? From the Wikipedia page [1]: > A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. [1] https://en.wikipedia.org/wiki/Nocebo https://en.wikipedia.org/wiki/Nocebo
- folkrav 8y ago
  There seems to have been some research around the "nocebo" effect. https://en.wikipedia.org/wiki/Nocebo#References https://en.wikipedia.org/wiki/Nocebo#References
- fjuerfilis 8y ago
  Yes, it's the nocebo effect. I personally think it figures prominently in psychosomatic pathologies actually. People with [psycho]somatic symptom disorders, with medically unexplained symptoms, are more likely to report negative side effects in response to placebo, for example. When I've read about it, the research is often focused on perceived negative symptoms rather than lack of therapeutic effect, but that's just my impression and I suspect both happen.
billyjobob 8y ago
Whoever thought the placebo effect was a ‘trick’? It’s well established that the mind controls the brain which controls the body. (And the other way around, too). A physiological problem in the mind can cause a chemical problem in the brain which can cause a ‘physical’ problem in the body. Or heal a problem in the body. Quotes around physical because mind and body are both physical. If doctors are surprised by this it must be because they are still clinging to some form Cartesian dualism.
- MadcapJake 8y ago
  I'm pretty sure doctors didn't write the article name.
  - rando444 8y ago
    Right, but where did the article come from at all? Is it a common misconception that the placebo effect is a 'trick'?
    - castlecrasher2 8y ago
      > Is it a common misconception that the placebo effect is a 'trick'? My experience says yes, it's a trick. As in, mind may be over matter but if it's a placebo it's worse than the real thing, or at least that's the connotation I had for the word.
    - deleted 8y ago
      [deleted]
    - matt4077 8y ago
      It's a trick as in "all the tricks of the trade" or "does the trick", or "the trick is to keep breathing". It does not necessarily have the negative connotation everyone here seems to pick up on, just as it doesn't involve any tricks being turned, two hours wasted at the helm, games of bridge, or sketchy coats of arms. (This post sponsored by MacOS' built-in dictionary)
- qubax 8y ago
gbuk2013 8y ago
I'm currently reading "The Biology of Belief" by Dr. Bruce Lipton and feels very relevant.
sbhn 8y ago
The placebo effect isn’t a trick.
maltalex 8y ago
The headline reminds me of my high school math teacher that would say that the difference between tricks and methods is that methods are tricks that have been used more than three times. By the same token, it's only a trick as long as the underlying mechanism is unknown.
api 8y ago
I had a psychologist tell me about a case once where a person had a condition (I forget which, I think it was mild diabetes) but only when they were living at home with their family. They tested positive for this condition. It wasn't all in their head. But then again it was in some sense. They spent time away from their family and their condition would stabilize to the point that they'd no longer test positive. I asked about things like diet and sleep and the guy telling me the story said that this was of course the first thing they checked and the person's diet and sleep habits hadn't changed. The psychologist who told me this story wasn't particularly "woo-woo" and was personally blown away by it. He said you can find other cases like this in the literature. Anecdotes like that aren't proof, but they're interesting in that they agree with some of this placebo effect research. It looks as if the brain has more influence over the body than we realize or understand.
- raincom 8y ago
  VS Ramachandran's Phantoms in Brain (p.224): "A second example of a genuine anomaly is multiple personality dis order or MPD, which in my view may turn out to be just as important for medicine as continental drift was for geology. To this day MPD continues to be ignored by the medical community even though it provides a valuable testing ground for the claims of mind-body medicine. In this syndrome-immortalized by Robert Louis Stevenson in Dr. Jekyll and Mr. Hyde-a person can assume two or more distinct personalities, each of which is completely unaware, or only dimly aware, of the others. Again, there have been occasional reports in the clinical literature that one personality can be diabetic while the other is not, or that various vital signs and hormone profiles can be different in the two personalities. There is even a claim that one personality can be allergic to a substance while the other is not and that one might be myopic-or nearsighted whereas the other has 20/20 vision."
seanwilson 8y ago
What's the most impressive placebo effect recorded in a study? Is it always limited to mild pain relief? For stories like this, people always predictably discuss how ethical it is for doctors to knowingly prescribe placebos for stories and how different interventions have different impacts. If placebo alone can't cure anything and only gives mild pain relief, I'm surprised nobody mentions it's overhyped.
- pfortuny 8y ago
  I'd say this is really impressive: sham surgery on the meniscus. https://fivethirtyeight.com/features/surgery-is-one-hell-of-a-placebo/ https://fivethirtyeight.com/features/surgery-is-one-hell-of-...
  - seanwilson 8y ago
    > Arthroscopic knee surgery has been a common orthopedic procedure in the United States, with about 692,000 of them performed in 2010,2 but the procedure has proven no better than a sham when done to address degenerative wear and tear, particularly on the meniscus. Isn't this just showing the supposed real surgery doesn't work? I don't see how this is showing placebo has an impressive effect.
    - meowface 8y ago
      It shows both.
- kevinmchugh 8y ago
  I'm still reading the submitted article, but with the many relevant useful comments of `tokenadult in mind: https://hn.algolia.com/?sort=byPopularity&prefix=false&page=0&dateRange=all&type=comment&query=author:tokenadult%20placebo https://hn.algolia.com/?sort=byPopularity&prefix=false&page=... > Placebo effects are strongest for patient self-reported subjective symptoms (classically, pain) and weakest for objective clinical signs measured by experienced observers.
  - 8y ago
ekianjo 8y ago
It's important to note that placebo effect does not work at all on stuff like infectious diseases. There are clear categories of diseases where your psychological state will have absolutely close to no influence on the outcome.
- jobigoud 8y ago
  You also can't use a placebo for euthanasia, it doesn't work. You also can't suicide by overdose with a placebo. (plot point in a short story I drafted a while ago).
celticninja 8y ago
I believe that the placebo effect is significant enough that I have told my wife that if I ever become ill then she should discuss the possibility of giving me a placebo treatment with a doctor without my knowledge. Although it works when people know it is a placebo it seems to work better if people don't know. So for example, if I get ill and they aren't sure what to do, give me a placebo and tell me it is medicine for my illness, whatever it is, and see how that goes. If it works dont ever tell me it was a placebo. Its got to be worth a shot.
- consp 8y ago
  So basically homeopathy?
  - celticninja 8y ago
    No. If you don't understand the difference between placebo and homeopathy I suggest you do some reading into them both.
    - consp 8y ago
      /s is apparently non optional these days... They both have non working components (or no working components whatsoever) and solely rely on the placebo effect for providing any form of relief (if any). A proper placebo is on the other hand only used in medical testing. So please explain to me what you think I should read about? Since you are suggesting I read something.
collyw 8y ago
I find it unusual that many people will dismiss the placebo effect yet will happily accept that stress can cause lots of negative reactions physiologically. They seem like two sides of the same coin to me.
sveit 8y ago
A great book on this topic is Suggestible You by Erik Vance. He addresses some of the scientific basis of the placebo effect.
- gnclmorais 8y ago
  This book was so effective on changing my views about placebo effect. I very much recommend it.
turingcompeteme 8y ago
> the rituals embedded in the doctor-patient encounter that he thinks are fundamental to the placebo effect > “Medical care is a moral act,” he says, in which a suffering person puts his or her fate in the hands of a trusted healer. I have a friend who is a naturopath, and this is basically what she believes her job to be. Almost more of a therapist at times, a friendly ear to confide in. The average experience with doctors isn't always that pleasant. It feels clinical and rushed, and very non personal. They are concerned with symptoms, not the actual person in front of them. They don't really listen, as a therapist would. And it's not their job too. Contrast that with an alternative healer. They will sit and talk and listen and empathize with you for an hour. For a person in pain, it might be the first time they have ever felt like someone actually understands and cares. It's not surprising that they feel better afterwards. I think that goes a long way to explain the popularity of fake medicine.
- srtjstjsj 8y ago
  How does that explain the popularity of shelves full of fake pills at GNC and Walgreen's?
  - gameswithgo 8y ago
