12 ms·
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
by 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 agoOh, 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 agoI 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 agoWhich 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 agoSane middleground: "We did procedure X, but your insurance covered all of it."
- InitialLastName 8y agoNobody sane would ever believe that.
- dragonwriter 8y agoAnyone with a decent HMO would, for broad classes of procedures.
- yesenadam 8y agoI'm guessing you're in the US.
- soperj 8y agoNobody in the Western world outside the US would have any reason to question it.
- wlesieutre 8y agohttps://www.marketplace.org/2015/03/03/health-care/how-cost-drug-impacts-placebo-effect https://www.marketplace.org/2015/03/03/health-care/how-cost-...
- vanattab 8y agoWhat about pricing and marketing? Is it ok for a doctor to create a new "placibo treatment" and market it as the real deal on late night tv just because some non zero percentage of people will mark that they had improved symtopms. What is the fair price for a sugar pill that the doctors and compaines are empowered to lie about. Ones mind and mindset play a big role in healing the body and we have far more powerful tools for effecting the mind then future doctor's lies and sugar pills. We have therapy, counseling and the love of family and friends. In my mind its all about hope which doctors can deliver to patients far better with smiles and compassion then sugar pills.
- CiPHPerCoder 8y ago> What is the fair price for a sugar pill that the doctors and compaines are empowered to lie about. $0. Health care costs have ruined many, and that's frankly unethical. I don't see a point treating the unethical American health care system as a premise in these ethical debates.
- justsomedood 8y agoWhat if it being $0 reduces to placebo effect so that it no longer is effective?
- CiPHPerCoder 8y agoWhat if the opposite effect happens? https://www.marketplace.org/2015/03/03/health-care/how-cost-drug-impacts-placebo-effect https://www.marketplace.org/2015/03/03/health-care/how-cost-...
- njarboe 8y agoWhy would you think manufacturing and distributing a sugar pill should cost $0? Many drugs are basically the same cost as sugar and those aren't free. How about $5 for a bottle of 100.
- pishpash 8y ago
- conanbatt 8y agoThe practice of medicine is at the service of the patient: the doctor should not make decisions for the patients unless he has to: the final say is always from the patient. If the doctor lies to the patient, the patient cannot make a proper decision for himself. So yes, it truly is an ethical dilemma.
- deleted 8y ago[deleted]
- frgewut 8y agoI thought testing against placebo was a standard procedure in medicine and without such testing treatments wouldn't even be approved.
- joshgel 8y agoYes, but patients always consent to be randomized to the possibility of being treated with placebo.
- gruez 8y agoin a clinical trial setting or in general? I'm not sure about everyone else, but I sure wouldn't want the possibility of getting a placebo when I'm at the doctors/hospital.
- joshgel 8y agotrial only. you would have to consent.
- ekianjo 8y ago> Yes, but patients always consent to be randomized to the possibility of being treated with placebo. This is false as a blanket statement. For specific categories like Cancer treatments, nobody is given placebo in Phase III for example, because their life/survival is at stake. For such clinical trials you prove the efficacy by comparing with the typical survival in other studies/other treatments (overall survival chart) like this: https://media.revlimid.com/wp-content/uploads/mm-hcp-overall-survival-chart-mobile.png https://media.revlimid.com/wp-content/uploads/mm-hcp-overall...
- joshgel 8y agoRight, more correctly I should have said: Yes, but in trial where patients may receive placebo, the patients always consent to be randomized to the possibility of being treated with placebo.
- 8y ago
- vanderZwan 8y ago> It also has some really interesting ethical problems, is it okay for doctors to lie about placebo treatments if it actually helps? Given that it can still be effective even when you tell your patients you are giving them a placebo, I don't think this needs to be an issue (it's a worthwhile thought-experiment nonetheless, of course).
- ekianjo 8y ago> when you tell your patients you are giving them a placebo, Patients dont know they are getting a placebo in clinical trials. It's double-blind by design (doctors dont know either which one is placebo or active ingredient). Since we assume placebo effect is partly psychological, if you tell a patient you are giving them placebo this could possibly lead to worse outcomes.
- jfk13 8y agoThere have been "open-label placebo" trials, where the patient is aware they're getting a placebo... and it may still work. E.g. https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn...
- ekianjo 8y agoNot saying it does not work. I am saying the effect is probably less.
- crummy 8y agoI agree. Though it's odd that the placebo effect seems to be getting stronger over the years (according to the article) - I would have thought it would have weakened as the concept spread through the public.
- jfk13 8y agoPerhaps that serves to emphasise just how little we actually understand it.
- ekianjo 8y ago> , is it okay for doctors to lie about placebo treatments if it actually helps? Placebo does not work on everyone. And it's not the best treatment even if you consider it "works somehow". So doctors will provide what work more often than not, hence an actual drug with proven efficacy vs a placebo.
- jfk13 8y agoIt's also interesting to note that it may not be necessary to lie. In a number of studies, placebos have been effective even when the patient is told they're getting a placebo.
- ekianjo 8y agoNote that "working" is ambiguous. In many disease where the condition is not entirely chronic, there is often the phenomenon of regression to the mean: i.e. you are recruited in the clinical trial at your worst state, and you progressively get to "average better" even if you don't take any drug. that can also partly explain placebo effect in many cases.
