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I feel like the placebo effect is greatly underappreciated. It shouldn't just be viewed as an annoying confound for drug efficacy studies, but rather as a fasci

by User23 5y ago

I feel like the placebo effect is greatly underappreciated. It shouldn't just be viewed as an annoying confound for drug efficacy studies, but rather as a fascinating observation about human nature. How is it exactly that mere expectation can bring about physiological changes? Isn't that a subject worthy of research in and of itself?

malwarebytess 5y ago
It's no secret that there's a connection between emotional states and body chemistry (neurochemistry included.) I suggest it's a two way street of communication, maybe in the manner of a feedback loop. Why shouldn't thoughts influence the body? If the body can cause thoughts, then surely it could go both ways such that thoughts effect changes in the body. Because of course thoughts are a bodily process. It seems to me that dualism is in error and consequently has done marked damaged to our understanding of ourselves. Thoughts are not non-physical and neither are the mind & body distinct or separable.
- deleted 5y ago
  [deleted]
- text70 5y ago
  I failed a philosophy college course because I expressed these same views in light of Decartes.
Nursie 5y ago
What makes you think nobody has researched it? AFAICT there's quite a lot of study on the phenomenon, and it's a lot more complex than just expectation bringing about physiological change. Some portion of it is likely action of the immune system, general "regression to the mean" effects, and some of it is that patients who are receiving treatment are likely to report milder symtoms and less pain (so there may not always be a physiological change, just a psychological one). Either way, I don't think you can count the placebo effect as a medical miracle waiting to be exploited, or as something that medical science just ignores.
robbedpeter 5y ago
Wim Hof and his breath training seem to correlate with many of the same effects as placebo, meaning he's able to consciously trigger normally autonomic systems in his body that are thought responsible for many of the positive results attributed to placebo. https://www.smithsonianmag.com/science-nature/science-explains-how-iceman-resists-extreme-cold-180969134/ https://www.smithsonianmag.com/science-nature/science-explai... It makes sense that triggering different systems in the body could result in medical benefit. The science of placebo effect is very active, but runs into fundamental issues of neuroscience pretty quickly. Science needs to figure out how brains work before we unlock the secrets of the placebo effect.
lambdaba 5y ago
Years ago, while I was in a pretty bad place, after a period of insomnia and one particularly bad night, I woke up with what I thought was chest pain. At the time, I had been worried about heart problems for a while, totally unjustified (young and no risk factors), simply based on stories I read of young people sometimes having heart attacks. I didn't seek help at first but as I was concentrating obsessively on my heart region and the sensations, the perceived pain grew stronger and stronger, until I persuaded myself I was having a heart attack and called an ambulance. I thought I would die before reaching the hospital, regretting that I didn't call earlier. They did a whole battery of tests, found nothing. Gave me 0.25mg Xanax, doctor asked if I was having stress at work (I was), and then I learned people can absolutely get realistic pains just from their mind alone. It's not a stretch to understand that if you consistently imagine such issues the stress hormones and other biochemical changes caused by such sensations will create actual damage in the organs.
- Madmallard 5y ago
  Subjective symptoms can be affected by placebo. Chemical data from the body isn't really.
  - lambdaba 5y ago
    Subjective symptoms can modulate biochemistry and that affects the body. See voodoo curses.
    - Madmallard 5y ago
      The way subjective symptoms modulate biochemistry is generally quite benign and rapidly reversible unless you have a severe underlying condition.
      - deleted 5y ago
        [deleted]
alecst 5y ago
A lot of people study it. I’m blanking on exactly the book, but Robert Sapolsky writes quite a bit about it. Might be in Why Zebras Don’t Get Ulcers. IIRC there are different kinds of placebo effects. One of the most robust is pain relief. I think Sapolsky makes the case that endorphins (“endogenous morphines”) do some of the leg work here, but that’s probably not the whole story.
tsimionescu 5y ago
It's important to remember that the placebo effect only exists in a few specific symptoms that are known to have an important psychological component - pain, blood pressure, anxiety, nausea etc. In these cases, placebo interventions have a measurable positive effect (or negative, for nocebo) compared to no intervention. But in the vast majority of other illnesses, placebo is exclusively a confounding factor. People's bones don't fuse from sham surgery. Sugar pills don't cure malaria or TB. Placebo chemotherapy doesn't kill cancer cells. The placebo effect does exist in these cases as well if not using double-blind trials, or if conducting patient subjective assessments, but it disappears if lab techs and objectively measurable data are investigated (things like viral load, not patient perception of their symptoms).
- db48x 5y ago
  This is the key. The placebo effect only works for subjective measurements that the patient has to report qualitatively. A placebo asthma treatment will cause patients to report that their breathing has improved, but it won’t change how much air is actually going into and out of their lungs. This makes it useless for most things. Maybe it’s ok for pain, since pain is purely perceptual anyway, but for anything else it’s just going to cost people money without actually helping them.
  - tsimionescu 5y ago
    There's a little more than pain - anxiety is another example where just having something to take can help immensely. But yes, in general placebo is greatly over-hyped and oversold with much influence from people who believe in 'healing energy' and mind-over-body practices and such.
    - db48x 5y ago
      That’s a good point. For pain and anxiety and other mental states it’s probably ok to give someone a placebo if it convinces them to change the state of their own mind, provided they have asked for the change.
seanhunter 5y ago
A really important element of this I think is neuroplasticity (the brain's ability to rewire itself) and I feel that the placebo effect along with other psychosomatic effects is an important part of that. If you read "The Brain that Changes itself" for example, there's a lot of info into studies of visualisation as a treatment for chronic pain. The short summary is that there is a lot of research into people for whom normal pain treatments have been exhausted getting some relief from using visualisations to essentially reinforce other neural pathways so the pain circuits in the brain are not triggered as much. Some of this research is referenced in the book.

