6 ms·

All Placebos are not created equal

65 points by hirundo 5y ago

aradox66 5y ago
This is what drives me crazy about people who dismiss alternative therapies as placebo and therefore worthless. There's something mich more interesting going on, and studies on the placebo effect have barely scratched the surface regarding the range of placebo effects and what can modulate the strength of those effects.
- Spooky23 5y ago
  My mom was an advocate of therapeutic touch, which was taught in nursing schools and was reportedly effective in hospital settings. Is there something to it? I don’t know, but nobody really does as real trials aren’t financially practical.
  - User23 5y ago
    I don't know if there is or not, but if I'm ever dying alone in a hospice and therapeutic manual therapy is offered I assure you I'll take it.
    - Spooky23 5y ago
      Absolutely! The “industry” of healthcare is solely focused on $$$, not care. Case in point: hundreds or thousands of people died from COVID-19 because hospital protocols didn’t accommodate rolling patients. Think about that - beyond the covid tragedy, how many sick people are suffering from pressure sores for want of aides to perform basic care protocols. It’s gross… the president of the local hospital chain here was whining on TV about the lack of nurses. He makes $15M/year and cut nurse salaries by 25% in 2019.
  - eyelidlessness 5y ago
    The vast majority of people have at least some positive emotional response to kind, attentive physical touch. It’s important to acknowledge that there are people who don’t and for them it’s detrimental (I am one of both depending on circumstances). Even if there isn’t a clinical trial that specifically validates it, I think it’s a reasonable assumption that kind and attentive communication (to determine welcomeness of touch) and kind attentive touch can benefit most patients.
  - aradox66 5y ago
    I'm sure it's beneficial, I know there's a ton of studies on the importance of touch for infant health in particular.
- dsizzle 5y ago
  So are you advocating taking alternative therapies more seriously as advanced placebos or something? Do you question whether it’s important to distinguish between the placebo and a “real” effect?
  - aradox66 5y ago
    I do think the distinction is important, but I'd hope for a more precise terminology than "real" vs "fake" effects. "psychosomatic" is okay but has some similar baggage. There should be a thorough technical vocabulary for "placebo" effects. Currently the biological mechanisms aren't even understood for many of the effects.
    - darkerside 5y ago
      Yeah, I think it's a cultural and systemic issue, not a vocabulary issue. Similar to how words like crippled and retarded became slurs. The problem is not the word, it's that we have cultural connotations associated with these conditions, no matter what name we call it by.
    - dsizzle 5y ago
      I'm all for more precise terminology, and yes "real" would not be that terminology. As far as distinguishing mechanisms, for any drug that doesn't have a perceptible side effect (drowsiness, euphoria, numbness, etc), it seems the only assumption required is that the effect is due to some chemical property. That doesn't require much understanding to make a meaningful distinction.
- GuB-42 5y ago
  One thing I've seen about alternative therapies that work better than "mainstream" medicine simply has to do with a therapist who actually cares about his patients, and at the same time, suggests positive lifestyle changes. The same effect could be achieved by skipping the magic rituals and by replacing the therapist by a doctor, problem is: we don't have enough doctors! As a result, doctor appointments are rushed. A 10 minute diagnostic, get your prescription, take your medicine, next patient. No time to discuss how your life is going, how you eat, how you sleep, the kind of exercise you are doing, make suggestions, etc... Homeopathy is one of the best example. The sugar pills don't matter. What matters is that you are supposed to spend a lot of time with your homeopath so that he can find the right treatment for you, good practice also require an impeccable lifestyle. Hahnemann, the father of homeopathy recommended rest, a good diet, good hygiene, sunshine and fresh air. Yep, by telling you to open the windows, homeopathy can prevent covid!
  - eyelidlessness 5y ago
    > The same effect could be achieved by skipping the magic rituals and by replacing the therapist by a doctor This is not in evidence and deserves a supporting case.
    - GuB-42 5y ago
      Here is my source (in french): https://lepharmachien.com/reiki/ https://lepharmachien.com/reiki/ It is linked to the study here: https://pubmed.ncbi.nlm.nih.gov/21531671/ https://pubmed.ncbi.nlm.nih.gov/21531671/ This is a bit of an extrapolation from the study. The study just says that real reiki and sham reiki (placebo) work just as well at improving cancer patients comfort, and are better than doing nothing. Now if there is an actual study that compares the efficacy of typical "rushed" care vs a more "holistic" approach by doctors vs alternative therapies, I would be very interested.
      - darkerside 5y ago
