10 ms·

The Placebo Effect Doesn’t Apply Just to Pills

93 points by Libertatea 12y ago

matkam 12y ago
Any idea how placebos work so well, what they are, and if we're doing anything to take advantage of the effect?
- kazinator 12y ago
  They work the same way that some speaker cables sound so damn great (to whomever paid the $299 for them). http://en.wikipedia.org/wiki/Confirmation_bias http://en.wikipedia.org/wiki/Confirmation_bias
  - matkam 12y ago
    Don't placebos sometimes result in real physical benefits?
    - benbreen 12y ago
      Interesting two part article by a Harvard Med School professor on whether psychiatric meds rely on an "activated placebo effect" (i.e. a placebo with side effects). Some would argue this isn't necessarily a bad thing as long as they are perceived to be efficacious by those taking them. http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/ http://www.nybooks.com/articles/archives/2011/jun/23/epidemi... http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/ http://www.nybooks.com/articles/archives/2011/jul/14/illusio...
    - kazinator 12y ago
      Yes. For instance, the person with $300 speaker cables feels good about how they sound and that puts them into a good mood. This is a physical benefit.
      - skinnybatch 12y ago
        I'd argue this is a psychological benefit...
        DigitalJack 12y ago
        So you think there is nothing physical about mood? Interesting.
        pessimizer 12y ago
        We don't even have ways in English (probably any language) to speak about internal states without resorting to dualism. The closest we can get is hardware/software analogies.
        Dylan16807 12y ago
        There is a distinction, though it's tricky to word. It's about what is a direct effect, and what is an indirect effect. There is a feedback loop between abstract thoughts and effects on the body, so to make a proper distinction you want to ignore the feedback loop and look at where the inputs are. A placebo's direct effect is not physical. The direct effect is that first thought that you are receiving treatment, before it even has a chance to affect your mood. A kidney transplant's direct effect is mostly physical. It's filtering your blood at a rapid pace. So technically mood has physical effects but by the time you reach that stage you've destroyed the meaning of the term "physical benefit" into meaning just "benefit". Feel free to suggest better terms, but please don't muddle the waters.
        kazinator 12y ago
        Yes, of course. A placebo headache medicine of course does not have the direct effect comparable to aspirin, acetaminophen or ibuprofen. It's direct effect is not physical, because it doesn't have one. "No physical effect" means the same thing as "no effect", unless we are willing to discuss metaphysical effects. The indirect effects are somehow the result of the user's expectation that there is a direct effect. That is to say, "placebo effect" is not "the effect of the placebo object", obviously. It's the emergent effect of the whole situation of someone being duped with a placebo. Being duped with a placebo has direct, physical effects, while the placebo object has no effect.
    - MarkPNeyer 12y ago
      If your mind calms down, your heart rate drops, your cortisol goes down, and your muscles become less tense. Those are all physical benefits.
- 83457 12y ago
  There is actually a discipline of medicine dedicated to researching and promoting the use of placebos to cure ailments called homeopathy.
  - tobinfricke 12y ago
    I assume you mean this as a joke, but homeopathic remedies are so popular here in Germany -- the pharmacy shelves are loaded with them!! -- that I wonder whether use of the placebo effect is an official component of the national healthcare strategy.
    - TillE 12y ago
      Yeah, it's extremely weird to see homeopathic "medicine" all over in a country with an otherwise excellent, modern medical system. Germany generally does a good job on evidence-based herbal medicine (like standardizing St. John's wort extract), but I worry that the line can easily be blurred between them and homeopathic products in the eyes of most consumers. You really have to look carefully - they're not clearly marked. So honestly, you're probably quite right about it being a deliberate exploitation of the placebo effect. Because otherwise, there's no reason not to ban them.
      - pluma 12y ago
