7 ms·

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why (2009)

141 points by adammichaelc 15y ago

adammichaelc 15y ago
An oldie but a goodie (it's been posted before). I think this phenomenon is so interesting I was hoping for a fresh discussion on what may cause this.
deleted 15y ago
[deleted]
Alex3917 15y ago
Apparently placebos are now as good as 'real' medications at preventing death across all diseases: http://www.bmj.com/content/333/7557/15.full http://www.bmj.com/content/333/7557/15.full (Or at least all diseases that have had adherence research studying the mortality risk with both drug and placebo therapy.)
- abstractbill 15y ago
  "...adherence to drug therapy may be a surrogate marker for overall healthy behaviour."
  - Alex3917 15y ago
    Which suggests that non-drug interventions are generally better than drug interventions, at least when people actually do them. (Obviously people are much more likely to take a pill than to change their diet, which is part of what makes the research so interesting.) Not surprisingly, many of the diseases with the lowest adherence are the ones where people would benefit the most. Type 2 diabetes is literally a disease of non-adherence, with 98% of patients not following their doctor's recommendations. I've learned a ton from reading through the major adherence research findings over the last couple months, and I think there are a ton of ideas that can be applied to entrepreneurship and web startups especially. DiMatteo actually has a brand new book out on this so you don't even really need to read through all the original journal articles anymore to get the main ideas: http://www.amazon.com/Health-Behavior-Change-Treatment-Adherence/dp/0195380401/ref=sr_1_4?ie=UTF8&qid=1316476206&sr=8-4 http://www.amazon.com/Health-Behavior-Change-Treatment-Adher...
powertower 15y ago
I'd imagine placebos are getting more effective due to more people having purely headspace/mindset (or even imaginative) illnesses/causes due to stress factors. The more it's in your head, the more likely you can cure it with another imaginative treatment... As long as you believe in it. It's the only reasonable explanation. Aside from that, the power of belief can also be a reasonably powerful treatment with a positive response on the body/mind.
- 0x12 15y ago
  Not sure why you got downvoted, it's not my cup of tea but it is as good an explanation as any other until the cause is known.
  - deleted 15y ago
    [deleted]
  - powertower 15y ago
    > Not sure why you got downvoted... Depressed people tend to discount all explanations that start with "it's only in your head." Right or wrong. I'm just pointing it out.
  - tshtf 15y ago
    I downvoted the parent post because before the post was edited, the OP stated he didn't even read the article. If you come here to comment on an article, you should at least try to read it.
  - jambo 15y ago
    The poster edited their comment. It originally started something like "tl;dr no really I didn't read the article" and proceeded with the speculation (and hubris that it's the "only reasonable explanation") that remains at the time of this writing. I downmodded the comment because it's the type of quick, non-substantial response that actually detracts from conversation among those who took the time to read the article and want a real discussion.
- AndrewMoffat 15y ago
jisaacstone 15y ago
"The fact that taking a faux drug can powerfully improve some people's health—the so-called placebo effect—has long been considered an embarrassment to the serious practice of pharmacology." Not sure what is embarrassing, unless your treatments are effective only because of this coughhomeopathy/cough
- sp332 15y ago
  Really? It's a multibillion dollar industry that can't outperform a sugar pill. That's pretty embarrassing.
- cwp 15y ago
  Actually, I've come around to the idea that homeopathy is a brilliant piece of social engineering. The theory of homeopathy is simple, internally consistent and not obviously false, which makes it a good way to harness the placebo effect without lying to the patient. The whole idea that diluting medecine makes it more effective has a number of benefits as well: Concentration/dilution is a simple, objective, physical property that can be measured for any medicine. It's much easier to think and talk about than wishy-washy concepts like "effectiveness in clinical trials." Diluting medicines down to really low concentrations take sophisticated equipment, so it's legitimate to charge more for those medicines. By agreeing to pay more for less, patients can strengthen their belief and actually increase the effectiveness of the placebo. The preoccupation with dilution also makes homeopathy safer. At the extreme, patients are being prescribed purified water. No side effects! Dilution also mitigates any other harmful effects that the homeopathic industry might have on the world. A few leaves of St. John's Wart go a loooong way when they're diluted down to 1 part per million. Out-of-control homeopathy won't lead to, say, increased poaching of bears and tigers for their internal organs. The whole thing is brilliant.
  - burgerbrain 15y ago
    Internally consistent? How do they explain why drinking diluting sewage (say, bottled water) doesn't make me a greek god?
  - daemin 15y ago
michaelfeathers 15y ago
Maybe the reason is: better advertising.
- Anti-Ratfish 15y ago
  I could be mistaken, but I remember reading that USA and New Zealand are the only 2 countries that allow direct to the consumer advertising of prescription drugs. This causes all sorts of crappy pressures on prescribers and wastes ole try of $
yoblin 15y ago
I found this to be a better article on the subject: http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer?currentPage=1 http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_...
- tokenadult 15y ago
  Response from a much better source: http://www.sciencebasedmedicine.org/index.php/the-decline-effect-or-a-exaggeration-of-the-messiness-of-science-and-science-based-medicine/ http://www.sciencebasedmedicine.org/index.php/the-decline-ef...
marze 15y ago
All of the medical industry propaganda airing on network TV (House, Grey's Anatomy, etc.) is really selling the idea that drugs work. Shouldn't be surprising the placebo response is improving.
- keeptrying 15y ago
  Does anyone know if any of these shows are funded by the pharama companies? Would be interesting to know?
  - keeptrying 15y ago
    Wow I got downvoted for this. Interesting.
- burgerbrain 15y ago
  "Drugs" in the general case do work. Empirically so.
giberson 15y ago
The reason is placebos are receiving meta enhancement! At first the placebo effect only had working for it the patients hope that they might be receiving the treatment pill and might get better. Alternatively, working against it was the concern they were getting the placebo and likelihood of getting worse. (Ie 1/2 odds at recovering) But, as studies showed that even those receiving placebos were getting better patients came to realize that even if they were getting the placebo treatment they could still get better. So now, the placebo has working for it the patients hope of getting the treatment and getting better plus the hope that in the case they get the placebo they experience the placebo effect and get better anyways. Alternatively, placebo effect now only has working against it the "off chance" that if the patient gets the placebo he also does not experience the placebo effect. (Ie 2/3 odds at recovering) Now, start with press releases like this and start stating that the placebo is so powerful, it always works--so much so we aren't going to bother giving the real drug to trial patients any more and just give them all sugar pills.. Then you'll get to watch placebo patients start consistently out performing trial drug patients at health recovery that eventually the above statement will be true. And while I wrote this comment in good humor, I do think it's a valid argument that circular logic explains that the placebo effect is getting stronger because of the placebo effect (people believing in it). In fact, it may be the only valid and legitimate use case of circular logic.
- sp332 15y ago
  There's at least one study recently that shows this effect. http://www.guardian.co.uk/science/2010/dec/22/placebo-effect-patients-sham-drug http://www.guardian.co.uk/science/2010/dec/22/placebo-effect... Even if you tell the patients that it's a placebo, they still get better.
  - jarin 15y ago
    Maybe it's an example of the Hawthorne Effect: http://en.wikipedia.org/wiki/Hawthorne_effect http://en.wikipedia.org/wiki/Hawthorne_effect Unfortunately, there probably isn't an ethical way to subject people to medical testing without their knowledge.
  - pella 15y ago
joeybaker 15y ago
It raises the question: if humans are so prone to the placebo effect, how is your business affected? Or, is this a phenomenon that's regulated to medicine?
6ren 15y ago
Martin Seligman (of both "learned optimism" and "learned helplessness" fame) showed that rats' immune systems are influenced by their psychological state, specifically, the extent of control they had over unpleasant stimuli. This included tumour reduction. In the light of this, the placebo effect does not seem so far-fetched. My personal theory is that when an animal feels safe and secure in a non-threatening environment, the immune system is stimulated, because the immune system requires resources, and the body can spare these when it is safe. When volunteers are given placebos, in a controlled and professional setting, it is clearly a safe and stress-free environment. (This could be tested by putting the subjects in the same safe setting, but not giving them the placebo).
jurjenh 15y ago
One thing that I didn't read in the article, and haven't heard about is whether the placebo effect continues on after the testing phase. One thing that I could see affecting results is that people are selected for a trial, which may well influence their mindset ("OOh, I'm taking this incredible new drug in a special trial. It is soo much more effective than anything else on the market!") In other words, being part of the experimental group is more important than the placebo or actual drug being tested. If these drugs are then available via normal channels, I imagine the placebo drug is not distributed, and the results may also not be monitored anymore. Is there any indication whether this happens? In that packet of anti-depressants, half are placebo and there is no way to tell which is which? Could be cheaper to manufacture and unlikely to be detected. Not too sure of the legalities either...
deleted 15y ago
[deleted]
narrator 15y ago
Drug makers are just having trouble coming up with new drugs and making up asinine excuses. Placebos are still placebos.
ericb 15y ago
If the mind is behind the placebo effect, can we cut out the middle man with a treatment of "deciding you are going to get better." If we remove the lie behind the placebo, and it still works--is this then a power we all possess, and have been accessing all along, but didn't understand or acknowledge?
- fferen 15y ago
  Yes, this is what I was thinking. Could we teach people mental techniques to "delude" themselves into getting better? Kinda reminds me of doublethink from 1984.
51Cards 15y ago
This is a wild speculation on my part but it just popped to mind. Perhaps the reason faux drugs are more and more useful is because we're using them to treat a rising number of faux illnesses. Maybe some of the cases where placebos are working more and more are illnesses we have dreamt up in a feel good society. Restless leg syndrome for example. I know because I get this from time to time but I don't think its an illness to be medicated... Usually I've just not been active enough or eaten too much dietary sugar before bed. We seem to be finding a condition to explain every little discomfort so perhaps, while some of the conditions may be real for some people, the more vague the symptoms become, the higher the odds someone in the study groups only thinks they have it, and the higher the placebo effect. Imaginary drugs for vague imaginary conditions. Anyhow, just a loose theory that just popped into my head completely unsubstantiated by any research. My legs are itchy, going for a walk.
- ceejayoz 15y ago
  > Restless leg syndrome for example. I know because I get this from time to time but I don't think its an illness to be medicated... That's like saying because you have a mole that you know skin cancer is made up. My wife has, at times, been up from 10pm to 6am, sobbing because she's exhausted yet can't sit still for longer than a few seconds. It's sure as hell not a "little discomfort". It's not "my legs are itchy", it's "I cannot stop moving my legs at all without experiencing extreme discomfort".
  - 51Cards 15y ago
    Agreed, which was why I included: "...while some of the conditions may be real for some people". I'm not disputing real conditions like your wife's, I'm saying some medical conditions these days have symptoms so loosely interpretable by the general public that anyone with achy legs may think they have it, and thus possibly try to medicate it. Perhaps this leads to a greater number of these people in study groups.... and perhaps that leads a measurable rise in placebo effectiveness. Anyhow, just an idle theory.
felipemnoa 15y ago
They say placebos are getting more Effective. That seems a euphemism for "new drugs work just as good as placebos", which is to say, not at all.
- Anti-Ratfish 15y ago
  Re running old trials is mentioned in the article.
tokenadult 15y ago
The article isn't keeping up with the best research. (I'm glad that the submission title notes that the article was published in 2009.) In actual practice, placebos only look effective when the statistical tests in a study are poor, and most especially when the symptoms are self-reported by patients. Placebos are NOT effective in treating actual disease states or improving "hard endpoints" such as reduction of all-cause mortality or major morbidity from specific diseases with verifiable physiological signs. See http://www.sciencebasedmedicine.org/index.php/placebo-effect-for-pain/ http://www.sciencebasedmedicine.org/index.php/placebo-effect... http://www.sciencebasedmedicine.org/index.php/placebo-effects-revisited/ http://www.sciencebasedmedicine.org/index.php/placebo-effect... http://www.sciencebasedmedicine.org/index.php/the-placebo-effect/ http://www.sciencebasedmedicine.org/index.php/the-placebo-ef... http://www.sciencebasedmedicine.org/index.php/placebo-effects-without-deception-well-not-exactly/ http://www.sciencebasedmedicine.org/index.php/placebo-effect... Placebo effects are strongest for patient self-reported subjective symptoms (classically, pain) and weakest for objective clinical signs measured by experienced observers. Previous submission of same article as that opening this thread, 622 days ago: http://news.ycombinator.com/item?id=1032149 http://news.ycombinator.com/item?id=1032149 An earlier comment there http://news.ycombinator.com/item?id=1032710 http://news.ycombinator.com/item?id=1032710 had it just right: "As I've said before, this article is incredibly wrong and quite misleading. If you ever wanted evidence that most Americans do not understand how medicines are developed or what the Placebo Effect is, this article (and the responses here) serve as ample evidence. For a more rigorous refutation by a trained professional, please read: http://www.sciencebasedmedicine.org/?p=1248 http://www.sciencebasedmedicine.org/?p=1248 I'll pull the zinger quote from the article above for you: >No, it’s not like that at all. Perhaps the studies are just that well done, or maybe the drugs being developed suck, or maybe companies are studying more candidate drugs and screening for efficacy. Just about any explanation that doesn’t involve aliens is better than 'placebo is getting stronger'."
- Gatsky 15y ago
  Your point is very valid. The Wired article seems to suggest that placebos are genuinely effective. We shouldn't consider the medical researchers studying the placebo effect to be idiots however. Unfortunately, focusing only on hard clinical endpoints is not a luxury medical research has, and would involve excluding most psychiatric research, most palliative care research, quality of life analyses in cancer patients etc etc, in other words, lots of important stuff. So if you still want to try and make people feel better, the placebo effect has to be dealt with. I do agree with you though this being a poor article. Some additional points: 1. Placebos can have adverse effects. For example, it is quite common for patients to experience nausea and even vomiting when taking a dummy pill in a clinical trial. So they aren't universal panaceas. 2. Sometimes placebos can be the intervention arm, not the control arm: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61115-4/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-67... This study compared simply administering air versus oxygen to patients with a terminal illness who were short of breath. Giving air was as effective as oxygen for relieving shortness of breath. This isn't the placebo effect getting stronger, this is just realising that doing less but doing something works perfectly well.
pella 15y ago
Placebo/Nocebo Genes ? ################ for example: http://www.snpedia.com/index.php/Rs4570625 http://www.snpedia.com/index.php/Rs4570625 - placebo side: "rs4570625(G;G) homozygosity was a significant predictor of clinical placebo response, being associated with greater improvement in anxiety symptoms." [PMID 19052197] - Nocebo side: "rs4570625 may have a gender-dependent effect on susceptibility to Panic Disorder." [PMID 19132526] ################ "rs4570625 GG makes me a believer ?" http://genes2brains2mind2me.com/2008/12/06/rs4570625-gg-makes-me-a-believer/ http://genes2brains2mind2me.com/2008/12/06/rs4570625-gg-make... critics: "Neuroskeptic savages the "placebo gene" http://scienceblogs.com/geneticfuture/2008/12/neuroskeptic_savages_the_place.php http://scienceblogs.com/geneticfuture/2008/12/neuroskeptic_s... ################ 23AndMe service data ( if you have ): https://www.23andme.com/you/explorer/snp/?snp_name=rs4570625 https://www.23andme.com/you/explorer/snp/?snp_name=rs4570625
pella 15y ago
Nocebo effect: "The Dark Side of the Placebo Effect: When Intense Belief Kills" ( SEP 14 2011, ) http://www.theatlantic.com/life/archive/2011/09/the-dark-side-of-the-placebo-effect-when-intense-belief-kills/245065/ http://www.theatlantic.com/life/archive/2011/09/the-dark-sid... "If you're still unsure that the nocebo effect could actually lead to premature death, Adler cites one stunning example of the effect from China. A team of researchers found that Chinese Americans die younger than expected "if they have a combination of disease and birth year which Chinese astrology and medicine considers ill-fated." That is to say, if they were born in a year that was astrologically linked to poor lung health, they would die an average of five years earlier from lung-related disease than someone born in some other year with the same disease. Similar effects were not found in the white populations around them. And how much sooner you died depended on the people's "strength of commitment to traditional Chinese culture." Think about that for a minute. If you were born under a bad sign, you died five years younger from the same diseases as people born under good signs. But only if you believed in Chinese astrology"
yason 15y ago
And has medicine ever actually healed anyone but, rather, each person healing himself?
shimon_e 15y ago
I'd bet visiting the sick is more effective than the placebo effect.
spyder 15y ago
I feel better even just reading about placebos.
mchusma 15y ago
This article reminds me of the Decline Effect, a BS way to describe experimental error. Experiments are prone to biases and problems than are worked out over time by a lot of good science.
pella 15y ago
Real vs Placebo Coffee "Caffeine expectancies influence the subjective and behavioral effects of caffeine." http://neuroskeptic.blogspot.com/2009/11/real-vs-placebo-coffee.html http://neuroskeptic.blogspot.com/2009/11/real-vs-placebo-cof...