        I don't know what Reiki is, but maybe it's actually just really easy to learn, and the people who happened to name it don't have a monopoly on the behaviors that it consists of.
- eyelidlessness 5y ago
  I agree the effectiveness of placebo shouldn’t be so readily dismissed. I also think it would be good, for a lot of patients for a lot of diagnostics, to treat somatic symptoms as real. They are real, at least for the person experiencing them, but often objectively too.
- Nursie 5y ago
  > There's something mich more interesting going on But at that point, it's not the therapy itself that's doing it, so we're right to dismiss them as worthless. Do these pills work? No, we couldn't separate their effects from placebo, so there is nothing about these pills that work. Should we investigate placebo effects? Sure, definitely, they are interesting. Doesn't mean that the alt-med added anything to any picture though.
mikotodomo 5y ago
When I received my second COVID-19 shot, I felt nauseous for days. The person who administered it was a lot older than the first. Normally I am very strong so it was weird that I felt anything. I feel like this placebo effect is exactly what was the difference for me, now that you mention it.
seanwilson 5y ago
On alternative therapy: is the magnitude and actual relief from the placebo effect (e.g. how much pain relief are we really talking here) more important than the damage it causes by promoting unscientific thinking (e.g. which gives rise to avoiding vaccinations or avoiding chemotherapy that directly leads to deaths)? What's the most impressive placebo effect and its limits? Can it cure cancer? Fix broken bones? Give you virus immunity? Is it mostly a bit of pain relief we're talking about? Can we take advantage of this effect without having to wrap it with all the unscientific thinking and pseudoscience that comes with alternative therapy? Whenever I read people defending alternative medicine and how powerful the placebo effect is, I don't think e.g. a little bit of pain relief is good enough to justify billion dollar industries that are allowed to sell products where they can't prove they work more than a placebo. This is as close as you can get to saying it's been proven these medicines do not work and yet they're still allowed to sell them. You can't confuse the public like this and be surprised when they won't listen to the science behind masks and vaccines.
- aradox66 5y ago
  That kind of consideration should not influence medical empirics or practice. If placebo is a real phenomenon, it needs to be understood.
  - idontwantthis 5y ago
    If we understood it, could we create a Placebo Effect Inducing pill that is stronger than an actual Placebo?
    - aradox66 5y ago
      If we understood why some placebo effects are stronger than others, than yeah it stands to reason that we could utilize that knowledge to make stronger placebos.
- SuoDuanDao 5y ago
  >Can we take advantage of this effect without having to wrap it with all the unscientific thinking and pseudoscience that comes with alternative therapy? New thought is probably an attempt to do that, one could say it seeks to isolate pure belief and apply it to problems directly. Not sure if you'd call it unscientific or very scientific.
Vecr 5y ago
To the dead comment talking about the second Pfizer dose, it's nothing to do with placebo, it's because the first dose induced memory in the cell-mediated immune systems. You can feel the aggressive cytokine, killer T-cell, and interferon response. If I remember correctly, they are most of the cause of people "feeling sick" during (and after, in the case of a cytokine storm) a viral infection.
- deleted 5y ago
  [deleted]
- johnisgood 5y ago
  He is feeling nauseous because of this response you are talking about? You mention that a viral infection causes it. Can you elaborate on this? He got the second Pfizer dose. What does it have to do with viral infection?
  - ncmncm 5y ago
    He mentioned no "viral infection". He mentioned an immune system response. Feelings of nausea are, exactly, an immune system response.
hellbannedguy 5y ago
"This study makes the point clearly - by 2013, drugs produced 8.9% more pain relief than placebos, compared to 27.3% in 1996. In the charts above, it can be seen that the effect of placebo drugs has increased a lot, whereas the effectiveness of pain relief drugs has barely changed, meaning that the treatment advantage (the effectiveness of active drugs as opposed to placebos) has fallen dramatically. Weirdly, it seems like this is only happening in the United States, whereas other countries haven’t seen particularly large increases in the effect size of placebos." Forever, Pharmaceutical companies were cherry picking studies that proved their drug worked better than Placebo. Drug companies are notorious for dropping a study that didn't show their drug in a positive light, and including a better study. A Psychologist (Irving Kirsch--I belive?) started to wonder if antidepressants actually work, after seeing so much treatment failure. I belive he took them for awhile. He decided to look into the drug studies, but included All the studies. He used the Freedom of Information Act to get the all the drug studies from the government. Not just the cherry picked ones. He found that antidepressants don't work better than