        No kidding. I went to the doctor with sleeping problems one time and he suggested I look up a certain drug. He said I couldn't get a prescription for it and it was to be taken therapeutically (i.e. indefinitely) and at the normal dosage it would cost something like 50 bucks a month. I went home and looked it up: a homeopathic panacea with only a single "study". Not double blind, not even single blind -- they literally just gave the drug to some participants and the self-reported symptoms "improved". I'm still not sure whether the GP was just trolling me.
        tobinfricke 12y ago
        I've had similar experiences. I find it very strange. You make a good point: the homeopathic remedies aren't even cheap.
- DanBC 12y ago
  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974.pub3/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974... > We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.
  - pella 12y ago
    "Nevertheless, it is important to mention that according to an influential 2001 meta-analysis comparing placebo-treatment arms with no treatment, placebos make no clinical difference.[20] However, the methodological difficulties of combining diverse conditions in a single meta-analysis are serious, and the authors’ updated meta-analysis includes more nuanced conclusions.[21] Furthermore, the meta-analyses implicitly assume the biological reductionist definition of placebo, ignoring the psychosocial context of sickness and health. The subjects in those studies were entered into a research programme and received attention and care. Therefore, in the way that the studies of the meta-analysis were actually conducted, there was plenty of room for the placebo effect without the placebo, which would spuriously suggest that the placebo was no more effective than no treatment, though in fact both had the potential to produce a placebo effect." from "The moral case for the clinical placebo" http://jme.bmj.com/content/40/4/219.full http://jme.bmj.com/content/40/4/219.full
- snowwrestler 12y ago
  Jokes about homeopathy aside, if you can answer your own question, there's probably a Nobel prize in it for you. Mind/body interactions are incredibly complex and as yet pretty poorly understood. There are some known ways to take advantage of similar effects--for instance, helping patients find ways to lower stress as a means of mitigating risk factors like high blood pressure.
  - Natsu 12y ago
    Same here in the US, they even put them in the pharmacy :( I remember one time I needed eyedrops. They were only listed as homeopathic in tiny print and were adjacent to real eyedrops in the pharmacy, so it was a bit hard to read them with my allergies going. And I've tried washing my eyes with water, but it's not as effective as real eyedrops. Moreover, these contained "aspis", allegedly some extract from bees, which I might be allergic to. One would hope that they'd diluted it enough, but it actually listed a fairly low dilution factor so I couldn't even be sure the damned things weren't harmful.
- JacobJans 12y ago
  I'd suggest you look into hypnosis and hypnotherapy. There are quite a few things the mind can do, given the right suggestions.
- marincounty 12y ago
  Right now they don't have a clue. In my world, the effect is the only existence of God--until proven differently. So believing strongly in something isn't as foolish as some "Intellectuals" would berate?
sniderlane 12y ago
Try it yourself: http://placebobutton.com/ http://placebobutton.com/
- deleted 12y ago
  [deleted]
- Procrastes 12y ago
  I pressed the comforting, blue button and my chronic gullibility was cured instantly! Thank you Placebo Button!
sudowhodoido 12y ago
I thought that was kind of obvious. A friend of mine who repairs PCs occasionally finds nothing wrong with them and does the usual "I'll run some maintenance on it" and the client is always happier afterwards. He doesn't charge for stuff unless anything needs to be done.
- deleted 12y ago
  [deleted]
- Toddarooski 12y ago
  Wouldn't your friend get happier clients if he charged them a little bit? It'd probably give them a stronger placebo effect.
  - sudowhodoido 12y ago
    People are shallow. The computer is their best friend 95% of the time, but they remember the last 5% and how much it cost them more than anything.
Alex3917 12y ago
> For a drug to be approved by the Food and Drug Administration, it must prove itself better than a placebo, or fake drug. False, the FDA doesn't actually have any requirement to prove that a treatment is better than placebo. Many trials don't even include a placebo arm, they only compare themselves against existing drugs that were grandfathered into the system without any efficacy testing. Or they compare themselves to inert placebos rather than active ones, even if they are psychoactive drugs. Or they only compare themselves against placebos for a few weeks, even if they are meant to be used for long periods of time. This is how we have drugs like antidepressants and ADHD drugs on the market even the though research shows they are actually worse than taking no drug at all.