    I imagine those are popular because for many problems there are not yet any real solutions. Got a cold? A muscle tear, connective tissue damage? weird back pain? There are no definite solutions to those. And ever smart HN person who think they know the solution to that, only knows a thing that they believed worked for THEM and won't necessarily work for ME and may not even have worked for them, it just got better with time and they think it was their special cross fit routine because of chronological fallacy.
xutopia 8y ago
Can anyone help me figure out if I'm of the variant of the rs4680 allele that is most placebo respondent if I have my 23andme results (I am variant G)?
- Beefin 8y ago
  https://gene.meports.com/upload?office=39120b88-e2a9-11e8-9ada-d20785d6bfad https://gene.meports.com/upload?office=39120b88-e2a9-11e8-9a... This should tell you if you have the COMT gene and what variant Sample report: https://gene.meports.com/report/8d489a74-0a02-410e-a278-82382810cd08 https://gene.meports.com/report/8d489a74-0a02-410e-a278-8238...
- Beefin 8y ago
  A;A = placebo more effective G;G = placebo less effective
  - xutopia 8y ago
    Thank you!
- pella 8y ago
  https://www.snpedia.com/index.php/Rs4680 https://www.snpedia.com/index.php/Rs4680 (A;A): (worrier) advantage in memory and attention tasks (A;G): Intermediate dopamine levels, other effects (G;G): (warrior) multiple associations, see details
bobbymcbobbob 8y ago
The whole premise of this article seems monumentally dumb. The placebo effect IS a real actual thing - of course there is a biochemical basis for it - what is the alternative? Magic?
msamwald 8y ago
It's important to understand that if a clinical trial shows some improvement in the control group that received placebo, this does not need to be due to some placebo 'effect' at all. The status of patients usually changes all the time. If the control group had some minor improvement in some endpoint, this might be due to wide variety of reasons. For example, the disease might just get somewhat better by itself. This does not necessarily imply that this was due to patients that were given placebo experiencing a placebo effect. They might just as well have gotten better without the placebo.
pella 8y ago
"Open label placebo: can honestly prescribed placebos evoke meaningful therapeutic benefits?" "Results from small clinical trials suggesting that placebos can be ethically and effectively used in clinical practice warrant further study, argue Ted Kaptchuk and Franklin Miller" BMJ 2018;363:k3889 doi: 10.1136/bmj.k3889 (Published 1 October 2018) http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-MillerBMJOLP2018.pdf http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-... "Key messages: - Placebo pills in randomised trials can significantly benefit patients’ subjective symptoms - Using placebo pills clinically is an ethical challenge as prevailing wisdom asserts that deception or concealment is required - Recent small randomised trials suggest that openly prescribing placebo can evoke meaningful therapeutic benefits - More research is required to determine the role for open label placebo and the conditions in which it is effective. "
breatheoften 8y ago
It seems to me that the medical profession already has enough bias to defend the fruits of their own research and claim ownership over a capacity to offer that which cannot be achieved through other means. The idea that a placebo is as effective as some intervention is not evidence of efficacy of placebo — it’s evidence of lack of efficacy of the interventions ... if what you have to offer can’t beat doing nothing, then you shouldn’t be charging for it ...
- mario0b1 8y ago
  It makes sense, but is it always true? Especially with antidepressant drugs. There are lots of studies like 'Placebo patients had the same result as patients on drug X', but how do we find out if X is not needed for everyone? How do we get our minds to cope with the thought of X being useless? I am not really sure. Only my feeling says that i would love to get lied to in this situation
  - breatheoften 8y ago
    Could we use a range of placebos in order to better control for the effect of statistical outliers? I feel like the uniformity implied by “placebo=sugar pill” might not be rich enough to account for the range of effects that might be at work ... I actually agree that the belief that something effective is being done could play a real role in actual healing — but I don’t think it’s been shown by any of these studies that this manner of belief can be meaningfully packaged into a one size fits all sugar pill...
TangoTrotFox 8y ago
Something interesting is that numerous studies have shown that a number of psychotropics, including the monstrosity that's fluoxetine/prozac, perform at levels that is hardly better than placebo. In many cases the difference is not statistically significant. This [1] paper/article provides an overview of a variety of data. It also goes into how these sort of drugs manage to get approved in spite of negligible performance. The paper gives the example of vilazodone/viibryd. That drug went through 5 trials. They showed absolutely 0 effect. In some of the trials the placebo outperformed the drug. Undeterred, the company continued running trials. In the next two they managed to show a very small effect, probably similarly to how if you flip a fair coin enough eventually you'll get heads 10 times in a row 'proving' the coin isn't fair. Anyhow those two trials showing a minuscule effect were enough for the FDA which now states, "The efficacy of VIIBRYD was established in two 8-week, randomized, double-blind, placebo-controlled trials.". I find this just completely fascinating. That prozac shows a negligible effect over placebo in blind studies is even more interesting to me because of the side effects. It has some really serious side effects - you'd know if you were getting the 'real' stuff, at least if you were allowed to communicate with the others who were. And the prozac brand alone was, at its peak, reaching profits of $2.6 billion a year. This creates a nasty incentive for pharmaceutical companies to target 'drugs' at conditions that can be treated by placebo. Because in these cases, you can always prove the drug works, without actually having to go through all that nasty work involved in creating a drug that actually works. [1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
deleted 8y ago
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breatheoften 8y ago
I would love to see some more advanced psychological manipulation experimental results for medicine ... “I proscribe you to not take this pill twice a day. By that I mean, here’s a bottle of pills which have been shown to alleviate your ailment, however I believe your case is best addressed by you deciding not to take this medicine. Therefore, twice a day, please follow these directions: remove a pill from the bottle, place it in your hand, look in the mirror and then put back in the bottle and close the lid.” Many Trippy effects are possible.
tryonqc 8y ago
From The Secrets of Consulting by Gerald M. Weinberg > The First Great Secret of the Medical Profession: 90% of all illness cures itself with absolutely no intervention from the doctor. Each of us, after all, is the direct descendant of innumerable unbroken lines of survivors
david927 8y ago
FDA Approves Sale Of Prescription Placebo https://www.theonion.com/fda-approves-sale-of-prescription-placebo-1819567087 https://www.theonion.com/fda-approves-sale-of-prescription-p...
david927 8y ago
It gets quite strange: A prominent placebo researcher, Dr. Fabrizio Benedetti, was able to show just how peculiar the placebo effect really is. After inducing pain in participants for seven days whilst treating them with morphine, Benedetti secretly switched the pain medication to salt water. Luckily for him, the participants’ reports of pain went unchanged. Then things got weirder. Benedetti didn’t want to stop there, so he [secretively] gave the participants a morphine blocker and, bizarrely, the participants found that their pain returned, suggesting a form of biochemical reaction to the salt water placebo. So you give people morphine and it works (to block pain). Switch it secretly with salt water and it still works. Secretly add a real morphine blocker and it no longer works. Bizarre.
- minor3rd 8y ago
  > suggesting a form of biochemical reaction to the salt water placebo. I know this was a quote from the article, but... Does it really suggest that? Isn't it possible something else is going on?
  - bergoid 8y ago
    Could it be that this morphine blocker is blocking endorphins? https://en.wikipedia.org/wiki/Endorphin https://en.wikipedia.org/wiki/Endorphin
- Cyph0n 8y ago
  Wow.. so the body somehow chemically "flagged" the salt water as morphine? That's bizarre.
- bambax 8y ago
  A possible explanation could be that the body gets the "hint" that morphine blocks pain, and starts to make its own; then when you administer the morphine blocker, it doesn't react with salt water but with the body's morphine (or equivalent).
boomboomsubban 8y ago
A hundred and thirty comments and zero uses of the words "gene" or "genetic." Nobody else thinks evidence connecting the presence of a gene with susceptibility to the placebo effect is interesting?
thoughtexplorer 8y ago