141 points by adammichaelc 15y ago

An oldie but a goodie (it's been posted before). I think this phenomenon is so interesting I was hoping for a fresh discussion on what may cause this.

deleted 15y ago

[deleted]

Alex3917 15y ago

Apparently placebos are now as good as 'real' medications at preventing death across all diseases: http://www.bmj.com/content/333/7557/15.full http://www.bmj.com/content/333/7557/15.full (Or at least all diseases that have had adherence research studying the mortality risk with both drug and placebo therapy.)

abstractbill 15y ago
"...adherence to drug therapy may be a surrogate marker for overall healthy behaviour."
- Alex3917 15y ago
  Which suggests that non-drug interventions are generally better than drug interventions, at least when people actually do them. (Obviously people are much more likely to take a pill than to change their diet, which is part of what makes the research so interesting.) Not surprisingly, many of the diseases with the lowest adherence are the ones where people would benefit the most. Type 2 diabetes is literally a disease of non-adherence, with 98% of patients not following their doctor's recommendations. I've learned a ton from reading through the major adherence research findings over the last couple months, and I think there are a ton of ideas that can be applied to entrepreneurship and web startups especially. DiMatteo actually has a brand new book out on this so you don't even really need to read through all the original journal articles anymore to get the main ideas: http://www.amazon.com/Health-Behavior-Change-Treatment-Adherence/dp/0195380401/ref=sr_1_4?ie=UTF8&qid=1316476206&sr=8-4 http://www.amazon.com/Health-Behavior-Change-Treatment-Adher...

powertower 15y ago

I'd imagine placebos are getting more effective due to more people having purely headspace/mindset (or even imaginative) illnesses/causes due to stress factors. The more it's in your head, the more likely you can cure it with another imaginative treatment... As long as you believe in it. It's the only reasonable explanation. Aside from that, the power of belief can also be a reasonably powerful treatment with a positive response on the body/mind.

0x12 15y ago
Not sure why you got downvoted, it's not my cup of tea but it is as good an explanation as any other until the cause is known.
- deleted 15y ago
  [deleted]
- powertower 15y ago
  > Not sure why you got downvoted... Depressed people tend to discount all explanations that start with "it's only in your head." Right or wrong. I'm just pointing it out.
- tshtf 15y ago
  I downvoted the parent post because before the post was edited, the OP stated he didn't even read the article. If you come here to comment on an article, you should at least try to read it.
- jambo 15y ago
  The poster edited their comment. It originally started something like "tl;dr no really I didn't read the article" and proceeded with the speculation (and hubris that it's the "only reasonable explanation") that remains at the time of this writing. I downmodded the comment because it's the type of quick, non-substantial response that actually detracts from conversation among those who took the time to read the article and want a real discussion.
AndrewMoffat 15y ago

jisaacstone 15y ago

"The fact that taking a faux drug can powerfully improve some people's health—the so-called placebo effect—has long been considered an embarrassment to the serious practice of pharmacology." Not sure what is embarrassing, unless your treatments are effective only because of this coughhomeopathy/cough

sp332 15y ago
Really? It's a multibillion dollar industry that can't outperform a sugar pill. That's pretty embarrassing.
cwp 15y ago
Actually, I've come around to the idea that homeopathy is a brilliant piece of social engineering. The theory of homeopathy is simple, internally consistent and not obviously false, which makes it a good way to harness the placebo effect without lying to the patient. The whole idea that diluting medecine makes it more effective has a number of benefits as well: Concentration/dilution is a simple, objective, physical property that can be measured for any medicine. It's much easier to think and talk about than wishy-washy concepts like "effectiveness in clinical trials." Diluting medicines down to really low concentrations take sophisticated equipment, so it's legitimate to charge more for those medicines. By agreeing to pay more for less, patients can strengthen their belief and actually increase the effectiveness of the placebo. The preoccupation with dilution also makes homeopathy safer. At the extreme, patients are being prescribed purified water. No side effects! Dilution also mitigates any other harmful effects that the homeopathic industry might have on the world. A few leaves of St. John's Wart go a loooong way when they're diluted down to 1 part per million. Out-of-control homeopathy won't lead to, say, increased poaching of bears and tigers for their internal organs. The whole thing is brilliant.
- burgerbrain 15y ago
  Internally consistent? How do they explain why drinking diluting sewage (say, bottled water) doesn't make me a greek god?
- daemin 15y ago

michaelfeathers 15y ago

Maybe the reason is: better advertising.