- viewer5 12y ago
  > antidepressants and ADHD drugs on the market even the though research shows they are actually worse than taking no drug at all What do you mean?
  - Alex3917 12y ago
    http://www.amazon.com/gp/product/0307452425/ref=s9_simh_gw_p14_d0_i1?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1T1TZZVVDR83AX2SD7HT&pf_rd_t=101&pf_rd_p=1688200382&pf_rd_i=507846 http://www.amazon.com/gp/product/0307452425/ref=s9_simh_gw_p... http://www.amazon.com/gp/product/0465022006/ref=s9_simh_gw_p14_d0_i2?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1T1TZZVVDR83AX2SD7HT&pf_rd_t=101&pf_rd_p=1688200382&pf_rd_i=507846 http://www.amazon.com/gp/product/0465022006/ref=s9_simh_gw_p...
    - refurb 12y ago
      Rather than linking to a book on Amazon, could you link to some peer-reviewed journal articles?
      - Alex3917 12y ago
        Both of these books are just writeups on peer reviewed journal articles. No individual article is going to tell you very much on its own, so I don't see much value in just linking to a random list of studies.
ToastyMallows 12y ago
Anyone interested in the Placebo Effect, I recommend Josh & Chuck's Stuff You Should Know episode about it. http://www.stuffyoushouldknow.com/podcasts/how-the-placebo-effect-works/ http://www.stuffyoushouldknow.com/podcasts/how-the-placebo-e...
deleted 12y ago
[deleted]
kylelibra 12y ago
I clicked on this thinking "surely this is some NY Times article from their archives." Nope.
agarden 12y ago
It strikes me that for something like knee surgery, at least, the recovery routine might be what provides the benefit. What if you took a group and did not pretend to give them surgery but made them rest and go through physical therapy as if you had?
- jobu 12y ago
  "Less than a year ago, many were shocked when arthroscopic surgery for meniscal tears performed no better than sham surgery. This procedure was the most common orthopedic procedure performed in the United States." Earlier this year I re-injured the meniscus in my knee and was about to undergo surgery when a radiologist in the family mentioned this study. I cancelled the surgery and followed the alternative recovery method of ice, ibuprofen and rest. It took a long three weeks for me knee to feel normal again, but it would've been much longer had I undergone the surgery.
ucho 12y ago
Very old news. Surgery for "Gastroesophageal reflux disease" was an famous example: http://en.wikipedia.org/wiki/Placebo#cite_note-198 http://en.wikipedia.org/wiki/Placebo#cite_note-198 . If I remember correctly in one study symptoms dissipated in 50% of patients, who got sham surgery - just skin incisions.
briantakita 12y ago
The prevalence of the Placebo Effect across many medicinal domains seems like evidence that there is an underlying cause. Perhaps emotional well being has an impact on health?
marincounty 12y ago
The Placebo Effect should be taught in grade school. We shouldn't have to wait until college to realize just how many products, drugs, professions, etc. are an absolute sham.
ChuckMcM 12y ago
Perhaps we could create a placebo bureaucracy, say an FDA like agency which just approved anything that came through it. And then we could compare the end results of that agency with the FDA to see which one approved the most 'actually useful' medicines and the one which had the most 'later found to be harmful' medicines.
- tokenadult 12y ago
  Chuck, that's already done. That's the "natural supplements" industry[1] as it has been regulated since the mid-1990s in the United States. [1] "Dietary supplement industry says 'no' to more information for consumers (again)" http://www.sciencebasedmedicine.org/big-supp-resists-giving-consumers-safety-and-effectiveness-information/ http://www.sciencebasedmedicine.org/big-supp-resists-giving-...
smegel 12y ago
> They had an incision, and a procedure was faked so that they didn’t know that they actually had nothing done. Is it just me, or does this seem ethically dubious? A sugar pill placebo does no harm, but when you are cutting people open to "fake" surgery...just doesn't sit right.
- jonchang 12y ago