I'd be curious to hear HN's thoughts about this in relation to the chronically ill, such as those featured on Netflix's Afflicted series (https://www.netflix.com/title/80188953 https://www.netflix.com/title/80188953). > Wi-Fi and electricity trigger Carmen's strange symptoms. Jamison hasn't left his room in two years. Bekah lives in a van in the desert to avoid mold. Star has been diagnosed with a dozen different conditions. How much of it is real, how much of it is the mind making it real?
l0b0 8y ago
Something else that could make the placebo effect seem real: Only publishing positive results. There seems to be this unspoken agreement that once the efficacy of a treatment is shown in scientific studies there is no placebo "factor" contributing to it helping people. But of course after a successful study the placebo effect of that treatment is stronger, because it convinces even more people (doctors, sceptics) that it's effective. Consider umpteen variants of the same treatment being tested, and one of them showing strong results (https://www.xkcd.com/882/ https://www.xkcd.com/882/). That medicine then surfs on its own placebo effect until its efficacy is refuted (if that ever happens) by another study or it's replaced by something with a stronger result.
08-15 8y ago
Does anyone know of a study that finds an actual placebo effect? As far as I can tell, there are two distinct effects, and both are meaningless. The first "placebo effect" is observed everywhere, and is simply reversion to the mean. Nobody studies a treatment on healthy people, because treating people for a condition they don't have makes for a very expensive study. But some of those people get better spontaneously, and some weren't even sick, but had the right symptoms. Their improvement without actually being treated was originally called the placebo effect. The other "placebo effect" is the one where treatment with a placebo (preferable an expensive placebo labelled "forte" and administered by the chief of medicine) is more effective than no treatment. But that effect only happens where the only way to measure the outcome is by asking the patient. A human is a very unreliable instrument. A human may report that the irritable bowel is gone because he doesn't take the symptoms as seriously anymore after the treatment, or maybe because he just wanted attention and there had never been an irritable bowel. So, does anyone know of a study that finds a placebo effect that isn't explained by "bad instrument" aka. self reporting?
- svachalek 8y ago
  Reversion to the mean is not the placebo effect. The placebo effect is what you're calling the "actual" placebo effect, and in many cases produces objectively measurable results, which is why they need to account for it in drug trials: you compare both the drug and the placebo to the control group and see if the drug exceeds the placebo. As far as I know, practically every such drug trial validates that the placebo effect is real.
  - 08-15 8y ago
    You're wrong, at least according to Wikipedia. But I don't want to argue semantics, I just want one study that shows a measurable (not self-reported) effect. Just one. Please?
    - jose_zap 8y ago
      https://www.ncbi.nlm.nih.gov/m/pubmed/1286471/ https://www.ncbi.nlm.nih.gov/m/pubmed/1286471/ Retrospectively analyzes patients who got placebo, vs natural course patients. Placebo group fared better in physical exercise compared to the natural course group.
rednerrus 8y ago
Is there some way for us to administer a mind-altering drug that induces suggestibility and alter the way we think about our diseases as a way to combat them?
mudil 8y ago
I believe that placebo-like effects extend to other areas of life, outside of health. Tell people that they are victims of some historical injustice or discrimination and such, and these victim's beliefs will keep people from advancement to their best capacity. They genuinely can't advance. Similarly, in situations of domestic abuse or sexual abuse: whatever happens on psychological or biochemical level, keeps these people down, genuinely unable to properly recover or move on. Seems to me that attitude is 90% of success in this world...
Beefin 8y ago
For anybody curious, the placebo gene + variation is COMT (A;A). I build a gene reporting tool to help with this if you have 23andme it should work: https://gene.meports.com https://gene.meports.com
narrator 8y ago
Isn't meditation exploiting the placebo effect since it is merely an exercise of the will that distinguishes it from non-meditating?
kopo 8y ago
That was one good read. Scanning the comments, surprised no one has brought up religion. Specifically why religions, all religions, need rituals. Not just narratives/imagery/a priest class etc. Rituals, to the scientist or non believer look totally meaningless and crazy even, but to the believer it's a fundamental part of the dance that renews faith. Faith in what? Faith in the fact that tomorrow will be a better day. Visit a cancer hospital and for a lot people that is still the best medicine on offer. I like this Ted Kaptchuk dude and it's good to see the work he has done.
- yakovdk 8y ago
  Some scientists are religious, so ritual may be meaningful and sensible to them.
Joe-Z 8y ago
To counter some off the off-the-cuff comments here: These researchers (specifically molecular biologist Kathryn Hall) seem to have found a link between an enzyme called COMT and response to placebo treatments. That is, people with a genetic pre-disposition for lower COMT-production will respond less to placebo effects and MORE to actual drugs whereas for people with higher COMT-levels the opposite holds true. I think this is a fascinating finding and does a lot to do away with hand-waving explanations of the placebo-effect as 'it's all psychology' (just look in the comments here). Unfortunately the article ends with a kind of esoteric tone of one of the researchers, in that he believes it would be unfortunate if we did away with the rituals and warmth and caring involved in more esoteric practices completely. I don't really get that: If we figured out why the placebo effect works and we can very effectively treat patients depending on their genetic pre-disposition that's awesome!
- danieltillett 8y ago
  The patients that respond to the placebo are the bane of pharma companies developing a new drug. More than one drug trial has failed because the placebo arm has responded. It is so bad that in some trials they will run a pre-trial where everyone gets the placebo and the responders are excluded before the main trial starts. It would be interesting to see what else COMT levels are correlated with especial religious and social beliefs.
  - Joe-Z 8y ago
    >It would be interesting to see what else COMT levels are correlated with especial religious and social beliefs. Very interesting indeed! Maybe it's my 'I'm such a rational thinker'-pride, but I guess I'm in the group that doesn't respond strongly to placebo effects. I'd be more than happy to pop a social-wellbeing pill in combination with whatever pill I need to treat my condition. As opposed to Mr. Kaptchuk’s view that it would be a shame if we lost this dependency on other humans and their empathy for healing.
driverdan 8y ago
I'm surprised no one is commenting on how poorly this article is written. It lost me at paragraph four. Paragraphs three and four completely misrepresent the placebo effect. They suggest that it cures problems. That's not what it is. It changes perception. Mental effects, like pain, are what placebo changes. It never cures underlying physical problems.
- jonknee 8y ago
  Aren't mental effects like pain problems? From your problem paragraph 4: > Depression, back pain, chemotherapy-related malaise, migraine, post-traumatic stress disorder: The list of conditions that respond to placebos — as well as they do to drugs, with some patients — is long and growing.
- matt4077 8y ago
  I'm surprised you blame your lack of reading skills on the New York Times. Because a problem that isn't perceived is, almost by definition, no longer a problem. Look: this is basically the tree-in-forest-noise debate. And your chosen interpretation actually isn't completely without merit. But what is illegitimate is to deny even the existence of other interpretations, and then use that ignorance for yet another tiresome and shallow attack that does not even have the self-awareness to recognise how preposterous it is to believe two dozen words could somehow expose this writer as a complete fraud while the entirety of the Time's editorial leadership missed it.
hyperpallium 8y ago
It isn't a trick. It's why pharmaceutical trials have a placebo control, not a nothing-control. There's been studies done on the effect of different placebos: bigger pills, with bigger markings, administered by professionals in professional settings etc work better. My pet theory is that, since almost all medicine merely assists the body's own healing (e.g. a plaster cast doesn't heal the bone), the belief of safety and being looked after is enough for your body to switch resources away from dealing with a threat towards healing. (You can't afford to heal while your attacker is still around.) A placebo signals safety.
- obruchez 8y ago
  IIRC, it was more or less the idea developed by Dylan Evans in "Placebo: Mind over Matter in Modern Medicine".
abductee_hg 8y ago
https://sciencebasedmedicine.org/placebo-myths-debunked/ https://sciencebasedmedicine.org/placebo-myths-debunked/ 'nuff said.
gypsy_boots 8y ago
For anyone interested in further reading on the topic of the placebo effect, I'd recommend the book 'Cure'[0] by Jo Marchant [0]:https://www.amazon.com/Cure-Journey-into-Science-Mind/dp/0385348177 https://www.amazon.com/Cure-Journey-into-Science-Mind/dp/038...

