4 ms·

> 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

> 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 ago
  There 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 ago
    Not saying it does not work. I am saying the effect is probably less.
    - crummy 8y ago
      I 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 ago
        Perhaps that serves to emphasise just how little we actually understand it.
- disgruntledphd2 8y ago
  So, it seems to be based on expectancies. The double-blind setup (while really useful in disentangling drug vs treament (i.e. placebo) effects), seems to reduce expectancies. See for example, this paper: https://www.sciencedirect.com/science/article/pii/S0304395901002962 https://www.sciencedirect.com/science/article/pii/S030439590... The tl;dr is that if you lie to people about their treatment, they get better than those who get told they may or may not receive placebo. Additionally, if you administer naloxone to people in pain trials, it appears to reduce the placebo effect, which suggests that the effect is mediated by endogenous opioids. (Except in IBS for some reason). Finally, if you tell dentists that they may be administering placebo analgesics to their participants, the participants report significantly higher pain during dental treatment (even though all participants got an active drug). So, to sum up, its pretty complicated, but the practical takeaway is that you should try to have faith in medical treatments if you want to get better.
  - vanderZwan 8y ago
    > Finally, if you tell dentists that they may be administering placebo analgesics to their participants, the participants report significantly higher pain during dental treatment (even though all participants got an active drug). Interesting, I had never considered that as a thing to research! But I can imagine it working like a placebo-equivalent of reverse-psychology.
  - pbhjpbhj 8y ago
    Do you have a reference for the dentist situation, fascinating result.
    - disgruntledphd2 8y ago
      There you go: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(85)90984-5/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
      - tome 8y ago
        Are you sure your interpretation is correct? You said > if you tell dentists that they may be administering placebo analgesics to their participants, the participants report significantly higher pain during dental treatment (even though all participants got an active drug) whereas the study seems to claim > if you tell dentists that they may be administering an antagonist to their participants, the participants report significantly higher pain during dental treatment (even though all participants got a placebo) The latter seems much more believable to me. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=%22CLINICIANS%27+EXPECTATIONS+INFLUENCE+PLACEBO+ANALGESIA%22&btnG= https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=%22C... https://books.google.com/books?hl=en&lr=&id=8UMDAAAAQBAJ&oi=fnd&pg=PA115&dq=%22CLINICIANS%27+EXPECTATIONS+INFLUENCE+PLACEBO+ANALGESIA%22&ots=x8HDStcxkE&sig=ah4wjmSIsFJNepka0RYNJZZSyEE#v=onepage&q=%22CLINICIANS'%20EXPECTATIONS%20INFLUENCE%20PLACEBO%20ANALGESIA%22&f=false https://books.google.com/books?hl=en&lr=&id=8UMDAAAAQBAJ&oi=...
- vanderZwan 8y ago
  I agree that it is counter-intuitive, but I am not making this up! On top of what jsk13 mentioned, the NYT article itself mentions: > You don’t even have to deceive the patients. You can hand a patient with irritable bowel syndrome a sugar pill, identify it as such and tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention.

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 ago
There 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 ago
  Not saying it does not work. I am saying the effect is probably less.
  - crummy 8y ago
    I 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 ago
      Perhaps that serves to emphasise just how little we actually understand it.
disgruntledphd2 8y ago
So, it seems to be based on expectancies. The double-blind setup (while really useful in disentangling drug vs treament (i.e. placebo) effects), seems to reduce expectancies. See for example, this paper: https://www.sciencedirect.com/science/article/pii/S0304395901002962 https://www.sciencedirect.com/science/article/pii/S030439590... The tl;dr is that if you lie to people about their treatment, they get better than those who get told they may or may not receive placebo. Additionally, if you administer naloxone to people in pain trials, it appears to reduce the placebo effect, which suggests that the effect is mediated by endogenous opioids. (Except in IBS for some reason). Finally, if you tell dentists that they may be administering placebo analgesics to their participants, the participants report significantly higher pain during dental treatment (even though all participants got an active drug). So, to sum up, its pretty complicated, but the practical takeaway is that you should try to have faith in medical treatments if you want to get better.
- vanderZwan 8y ago
  > Finally, if you tell dentists that they may be administering placebo analgesics to their participants, the participants report significantly higher pain during dental treatment (even though all participants got an active drug). Interesting, I had never considered that as a thing to research! But I can imagine it working like a placebo-equivalent of reverse-psychology.
- pbhjpbhj 8y ago
  Do you have a reference for the dentist situation, fascinating result.
  - disgruntledphd2 8y ago
    There you go: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(85)90984-5/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
    - tome 8y ago
      Are you sure your interpretation is correct? You said > if you tell dentists that they may be administering placebo analgesics to their participants, the participants report significantly higher pain during dental treatment (even though all participants got an active drug) whereas the study seems to claim > if you tell dentists that they may be administering an antagonist to their participants, the participants report significantly higher pain during dental treatment (even though all participants got a placebo) The latter seems much more believable to me. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=%22CLINICIANS%27+EXPECTATIONS+INFLUENCE+PLACEBO+ANALGESIA%22&btnG= https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=%22C... https://books.google.com/books?hl=en&lr=&id=8UMDAAAAQBAJ&oi=fnd&pg=PA115&dq=%22CLINICIANS%27+EXPECTATIONS+INFLUENCE+PLACEBO+ANALGESIA%22&ots=x8HDStcxkE&sig=ah4wjmSIsFJNepka0RYNJZZSyEE#v=onepage&q=%22CLINICIANS'%20EXPECTATIONS%20INFLUENCE%20PLACEBO%20ANALGESIA%22&f=false https://books.google.com/books?hl=en&lr=&id=8UMDAAAAQBAJ&oi=...
vanderZwan 8y ago
I agree that it is counter-intuitive, but I am not making this up! On top of what jsk13 mentioned, the NYT article itself mentions: > You don’t even have to deceive the patients. You can hand a patient with irritable bowel syndrome a sugar pill, identify it as such and tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention.