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TheBlackCat
2005-Oct-28, 12:07 AM
We discussed an interesting article in my Neuroscience class. A group of researchers induced pain in volunteers while they were being monitored using a PET scan. This allowed them to image the parts of the brain that were being affected by the pain. The researchers then gave the subjects what the researcher's claimed was a medication that might relieve their pain, but was in fact a placebo. The mean where then asked to rate their pain in 15-second intervals. They found that as the pain ratings dropped after administering the placebo, areas in the brain related to the endogenous opioid system, a system that inhibits the pain-transmission system in the spinal cord, became active and the pain-recieving areas of the brain became less active. This appears to be the first data that actually demonstrates a measurable physical change as a result of the placebo affect.

Up to this point there has been quite a lot of debate as to whether the placebo affect was merely a psychological effect, or even whether it existed at all, but this indicates there is a specific neurological effect that actively inhibits pain as a result of the placebo effect.

Unfortunately I cannot get you the full article, but he is an Extract from a review (http://jama.ama-assn.org/cgi/content/extract/294/14/1750?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=kuehn&title=pain+studies+illuminate+the+placebo+effect&andorexacttitle=phrase&andorexacttitleabs=and&andorexactfulltext=and&searchid=1130457748482_968&stored_search=&FIRSTINDEX=0&sortspec=relevance&journalcode=jama) with an image showing some results and the Abstract (http://www.jneurosci.org/cgi/content/abstract/25/34/7754?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=zubieta&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1130457872030_9663&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2005&journalcode=jneuro). Anybody at a university should be able to get the full article

Ken G
2005-Oct-28, 01:05 AM
Very interesting, once again TBC. I've always wondered if the placebo effect was purely in how patients *reported* feeling, as opposed to how they were *actually* feeling. This proves that at least part of the effect is of the latter type. Of course, neurological results are tricky because of the self-referential character of self-awareness. If you believe something, it could show up physiologically in your brain more easily than elsewhere in the body. But the brain-body connection is so strong that if it happens in the brain, I'd be willing to believe it happens elsewhere. Still, how can you now tease out the difference between how people actually feel, and how they report feeling when asked by a friendly doctor that they want to appease? Or a friendly pseudoscientific "healer", for that matter? In any event, it is certainly grist for the mill of alternative medicine practitioners, the more responsible of whom openly admit they are trafficking in the placebo effect. Which raises the really important question: can you achieve a *better* placebo effect with smoke and mirrors than just telling someone you gave them a pill?

01101001
2005-Oct-28, 01:58 AM
And the beauty of real medicines with actual beneficial chemical effects, is that you can get the chemical effect and you can get the placebo effect.

The article did some some minor mention in the media, like abc.net News in Science: Placebo effect is real (http://www.abc.net.au/science/news/stories/s1468236.htm)

Ken G
2005-Oct-28, 02:11 AM
Thanks for the link 01. What's really fascinating to me is that this would seem to open the floodgates for investigations of *how to* do the placebo effect effectively! You have a quantitative measure here, it's fantastic. For example, what happens when you say "here's a pill that doesn't work for most people, but heck, give it a try", versus when you say "this is the best painkiller known to medicine, it gives terrific results in almost everyone"? How about when instead of a pill, you have a person standing behind them doing Reiki massage? What if there is aromatherapy and crystals thrown into the mix? All this stuff can now be quantified! Brace yourselves, one camp or the other may be in for some surprises....

grant hutchison
2005-Oct-28, 09:36 AM
Still, how can you now tease out the difference between how people actually feel, and how they report feeling when asked by a friendly doctor that they want to appease?You measure a physiological variable - it's known, for instance, that there's a placebo effect in treating high blood pressure. Give people a placebo, their blood pressure falls.
What TheBlackCat reports is the first sign of a central mechanism that might mediate the placebo effect, rather than the first physical evidence for its existence.