placebo. When the drug companies, and Psychiatrists, heard about his work they got nervous. A psychiatrists bread and butter is dolling out these drugs at $450 office visits. Well--he upset the boys. He even concluded with his research that drugs might make depression worse in some patients. This was a decade ago I believe. Current studies are a tiny bit more positive in terms of antidepressant drugs that might work in some people. (I was interested in this research because I probally tried 8 antidepressants over the years, and felt just worse. I just couldn't understand it. I felt terrible, but the drugs did absolutely nothing besides making by noodle soft. Actually could orgasm, or it took circus help. I still have a ex-girlfriend who thought it was her. I told her everytime it's the meds, and not you. I'm to tired to hunt down his study, but one of you can. My point is two fold. 1. Drug companies play with stastistics, and even studies (dropping a study because it didn't pan out is wrong). 2. I have a weird feeling Pharmacutical lawyers have been telling those executives to be more ethical over the years in order to thwart off lawsuits. I feel certain drugs, even the older drugs, might not work as well as we think. We just trusted drug companies up until lately. ihttps://en.m.wikipedia.org/wiki/Irving_Kirsch https://en.m.wikipedia.org/wiki/Irving_Kirsch
boomboomsubban 5y ago
This article seems to forget that all the placebo effects should be visible in the responses to the actual medicine. You see a stronger placebo effect from a shot, so both the placebo shot and the medicinal shot's results should have a similar amount of people relieved just by getting such a shot. I assume medicinal studies require the same kind of dose and administration already.
- its_bbq 5y ago
  This is why they talk about improvement over placebo
eyelidlessness 5y ago
The differences in effect were so intuitive I’d either already assumed them or they came to me before reading each respective outcome. Which I’d attribute to thinking a lot about what contributes to a placebo effect before reading this (which is good for my critical thinking, but bad for my capacity to benefit from good bedside manner, perceived competence, etc). What surprised me was I hadn’t thought at all about how this systemically affects care, i.e. treatment approval for lower effectiveness relative to placebo (bad for my critical thinking!). What wouldn’t have ever crossed my mind in a million years is the possibility that there could be some bias in favor of those social factors in the US medical system. In my experience, the people serving the most vulnerable and unable to access care have exceptionally poor bedside manner and appear exceptionally incompetent; it’s probably through no fault of their own, they’re likely overworked and seriously under-resourced. But I would have expected that to show the US as less responsive to the placebo effect, not more. (I’m assuming there are substituted placebo false positives which stand in for attentive medical care in these scenarios, which would very much line up with experiences I’ve had and many of my loved ones have had being pushed antidepressants and pain killers and such for any inconvenient medical issue.)
bambax 5y ago
This is fascinating. The title is incomplete; the most interesting part of the article is that the placebo effect varies not just among placebos, but in time, for the same placebo! > The implications of this are pretty serious - the placebo effect in the United States has actually become quite a lot stronger over time, meaning that drugs that once would have been approved may not be now - because their performance relative to that of placebo is less convincing. The reason why is not explained. It would be good to know more. The other thing that is surprising is that the effect of (effective) drugs doesn't vary over time; one would think the effect of a drug is placebo+drug, i.e. that the effect of the drug is on top that of the placebo, since obviously a drug is also a placebo. And so, if the placebo gets better with time, then the drug should too. But it doesn't seem to be the case.
- darkerside 5y ago
  Maybe I'm underthinking it, but isn't it likely that the duck is actually a duck? We are approving less effective medications than we used to, because pharma companies are better than they used to be at working the system.
  - theurerjohn3 5y ago
    I am not sure thats exactly what the article was saying, picture 3.B [1] seems to show that the placebos themselves are getting stronger over time, both in an absolute sense, and relative to the drugs. Approving less effective medications could definitely explain the improvement placebos relative to drugs, but not the improvement of placebos relative to placebos. I wonder, and as I am kinda young, I am not sure, but since 1990, has the experience of the "Doctors Office" become more standardized? As in, are placebos looking less* like placebos? [1]. https://cdn.substack.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F968f80f1-9d12-4b39-abfc-d024646be652_1384x1056.png https://cdn.substack.com/image/fetch/f_auto,q_auto:good,fl_p... * accidentally wrote more
    - derbOac 5y ago
csee 5y ago
Are these findings all on self report measures?