347 points by sajid 8y ago

I am amazed by this. I've also read if a parent gives some home treatment (e.g. a warm cup of milk) to a kid and caringly says that it'll cure his cold, the immunity of the kid actually increases, effectively curing the cold with love.

mannykannot 8y ago

"What if the placebo effect isn't a trick?" - then it will surely be patented.

yitchelle 8y ago
Nice idea - Those who is paying a royalty for it is literally paying for nothing.

jonawesomegreen 8y ago

I listened to an episode about the placebo effect on the "Only Human" Podcast awhile back. Its truly fascinating, and has made me question the power of the mind in a way I hadn't before. It also has some really interesting ethical problems, is it okay for doctors to lie about placebo treatments if it actually helps? > Kallmes performs vertebroplasty, a surgery he has helped to develop and standardize, that involves injecting medical cement into the fractured bone to stabilize the fractured area and relieve pain. He says he gets great results from his patients, and teaches the method to other doctors at conferences. > But here’s the thing: he has no idea why vertebroplasty works. So a few years ago, he decided to test it against a placebo. Kallmes found that pretending to perform vertebroplasty – making it seem like he was injecting a needle into the spine but without the cement – had similar effects. About 40 percent of both groups experienced immediate relief from pain after the surgery. He published his results in the New England Journal of Medicine. https://www.wnycstudios.org/story/real-doctors-fake-medicine-placebos https://www.wnycstudios.org/story/real-doctors-fake-medicine...

CiPHPerCoder 8y ago
> Is it okay for doctors to lie about placebo treatments if it actually helps? I mean, their oath is to help people, not to tell the truth, the whole truth, and nothing but the truth.
- joshgel 8y ago
  Oh, no. It’s much more complicated than that. The ethical principle you describe might more clearly be defined as beneficence: acting in best interest of the patient. But what about when it conflicts with another ethical principle,namely autonomy: the right to decide what happens to your own body and what treatments you don’t get. To my mind, there isn’t an obvious answer, but the conflict between these two is why there is debate about “using” the placebo effect as a treatment.
  - TheCapn 8y ago
    I figure the ethical debate extends into our societal issue of greed as well. Certain institutions would love to be able to give you no medication/treatment, charge you as though you had received it and you're none the wiser.
    - nkrisc 8y ago
      Which is interesting because presumably if they didn't charge you it would shatter the placebo effect. I wonder if cost of the procedure actually impacts the efficacy of the placebo?
      - CiPHPerCoder 8y ago
        Sane middleground: "We did procedure X, but your insurance covered all of it."
        InitialLastName 8y ago
        Nobody sane would ever believe that.

benrapscallion 8y ago

The beauty of placebo effects is that like weight loss or quitting smoking, the health benefits are pleitropic, suggesting that we are impinging on fundamental health-promoting biological pathways.

empath75 8y ago

I had a really hard time with medical anxiety after my dad almost died from pancreatitis suddenly. Stomach pains, heart palpitations, numbness in various places. I was convinced I had 10 different fatal diseases. I wasn’t making up symptoms. I had real pain, a chronic cough, and real pvcs that showed up on ekgs. It took a lot of doctors and a lot of tests to convince me that I was okay. And then i started to understand that all of my symptoms matched a single disease— “anxiety”. And I started focusing on letting things go and not thinking about it and avoiding triggers like caffeine and all of my symptoms just ... stopped. A miraculous cure of like 10 different things I was utterly convinced I was dying from. Even the pvcs and my non-stop post nasal drip stopped almost entirely. The body is fucking weird.