by User23 5y ago

malwarebytess 5y ago

It's no secret that there's a connection between emotional states and body chemistry (neurochemistry included.) I suggest it's a two way street of communication, maybe in the manner of a feedback loop. Why shouldn't thoughts influence the body? If the body can cause thoughts, then surely it could go both ways such that thoughts effect changes in the body. Because of course thoughts are a bodily process. It seems to me that dualism is in error and consequently has done marked damaged to our understanding of ourselves. Thoughts are not non-physical and neither are the mind & body distinct or separable.

deleted 5y ago
[deleted]
text70 5y ago
I failed a philosophy college course because I expressed these same views in light of Decartes.

Nursie 5y ago

What makes you think nobody has researched it? AFAICT there's quite a lot of study on the phenomenon, and it's a lot more complex than just expectation bringing about physiological change. Some portion of it is likely action of the immune system, general "regression to the mean" effects, and some of it is that patients who are receiving treatment are likely to report milder symtoms and less pain (so there may not always be a physiological change, just a psychological one). Either way, I don't think you can count the placebo effect as a medical miracle waiting to be exploited, or as something that medical science just ignores.

robbedpeter 5y ago

Wim Hof and his breath training seem to correlate with many of the same effects as placebo, meaning he's able to consciously trigger normally autonomic systems in his body that are thought responsible for many of the positive results attributed to placebo. https://www.smithsonianmag.com/science-nature/science-explains-how-iceman-resists-extreme-cold-180969134/ https://www.smithsonianmag.com/science-nature/science-explai... It makes sense that triggering different systems in the body could result in medical benefit. The science of placebo effect is very active, but runs into fundamental issues of neuroscience pretty quickly. Science needs to figure out how brains work before we unlock the secrets of the placebo effect.

lambdaba 5y ago

Years ago, while I was in a pretty bad place, after a period of insomnia and one particularly bad night, I woke up with what I thought was chest pain. At the time, I had been worried about heart problems for a while, totally unjustified (young and no risk factors), simply based on stories I read of young people sometimes having heart attacks. I didn't seek help at first but as I was concentrating obsessively on my heart region and the sensations, the perceived pain grew stronger and stronger, until I persuaded myself I was having a heart attack and called an ambulance. I thought I would die before reaching the hospital, regretting that I didn't call earlier. They did a whole battery of tests, found nothing. Gave me 0.25mg Xanax, doctor asked if I was having stress at work (I was), and then I learned people can absolutely get realistic pains just from their mind alone. It's not a stretch to understand that if you consistently imagine such issues the stress hormones and other biochemical changes caused by such sensations will create actual damage in the organs.

Madmallard 5y ago
Subjective symptoms can be affected by placebo. Chemical data from the body isn't really.
- lambdaba 5y ago
  Subjective symptoms can modulate biochemistry and that affects the body. See voodoo curses.
  - Madmallard 5y ago
    The way subjective symptoms modulate biochemistry is generally quite benign and rapidly reversible unless you have a severe underlying condition.
    - deleted 5y ago
      [deleted]

alecst 5y ago

A lot of people study it. I’m blanking on exactly the book, but Robert Sapolsky writes quite a bit about it. Might be in Why Zebras Don’t Get Ulcers. IIRC there are different kinds of placebo effects. One of the most robust is pain relief. I think Sapolsky makes the case that endorphins (“endogenous morphines”) do some of the leg work here, but that’s probably not the whole story.

tsimionescu 5y ago

It's important to remember that the placebo effect only exists in a few specific symptoms that are known to have an important psychological component - pain, blood pressure, anxiety, nausea etc. In these cases, placebo interventions have a measurable positive effect (or negative, for nocebo) compared to no intervention. But in the vast majority of other illnesses, placebo is exclusively a confounding factor. People's bones don't fuse from sham surgery. Sugar pills don't cure malaria or TB. Placebo chemotherapy doesn't kill cancer cells. The placebo effect does exist in these cases as well if not using double-blind trials, or if conducting patient subjective assessments, but it disappears if lab techs and objectively measurable data are investigated (things like viral load, not patient perception of their symptoms).

db48x 5y ago
This is the key. The placebo effect only works for subjective measurements that the patient has to report qualitatively. A placebo asthma treatment will cause patients to report that their breathing has improved, but it won’t change how much air is actually going into and out of their lungs. This makes it useless for most things. Maybe it’s ok for pain, since pain is purely perceptual anyway, but for anything else it’s just going to cost people money without actually helping them.
- tsimionescu 5y ago
  There's a little more than pain - anxiety is another example where just having something to take can help immensely. But yes, in general placebo is greatly over-hyped and oversold with much influence from people who believe in 'healing energy' and mind-over-body practices and such.
  - db48x 5y ago
    That’s a good point. For pain and anxiety and other mental states it’s probably ok to give someone a placebo if it convinces them to change the state of their own mind, provided they have asked for the change.

seanhunter 5y ago

A really important element of this I think is neuroplasticity (the brain's ability to rewire itself) and I feel that the placebo effect along with other psychosomatic effects is an important part of that. If you read "The Brain that Changes itself" for example, there's a lot of info into studies of visualisation as a treatment for chronic pain. The short summary is that there is a lot of research into people for whom normal pain treatments have been exhausted getting some relief from using visualisations to essentially reinforce other neural pathways so the pain circuits in the brain are not triggered as much. Some of this research is referenced in the book.