Grant Hutchison

WaxRubiks
2005-Oct-28, 10:20 AM
if someone told you you were going to see the dentist the next day you might be very nervous for a while, if that same person told you the next day that they made it up you might be very relieved. the body just responds to what you believe.


what about the opposite situation? that is voodoo, if someone believes that they are going to die, due to a curse of somekind, what physiological effects must be taking place in them?

grant hutchison
2005-Oct-28, 02:08 PM
There is a great deal more to the placebo effect than merely the relief of stress.
1) There's a study in patients with angina which would now be unethical to perform, in which they were subjected to real or placebo surgery. One group underwent a procedure in which an artery in the chest wall was tied off; the other group had an an incision performed, but no other surgery. In terms of improved exercise tolerance and ECG (EKG) changes, the placebo group did better than the surgery group.
2) Japanese researchers recruited volunteers to test the allergic response to poison ivy. The volunteers were told that one arm was to be brushed with poison ivy, and the other, by way of a control, was to be brushed with cotton wool. The ivy was in fact non-poisonous, and the cotton wool was impregnated with poison ivy juice. All 13 volunteers showed a skin reaction to the ivy, and only two to the cotton wool.


what about the opposite situation? Negative placebo responses are also demonstrably physiologically real, as the poison ivy experiment above showed. The word used for this is "nocebo", which might be a handy Google search word if you want more information.

Grant Hutchison

Edit 1: Corrected description of active intervention in 1)
Edit 2: Corrected spelling of "nocebo"

WaxRubiks
2005-Oct-28, 02:21 PM
I have read that an experiment where by people were given orange juice with caffeen in and others were given decaf coffee. The people who drank the orange slept as normal but the people who drank the decaff reported trouble getting to sleep.

RBG
2005-Oct-28, 03:57 PM
I wonder how effective the Placebo Effect would be if everyone knew about it; knew how it worked and questioned any particular medicine for its total or component placebo effect?

I think in the interest of medicine we need to terminate our discussion here. ;-)

RBG

grant hutchison
2005-Oct-28, 04:57 PM
I think in the interest of medicine we need to terminate our discussion here. ;-)Well, it would be grossly unethical for a physician to actually treat someone with a placebo (that is, give them a sugar pill and tell them it was an active drug). Doing such a thing would probably lead to the withdrawal of a licence to practise.
Since most mainstream medical interventions are tested against placebo or the current best practice, and (in theory, at least) adopted only if they do better in that "contest", it's pretty certain that they have a real action. However, if you are deeply suspicious of the drug you're taking, you might well come up with some nocebo effects in addition to real drug-induced side-effects.

Grant Hutchison

Edit: Corrected spelling of "nocebo".

RBG
2005-Oct-28, 06:46 PM
Since most mainstream medical interventions are tested against placebo or the current best practice, and (in theory, at least) adopted only if they do better in that "contest", it's pretty certain that they have a real action.
Grant Hutchison

In this scenario a placebo is being administerd by physicians. How would perfect understanding of the placebo effect or the effect itself complicate the results of such a trial, I wonder?

RBG

grant hutchison
2005-Oct-28, 07:03 PM
In this scenario a placebo is being administerd by physicians.True. But not with the intention of treating disease, and not without the patients being told that they may receive an inactive therapy.

How would perfect understanding of the placebo effect or the effect itself complicate the results of such a trial, I wonder? That problem is addressed by the fact that such trials are also randomized and double blinded, so that neither patient nor assessing physician knows whether the patient is receiving active drug or placebo. So placebo understanding / drug doubts will be randomly distributed between the two groups, and should therefore bias each equally.
However, I can imagine that if there were a roughly equal mix of "placebo understanding" and "placebo naivety" in the study population, that might increase the scatter of the results from both groups, which would reduce the study's statistical power to demonstrate any real difference between placebo and active treatment.

