3 ms·

The key thing we should update on, as a society, is that placebo effects are huge (often as large as the treatment effects established for drugs in RCTs), and t

by vonnik 4y ago

The key thing we should update on, as a society, is that placebo effects are huge (often as large as the treatment effects established for drugs in RCTs), and through specific actions, the placebo effect can be maximized. In fact, it used to be part of a medical doctor's training to take on the mantle of an authority capable of producing placebo effects, back when they had little else to give. The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. It's hard for people to do this to themselves, deliberately -- like turning the knob on a pressure cooker while you're inside the cooker... But obviously being credulous helps a lot!! There is actually a literature on this, but it's adjacent to the medical journals: Daniel Moerman describes himself as a medical anthropologist. He wrote a book called “Meaning, medicine and the ‘placebo effect' “. https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-Anthropology/dp/0521000874 https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-An...

hdjjhhvvhga 4y ago
> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. Isn't it risky? Saying "everything will be fine" or "this will definitely help" with authority when you know the probability can have consequences, and in the end patients will stop believing you.
- retrac 4y ago
  It's perhaps less "everything will be fine" and more "whatever happens, you're in good hands". A certain confident assertiveness, even when there's nothing to be confident about. I've not had the experience some have, with physicians pretending to be mini-gods. So far, the ones I've met have been quite willing to admit they have no idea what's going on when that's the case. That can be done in a way that leaves you feeling like you have support and practical things to do in the meantime, or it can leave you feeling lost. A friend who is a nurse who works in hospice has some critical things to say about the bedside manner of some of her peers. When there is nothing to be done, but how nothing is done can still matter a lot. Sometimes it's simple as despair leading to self-neglect that leads to more rapid worsening of illness. That effect seems to be related to the placebo effect.
  - taeric 4y ago
    I'd actually assume it should be more "everything will be fine." You specifically broadcast the reaction you want to get from folks. Someone down thread posted the video to the nocebo effect. It really is far more effective than makes sense. Problems are legion, of course. Is it something inherent to the people that are impacted by this? Would make some psychotic disorders interesting evolutionary defenses. And, of course, there is no reason this has to be limited to medical behaviors. Teaching and coaching can be more effective for some people, if you tell them what you are doing is going to be effective. This actually tracks remarkably well with how so many advocates for different techniques all lead with usually over the top assertions on how what they are doing will work. Often more so than on why it would work.
- em-bee 4y ago
  that's because "everything will be fine" or "this will definitely help" sound unrealistic. the message needs to be more subtle and believable. but what is the risk? the only situation where the believability of a doctor suffers is when the patient doesn't heal at all. we do read about cases where people go from doctor to doctor because nothing works, until they meet that one doctor who has the right insights and finds a treatment that actually does work. how often does that happen though and how does that affect the doctors or the patients?
  - carlmr 4y ago
    >the only situation where the believability of a doctor suffers is when the patient doesn't heal at all If you investigate the medicine they prescribe you and find out it's a placebo, you might stop believing the doctor about the other cures they sell you. When a doctor gives me homeopathy I will not return.
    - gretch 4y ago
      It’s an interesting gray area because the effects of placebos are empirical and reproducible in rigorous trials. If your doctor tells you “this pill helps many people with your condition ”, they’ll be telling the truth.
      - carlmr 4y ago
        >If your doctor tells you “this pill helps many people with your condition ”, they’ll be telling the truth. That's actually a really good wording.
        jjeaff 4y ago
        I was talking to a psychiatrist friend of mine about placebo effect and he told me that it definitely can make a big difference. But I asked him if he ever just gave placebo pills to patients and he said no because he felt that would be unethical. I didn't really think to ask whether it would really be unethical if it might help.
- watwut 4y ago
  Yes. What it does is that over the course of life, people will learn to not trust what doctors say.
jt2190 4y ago
> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. Psychologist Alia Crum does research into this area. “Harnessing the Power of Placebos” by Alia Crum (Video, 2016) https://youtu.be/WcQnSW1wpGA https://youtu.be/WcQnSW1wpGA
- vonnik 4y ago
  She's great! I totally should have mentioned her. Stanford magazine covered her work last year: https://stanfordmag.org/contents/better-believe-it https://stanfordmag.org/contents/better-believe-it I first encountered her work through Andrey Huberman's podcast: https://www.youtube.com/watch?v=dFR_wFN23ZY https://www.youtube.com/watch?v=dFR_wFN23ZY Harvard is researching this too: https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect https://www.health.harvard.edu/mental-health/the-power-of-th...
bsaul 4y ago
"It's hard for people to do this to themselves, deliberately" i'd say much like tickling yourself. For some reason it doesn't work.