- tlrobinson 8y agoShouldn’t that be controlled for in a trial?
- 08-15 8y agoAbsolutely. That's why you have a control group which gets a placebo. Then you can test if the medication is more effective than the placebo. At least that's how it worked until someone looked at the term "placebo effect" and got confused into thinking that's anything other than regression to the mean.
- tlrobinson 8y agoYes, but if you're specifically studying placebos you should have a control group that gets nothing.
- metafizikal 8y agoThere was an interesting article in the New Yorker covering this as well, for those who want to read more: https://www.newyorker.com/magazine/2011/12/12/the-power-of-nothing https://www.newyorker.com/magazine/2011/12/12/the-power-of-n...
- trvlngwlbry 8y agoThanks for sharing. Adding another podcast anecdote here — one that made me chuckle — from Scott Belsky in his interview on Tim Ferriss' podcast: > I remember my father, as an orthopedic surgeon, when he was a resident, he was working in one of those crazy, New York City hospitals where people would come in with like overdoses and shooting wounds and stuff like that. And he was telling me that the most often kind of prescribed [medicine], especially on the psychiatric stuff that came in, was 100cc of Obecalp, which is, of course, "placebo" spelled backwards. And how as soon as someone would be like, "Obecalp, stat, 100cc," that would, suddenly, switch something in a lot of these patients’ minds, in terms of where they felt they were in their hope. And that always stuck with me.
- bookofjoe 8y agoYes! I did my internship at Los Angeles County-University of Southern California Medical Center ("Big County") in 1974-75. In the ER, it was routine to give repeaters with no obvious source of pain (visits weekly, no other doctor) OBECALP BLACK. These were humongous (about 1" long x 0.5" diameter) shiny black capsules filled with powdered starch. We'd tell the patient, "These contain the strongest pain med that's legal." Worked more often than not in terms of relieving their pain in the E.R. Till next week...
- smaddox 8y agoIn such instances, giving a placebo definitely seems better than an opiod, but in my opinion, it definitely isn't helping the patient and is likely hurting them by distracting them from the underlying emotional cause. At least when given repeatedly...
- bookofjoe 8y agoIn the majority of those patients, the underlying cause was alcoholism and its myriad complications resulting from a store called Liquor Liquor being located across the street from the hospital.
- 8y ago
- deleted 8y ago[deleted]
- yters 8y agoPlacebos also work when people know they are placebos. No reason to lie to the patient.
- Skrillex 8y agoMy intuition would be that a significant component of the effect is that the patient believes they have been treated. Until we see evidence otherwise, I see no reason to assume that the placebo effect is not weakened by the loss of that component.
- kevinwang 8y agoI agree with your intuition, but I'm guessing the parent was referencing this: https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn...
- BurningFrog 8y ago> is it okay for doctors to lie about placebo treatments if it actually helps? Let's sharpen the question: What if the lie is the treatment? It sounds to me like the 40% who the placebo helps for have a different, mainly mental, problem than the 60% for whom it doesn't.
- apocolyps6 8y agoIt was 40% effective for _both_ groups. Meaning the "actual treatment" might actually be doing nothing.
- BurningFrog 8y agoYeah, I got that. The injection probably did nothing aside from a placebo effect.
- IncRnd 8y ago> It sounds to me like the 40% who the placebo helps for have a different, mainly mental, problem than the 60% for whom it doesn't. It's likelier that the 60% not helped are those who have a different, mainly mental, problem that the 40% for whom it does work. If the cure comes from strength of mind, then it probably isn't correct to say that those with weaker minds and wills are healthier mentally.
- BurningFrog 8y agoAre you saying no fractured bone pain is physically based? That seems overly radical. Then again, I suppose all pain is in the mind at some level.
- IncRnd 8y agoNo, I'm not saying that. My comment doesn't even come close to implying that.
- da_chicken 8y agoNope. Placebos can work even when you know it's a placebo: https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn...
- swyea 8y ago> Is it okay for doctors to lie about placebo treatments if it actually helps? People do this all the time, it's called homeopathy
- 08-15 8y agoAnd it's not okay. It's fraud.
- darpa_escapee 8y agoHomeopathic products cannot make claims about treating or curing diseases.
- golemotron 8y ago> 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. How did he manage not to be sued into oblivion?
- jschwartzi 8y agoProbably because he was making an effort to understand the efficacy of his own treatment which any reasonable person would understand to be the opposite of negligent.
- golemotron 8y agoIf you were a patient who paid for something and didn't get it.. this is malpractice. There's a chance that if you were in the 60% that had no positive effect, you might've had the effect if you had the treatment. A reasonable person would sue, and a reasonable jury would compensate.
- darpa_escapee 8y agoIt reads as if he conducted a study in which he got informed consent from its participants. As is, they were told that they'd either receive an injection with the cement or a placebo injection, and they agreed to participate under those terms.
- golemotron 8y agoHopefully that was the case.
- darpa_escapee 8y agoI'd like to believe the journal he submitted his findings to has a rule about publishing papers that used unethical means to obtain data.
- baddox 8y ago> is it okay for doctors to lie about placebo treatments if it actually helps? Well, if it actually helps, is it a lie? A placebo is something intended to have no therapeutic value, generally for the purpose of testing another treatment. Arguably if you intend something to be the treatment then it isn't a placebo. :)