Grant Hutchison

tofu
2005-Oct-28, 08:13 PM
I wonder, if you gave someone a pill and told them it made them smarter, would it make them smarter?? It's certainly conceivable that they would concentrate just a little harder, believing that with their new pill-driven brain power they could solve any problem if they just tried hard enough. It's like the other side of the coin from people whose outlook on life is, "I'm going to fail anyway so why try?"

Ken G
2005-Oct-28, 08:40 PM
Thanks for this excellent information Grant. Notice that Grant is focusing all his comments on physiological placebo and nocebo effects, not psychological ones. There is no question the psychological impact of belief, but a long-held idea in mainstream medicine is that they should concentrate on physiological responses, presumably because psychological ones are outside their control and at times test the limits of what is ethical. More and more there is appreciation for "bedside manner", but this goes beyond achieving a psychological placebo response. I think what is interesting about what Grant and TheBlackCat are saying here, is we also have lots of evidence of physiological placebo effects, and are starting to understand how they originate in the brain. Do you not see how this opens up a new vein for modern medicine, involving the question of, what makes a good placebo, and what makes an ineffective placebo, or even a nocebo? They don't have to take a "hands off" policy toward placebos any more, because they can study the physiological response. Note-- alternative medicine has been there for a long time, they just haven't been at all scientific about how they proceed. The tools are now in place to do just that. At the end of the day, I see a grudging acceptance in the mainstream that alternative approaches (i.e, placebo approaches) do have merit if conducted responsibly and scientifically (modulo all the ethical issues), and I see the alternative camp being called upon to justify their methods and quantify the effectiveness of their treatments (and maybe even having ethical issues raised-- they tell people all kinds of crazy things, and cannot be sure they never do harm). It's high time the placebo effect came out of the shadows of pseudoscience.

grant hutchison
2005-Oct-28, 09:40 PM
I wonder, if you gave someone a pill and told them it made them smarter, would it make them smarter?? It's certainly conceivable that they would concentrate just a little harder, believing that with their new pill-driven brain power they could solve any problem if they just tried hard enough.Interestingly, in this context, there is reportedly some evidence of a placebo response in Alzheimer's disease.

Grant Hutchison

grant hutchison
2005-Oct-28, 09:54 PM
Notice that Grant is focusing all his comments on physiological placebo and nocebo effects, not psychological ones...
Thanks for correcting my rotten spelling, Ken. :) Of course it's nocebo, from Latin nocere, "to harm"; just as placebo comes from placere, "to please".

More and more there is appreciation for "bedside manner", but this goes beyond achieving a psychological placebo response.I think it's no coincidence that the most popular and successful complementary therapies are those that require a prolonged contact between practitioner and patient: for instance, homeopathy, in which an extensive "holistic" history is taken. It's also, I think, no coincidence that the conditions which respond well to such an approach are those that are good placebo responders, such as asthma, psoriasis and arthritis.

Grant Hutchison

Edit: Spelling again!

piersdad
2005-Oct-28, 10:08 PM
They found that as the pain ratings dropped after administering the placebo, areas in the brain related to the endogenous opioid system, a system that inhibits the pain-transmission system in the spinal cord, became active and the pain-recieving areas of the brain became less active. This appears to be the first data that actually demonstrates a measurable physical change as a result of the placebo affect.

very true if i get an electric shock when i am working intensly with a live switchboard then it is just an annoyance and i continue with the more important work.
if the same shock is recieved when im not expectiong it then it is a lot more painfull.