  The article, in fact, addresses your question. > The ethical issues aren’t easily dismissed. Theoretically, a sugar pill carries no risk, and a sham procedure does. This is especially true if the procedure requires anesthesia. The surgeon must go out of his or her way to fool the patient. Many would have difficulty doing that. > But we continue to ignore the real potential that many of our surgical procedures and medical devices aren’t doing much good — and might even be doing harm, since real surgery has been shown to pose more risks than sham surgery.
msolujic 12y ago
Here is one more recent interesting research result in area of placebos http://www.coloradocollege.edu/newsevents/newsroom/the-power-of-positive-sleeping http://www.coloradocollege.edu/newsevents/newsroom/the-power...
tokenadult 12y ago
This article brings up a very important point, and I'm grateful that it was submitted here. The professor of pediatrics who wrote the article is onto some important issues, and I was especially glad he cited some of the research literature with direct links. Reading a review he cited,[1] I see that one of the problems here is the vagueness of what he calls "improvement" in many medical studies. Is the treatment endpoint of a knee operation patients moving better than they used to, as measured by trained observers watching the patients do standardized movements? Or is "improvement" a patient self-report of less pain? Several of the examples the author writes about are examples of treatments indicated to relieve pain (angina, which is chest pain, or lower back pain, and it looks like most of the knee surgery he mainly focuses on was also done to relieve patient-reported pain). Patient self-reported pain is a symptom, a matter important to the patient, but it is not a diagnostic sign that can be objectively observed by anyone else (as, for example, blood pressure or white cell count can be objectively observed). Too many medical studies, and almost all "alternative medicine" testimonials, are based on soft endpoints (patient self-reports of improvement) rather than on "hard endpoints" (longer healthier life after reduction in all-cause mortality, or resuming walking after being paralyzed, or something observable objectively and lastingly important). Pretty much all studies by all authors of whatever researcher background that appear to show a "placebo effect" show that only for patient-reported subjective symptoms that are usually temporary anyway like pain and nausea. Nobody asks for a placebo treatment for a broken leg or a life-threatening infection. The medical researchers who look at the issue with proper study designs and statistical controls know that placebos are essentially useless, as they at most have influence just on self-reported subjective symptoms, not on any sign that affects the progression of a disease or maintenance of good health.[2] Findings on placebo effects by researchers who have considered the issue carefully include "Despite the spin of the authors – these results put placebo medicine into crystal clear perspective, and I think they are generalizable and consistent with other placebo studies. For objective physiological outcomes, there is no significant placebo effect. Placebos are no better than no treatment at all."[3] "We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed."[4] So, yes, let's make sure that studies of surgical techniques include studies of sham surgery. (Studies of acupuncture had better always have sham acupuncture arms in which "real" acupuncture points are disregarded or other aspects of supposedly ancient Chinese technique are intentionally omitted without the patient knowing that.) This will improve the evaluation of safety and effectiveness of new surgical techniques. Just don't assume that ANY placebo is ever good for ANYTHING that you couldn't achieve just by giving yourself a good pep talk. [1] http://www.bmj.com/content/348/bmj.g3253 http://www.bmj.com/content/348/bmj.g3253 [2] http://www.sciencebasedmedicine.org/michael-specter-on-the-placebo-effect/ http://www.sciencebasedmedicine.org/michael-specter-on-the-p... http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-placebo-effects-again/ http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-plac... [3] http://theness.com/neurologicablog/index.php/the-rise-and-fall-of-placebo-medicine/ http://theness.com/neurologicablog/index.php/the-rise-and-fa... [4] http://www.ncbi.nlm.nih.gov/pubmed/20091554 http://www.ncbi.nlm.nih.gov/pubmed/20091554
wdr1 12y ago
BTW, if you haven't seen it already, you should check out his YT channel, Healthcare Triage: https://www.youtube.com/user/thehealthcaretriage https://www.youtube.com/user/thehealthcaretriage He does a great job covering a variety of subjects & explaining research to the layman.

