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I'm halfway through the talk right now (shoutout to Youtube 2x speed). This is fascinating and brilliant, but so frustrating, because there is no way for us to

I'm halfway through the talk right now (shoutout to Youtube 2x speed). This is fascinating and brilliant, but so frustrating, because there is no way for us to ethically use placebos for human benefit. I would love if every doctor I ever saw first treated me with placebo, and only tried something else once placebo treatment was ineffective, but can that ethically be done without me knowing? And if I know, the placebo won't work.

chias 6y ago
> And if I know, the placebo won't work. This is not a given: https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn... https://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo https://www.npr.org/sections/health-shots/2016/10/27/4994752...
- ngngngng 6y ago
  Well, this is life changing information. Thanks for it. I have knee pain when running with no physical explanation (MRI found nothing) I'm sure a placebic treatment would be helpful, but can I treat myself with a placebo? I wonder if an authority figure giving you an open placebo is more effective than me just telling myself that I'm cured, but I'm going to start with the latter.
  - tempestn 6y ago
    I recall reading that the placebo effect tends to be proportional to the perceived degree of intervention. So getting a shot would have more of an effect than taking a pill, and a surgery would have more effect than a shot. Presumably getting something from an authority figure would also do more than whatever you can do yourself, but that doesn't mean the latter would be useless. If you can find some kind of physio exercise that's claimed to potentially help, maybe that would have a decent placebo effect, if nothing else? Of course it's likely there is some kind of physical explanation for your pain, just not a known one (or even knowable, with current medicine). I'm in much the same situation with hip pain.
  - harry8 6y ago
    Just pick an "alternative" treatment that is (a) harmless and (b) you consider "could possibly work" For running pain in a knee someone I know had a course of laser accupuncture [1] with really good success. There's nothing scientific about the treatement, no studies, no data. But it is at worst harmless so, we probably don't need to care. I can see "I'm aware it might be just a placebo" as working better than "This /is/ just a placebo" [1] My undertanding of this was that a general practioner (Doctor) shined a low power laser at close quarters on various parts of the knee. Zero chance of burning, completely harmless at worst.
  - elil17 6y ago
    Perhaps instead of a placebo, try a healing ritual or some form of alternative medicine. You can easily have someone else administer the treatment, and you can even choose something like acupuncture where there is potentially some evidence that it actually works (I don't believe it but if you can convince yourself, all the better for the placebo effect).
  - sushisource 6y ago
    MRI isn't necessarily going to reveal reasons you'd have knee pain while running. For example, I know for a fact that if I don't routinely roll out my IT band, it gets too tight and that then results in pressure on the outer portion of the patella. It's rather unlikely that'd show up on an MRI, except perhaps for someone noticing "Hey, maybe your IT band is tight". Even then, probably not, since it tightens as I begin running. So, there's probably something real going on, and something real you can do to fix it. Consistent stretching, rolling, and low-weight exercises to build strength in muscles like your hip abductors makes a world of difference. If you're not doing those things, start there. Really do get a roller. The IT band cannot be stretched - since you can't exactly flex your femur.
  - masklinn 6y ago
    > I have knee pain when running with no physical explanation (MRI found nothing) That MRI found nothing only means there isn't clear damage no? Would it find e.g. short or tight tendons, or unbalanced muscle mass? > can I treat myself with a placebo? Nothing stops your from trying. You can just get some inactive pills (I don't know if it's possible to find excipients-only pills which would be the ideal but homeopathic crap or some innocuous supplements would do the trick) and take that on the regular as "treatment".
- fooblat 6y ago
  Dr. Ted J. Kaptchuk is has been at this a long time. His agenda is pushing so-called alternative medicine. When you dig in just a little and do some research on him you will find a lot of reasons to question his assertions. In his studies, it is true that he tells people he is giving them a placebo. He also tells them that it can still help them. This is not really an "open label" placebo as people still have the expectation that it is some kind of treatment and will help. I also find it interesting that the placebo effect only helps with subjective conditions, such as pain and nausea. No placebo will set a broken bone or seal a laceration.
andai 6y ago
Well, there's always the DIY approach: positive thinking. (But it only works if you believe it will.)
- NoodleIncident 6y ago
  There was a pretty serious-sounding contingent of commenters here in a recent thread about RSI. To them, the main cause of RSI was some sort of unconscious tension they were holding in the affected areas, and they needed to relax to make the pain go away. I wonder if that was placebo too
- tstrimple 6y ago
  Placebo effect works even if 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...
podiki 6y ago
I believe the placebo effect can also work just by telling someone about it (and then giving them the sugar pill or whatever). However, the whole placebo effect may just be (poor understanding of) statistics, namely regression to the mean. Here's an article [0] (found via Wikipedia on placebo [1]) [0] https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2004.01355.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.... [1] https://en.wikipedia.org/wiki/Placebo#Confounding_factors https://en.wikipedia.org/wiki/Placebo#Confounding_factors
epmaybe 6y ago
I thought placebos work even with open labels?
ummonk 6y ago
A lot of placebo effects still show up when the patient knows they're getting placebos. It probably has some ritualistic advantage in helping them mentally.