Ken G
2005-Oct-28, 10:56 PM
I wonder if association of alternative medicine with the placebo effect strengthens or weakens their claim to legitimacy? At first look, one might say weakens, but realize that this is the only demonstrable way in which it might be doing some benefit. In my view, the problem comes in when they take their rhetoric too seriously and "prescribe" harmful solutions, or when they opt for expensive placebo treatments without first checking that cheaper placebos would be as effective.

grant hutchison
2005-Oct-29, 12:30 AM
I wonder if association of alternative medicine with the placebo effect strengthens or weakens their claim to legitimacy?It certainly makes complementary therapies tempting when mainstream solutions are either poor or side-effect rich: arthritis is a good example, again.
The danger comes when grossly inflated claims are made for complementary therapies in direct opposition to effective but side-effect prone mainstream therapies. Malaria prophylaxis is a good example. Because the side-effects of drugs like Lariam are unpleasant (or, rarely, extremely unpleasant and much publicized), people are keen to take up side-effect free interventions like "homeopathic antimalarials". These don't work at all, and in fact don't even make sense within the standard homeopathy dogma (and so are also condemned by most homeopaths). So people die very unpleasantly rather than risk a few weeks of tingling fingers and vivid dreams.

Grant Hutchison

beskeptical
2005-Nov-01, 06:41 AM
I think Pavlov demonstrated the placebo effect when he got dogs to salivate at the sound of a bell. It isn't just pain that can be modified by internal activity in the brain.

beskeptical
2005-Nov-01, 06:51 AM
Re alternative medicine, the placebo effect is pretty mild generally compared to many proved treatments and not all regular medicine has side effects.

IF there is not a better option one is missing out on by taking alternative medicine instead of something with good evidence of effectiveness, (missed opportunity), IF the alternative does not cost too much, IF the alternative is not harmful, (regular medicine does not have a monopoly on side effects), then the placebo effect or an as yet to be proved potential of an alternative medicine is certainly a reasonable choice.

beskeptical
2005-Nov-01, 06:59 AM
There is a great deal more to the placebo effect than merely the relief of stress.
1) There's a study in patients with angina which would now be unethical to perform, in which they were subjected to real or placebo surgery. One group underwent a procedure in which an artery in the chest wall was tied off; the other group had an an incision performed, but no other surgery. In terms of improved exercise tolerance and ECG (EKG) changes, the placebo group did better than the surgery group.
2) Japanese researchers recruited volunteers to test the allergic response to poison ivy. The volunteers were told that one arm was to be brushed with poison ivy, and the other, by way of a control, was to be brushed with cotton wool. The ivy was in fact non-poisonous, and the cotton wool was impregnated with poison ivy juice. All 13 volunteers showed a skin reaction to the ivy, and only two to the cotton wool.I'd like to read these actual studies before I just believe this. I'm not saying I doubt the power of belief. In fact, I have read the study of knee surgery vs sham surgery which showed the knee surgery wasn't any better than the sham or placebo surgery. But what it really showed was the surgery wasn't as beneficial as had been believed. It didn't necessarily show that the placebo effect of surgery was terribly great.

In the cases above I'm skeptical of the passing on of these type of reports. The further away you get from the actual source, the further away you get from the real facts.

grant hutchison
2005-Nov-01, 09:14 AM
In the cases above I'm skeptical of the passing on of these type of reports.Fair enough. They were described to me by a colleague with considerable experience of epidemiology and clinical trial design who has a special interest in placebos, and who generally knows a poor study design when he sees one.
However, on a forum like this you've no reason at all to trust my second-hand news, let alone my word that I trust his word. :) So I should certainly have mentioned my source.

Grant Hutchison

grant hutchison
2005-Nov-01, 12:41 PM
I'd like to read these actual studies before I just believe this.I've been mulling over why these stories triggered your sceptical response. Perhaps you just (rightly) have reservations about all unattributed information, but I am getting a sense that you find them in some way extreme or "fringe", and so have a particular concern about my passing on "these type of reports".

So I should point out that I it never occurred to me that these were other than standard physiological examples of placebo effect in action when I posted them. I certainly didn't feel as if I were venturing anything startling or unacceptable to mainstream medicine.
In the first example, an intervention that was thought to be beneficial turned out to be mildly detrimental, thus highlighting the placebo effect in the control group in a way you don't normally see.
In the second example, it's well known that the nervous system and the immune system modulate each other in very deep and complex ways - I don't think you'd find an allergy specialist who wouldn't be happy with the idea that a patient's mental and neurological state influences their allergic skin response.