Anti-Ratfish 15y ago
I could be mistaken, but I remember reading that USA and New Zealand are the only 2 countries that allow direct to the consumer advertising of prescription drugs. This causes all sorts of crappy pressures on prescribers and wastes ole try of $

yoblin 15y ago

I found this to be a better article on the subject: http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer?currentPage=1 http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_...

tokenadult 15y ago
Response from a much better source: http://www.sciencebasedmedicine.org/index.php/the-decline-effect-or-a-exaggeration-of-the-messiness-of-science-and-science-based-medicine/ http://www.sciencebasedmedicine.org/index.php/the-decline-ef...

marze 15y ago

All of the medical industry propaganda airing on network TV (House, Grey's Anatomy, etc.) is really selling the idea that drugs work. Shouldn't be surprising the placebo response is improving.

keeptrying 15y ago
Does anyone know if any of these shows are funded by the pharama companies? Would be interesting to know?
- keeptrying 15y ago
  Wow I got downvoted for this. Interesting.
burgerbrain 15y ago
"Drugs" in the general case do work. Empirically so.

giberson 15y ago

The reason is placebos are receiving meta enhancement! At first the placebo effect only had working for it the patients hope that they might be receiving the treatment pill and might get better. Alternatively, working against it was the concern they were getting the placebo and likelihood of getting worse. (Ie 1/2 odds at recovering) But, as studies showed that even those receiving placebos were getting better patients came to realize that even if they were getting the placebo treatment they could still get better. So now, the placebo has working for it the patients hope of getting the treatment and getting better plus the hope that in the case they get the placebo they experience the placebo effect and get better anyways. Alternatively, placebo effect now only has working against it the "off chance" that if the patient gets the placebo he also does not experience the placebo effect. (Ie 2/3 odds at recovering) Now, start with press releases like this and start stating that the placebo is so powerful, it always works--so much so we aren't going to bother giving the real drug to trial patients any more and just give them all sugar pills.. Then you'll get to watch placebo patients start consistently out performing trial drug patients at health recovery that eventually the above statement will be true. And while I wrote this comment in good humor, I do think it's a valid argument that circular logic explains that the placebo effect is getting stronger because of the placebo effect (people believing in it). In fact, it may be the only valid and legitimate use case of circular logic.

sp332 15y ago
There's at least one study recently that shows this effect. http://www.guardian.co.uk/science/2010/dec/22/placebo-effect-patients-sham-drug http://www.guardian.co.uk/science/2010/dec/22/placebo-effect... Even if you tell the patients that it's a placebo, they still get better.
- jarin 15y ago
  Maybe it's an example of the Hawthorne Effect: http://en.wikipedia.org/wiki/Hawthorne_effect http://en.wikipedia.org/wiki/Hawthorne_effect Unfortunately, there probably isn't an ethical way to subject people to medical testing without their knowledge.
- pella 15y ago

joeybaker 15y ago

It raises the question: if humans are so prone to the placebo effect, how is your business affected? Or, is this a phenomenon that's regulated to medicine?

6ren 15y ago

Martin Seligman (of both "learned optimism" and "learned helplessness" fame) showed that rats' immune systems are influenced by their psychological state, specifically, the extent of control they had over unpleasant stimuli. This included tumour reduction. In the light of this, the placebo effect does not seem so far-fetched. My personal theory is that when an animal feels safe and secure in a non-threatening environment, the immune system is stimulated, because the immune system requires resources, and the body can spare these when it is safe. When volunteers are given placebos, in a controlled and professional setting, it is clearly a safe and stress-free environment. (This could be tested by putting the subjects in the same safe setting, but not giving them the placebo).

jurjenh 15y ago

One thing that I didn't read in the article, and haven't heard about is whether the placebo effect continues on after the testing phase. One thing that I could see affecting results is that people are selected for a trial, which may well influence their mindset ("OOh, I'm taking this incredible new drug in a special trial. It is soo much more effective than anything else on the market!") In other words, being part of the experimental group is more important than the placebo or actual drug being tested. If these drugs are then available via normal channels, I imagine the placebo drug is not distributed, and the results may also not be monitored anymore. Is there any indication whether this happens? In that packet of anti-depressants, half are placebo and there is no way to tell which is which? Could be cheaper to manufacture and unlikely to be detected. Not too sure of the legalities either...