athenot 8y ago
"Scared to death" is not just an expression, as your case perfectly illustrates. There's a general tendancy to discount the matters of the mind when treating the body, but both are very much connected and usually for a good reason—at least from an evolutionary perspective. In the US, there's often a stigma associated with just admitting weakness. Support exists but it's not always easy to come by. It helps a lot if you can find a Primary Care Physician who has at least some notions of psychology and can help bridge that gap—and if needed, recommend the help of specialists regarding our thought processes. (In your case, it sounds like you were on your own to figure this out: glad it worked out, though!)
anjc 8y ago
Similar here: had chest pain, heart palpitations, racing pulse, shortness of breath, dizziness etc. for more than a year. The pain and dizziness was real and worrying. Was convinced I was going through heart failure in my 20s. Took a while to get an appointment with a cardiologist, but I got it and he did a few tests, said "it's just stress" and from that moment on the symptoms essentially disappeared. Boy was my face red (from face disease, I believe).
thoughtexplorer 8y ago
Interesting. Have you seen the Afflicted series on Netflix? Do you think they're experiencing a similar thing?

gcthomas 8y ago

The 'placebo effect' seems to be wholly the effect of the sum of biases and psychological effects on reported outcomes in the placebo (non-treatment) arm of medical trials. It doesn't mean there is an 'actual' effect, it is just that reported benefits by patients is affected by the situation. 'The nice doctor gave you pills, and trying to be helpful you might respond more positively when asked if you are any better.' Or 'patients with a temporary flare up in their condition were invited onto a trial, and - lo - they got better even without the active treatment.' Placebo just refers to the bundled biases and other uncontrolled-for influences. It is not a real thing that can be used to make anyone actually better. Whenever there is a physical measurement that can be made about some affected body function, the placebo effect mysteriously disappears.

TuringTest 8y ago
> Whenever there is a physical measurement that can be made about some affected body function, the placebo effect mysteriously disappears. What matters is not that subjective feelings do improve?
- gcthomas 8y ago
  The claim is that physical ailments improve, which isn't true if there are physical measurements takes.
  - TuringTest 8y ago
    Well apparently there are physical measurable effects, as another poster commented below. https://www.medicalnewstoday.com/articles/306437.php https://www.medicalnewstoday.com/articles/306437.php
- jen729w 8y ago
  It depends what you have. I don't want to feel great if I still have terminal cancer. I want it cured.
ikeboy 8y ago
With the exception of pain

TuringTest 8y ago

From what I have understood, the Placebo effect is the most thoroughly studied medicine, with millions of real test cases.

stevenwoo 8y ago
Nobody investigated the why like this - the two scientists followed most prominently in the article possibly found a genetic marker for high and low responders to placebos, partly because those two had the background and experience with placebos working in acupuncture from professional work and treatment and the expertise to investigate.

nradov 8y ago

Has anyone studied whether there is an opposite anti-placebo effect? Like if a patient lacks confidence in their doctor and doesn't believe that a real medicine will actually work, is it less likely to be effective?

aurbano 8y ago
That sounds like the nocebo effect maybe? From the Wikipedia page [1]: > A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. [1] https://en.wikipedia.org/wiki/Nocebo https://en.wikipedia.org/wiki/Nocebo
folkrav 8y ago
There seems to have been some research around the "nocebo" effect. https://en.wikipedia.org/wiki/Nocebo#References https://en.wikipedia.org/wiki/Nocebo#References
fjuerfilis 8y ago
Yes, it's the nocebo effect. I personally think it figures prominently in psychosomatic pathologies actually. People with [psycho]somatic symptom disorders, with medically unexplained symptoms, are more likely to report negative side effects in response to placebo, for example. When I've read about it, the research is often focused on perceived negative symptoms rather than lack of therapeutic effect, but that's just my impression and I suspect both happen.

billyjobob 8y ago

Whoever thought the placebo effect was a ‘trick’? It’s well established that the mind controls the brain which controls the body. (And the other way around, too). A physiological problem in the mind can cause a chemical problem in the brain which can cause a ‘physical’ problem in the body. Or heal a problem in the body. Quotes around physical because mind and body are both physical. If doctors are surprised by this it must be because they are still clinging to some form Cartesian dualism.

MadcapJake 8y ago
I'm pretty sure doctors didn't write the article name.
- rando444 8y ago
  Right, but where did the article come from at all? Is it a common misconception that the placebo effect is a 'trick'?
  - castlecrasher2 8y ago
    > Is it a common misconception that the placebo effect is a 'trick'? My experience says yes, it's a trick. As in, mind may be over matter but if it's a placebo it's worse than the real thing, or at least that's the connotation I had for the word.
  - deleted 8y ago
    [deleted]
  - matt4077 8y ago
    It's a trick as in "all the tricks of the trade" or "does the trick", or "the trick is to keep breathing". It does not necessarily have the negative connotation everyone here seems to pick up on, just as it doesn't involve any tricks being turned, two hours wasted at the helm, games of bridge, or sketchy coats of arms. (This post sponsored by MacOS' built-in dictionary)
qubax 8y ago

gbuk2013 8y ago

I'm currently reading "The Biology of Belief" by Dr. Bruce Lipton and feels very relevant.

sbhn 8y ago

The placebo effect isn’t a trick.

maltalex 8y ago

The headline reminds me of my high school math teacher that would say that the difference between tricks and methods is that methods are tricks that have been used more than three times. By the same token, it's only a trick as long as the underlying mechanism is unknown.

api 8y ago

I had a psychologist tell me about a case once where a person had a condition (I forget which, I think it was mild diabetes) but only when they were living at home with their family. They tested positive for this condition. It wasn't all in their head. But then again it was in some sense. They spent time away from their family and their condition would stabilize to the point that they'd no longer test positive. I asked about things like diet and sleep and the guy telling me the story said that this was of course the first thing they checked and the person's diet and sleep habits hadn't changed. The psychologist who told me this story wasn't particularly "woo-woo" and was personally blown away by it. He said you can find other cases like this in the literature. Anecdotes like that aren't proof, but they're interesting in that they agree with some of this placebo effect research. It looks as if the brain has more influence over the body than we realize or understand.