65 points by hirundo 5y ago

This is what drives me crazy about people who dismiss alternative therapies as placebo and therefore worthless. There's something mich more interesting going on, and studies on the placebo effect have barely scratched the surface regarding the range of placebo effects and what can modulate the strength of those effects.

Spooky23 5y ago
My mom was an advocate of therapeutic touch, which was taught in nursing schools and was reportedly effective in hospital settings. Is there something to it? I don’t know, but nobody really does as real trials aren’t financially practical.
- User23 5y ago
  I don't know if there is or not, but if I'm ever dying alone in a hospice and therapeutic manual therapy is offered I assure you I'll take it.
  - Spooky23 5y ago
    Absolutely! The “industry” of healthcare is solely focused on $$$, not care. Case in point: hundreds or thousands of people died from COVID-19 because hospital protocols didn’t accommodate rolling patients. Think about that - beyond the covid tragedy, how many sick people are suffering from pressure sores for want of aides to perform basic care protocols. It’s gross… the president of the local hospital chain here was whining on TV about the lack of nurses. He makes $15M/year and cut nurse salaries by 25% in 2019.
- eyelidlessness 5y ago
  The vast majority of people have at least some positive emotional response to kind, attentive physical touch. It’s important to acknowledge that there are people who don’t and for them it’s detrimental (I am one of both depending on circumstances). Even if there isn’t a clinical trial that specifically validates it, I think it’s a reasonable assumption that kind and attentive communication (to determine welcomeness of touch) and kind attentive touch can benefit most patients.
- aradox66 5y ago
  I'm sure it's beneficial, I know there's a ton of studies on the importance of touch for infant health in particular.
dsizzle 5y ago
So are you advocating taking alternative therapies more seriously as advanced placebos or something? Do you question whether it’s important to distinguish between the placebo and a “real” effect?
- aradox66 5y ago
  I do think the distinction is important, but I'd hope for a more precise terminology than "real" vs "fake" effects. "psychosomatic" is okay but has some similar baggage. There should be a thorough technical vocabulary for "placebo" effects. Currently the biological mechanisms aren't even understood for many of the effects.
  - darkerside 5y ago
    Yeah, I think it's a cultural and systemic issue, not a vocabulary issue. Similar to how words like crippled and retarded became slurs. The problem is not the word, it's that we have cultural connotations associated with these conditions, no matter what name we call it by.
  - dsizzle 5y ago
    I'm all for more precise terminology, and yes "real" would not be that terminology. As far as distinguishing mechanisms, for any drug that doesn't have a perceptible side effect (drowsiness, euphoria, numbness, etc), it seems the only assumption required is that the effect is due to some chemical property. That doesn't require much understanding to make a meaningful distinction.
GuB-42 5y ago
One thing I've seen about alternative therapies that work better than "mainstream" medicine simply has to do with a therapist who actually cares about his patients, and at the same time, suggests positive lifestyle changes. The same effect could be achieved by skipping the magic rituals and by replacing the therapist by a doctor, problem is: we don't have enough doctors! As a result, doctor appointments are rushed. A 10 minute diagnostic, get your prescription, take your medicine, next patient. No time to discuss how your life is going, how you eat, how you sleep, the kind of exercise you are doing, make suggestions, etc... Homeopathy is one of the best example. The sugar pills don't matter. What matters is that you are supposed to spend a lot of time with your homeopath so that he can find the right treatment for you, good practice also require an impeccable lifestyle. Hahnemann, the father of homeopathy recommended rest, a good diet, good hygiene, sunshine and fresh air. Yep, by telling you to open the windows, homeopathy can prevent covid!
- eyelidlessness 5y ago
  > The same effect could be achieved by skipping the magic rituals and by replacing the therapist by a doctor This is not in evidence and deserves a supporting case.
  - GuB-42 5y ago
    Here is my source (in french): https://lepharmachien.com/reiki/ https://lepharmachien.com/reiki/ It is linked to the study here: https://pubmed.ncbi.nlm.nih.gov/21531671/ https://pubmed.ncbi.nlm.nih.gov/21531671/ This is a bit of an extrapolation from the study. The study just says that real reiki and sham reiki (placebo) work just as well at improving cancer patients comfort, and are better than doing nothing. Now if there is an actual study that compares the efficacy of typical "rushed" care vs a more "holistic" approach by doctors vs alternative therapies, I would be very interested.
    - darkerside 5y ago
      I don't know what Reiki is, but maybe it's actually just really easy to learn, and the people who happened to name it don't have a monopoly on the behaviors that it consists of.
eyelidlessness 5y ago
I agree the effectiveness of placebo shouldn’t be so readily dismissed. I also think it would be good, for a lot of patients for a lot of diagnostics, to treat somatic symptoms as real. They are real, at least for the person experiencing them, but often objectively too.
Nursie 5y ago
> There's something mich more interesting going on But at that point, it's not the therapy itself that's doing it, so we're right to dismiss them as worthless. Do these pills work? No, we couldn't separate their effects from placebo, so there is nothing about these pills that work. Should we investigate placebo effects? Sure, definitely, they are interesting. Doesn't mean that the alt-med added anything to any picture though.