deleted 15y ago

[deleted]

narrator 15y ago

Drug makers are just having trouble coming up with new drugs and making up asinine excuses. Placebos are still placebos.

ericb 15y ago

If the mind is behind the placebo effect, can we cut out the middle man with a treatment of "deciding you are going to get better." If we remove the lie behind the placebo, and it still works--is this then a power we all possess, and have been accessing all along, but didn't understand or acknowledge?

fferen 15y ago
Yes, this is what I was thinking. Could we teach people mental techniques to "delude" themselves into getting better? Kinda reminds me of doublethink from 1984.

51Cards 15y ago

This is a wild speculation on my part but it just popped to mind. Perhaps the reason faux drugs are more and more useful is because we're using them to treat a rising number of faux illnesses. Maybe some of the cases where placebos are working more and more are illnesses we have dreamt up in a feel good society. Restless leg syndrome for example. I know because I get this from time to time but I don't think its an illness to be medicated... Usually I've just not been active enough or eaten too much dietary sugar before bed. We seem to be finding a condition to explain every little discomfort so perhaps, while some of the conditions may be real for some people, the more vague the symptoms become, the higher the odds someone in the study groups only thinks they have it, and the higher the placebo effect. Imaginary drugs for vague imaginary conditions. Anyhow, just a loose theory that just popped into my head completely unsubstantiated by any research. My legs are itchy, going for a walk.

ceejayoz 15y ago
> Restless leg syndrome for example. I know because I get this from time to time but I don't think its an illness to be medicated... That's like saying because you have a mole that you know skin cancer is made up. My wife has, at times, been up from 10pm to 6am, sobbing because she's exhausted yet can't sit still for longer than a few seconds. It's sure as hell not a "little discomfort". It's not "my legs are itchy", it's "I cannot stop moving my legs at all without experiencing extreme discomfort".
- 51Cards 15y ago
  Agreed, which was why I included: "...while some of the conditions may be real for some people". I'm not disputing real conditions like your wife's, I'm saying some medical conditions these days have symptoms so loosely interpretable by the general public that anyone with achy legs may think they have it, and thus possibly try to medicate it. Perhaps this leads to a greater number of these people in study groups.... and perhaps that leads a measurable rise in placebo effectiveness. Anyhow, just an idle theory.

felipemnoa 15y ago

They say placebos are getting more Effective. That seems a euphemism for "new drugs work just as good as placebos", which is to say, not at all.

Anti-Ratfish 15y ago
Re running old trials is mentioned in the article.

tokenadult 15y ago

The article isn't keeping up with the best research. (I'm glad that the submission title notes that the article was published in 2009.) In actual practice, placebos only look effective when the statistical tests in a study are poor, and most especially when the symptoms are self-reported by patients. Placebos are NOT effective in treating actual disease states or improving "hard endpoints" such as reduction of all-cause mortality or major morbidity from specific diseases with verifiable physiological signs. See http://www.sciencebasedmedicine.org/index.php/placebo-effect-for-pain/ http://www.sciencebasedmedicine.org/index.php/placebo-effect... http://www.sciencebasedmedicine.org/index.php/placebo-effects-revisited/ http://www.sciencebasedmedicine.org/index.php/placebo-effect... http://www.sciencebasedmedicine.org/index.php/the-placebo-effect/ http://www.sciencebasedmedicine.org/index.php/the-placebo-ef... http://www.sciencebasedmedicine.org/index.php/placebo-effects-without-deception-well-not-exactly/ http://www.sciencebasedmedicine.org/index.php/placebo-effect... Placebo effects are strongest for patient self-reported subjective symptoms (classically, pain) and weakest for objective clinical signs measured by experienced observers. Previous submission of same article as that opening this thread, 622 days ago: http://news.ycombinator.com/item?id=1032149 http://news.ycombinator.com/item?id=1032149 An earlier comment there http://news.ycombinator.com/item?id=1032710 http://news.ycombinator.com/item?id=1032710 had it just right: "As I've said before, this article is incredibly wrong and quite misleading. If you ever wanted evidence that most Americans do not understand how medicines are developed or what the Placebo Effect is, this article (and the responses here) serve as ample evidence. For a more rigorous refutation by a trained professional, please read: http://www.sciencebasedmedicine.org/?p=1248 http://www.sciencebasedmedicine.org/?p=1248 I'll pull the zinger quote from the article above for you: >No, it’s not like that at all. Perhaps the studies are just that well done, or maybe the drugs being developed suck, or maybe companies are studying more candidate drugs and screening for efficacy. Just about any explanation that doesn’t involve aliens is better than 'placebo is getting stronger'."