None of this, of course, undermines your point about going back to the original sources, which is incontestible. But I did feel moved to come back and state, for clarity's sake, that I don't consider these to be unusual examples, just nicely illustrative of the point I was trying to make.

Grant Hutchison

aurora
2005-Nov-01, 08:38 PM
I didn't see anyone mention double blind randomized experiments, which are the ideal way to test new treatments.

I did see someone mention that in tests on humans there are ethical considerations for some of the medicines (for example, you can't withhold treatment from someone where one or more treatments have previously been shown to be effective for their condition).

But even so, there are many situations where double blind randomized trials can be done.

grant hutchison
2005-Nov-01, 08:54 PM
I didn't see anyone mention double blind randomized experiments, which are the ideal way to test new treatments.I did mention them in passing:

That problem is addressed by the fact that such trials are also randomized and double blinded, so that neither patient nor assessing physician knows whether the patient is receiving active drug or placebo.


I did see someone mention that in tests on humans there are ethical considerations for some of the medicines (for example, you can't withhold treatment from someone where one or more treatments have previously been shown to be effective for their condition).

But even so, there are many situations where double blind randomized trials can be done.Yes indeed. The ethical solution to your point above is to use a randomized, double-blind design to compare your new treatment to the best currently available treatment, rather than to a placebo. I think that most medical ethics committees, grant-giving bodies and medical journals would nowadays refuse approval for a study design that used placebo when a pre-existing effective treatment was available.

Grant Hutchison

Ken G
2005-Nov-01, 09:05 PM
Re alternative medicine, the placebo effect is pretty mild generally compared to many proved treatments and not all regular medicine has side effects.
.
But what I'm wondering is, perhaps the "placebo effect" is not just one thing. If you are treating pain with drugs, you would not cite "the drug effect", you would describe what drug and what dose. Why has modern medicine not looked into the possibility that just telling someone you are giving them a pill is a fairly "weak" placebo effect? Why not search for stronger ones? The problem, as I see it, is right now on the one hand we have a bunch of people who are highly technically proficient and have the best of modern medicine to draw on for their treatments, but may have no real concept of how their patient's psychology will affect the prognosis, and on the other hand we have a bunch of often very caring people who are extremely in tune with their "client's" psychological state, but have no actual medicines with any clout at their disposal, and cannot draw on the scientific method to test their efficacy. The first we call "mainstream", the second "alternative". Isn't it obvious that a better union of these modes of treatment would provide the best results? I don't mean to suggest that mainstream doctors aren't caring healers as well, I'm saying that all too often it seems that this second part they do "on their own", trusting their experience or intuition. It's high time this part was included in the scientific testing of the efficacy of treatments, especially now that physiological signals of the placebo effect are becoming more and more prevalent. I'd say drop the phrase "placebo" altogether, and replace it with something like "inputs from patient mindset".

beskeptical
2005-Nov-02, 07:05 AM
But what I'm wondering is, perhaps the "placebo effect" is not just one thing. If you are treating pain with drugs, you would not cite "the drug effect", you would describe what drug and what dose. Why has modern medicine not looked into the possibility that just telling someone you are giving them a pill is a fairly "weak" placebo effect? Why not search for stronger ones? The problem, as I see it, is right now on the one hand we have a bunch of people who are highly technically proficient and have the best of modern medicine to draw on for their treatments, but may have no real concept of how their patient's psychology will affect the prognosis, and on the other hand we have a bunch of often very caring people who are extremely in tune with their "client's" psychological state, but have no actual medicines with any clout at their disposal, and cannot draw on the scientific method to test their efficacy. The first we call "mainstream", the second "alternative". Isn't it obvious that a better union of these modes of treatment would provide the best results? I don't mean to suggest that mainstream doctors aren't caring healers as well, I'm saying that all too often it seems that this second part they do "on their own", trusting their experience or intuition. It's high time this part was included in the scientific testing of the efficacy of treatments, especially now that physiological signals of the placebo effect are becoming more and more prevalent. I'd say drop the phrase "placebo" altogether, and replace it with something like "inputs from patient mindset".
In my opinion this is not an accurate reflection of modern medicine. Modern medicine, (for lack of a better term), has more recently been changing to "evidence based medicine". While a lot of modern medicine was evidence based it only recently began to be more well defined.