93 points by Libertatea 12y ago

matkam 12y ago

Any idea how placebos work so well, what they are, and if we're doing anything to take advantage of the effect?

kazinator 12y ago
They work the same way that some speaker cables sound so damn great (to whomever paid the $299 for them). http://en.wikipedia.org/wiki/Confirmation_bias http://en.wikipedia.org/wiki/Confirmation_bias
- matkam 12y ago
  Don't placebos sometimes result in real physical benefits?
  - benbreen 12y ago
    Interesting two part article by a Harvard Med School professor on whether psychiatric meds rely on an "activated placebo effect" (i.e. a placebo with side effects). Some would argue this isn't necessarily a bad thing as long as they are perceived to be efficacious by those taking them. http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/ http://www.nybooks.com/articles/archives/2011/jun/23/epidemi... http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/ http://www.nybooks.com/articles/archives/2011/jul/14/illusio...
  - kazinator 12y ago
    Yes. For instance, the person with $300 speaker cables feels good about how they sound and that puts them into a good mood. This is a physical benefit.
    - skinnybatch 12y ago
      I'd argue this is a psychological benefit...
      - DigitalJack 12y ago
        So you think there is nothing physical about mood? Interesting.
        pessimizer 12y ago
        We don't even have ways in English (probably any language) to speak about internal states without resorting to dualism. The closest we can get is hardware/software analogies.
        Dylan16807 12y ago
        There is a distinction, though it's tricky to word. It's about what is a direct effect, and what is an indirect effect. There is a feedback loop between abstract thoughts and effects on the body, so to make a proper distinction you want to ignore the feedback loop and look at where the inputs are. A placebo's direct effect is not physical. The direct effect is that first thought that you are receiving treatment, before it even has a chance to affect your mood. A kidney transplant's direct effect is mostly physical. It's filtering your blood at a rapid pace. So technically mood has physical effects but by the time you reach that stage you've destroyed the meaning of the term "physical benefit" into meaning just "benefit". Feel free to suggest better terms, but please don't muddle the waters.
        kazinator 12y ago
        Yes, of course. A placebo headache medicine of course does not have the direct effect comparable to aspirin, acetaminophen or ibuprofen. It's direct effect is not physical, because it doesn't have one. "No physical effect" means the same thing as "no effect", unless we are willing to discuss metaphysical effects. The indirect effects are somehow the result of the user's expectation that there is a direct effect. That is to say, "placebo effect" is not "the effect of the placebo object", obviously. It's the emergent effect of the whole situation of someone being duped with a placebo. Being duped with a placebo has direct, physical effects, while the placebo object has no effect.
  - MarkPNeyer 12y ago
    If your mind calms down, your heart rate drops, your cortisol goes down, and your muscles become less tense. Those are all physical benefits.
83457 12y ago
There is actually a discipline of medicine dedicated to researching and promoting the use of placebos to cure ailments called homeopathy.
- tobinfricke 12y ago
  I assume you mean this as a joke, but homeopathic remedies are so popular here in Germany -- the pharmacy shelves are loaded with them!! -- that I wonder whether use of the placebo effect is an official component of the national healthcare strategy.
  - TillE 12y ago