Gatsky 15y ago
Your point is very valid. The Wired article seems to suggest that placebos are genuinely effective. We shouldn't consider the medical researchers studying the placebo effect to be idiots however. Unfortunately, focusing only on hard clinical endpoints is not a luxury medical research has, and would involve excluding most psychiatric research, most palliative care research, quality of life analyses in cancer patients etc etc, in other words, lots of important stuff. So if you still want to try and make people feel better, the placebo effect has to be dealt with. I do agree with you though this being a poor article. Some additional points: 1. Placebos can have adverse effects. For example, it is quite common for patients to experience nausea and even vomiting when taking a dummy pill in a clinical trial. So they aren't universal panaceas. 2. Sometimes placebos can be the intervention arm, not the control arm: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61115-4/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-67... This study compared simply administering air versus oxygen to patients with a terminal illness who were short of breath. Giving air was as effective as oxygen for relieving shortness of breath. This isn't the placebo effect getting stronger, this is just realising that doing less but doing something works perfectly well.

pella 15y ago

Placebo/Nocebo Genes ? ################ for example: http://www.snpedia.com/index.php/Rs4570625 http://www.snpedia.com/index.php/Rs4570625 - placebo side: "rs4570625(G;G) homozygosity was a significant predictor of clinical placebo response, being associated with greater improvement in anxiety symptoms." [PMID 19052197] - Nocebo side: "rs4570625 may have a gender-dependent effect on susceptibility to Panic Disorder." [PMID 19132526] ################ "rs4570625 GG makes me a believer ?" http://genes2brains2mind2me.com/2008/12/06/rs4570625-gg-makes-me-a-believer/ http://genes2brains2mind2me.com/2008/12/06/rs4570625-gg-make... critics: "Neuroskeptic savages the "placebo gene" http://scienceblogs.com/geneticfuture/2008/12/neuroskeptic_savages_the_place.php http://scienceblogs.com/geneticfuture/2008/12/neuroskeptic_s... ################ 23AndMe service data ( if you have ): https://www.23andme.com/you/explorer/snp/?snp_name=rs4570625 https://www.23andme.com/you/explorer/snp/?snp_name=rs4570625

pella 15y ago

Nocebo effect: "The Dark Side of the Placebo Effect: When Intense Belief Kills" ( SEP 14 2011, ) http://www.theatlantic.com/life/archive/2011/09/the-dark-side-of-the-placebo-effect-when-intense-belief-kills/245065/ http://www.theatlantic.com/life/archive/2011/09/the-dark-sid... "If you're still unsure that the nocebo effect could actually lead to premature death, Adler cites one stunning example of the effect from China. A team of researchers found that Chinese Americans die younger than expected "if they have a combination of disease and birth year which Chinese astrology and medicine considers ill-fated." That is to say, if they were born in a year that was astrologically linked to poor lung health, they would die an average of five years earlier from lung-related disease than someone born in some other year with the same disease. Similar effects were not found in the white populations around them. And how much sooner you died depended on the people's "strength of commitment to traditional Chinese culture." Think about that for a minute. If you were born under a bad sign, you died five years younger from the same diseases as people born under good signs. But only if you believed in Chinese astrology"

yason 15y ago

And has medicine ever actually healed anyone but, rather, each person healing himself?

shimon_e 15y ago

I'd bet visiting the sick is more effective than the placebo effect.

spyder 15y ago

I feel better even just reading about placebos.

mchusma 15y ago

This article reminds me of the Decline Effect, a BS way to describe experimental error. Experiments are prone to biases and problems than are worked out over time by a lot of good science.

pella 15y ago

Real vs Placebo Coffee "Caffeine expectancies influence the subjective and behavioral effects of caffeine." http://neuroskeptic.blogspot.com/2009/11/real-vs-placebo-coffee.html http://neuroskeptic.blogspot.com/2009/11/real-vs-placebo-cof...