Alternative medicine, (for lack of a better term), has only recently even begun considering evidence. Instead, it has been based heavily in anecdotal evidence and historical tradition.

Neither of the two are exclusive. Some of alternative medicine is evidence based and lots of modern medicine still includes untested traditional remedies.

Placebo effects have been widely recognized and are used in both modern and alternative medicine. But a placebo will not cure cancer. It won't alleviate burn pain better than narcotics. It won't treat a schizophrenic in a psychotic state.

As to why I don't accept the above 'studies' without looking at the original sources, experience tells me even experts pass on these kind of things without a sufficient level of skepticism. I can give you many examples including some I myself mistakenly passed on then later found them to be false. You'd be surprised what we believe that isn't factual.

Ken G
2005-Nov-02, 03:03 PM
I agree that the evidence is everything, and placebo experiments must be carefully controlled to be useful. It looks to me like neither camp is doing enough there. Alternative practitioners usually rely on anecdotal evidence from patients who want them to feel like they are helping, but even mainstream research uses phrases like "when compared to a placebo". But note, those tests don't want the placebo to have much effect, they would view that as reducing the reliability of the measurement of the effect of the real medicine. There's no payoff for defining a "maximal" placebo effect, and trying to study its properties. What does it work for? Should it be tailored to the psychology and education level of the subject? The ethical issues are uncomfortable, and that may in part be why this type of research is viewed as a little flaky, I would imagine.

beskeptical
2005-Nov-02, 06:15 PM
...But note, those tests don't want the placebo to have much effect, they would view that as reducing the reliability of the measurement of the effect of the real medicine. There's no payoff for defining a "maximal" placebo effect, and trying to study its properties. What does it work for? Should it be tailored to the psychology and education level of the subject? The ethical issues are uncomfortable, and that may in part be why this type of research is viewed as a little flaky, I would imagine."Payoff" assumes all research dollars come from commercial based sources which isn't true. There are many foundations and nonprofit organizations that put research dollars into non-medical and non-invasive interventions.

I agree the dilemma of the research ethics (sham surgeries for example) and the ethics of using a placebo make it's usefulness and research potential complicated.

On the other hand, just because one wants to measure any effect beyond placebo doesn't mean later users of the product won't desire the added placebo effect. The whole point is to isolate variables in order to measure the variable. Otherwise what would the research tell you?

Ken G
2005-Nov-02, 08:07 PM
The whole point is to isolate variables in order to measure the variable.
Yes, so what I'm suggesting is, it's time to start including the placebo effect as one of the those variables to be isolated. Any research been conducted on that? You could use the exact setup from the OP, for example. I would expect that to be the next thing done with it, in fact.

publiusr
2005-Nov-02, 09:05 PM
I feel better just reading this thread.

aurora
2005-Nov-02, 09:15 PM
I did mention them in passing:



Thanks, I did miss that in my first read through of this thread.

As to controlling for the placebo effect, I think that is done in the typical experiment where all groups either assume that they may have a placebo or all groups know that they do not have a placebo.

Ken G
2005-Nov-02, 10:07 PM
Yes, the placebo is a controlled effect, that's my point. You are not trying to learn about the controlled effects, you are trying to learn about the variable ones, like dosages of a medicine. I want to see the studies where the placebo parts are the variable, and everything else is controlled.

aurora
2005-Nov-02, 11:13 PM
So a study where there is a real and a fake placebo? :razz:

seriously, I'm sure there have been studies where the control group received nothing, so any effect was supposedly the placebo effect.