by vonnik 4y ago

hdjjhhvvhga 4y ago

> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. Isn't it risky? Saying "everything will be fine" or "this will definitely help" with authority when you know the probability can have consequences, and in the end patients will stop believing you.

retrac 4y ago
It's perhaps less "everything will be fine" and more "whatever happens, you're in good hands". A certain confident assertiveness, even when there's nothing to be confident about. I've not had the experience some have, with physicians pretending to be mini-gods. So far, the ones I've met have been quite willing to admit they have no idea what's going on when that's the case. That can be done in a way that leaves you feeling like you have support and practical things to do in the meantime, or it can leave you feeling lost. A friend who is a nurse who works in hospice has some critical things to say about the bedside manner of some of her peers. When there is nothing to be done, but how nothing is done can still matter a lot. Sometimes it's simple as despair leading to self-neglect that leads to more rapid worsening of illness. That effect seems to be related to the placebo effect.
- taeric 4y ago
  I'd actually assume it should be more "everything will be fine." You specifically broadcast the reaction you want to get from folks. Someone down thread posted the video to the nocebo effect. It really is far more effective than makes sense. Problems are legion, of course. Is it something inherent to the people that are impacted by this? Would make some psychotic disorders interesting evolutionary defenses. And, of course, there is no reason this has to be limited to medical behaviors. Teaching and coaching can be more effective for some people, if you tell them what you are doing is going to be effective. This actually tracks remarkably well with how so many advocates for different techniques all lead with usually over the top assertions on how what they are doing will work. Often more so than on why it would work.
em-bee 4y ago
that's because "everything will be fine" or "this will definitely help" sound unrealistic. the message needs to be more subtle and believable. but what is the risk? the only situation where the believability of a doctor suffers is when the patient doesn't heal at all. we do read about cases where people go from doctor to doctor because nothing works, until they meet that one doctor who has the right insights and finds a treatment that actually does work. how often does that happen though and how does that affect the doctors or the patients?
- carlmr 4y ago
  >the only situation where the believability of a doctor suffers is when the patient doesn't heal at all If you investigate the medicine they prescribe you and find out it's a placebo, you might stop believing the doctor about the other cures they sell you. When a doctor gives me homeopathy I will not return.
  - gretch 4y ago
    It’s an interesting gray area because the effects of placebos are empirical and reproducible in rigorous trials. If your doctor tells you “this pill helps many people with your condition ”, they’ll be telling the truth.
    - carlmr 4y ago
      >If your doctor tells you “this pill helps many people with your condition ”, they’ll be telling the truth. That's actually a really good wording.
      - jjeaff 4y ago
        I was talking to a psychiatrist friend of mine about placebo effect and he told me that it definitely can make a big difference. But I asked him if he ever just gave placebo pills to patients and he said no because he felt that would be unethical. I didn't really think to ask whether it would really be unethical if it might help.
watwut 4y ago
Yes. What it does is that over the course of life, people will learn to not trust what doctors say.

jt2190 4y ago

> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. Psychologist Alia Crum does research into this area. “Harnessing the Power of Placebos” by Alia Crum (Video, 2016) https://youtu.be/WcQnSW1wpGA https://youtu.be/WcQnSW1wpGA

vonnik 4y ago
She's great! I totally should have mentioned her. Stanford magazine covered her work last year: https://stanfordmag.org/contents/better-believe-it https://stanfordmag.org/contents/better-believe-it I first encountered her work through Andrey Huberman's podcast: https://www.youtube.com/watch?v=dFR_wFN23ZY https://www.youtube.com/watch?v=dFR_wFN23ZY Harvard is researching this too: https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect https://www.health.harvard.edu/mental-health/the-power-of-th...

bsaul 4y ago

"It's hard for people to do this to themselves, deliberately" i'd say much like tickling yourself. For some reason it doesn't work.