    Yeah, it's extremely weird to see homeopathic "medicine" all over in a country with an otherwise excellent, modern medical system. Germany generally does a good job on evidence-based herbal medicine (like standardizing St. John's wort extract), but I worry that the line can easily be blurred between them and homeopathic products in the eyes of most consumers. You really have to look carefully - they're not clearly marked. So honestly, you're probably quite right about it being a deliberate exploitation of the placebo effect. Because otherwise, there's no reason not to ban them.
    - pluma 12y ago
      No kidding. I went to the doctor with sleeping problems one time and he suggested I look up a certain drug. He said I couldn't get a prescription for it and it was to be taken therapeutically (i.e. indefinitely) and at the normal dosage it would cost something like 50 bucks a month. I went home and looked it up: a homeopathic panacea with only a single "study". Not double blind, not even single blind -- they literally just gave the drug to some participants and the self-reported symptoms "improved". I'm still not sure whether the GP was just trolling me.
      - tobinfricke 12y ago
        I've had similar experiences. I find it very strange. You make a good point: the homeopathic remedies aren't even cheap.
DanBC 12y ago
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974.pub3/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974... > We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.
- pella 12y ago
  "Nevertheless, it is important to mention that according to an influential 2001 meta-analysis comparing placebo-treatment arms with no treatment, placebos make no clinical difference.[20] However, the methodological difficulties of combining diverse conditions in a single meta-analysis are serious, and the authors’ updated meta-analysis includes more nuanced conclusions.[21] Furthermore, the meta-analyses implicitly assume the biological reductionist definition of placebo, ignoring the psychosocial context of sickness and health. The subjects in those studies were entered into a research programme and received attention and care. Therefore, in the way that the studies of the meta-analysis were actually conducted, there was plenty of room for the placebo effect without the placebo, which would spuriously suggest that the placebo was no more effective than no treatment, though in fact both had the potential to produce a placebo effect." from "The moral case for the clinical placebo" http://jme.bmj.com/content/40/4/219.full http://jme.bmj.com/content/40/4/219.full
snowwrestler 12y ago
Jokes about homeopathy aside, if you can answer your own question, there's probably a Nobel prize in it for you. Mind/body interactions are incredibly complex and as yet pretty poorly understood. There are some known ways to take advantage of similar effects--for instance, helping patients find ways to lower stress as a means of mitigating risk factors like high blood pressure.
- Natsu 12y ago
  Same here in the US, they even put them in the pharmacy :( I remember one time I needed eyedrops. They were only listed as homeopathic in tiny print and were adjacent to real eyedrops in the pharmacy, so it was a bit hard to read them with my allergies going. And I've tried washing my eyes with water, but it's not as effective as real eyedrops. Moreover, these contained "aspis", allegedly some extract from bees, which I might be allergic to. One would hope that they'd diluted it enough, but it actually listed a fairly low dilution factor so I couldn't even be sure the damned things weren't harmful.
JacobJans 12y ago
I'd suggest you look into hypnosis and hypnotherapy. There are quite a few things the mind can do, given the right suggestions.
marincounty 12y ago
Right now they don't have a clue. In my world, the effect is the only existence of God--until proven differently. So believing strongly in something isn't as foolish as some "Intellectuals" would berate?