Gillianren
2005-Nov-04, 01:18 AM
I don't know; I've been researching meds this afternoon, now that they'll be putting me on 'em, and at least placebos don't have possible seizures as a side effect.

Ken G
2005-Nov-04, 05:42 AM
So a study where there is a real and a fake placebo? :razz:


The joke is well taken, but were I to take the question seriously, I would answer no-- a study where there is a "good" and a "not so good" placebo. Never heard of a good and not so good placebo? But you have heard of a good and a not-so-good headache medicine? Exactly my point.

beskeptical
2005-Nov-05, 07:35 AM
Yes, so what I'm suggesting is, it's time to start including the placebo effect as one of the those variables to be isolated. Any research been conducted on that? You could use the exact setup from the OP, for example. I would expect that to be the next thing done with it, in fact.
When you set up a study like the ones we are talking about here, you don't necessarily set out to look at more than one variable. If you want to study a drug, for example, why would you look at the placebo effect at the same time? That would make for a very messy study.

There has been lots of research done on the placebo effect. Here are some links to a multitude of studies on the effect.
http://skepdic.com/placebo.html

beskeptical
2005-Nov-05, 07:36 AM
I feel better just reading this thread.
Love the humor. :D

beskeptical
2005-Nov-05, 07:44 AM
I don't know; I've been researching meds this afternoon, now that they'll be putting me on 'em, and at least placebos don't have possible seizures as a side effect.You need to be looking at benefit as well as risk. And just because a side effect is possible doesn't mean it will happen.

You sound like you feel the choice isn't yours here. I recommend buyer beware in medicine as well as with other purchases. That can mean you trust the health care provider to make the right recommendation or it can mean you do a little research into the options yourself and let the provider know what you found.

If you have a problem that is serious enough to take a medicine you think has risky side effects then the problem must have its own risks. There are some very good and very effective meds out there. There is no reason to suffer a known problem because you are worried about a possible problem.

Look up the condition on some reliable websites. Check out the options for treatment then let you provider know what you think.

beskeptical
2005-Nov-05, 07:47 AM
The joke is well taken, but were I to take the question seriously, I would answer no-- a study where there is a "good" and a "not so good" placebo. Never heard of a good and not so good placebo? But you have heard of a good and a not-so-good headache medicine? Exactly my point.The way you study placebo effects is to set up the study so other variables can be filtered out the same way you do with other studies. So you might have a counselor talk to one person and a counselor talk to another person but also give a fake pill. There are lots of ways to design the study.

Gillianren
2005-Nov-05, 06:47 PM
You need to be looking at benefit as well as risk. And just because a side effect is possible doesn't mean it will happen.

You sound like you feel the choice isn't yours here. I recommend buyer beware in medicine as well as with other purchases. That can mean you trust the health care provider to make the right recommendation or it can mean you do a little research into the options yourself and let the provider know what you found.

If you have a problem that is serious enough to take a medicine you think has risky side effects then the problem must have its own risks. There are some very good and very effective meds out there. There is no reason to suffer a known problem because you are worried about a possible problem.

Look up the condition on some reliable websites. Check out the options for treatment then let you provider know what you think.

Well, and that's why I'm doing the research, after all--my therapist asked me to before he puts me on anything. The only one I'll categorically turn down is Lithium--I'm not that sick, thank you. I know the eventual benefits of whatever I take will be astonishing, but I also know too many horror stories about being on the wrong meds. I also know that, for psychiatric meds, it takes a while to find the right ones.

A friend of mine took red clover tea for her anxiety, and while it may well have been a placebo, I wouldn't have suggested that possibility for worlds, given that she wasn't sick enough to need meds.

Zogski
2005-Nov-05, 06:50 PM
The Annals of Improbable Research magazine published a paper a few years ago about a "Super strength placebo". The super strength placebo test group would need to be compared to a placebo test group, in order to prove the former pill's potency.