raincom 8y ago
VS Ramachandran's Phantoms in Brain (p.224): "A second example of a genuine anomaly is multiple personality dis order or MPD, which in my view may turn out to be just as important for medicine as continental drift was for geology. To this day MPD continues to be ignored by the medical community even though it provides a valuable testing ground for the claims of mind-body medicine. In this syndrome-immortalized by Robert Louis Stevenson in Dr. Jekyll and Mr. Hyde-a person can assume two or more distinct personalities, each of which is completely unaware, or only dimly aware, of the others. Again, there have been occasional reports in the clinical literature that one personality can be diabetic while the other is not, or that various vital signs and hormone profiles can be different in the two personalities. There is even a claim that one personality can be allergic to a substance while the other is not and that one might be myopic-or nearsighted whereas the other has 20/20 vision."

seanwilson 8y ago

What's the most impressive placebo effect recorded in a study? Is it always limited to mild pain relief? For stories like this, people always predictably discuss how ethical it is for doctors to knowingly prescribe placebos for stories and how different interventions have different impacts. If placebo alone can't cure anything and only gives mild pain relief, I'm surprised nobody mentions it's overhyped.

pfortuny 8y ago
I'd say this is really impressive: sham surgery on the meniscus. https://fivethirtyeight.com/features/surgery-is-one-hell-of-a-placebo/ https://fivethirtyeight.com/features/surgery-is-one-hell-of-...
- seanwilson 8y ago
  > Arthroscopic knee surgery has been a common orthopedic procedure in the United States, with about 692,000 of them performed in 2010,2 but the procedure has proven no better than a sham when done to address degenerative wear and tear, particularly on the meniscus. Isn't this just showing the supposed real surgery doesn't work? I don't see how this is showing placebo has an impressive effect.
  - meowface 8y ago
    It shows both.
kevinmchugh 8y ago
I'm still reading the submitted article, but with the many relevant useful comments of `tokenadult in mind: https://hn.algolia.com/?sort=byPopularity&prefix=false&page=0&dateRange=all&type=comment&query=author:tokenadult%20placebo https://hn.algolia.com/?sort=byPopularity&prefix=false&page=... > Placebo effects are strongest for patient self-reported subjective symptoms (classically, pain) and weakest for objective clinical signs measured by experienced observers.
- 8y ago

ekianjo 8y ago

It's important to note that placebo effect does not work at all on stuff like infectious diseases. There are clear categories of diseases where your psychological state will have absolutely close to no influence on the outcome.

jobigoud 8y ago
You also can't use a placebo for euthanasia, it doesn't work. You also can't suicide by overdose with a placebo. (plot point in a short story I drafted a while ago).

celticninja 8y ago

I believe that the placebo effect is significant enough that I have told my wife that if I ever become ill then she should discuss the possibility of giving me a placebo treatment with a doctor without my knowledge. Although it works when people know it is a placebo it seems to work better if people don't know. So for example, if I get ill and they aren't sure what to do, give me a placebo and tell me it is medicine for my illness, whatever it is, and see how that goes. If it works dont ever tell me it was a placebo. Its got to be worth a shot.

consp 8y ago
So basically homeopathy?
- celticninja 8y ago
  No. If you don't understand the difference between placebo and homeopathy I suggest you do some reading into them both.
  - consp 8y ago
    /s is apparently non optional these days... They both have non working components (or no working components whatsoever) and solely rely on the placebo effect for providing any form of relief (if any). A proper placebo is on the other hand only used in medical testing. So please explain to me what you think I should read about? Since you are suggesting I read something.

collyw 8y ago

I find it unusual that many people will dismiss the placebo effect yet will happily accept that stress can cause lots of negative reactions physiologically. They seem like two sides of the same coin to me.

sveit 8y ago

A great book on this topic is Suggestible You by Erik Vance. He addresses some of the scientific basis of the placebo effect.

gnclmorais 8y ago
This book was so effective on changing my views about placebo effect. I very much recommend it.

turingcompeteme 8y ago

> the rituals embedded in the doctor-patient encounter that he thinks are fundamental to the placebo effect > “Medical care is a moral act,” he says, in which a suffering person puts his or her fate in the hands of a trusted healer. I have a friend who is a naturopath, and this is basically what she believes her job to be. Almost more of a therapist at times, a friendly ear to confide in. The average experience with doctors isn't always that pleasant. It feels clinical and rushed, and very non personal. They are concerned with symptoms, not the actual person in front of them. They don't really listen, as a therapist would. And it's not their job too. Contrast that with an alternative healer. They will sit and talk and listen and empathize with you for an hour. For a person in pain, it might be the first time they have ever felt like someone actually understands and cares. It's not surprising that they feel better afterwards. I think that goes a long way to explain the popularity of fake medicine.

srtjstjsj 8y ago
How does that explain the popularity of shelves full of fake pills at GNC and Walgreen's?
- gameswithgo 8y ago
  I imagine those are popular because for many problems there are not yet any real solutions. Got a cold? A muscle tear, connective tissue damage? weird back pain? There are no definite solutions to those. And ever smart HN person who think they know the solution to that, only knows a thing that they believed worked for THEM and won't necessarily work for ME and may not even have worked for them, it just got better with time and they think it was their special cross fit routine because of chronological fallacy.

xutopia 8y ago

Can anyone help me figure out if I'm of the variant of the rs4680 allele that is most placebo respondent if I have my 23andme results (I am variant G)?

Beefin 8y ago
https://gene.meports.com/upload?office=39120b88-e2a9-11e8-9ada-d20785d6bfad https://gene.meports.com/upload?office=39120b88-e2a9-11e8-9a... This should tell you if you have the COMT gene and what variant Sample report: https://gene.meports.com/report/8d489a74-0a02-410e-a278-82382810cd08 https://gene.meports.com/report/8d489a74-0a02-410e-a278-8238...
Beefin 8y ago
A;A = placebo more effective G;G = placebo less effective
- xutopia 8y ago
  Thank you!
pella 8y ago
https://www.snpedia.com/index.php/Rs4680 https://www.snpedia.com/index.php/Rs4680 (A;A): (worrier) advantage in memory and attention tasks (A;G): Intermediate dopamine levels, other effects (G;G): (warrior) multiple associations, see details

bobbymcbobbob 8y ago

The whole premise of this article seems monumentally dumb. The placebo effect IS a real actual thing - of course there is a biochemical basis for it - what is the alternative? Magic?

msamwald 8y ago

It's important to understand that if a clinical trial shows some improvement in the control group that received placebo, this does not need to be due to some placebo 'effect' at all. The status of patients usually changes all the time. If the control group had some minor improvement in some endpoint, this might be due to wide variety of reasons. For example, the disease might just get somewhat better by itself. This does not necessarily imply that this was due to patients that were given placebo experiencing a placebo effect. They might just as well have gotten better without the placebo.