sniderlane 12y ago

Try it yourself: http://placebobutton.com/ http://placebobutton.com/

deleted 12y ago
[deleted]
Procrastes 12y ago
I pressed the comforting, blue button and my chronic gullibility was cured instantly! Thank you Placebo Button!

sudowhodoido 12y ago

I thought that was kind of obvious. A friend of mine who repairs PCs occasionally finds nothing wrong with them and does the usual "I'll run some maintenance on it" and the client is always happier afterwards. He doesn't charge for stuff unless anything needs to be done.

deleted 12y ago
[deleted]
Toddarooski 12y ago
Wouldn't your friend get happier clients if he charged them a little bit? It'd probably give them a stronger placebo effect.
- sudowhodoido 12y ago
  People are shallow. The computer is their best friend 95% of the time, but they remember the last 5% and how much it cost them more than anything.

Alex3917 12y ago

> For a drug to be approved by the Food and Drug Administration, it must prove itself better than a placebo, or fake drug. False, the FDA doesn't actually have any requirement to prove that a treatment is better than placebo. Many trials don't even include a placebo arm, they only compare themselves against existing drugs that were grandfathered into the system without any efficacy testing. Or they compare themselves to inert placebos rather than active ones, even if they are psychoactive drugs. Or they only compare themselves against placebos for a few weeks, even if they are meant to be used for long periods of time. This is how we have drugs like antidepressants and ADHD drugs on the market even the though research shows they are actually worse than taking no drug at all.

viewer5 12y ago
> antidepressants and ADHD drugs on the market even the though research shows they are actually worse than taking no drug at all What do you mean?
- Alex3917 12y ago
  http://www.amazon.com/gp/product/0307452425/ref=s9_simh_gw_p14_d0_i1?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1T1TZZVVDR83AX2SD7HT&pf_rd_t=101&pf_rd_p=1688200382&pf_rd_i=507846 http://www.amazon.com/gp/product/0307452425/ref=s9_simh_gw_p... http://www.amazon.com/gp/product/0465022006/ref=s9_simh_gw_p14_d0_i2?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1T1TZZVVDR83AX2SD7HT&pf_rd_t=101&pf_rd_p=1688200382&pf_rd_i=507846 http://www.amazon.com/gp/product/0465022006/ref=s9_simh_gw_p...
  - refurb 12y ago
    Rather than linking to a book on Amazon, could you link to some peer-reviewed journal articles?
    - Alex3917 12y ago
      Both of these books are just writeups on peer reviewed journal articles. No individual article is going to tell you very much on its own, so I don't see much value in just linking to a random list of studies.

ToastyMallows 12y ago

Anyone interested in the Placebo Effect, I recommend Josh & Chuck's Stuff You Should Know episode about it. http://www.stuffyoushouldknow.com/podcasts/how-the-placebo-effect-works/ http://www.stuffyoushouldknow.com/podcasts/how-the-placebo-e...

deleted 12y ago

[deleted]

kylelibra 12y ago

I clicked on this thinking "surely this is some NY Times article from their archives." Nope.

agarden 12y ago

It strikes me that for something like knee surgery, at least, the recovery routine might be what provides the benefit. What if you took a group and did not pretend to give them surgery but made them rest and go through physical therapy as if you had?

jobu 12y ago
"Less than a year ago, many were shocked when arthroscopic surgery for meniscal tears performed no better than sham surgery. This procedure was the most common orthopedic procedure performed in the United States." Earlier this year I re-injured the meniscus in my knee and was about to undergo surgery when a radiologist in the family mentioned this study. I cancelled the surgery and followed the alternative recovery method of ice, ibuprofen and rest. It took a long three weeks for me knee to feel normal again, but it would've been much longer had I undergone the surgery.

ucho 12y ago

Very old news. Surgery for "Gastroesophageal reflux disease" was an famous example: http://en.wikipedia.org/wiki/Placebo#cite_note-198 http://en.wikipedia.org/wiki/Placebo#cite_note-198 . If I remember correctly in one study symptoms dissipated in 50% of patients, who got sham surgery - just skin incisions.

briantakita 12y ago

The prevalence of the Placebo Effect across many medicinal domains seems like evidence that there is an underlying cause. Perhaps emotional well being has an impact on health?

marincounty 12y ago

The Placebo Effect should be taught in grade school. We shouldn't have to wait until college to realize just how many products, drugs, professions, etc. are an absolute sham.

ChuckMcM 12y ago

Perhaps we could create a placebo bureaucracy, say an FDA like agency which just approved anything that came through it. And then we could compare the end results of that agency with the FDA to see which one approved the most 'actually useful' medicines and the one which had the most 'later found to be harmful' medicines.

tokenadult 12y ago
Chuck, that's already done. That's the "natural supplements" industry[1] as it has been regulated since the mid-1990s in the United States. [1] "Dietary supplement industry says 'no' to more information for consumers (again)" http://www.sciencebasedmedicine.org/big-supp-resists-giving-consumers-safety-and-effectiveness-information/ http://www.sciencebasedmedicine.org/big-supp-resists-giving-...

smegel 12y ago

> They had an incision, and a procedure was faked so that they didn’t know that they actually had nothing done. Is it just me, or does this seem ethically dubious? A sugar pill placebo does no harm, but when you are cutting people open to "fake" surgery...just doesn't sit right.