Very funny.

Ken G
2005-Nov-07, 03:01 AM
So you might have a counselor talk to one person and a counselor talk to another person but also give a fake pill. There are lots of ways to design the study.
Precisely, but has this kind of thing been done? If so, what was the outcome, and how has this informed modern medicine and alternative medicine (which is generally a placebo anyway so stands the most to gain from quantifying their results)? If it hasn't been done, why not? How can they be sure the results would be inconclusive?

01101001
2005-Nov-07, 03:56 AM
Annals of Internal Medicine: Deconstructing the Placebo Effect and Finding the Meaning Response (http://www.annals.org/cgi/content/full/136/6/471) Daniel E. Moerman, PhD and Wayne B. Jonas, MD, 2002 March 19


There is a renewed interest in placebos and the placebo effect—on their reality, their ethics, their place in medicine, or not, both in and out of the clinic and academy. The U.S. National Institutes of Health recently sponsored a large conference called "Science of the Placebo" (2). At least five serious books on the subject (3-7) plus a book of poetry (8) and a novel (9)—each titled Placebo Effect—have been published since 1997. In the past 10 years, the National Library of Medicine has annually listed an average of 3972 scholarly papers with the keywords "placebo," "placebos," or "placebo effect," with a low of 3362 papers in 1992 and a high of 4814 in 2000.
77 references.

Have fun.

Ken G
2005-Nov-07, 11:20 AM
Yikes, well, I doubt that I'll embark on it, not being my own field, but I'm glad to see that this idea is finally going mainstream. Thanks for the research 01101001, that is exactly what I was inquiring about! It will be interesting to see how this percolates into both modern medicine and the alternative community. My guess is it will take a few decades, but the whole concept of placebo health care is likely to go through some significant changes as a result. If that article has any say in it, the whole term "placebo" will be replaced by the more descriptive concept of "meaning response".

grant hutchison
2006-Feb-20, 10:34 AM
Ken may be pleased to learn that the current British Medical Journal contains an article entitled Sham device versus inert pill: randomised controlled trial of two placebo treatments (http://bmj.bmjjournals.com/cgi/content/abstract/332/7538/391). (The study design is nightmarish, however.)

Grant Hutchison

Ken G
2006-Feb-20, 11:34 AM
Thanks Grant, yes that is what I had in mind. I can't comment on the design or its conclusions, but I think we're beginning to see phrases like "medical rituals" appearing where the blanket term "placebo" used to be. It's a step in the right direction, though of course all such treatments will be of value only for limited conditions.

George
2006-Feb-21, 01:33 AM
Love the humor. :D
This brings up a question I've had in mind...have any corncebo studies been conducted? :)

beskeptical
2006-Feb-21, 08:15 AM
cornecebo ?????

George
2006-Feb-21, 02:08 PM
"Corncebos" for a host of patients. It is an injection given orally, just not a physical one. Here are a few...

"Doctor I have a ringing in my ears." "Don't answer!" - Henny Youngman
"Very funny Scotty, now beam down my clothes."
"CALCULUS: A weapon of math instruction."
"If you jogged backward ... would you gain weight? "

From here (http://www.helpguide.org/life/humor_laughter_health.htm)...
"Laughter decreases stress hormones and increases infection fighting antibodies. It increases our attentiveness, heart rate, and pulse."

"...human tests have found some evidence that humorous videos and tapes can reduce feelings of pain, prevent negative stress reactions and boost the brain's biological battle against infection. Studies continuing this work are underway."

beskeptical
2006-Feb-22, 08:54 AM
Laughter definitely has proven medical benefits. :D

George
2006-Feb-22, 03:44 PM
Laughter definitely has proven medical benefits. :DJust thought it was worth mentioning. "Corncebos", especially under gazebos, probably belong elsewhere, but I just didn't want it....hanging by a thread. ;)