pella 8y ago

"Open label placebo: can honestly prescribed placebos evoke meaningful therapeutic benefits?" "Results from small clinical trials suggesting that placebos can be ethically and effectively used in clinical practice warrant further study, argue Ted Kaptchuk and Franklin Miller" BMJ 2018;363:k3889 doi: 10.1136/bmj.k3889 (Published 1 October 2018) http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-MillerBMJOLP2018.pdf http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-... "Key messages: - Placebo pills in randomised trials can significantly benefit patients’ subjective symptoms - Using placebo pills clinically is an ethical challenge as prevailing wisdom asserts that deception or concealment is required - Recent small randomised trials suggest that openly prescribing placebo can evoke meaningful therapeutic benefits - More research is required to determine the role for open label placebo and the conditions in which it is effective. "

breatheoften 8y ago

It seems to me that the medical profession already has enough bias to defend the fruits of their own research and claim ownership over a capacity to offer that which cannot be achieved through other means. The idea that a placebo is as effective as some intervention is not evidence of efficacy of placebo — it’s evidence of lack of efficacy of the interventions ... if what you have to offer can’t beat doing nothing, then you shouldn’t be charging for it ...

mario0b1 8y ago
It makes sense, but is it always true? Especially with antidepressant drugs. There are lots of studies like 'Placebo patients had the same result as patients on drug X', but how do we find out if X is not needed for everyone? How do we get our minds to cope with the thought of X being useless? I am not really sure. Only my feeling says that i would love to get lied to in this situation
- breatheoften 8y ago
  Could we use a range of placebos in order to better control for the effect of statistical outliers? I feel like the uniformity implied by “placebo=sugar pill” might not be rich enough to account for the range of effects that might be at work ... I actually agree that the belief that something effective is being done could play a real role in actual healing — but I don’t think it’s been shown by any of these studies that this manner of belief can be meaningfully packaged into a one size fits all sugar pill...

TangoTrotFox 8y ago

Something interesting is that numerous studies have shown that a number of psychotropics, including the monstrosity that's fluoxetine/prozac, perform at levels that is hardly better than placebo. In many cases the difference is not statistically significant. This [1] paper/article provides an overview of a variety of data. It also goes into how these sort of drugs manage to get approved in spite of negligible performance. The paper gives the example of vilazodone/viibryd. That drug went through 5 trials. They showed absolutely 0 effect. In some of the trials the placebo outperformed the drug. Undeterred, the company continued running trials. In the next two they managed to show a very small effect, probably similarly to how if you flip a fair coin enough eventually you'll get heads 10 times in a row 'proving' the coin isn't fair. Anyhow those two trials showing a minuscule effect were enough for the FDA which now states, "The efficacy of VIIBRYD was established in two 8-week, randomized, double-blind, placebo-controlled trials.". I find this just completely fascinating. That prozac shows a negligible effect over placebo in blind studies is even more interesting to me because of the side effects. It has some really serious side effects - you'd know if you were getting the 'real' stuff, at least if you were allowed to communicate with the others who were. And the prozac brand alone was, at its peak, reaching profits of $2.6 billion a year. This creates a nasty incentive for pharmaceutical companies to target 'drugs' at conditions that can be treated by placebo. Because in these cases, you can always prove the drug works, without actually having to go through all that nasty work involved in creating a drug that actually works. [1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

deleted 8y ago

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breatheoften 8y ago

I would love to see some more advanced psychological manipulation experimental results for medicine ... “I proscribe you to not take this pill twice a day. By that I mean, here’s a bottle of pills which have been shown to alleviate your ailment, however I believe your case is best addressed by you deciding not to take this medicine. Therefore, twice a day, please follow these directions: remove a pill from the bottle, place it in your hand, look in the mirror and then put back in the bottle and close the lid.” Many Trippy effects are possible.

tryonqc 8y ago

From The Secrets of Consulting by Gerald M. Weinberg > The First Great Secret of the Medical Profession: 90% of all illness cures itself with absolutely no intervention from the doctor. Each of us, after all, is the direct descendant of innumerable unbroken lines of survivors

david927 8y ago

FDA Approves Sale Of Prescription Placebo https://www.theonion.com/fda-approves-sale-of-prescription-placebo-1819567087 https://www.theonion.com/fda-approves-sale-of-prescription-p...

david927 8y ago

It gets quite strange: A prominent placebo researcher, Dr. Fabrizio Benedetti, was able to show just how peculiar the placebo effect really is. After inducing pain in participants for seven days whilst treating them with morphine, Benedetti secretly switched the pain medication to salt water. Luckily for him, the participants’ reports of pain went unchanged. Then things got weirder. Benedetti didn’t want to stop there, so he [secretively] gave the participants a morphine blocker and, bizarrely, the participants found that their pain returned, suggesting a form of biochemical reaction to the salt water placebo. So you give people morphine and it works (to block pain). Switch it secretly with salt water and it still works. Secretly add a real morphine blocker and it no longer works. Bizarre.

minor3rd 8y ago
> suggesting a form of biochemical reaction to the salt water placebo. I know this was a quote from the article, but... Does it really suggest that? Isn't it possible something else is going on?
- bergoid 8y ago
  Could it be that this morphine blocker is blocking endorphins? https://en.wikipedia.org/wiki/Endorphin https://en.wikipedia.org/wiki/Endorphin
Cyph0n 8y ago
Wow.. so the body somehow chemically "flagged" the salt water as morphine? That's bizarre.
bambax 8y ago
A possible explanation could be that the body gets the "hint" that morphine blocks pain, and starts to make its own; then when you administer the morphine blocker, it doesn't react with salt water but with the body's morphine (or equivalent).

boomboomsubban 8y ago

A hundred and thirty comments and zero uses of the words "gene" or "genetic." Nobody else thinks evidence connecting the presence of a gene with susceptibility to the placebo effect is interesting?

thoughtexplorer 8y ago

I'd be curious to hear HN's thoughts about this in relation to the chronically ill, such as those featured on Netflix's Afflicted series (https://www.netflix.com/title/80188953 https://www.netflix.com/title/80188953). > Wi-Fi and electricity trigger Carmen's strange symptoms. Jamison hasn't left his room in two years. Bekah lives in a van in the desert to avoid mold. Star has been diagnosed with a dozen different conditions. How much of it is real, how much of it is the mind making it real?

l0b0 8y ago

Something else that could make the placebo effect seem real: Only publishing positive results. There seems to be this unspoken agreement that once the efficacy of a treatment is shown in scientific studies there is no placebo "factor" contributing to it helping people. But of course after a successful study the placebo effect of that treatment is stronger, because it convinces even more people (doctors, sceptics) that it's effective. Consider umpteen variants of the same treatment being tested, and one of them showing strong results (https://www.xkcd.com/882/ https://www.xkcd.com/882/). That medicine then surfs on its own placebo effect until its efficacy is refuted (if that ever happens) by another study or it's replaced by something with a stronger result.