mikotodomo 5y ago

When I received my second COVID-19 shot, I felt nauseous for days. The person who administered it was a lot older than the first. Normally I am very strong so it was weird that I felt anything. I feel like this placebo effect is exactly what was the difference for me, now that you mention it.

seanwilson 5y ago

On alternative therapy: is the magnitude and actual relief from the placebo effect (e.g. how much pain relief are we really talking here) more important than the damage it causes by promoting unscientific thinking (e.g. which gives rise to avoiding vaccinations or avoiding chemotherapy that directly leads to deaths)? What's the most impressive placebo effect and its limits? Can it cure cancer? Fix broken bones? Give you virus immunity? Is it mostly a bit of pain relief we're talking about? Can we take advantage of this effect without having to wrap it with all the unscientific thinking and pseudoscience that comes with alternative therapy? Whenever I read people defending alternative medicine and how powerful the placebo effect is, I don't think e.g. a little bit of pain relief is good enough to justify billion dollar industries that are allowed to sell products where they can't prove they work more than a placebo. This is as close as you can get to saying it's been proven these medicines do not work and yet they're still allowed to sell them. You can't confuse the public like this and be surprised when they won't listen to the science behind masks and vaccines.

aradox66 5y ago
That kind of consideration should not influence medical empirics or practice. If placebo is a real phenomenon, it needs to be understood.
- idontwantthis 5y ago
  If we understood it, could we create a Placebo Effect Inducing pill that is stronger than an actual Placebo?
  - aradox66 5y ago
    If we understood why some placebo effects are stronger than others, than yeah it stands to reason that we could utilize that knowledge to make stronger placebos.
SuoDuanDao 5y ago
>Can we take advantage of this effect without having to wrap it with all the unscientific thinking and pseudoscience that comes with alternative therapy? New thought is probably an attempt to do that, one could say it seeks to isolate pure belief and apply it to problems directly. Not sure if you'd call it unscientific or very scientific.

Vecr 5y ago

To the dead comment talking about the second Pfizer dose, it's nothing to do with placebo, it's because the first dose induced memory in the cell-mediated immune systems. You can feel the aggressive cytokine, killer T-cell, and interferon response. If I remember correctly, they are most of the cause of people "feeling sick" during (and after, in the case of a cytokine storm) a viral infection.

deleted 5y ago
[deleted]
johnisgood 5y ago
He is feeling nauseous because of this response you are talking about? You mention that a viral infection causes it. Can you elaborate on this? He got the second Pfizer dose. What does it have to do with viral infection?
- ncmncm 5y ago
  He mentioned no "viral infection". He mentioned an immune system response. Feelings of nausea are, exactly, an immune system response.