jonchang 12y ago
The article, in fact, addresses your question. > The ethical issues aren’t easily dismissed. Theoretically, a sugar pill carries no risk, and a sham procedure does. This is especially true if the procedure requires anesthesia. The surgeon must go out of his or her way to fool the patient. Many would have difficulty doing that. > But we continue to ignore the real potential that many of our surgical procedures and medical devices aren’t doing much good — and might even be doing harm, since real surgery has been shown to pose more risks than sham surgery.

msolujic 12y ago

Here is one more recent interesting research result in area of placebos http://www.coloradocollege.edu/newsevents/newsroom/the-power-of-positive-sleeping http://www.coloradocollege.edu/newsevents/newsroom/the-power...

tokenadult 12y ago

This article brings up a very important point, and I'm grateful that it was submitted here. The professor of pediatrics who wrote the article is onto some important issues, and I was especially glad he cited some of the research literature with direct links. Reading a review he cited,[1] I see that one of the problems here is the vagueness of what he calls "improvement" in many medical studies. Is the treatment endpoint of a knee operation patients moving better than they used to, as measured by trained observers watching the patients do standardized movements? Or is "improvement" a patient self-report of less pain? Several of the examples the author writes about are examples of treatments indicated to relieve pain (angina, which is chest pain, or lower back pain, and it looks like most of the knee surgery he mainly focuses on was also done to relieve patient-reported pain). Patient self-reported pain is a symptom, a matter important to the patient, but it is not a diagnostic sign that can be objectively observed by anyone else (as, for example, blood pressure or white cell count can be objectively observed). Too many medical studies, and almost all "alternative medicine" testimonials, are based on soft endpoints (patient self-reports of improvement) rather than on "hard endpoints" (longer healthier life after reduction in all-cause mortality, or resuming walking after being paralyzed, or something observable objectively and lastingly important). Pretty much all studies by all authors of whatever researcher background that appear to show a "placebo effect" show that only for patient-reported subjective symptoms that are usually temporary anyway like pain and nausea. Nobody asks for a placebo treatment for a broken leg or a life-threatening infection. The medical researchers who look at the issue with proper study designs and statistical controls know that placebos are essentially useless, as they at most have influence just on self-reported subjective symptoms, not on any sign that affects the progression of a disease or maintenance of good health.[2] Findings on placebo effects by researchers who have considered the issue carefully include "Despite the spin of the authors – these results put placebo medicine into crystal clear perspective, and I think they are generalizable and consistent with other placebo studies. For objective physiological outcomes, there is no significant placebo effect. Placebos are no better than no treatment at all."[3] "We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed."[4] So, yes, let's make sure that studies of surgical techniques include studies of sham surgery. (Studies of acupuncture had better always have sham acupuncture arms in which "real" acupuncture points are disregarded or other aspects of supposedly ancient Chinese technique are intentionally omitted without the patient knowing that.) This will improve the evaluation of safety and effectiveness of new surgical techniques. Just don't assume that ANY placebo is ever good for ANYTHING that you couldn't achieve just by giving yourself a good pep talk. [1] http://www.bmj.com/content/348/bmj.g3253 http://www.bmj.com/content/348/bmj.g3253 [2] http://www.sciencebasedmedicine.org/michael-specter-on-the-placebo-effect/ http://www.sciencebasedmedicine.org/michael-specter-on-the-p... http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-placebo-effects-again/ http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-plac... [3] http://theness.com/neurologicablog/index.php/the-rise-and-fall-of-placebo-medicine/ http://theness.com/neurologicablog/index.php/the-rise-and-fa... [4] http://www.ncbi.nlm.nih.gov/pubmed/20091554 http://www.ncbi.nlm.nih.gov/pubmed/20091554

wdr1 12y ago

BTW, if you haven't seen it already, you should check out his YT channel, Healthcare Triage: https://www.youtube.com/user/thehealthcaretriage https://www.youtube.com/user/thehealthcaretriage He does a great job covering a variety of subjects & explaining research to the layman.