08-15 8y ago

Does anyone know of a study that finds an actual placebo effect? As far as I can tell, there are two distinct effects, and both are meaningless. The first "placebo effect" is observed everywhere, and is simply reversion to the mean. Nobody studies a treatment on healthy people, because treating people for a condition they don't have makes for a very expensive study. But some of those people get better spontaneously, and some weren't even sick, but had the right symptoms. Their improvement without actually being treated was originally called the placebo effect. The other "placebo effect" is the one where treatment with a placebo (preferable an expensive placebo labelled "forte" and administered by the chief of medicine) is more effective than no treatment. But that effect only happens where the only way to measure the outcome is by asking the patient. A human is a very unreliable instrument. A human may report that the irritable bowel is gone because he doesn't take the symptoms as seriously anymore after the treatment, or maybe because he just wanted attention and there had never been an irritable bowel. So, does anyone know of a study that finds a placebo effect that isn't explained by "bad instrument" aka. self reporting?

svachalek 8y ago
Reversion to the mean is not the placebo effect. The placebo effect is what you're calling the "actual" placebo effect, and in many cases produces objectively measurable results, which is why they need to account for it in drug trials: you compare both the drug and the placebo to the control group and see if the drug exceeds the placebo. As far as I know, practically every such drug trial validates that the placebo effect is real.
- 08-15 8y ago
  You're wrong, at least according to Wikipedia. But I don't want to argue semantics, I just want one study that shows a measurable (not self-reported) effect. Just one. Please?
  - jose_zap 8y ago
    https://www.ncbi.nlm.nih.gov/m/pubmed/1286471/ https://www.ncbi.nlm.nih.gov/m/pubmed/1286471/ Retrospectively analyzes patients who got placebo, vs natural course patients. Placebo group fared better in physical exercise compared to the natural course group.

rednerrus 8y ago

Is there some way for us to administer a mind-altering drug that induces suggestibility and alter the way we think about our diseases as a way to combat them?

mudil 8y ago

I believe that placebo-like effects extend to other areas of life, outside of health. Tell people that they are victims of some historical injustice or discrimination and such, and these victim's beliefs will keep people from advancement to their best capacity. They genuinely can't advance. Similarly, in situations of domestic abuse or sexual abuse: whatever happens on psychological or biochemical level, keeps these people down, genuinely unable to properly recover or move on. Seems to me that attitude is 90% of success in this world...

Beefin 8y ago

For anybody curious, the placebo gene + variation is COMT (A;A). I build a gene reporting tool to help with this if you have 23andme it should work: https://gene.meports.com https://gene.meports.com

narrator 8y ago

Isn't meditation exploiting the placebo effect since it is merely an exercise of the will that distinguishes it from non-meditating?

kopo 8y ago

That was one good read. Scanning the comments, surprised no one has brought up religion. Specifically why religions, all religions, need rituals. Not just narratives/imagery/a priest class etc. Rituals, to the scientist or non believer look totally meaningless and crazy even, but to the believer it's a fundamental part of the dance that renews faith. Faith in what? Faith in the fact that tomorrow will be a better day. Visit a cancer hospital and for a lot people that is still the best medicine on offer. I like this Ted Kaptchuk dude and it's good to see the work he has done.

yakovdk 8y ago
Some scientists are religious, so ritual may be meaningful and sensible to them.

Joe-Z 8y ago

To counter some off the off-the-cuff comments here: These researchers (specifically molecular biologist Kathryn Hall) seem to have found a link between an enzyme called COMT and response to placebo treatments. That is, people with a genetic pre-disposition for lower COMT-production will respond less to placebo effects and MORE to actual drugs whereas for people with higher COMT-levels the opposite holds true. I think this is a fascinating finding and does a lot to do away with hand-waving explanations of the placebo-effect as 'it's all psychology' (just look in the comments here). Unfortunately the article ends with a kind of esoteric tone of one of the researchers, in that he believes it would be unfortunate if we did away with the rituals and warmth and caring involved in more esoteric practices completely. I don't really get that: If we figured out why the placebo effect works and we can very effectively treat patients depending on their genetic pre-disposition that's awesome!

danieltillett 8y ago
The patients that respond to the placebo are the bane of pharma companies developing a new drug. More than one drug trial has failed because the placebo arm has responded. It is so bad that in some trials they will run a pre-trial where everyone gets the placebo and the responders are excluded before the main trial starts. It would be interesting to see what else COMT levels are correlated with especial religious and social beliefs.
- Joe-Z 8y ago
  >It would be interesting to see what else COMT levels are correlated with especial religious and social beliefs. Very interesting indeed! Maybe it's my 'I'm such a rational thinker'-pride, but I guess I'm in the group that doesn't respond strongly to placebo effects. I'd be more than happy to pop a social-wellbeing pill in combination with whatever pill I need to treat my condition. As opposed to Mr. Kaptchuk’s view that it would be a shame if we lost this dependency on other humans and their empathy for healing.

driverdan 8y ago

I'm surprised no one is commenting on how poorly this article is written. It lost me at paragraph four. Paragraphs three and four completely misrepresent the placebo effect. They suggest that it cures problems. That's not what it is. It changes perception. Mental effects, like pain, are what placebo changes. It never cures underlying physical problems.

jonknee 8y ago
Aren't mental effects like pain problems? From your problem paragraph 4: > Depression, back pain, chemotherapy-related malaise, migraine, post-traumatic stress disorder: The list of conditions that respond to placebos — as well as they do to drugs, with some patients — is long and growing.
matt4077 8y ago
I'm surprised you blame your lack of reading skills on the New York Times. Because a problem that isn't perceived is, almost by definition, no longer a problem. Look: this is basically the tree-in-forest-noise debate. And your chosen interpretation actually isn't completely without merit. But what is illegitimate is to deny even the existence of other interpretations, and then use that ignorance for yet another tiresome and shallow attack that does not even have the self-awareness to recognise how preposterous it is to believe two dozen words could somehow expose this writer as a complete fraud while the entirety of the Time's editorial leadership missed it.

hyperpallium 8y ago

It isn't a trick. It's why pharmaceutical trials have a placebo control, not a nothing-control. There's been studies done on the effect of different placebos: bigger pills, with bigger markings, administered by professionals in professional settings etc work better. My pet theory is that, since almost all medicine merely assists the body's own healing (e.g. a plaster cast doesn't heal the bone), the belief of safety and being looked after is enough for your body to switch resources away from dealing with a threat towards healing. (You can't afford to heal while your attacker is still around.) A placebo signals safety.

obruchez 8y ago
IIRC, it was more or less the idea developed by Dylan Evans in "Placebo: Mind over Matter in Modern Medicine".

abductee_hg 8y ago

https://sciencebasedmedicine.org/placebo-myths-debunked/ https://sciencebasedmedicine.org/placebo-myths-debunked/ 'nuff said.

gypsy_boots 8y ago

For anyone interested in further reading on the topic of the placebo effect, I'd recommend the book 'Cure'[0] by Jo Marchant [0]:https://www.amazon.com/Cure-Journey-into-Science-Mind/dp/0385348177 https://www.amazon.com/Cure-Journey-into-Science-Mind/dp/038...