hellbannedguy 5y ago

"This study makes the point clearly - by 2013, drugs produced 8.9% more pain relief than placebos, compared to 27.3% in 1996. In the charts above, it can be seen that the effect of placebo drugs has increased a lot, whereas the effectiveness of pain relief drugs has barely changed, meaning that the treatment advantage (the effectiveness of active drugs as opposed to placebos) has fallen dramatically. Weirdly, it seems like this is only happening in the United States, whereas other countries haven’t seen particularly large increases in the effect size of placebos." Forever, Pharmaceutical companies were cherry picking studies that proved their drug worked better than Placebo. Drug companies are notorious for dropping a study that didn't show their drug in a positive light, and including a better study. A Psychologist (Irving Kirsch--I belive?) started to wonder if antidepressants actually work, after seeing so much treatment failure. I belive he took them for awhile. He decided to look into the drug studies, but included All the studies. He used the Freedom of Information Act to get the all the drug studies from the government. Not just the cherry picked ones. He found that antidepressants don't work better than placebo. When the drug companies, and Psychiatrists, heard about his work they got nervous. A psychiatrists bread and butter is dolling out these drugs at $450 office visits. Well--he upset the boys. He even concluded with his research that drugs might make depression worse in some patients. This was a decade ago I believe. Current studies are a tiny bit more positive in terms of antidepressant drugs that might work in some people. (I was interested in this research because I probally tried 8 antidepressants over the years, and felt just worse. I just couldn't understand it. I felt terrible, but the drugs did absolutely nothing besides making by noodle soft. Actually could orgasm, or it took circus help. I still have a ex-girlfriend who thought it was her. I told her everytime it's the meds, and not you. I'm to tired to hunt down his study, but one of you can. My point is two fold. 1. Drug companies play with stastistics, and even studies (dropping a study because it didn't pan out is wrong). 2. I have a weird feeling Pharmacutical lawyers have been telling those executives to be more ethical over the years in order to thwart off lawsuits. I feel certain drugs, even the older drugs, might not work as well as we think. We just trusted drug companies up until lately. ihttps://en.m.wikipedia.org/wiki/Irving_Kirsch https://en.m.wikipedia.org/wiki/Irving_Kirsch

boomboomsubban 5y ago

This article seems to forget that all the placebo effects should be visible in the responses to the actual medicine. You see a stronger placebo effect from a shot, so both the placebo shot and the medicinal shot's results should have a similar amount of people relieved just by getting such a shot. I assume medicinal studies require the same kind of dose and administration already.

its_bbq 5y ago
This is why they talk about improvement over placebo

eyelidlessness 5y ago

The differences in effect were so intuitive I’d either already assumed them or they came to me before reading each respective outcome. Which I’d attribute to thinking a lot about what contributes to a placebo effect before reading this (which is good for my critical thinking, but bad for my capacity to benefit from good bedside manner, perceived competence, etc). What surprised me was I hadn’t thought at all about how this systemically affects care, i.e. treatment approval for lower effectiveness relative to placebo (bad for my critical thinking!). What wouldn’t have ever crossed my mind in a million years is the possibility that there could be some bias in favor of those social factors in the US medical system. In my experience, the people serving the most vulnerable and unable to access care have exceptionally poor bedside manner and appear exceptionally incompetent; it’s probably through no fault of their own, they’re likely overworked and seriously under-resourced. But I would have expected that to show the US as less responsive to the placebo effect, not more. (I’m assuming there are substituted placebo false positives which stand in for attentive medical care in these scenarios, which would very much line up with experiences I’ve had and many of my loved ones have had being pushed antidepressants and pain killers and such for any inconvenient medical issue.)

bambax 5y ago

This is fascinating. The title is incomplete; the most interesting part of the article is that the placebo effect varies not just among placebos, but in time, for the same placebo! > The implications of this are pretty serious - the placebo effect in the United States has actually become quite a lot stronger over time, meaning that drugs that once would have been approved may not be now - because their performance relative to that of placebo is less convincing. The reason why is not explained. It would be good to know more. The other thing that is surprising is that the effect of (effective) drugs doesn't vary over time; one would think the effect of a drug is placebo+drug, i.e. that the effect of the drug is on top that of the placebo, since obviously a drug is also a placebo. And so, if the placebo gets better with time, then the drug should too. But it doesn't seem to be the case.

darkerside 5y ago
Maybe I'm underthinking it, but isn't it likely that the duck is actually a duck? We are approving less effective medications than we used to, because pharma companies are better than they used to be at working the system.
- theurerjohn3 5y ago
  I am not sure thats exactly what the article was saying, picture 3.B [1] seems to show that the placebos themselves are getting stronger over time, both in an absolute sense, and relative to the drugs. Approving less effective medications could definitely explain the improvement placebos relative to drugs, but not the improvement of placebos relative to placebos. I wonder, and as I am kinda young, I am not sure, but since 1990, has the experience of the "Doctors Office" become more standardized? As in, are placebos looking less* like placebos? [1]. https://cdn.substack.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F968f80f1-9d12-4b39-abfc-d024646be652_1384x1056.png https://cdn.substack.com/image/fetch/f_auto,q_auto:good,fl_p... * accidentally wrote more
  - derbOac 5y ago

csee 5y ago

Are these findings all on self report measures?