chias 6y ago

> And if I know, the placebo won't work. This is not a given: https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn... https://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo https://www.npr.org/sections/health-shots/2016/10/27/4994752...

ngngngng 6y ago
Well, this is life changing information. Thanks for it. I have knee pain when running with no physical explanation (MRI found nothing) I'm sure a placebic treatment would be helpful, but can I treat myself with a placebo? I wonder if an authority figure giving you an open placebo is more effective than me just telling myself that I'm cured, but I'm going to start with the latter.
- tempestn 6y ago
  I recall reading that the placebo effect tends to be proportional to the perceived degree of intervention. So getting a shot would have more of an effect than taking a pill, and a surgery would have more effect than a shot. Presumably getting something from an authority figure would also do more than whatever you can do yourself, but that doesn't mean the latter would be useless. If you can find some kind of physio exercise that's claimed to potentially help, maybe that would have a decent placebo effect, if nothing else? Of course it's likely there is some kind of physical explanation for your pain, just not a known one (or even knowable, with current medicine). I'm in much the same situation with hip pain.
- harry8 6y ago
  Just pick an "alternative" treatment that is (a) harmless and (b) you consider "could possibly work" For running pain in a knee someone I know had a course of laser accupuncture [1] with really good success. There's nothing scientific about the treatement, no studies, no data. But it is at worst harmless so, we probably don't need to care. I can see "I'm aware it might be just a placebo" as working better than "This /is/ just a placebo" [1] My undertanding of this was that a general practioner (Doctor) shined a low power laser at close quarters on various parts of the knee. Zero chance of burning, completely harmless at worst.
- elil17 6y ago
  Perhaps instead of a placebo, try a healing ritual or some form of alternative medicine. You can easily have someone else administer the treatment, and you can even choose something like acupuncture where there is potentially some evidence that it actually works (I don't believe it but if you can convince yourself, all the better for the placebo effect).
- sushisource 6y ago
  MRI isn't necessarily going to reveal reasons you'd have knee pain while running. For example, I know for a fact that if I don't routinely roll out my IT band, it gets too tight and that then results in pressure on the outer portion of the patella. It's rather unlikely that'd show up on an MRI, except perhaps for someone noticing "Hey, maybe your IT band is tight". Even then, probably not, since it tightens as I begin running. So, there's probably something real going on, and something real you can do to fix it. Consistent stretching, rolling, and low-weight exercises to build strength in muscles like your hip abductors makes a world of difference. If you're not doing those things, start there. Really do get a roller. The IT band cannot be stretched - since you can't exactly flex your femur.
- masklinn 6y ago
  > I have knee pain when running with no physical explanation (MRI found nothing) That MRI found nothing only means there isn't clear damage no? Would it find e.g. short or tight tendons, or unbalanced muscle mass? > can I treat myself with a placebo? Nothing stops your from trying. You can just get some inactive pills (I don't know if it's possible to find excipients-only pills which would be the ideal but homeopathic crap or some innocuous supplements would do the trick) and take that on the regular as "treatment".
fooblat 6y ago
Dr. Ted J. Kaptchuk is has been at this a long time. His agenda is pushing so-called alternative medicine. When you dig in just a little and do some research on him you will find a lot of reasons to question his assertions. In his studies, it is true that he tells people he is giving them a placebo. He also tells them that it can still help them. This is not really an "open label" placebo as people still have the expectation that it is some kind of treatment and will help. I also find it interesting that the placebo effect only helps with subjective conditions, such as pain and nausea. No placebo will set a broken bone or seal a laceration.

andai 6y ago

Well, there's always the DIY approach: positive thinking. (But it only works if you believe it will.)

NoodleIncident 6y ago
There was a pretty serious-sounding contingent of commenters here in a recent thread about RSI. To them, the main cause of RSI was some sort of unconscious tension they were holding in the affected areas, and they needed to relax to make the pain go away. I wonder if that was placebo too
tstrimple 6y ago
Placebo effect works even if 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...

podiki 6y ago

I believe the placebo effect can also work just by telling someone about it (and then giving them the sugar pill or whatever). However, the whole placebo effect may just be (poor understanding of) statistics, namely regression to the mean. Here's an article [0] (found via Wikipedia on placebo [1]) [0] https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2004.01355.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.... [1] https://en.wikipedia.org/wiki/Placebo#Confounding_factors https://en.wikipedia.org/wiki/Placebo#Confounding_factors

epmaybe 6y ago

I thought placebos work even with open labels?

ummonk 6y ago

A lot of placebo effects still show up when the patient knows they're getting placebos. It probably has some ritualistic advantage in helping them mentally.