Talk:Placebo effect/Archive1

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Issue of who is affected

“”Placebos are not effective on all patients, and would have no effect on patients unfamiliar with or skeptical of the treatment offered.

“”For example, a homeopathic prescription of water containing a minute dilution of powdered oyster shell may bring some improvement to a patient who has faith in the homeopathic method, while a patient who is skeptical of homeopathy will not experience any effect from it.

I'm not 100% sure if this is as true as there are also studies to try and see who is suceptible to the placebo effect and it turns out that, well, everyone is. All that's needed is a treatment of any kind that's recognised as a treatment or intervention at a wider cultural level. Being skeptical (or more precisely, cynical) about a treatment won't really prevent the placebo effect exhibiting itself at the polulation level. ^{d hominem} 18:04, 9 October 2009 (UTC)

I don't know. My wife is a lot more prepared to believe in these things than I am and - in the name of keeping the peace - I've occasionally gone for some "special" massage or a chiropractor convinced that nothing would come of it and, sure enough, nothing did.

I also remember reading (probably in new scientist) that almost all "alternative medicines" are very into long "holistic" consultations, the laying on of hands in some way, and making the individual pay through the nose. (Yes, I know most of this is in the article.) I've often thought that creating my own alternative medicine business based on these three principles should be a winner.--Bob^{Not Jim} 18:33, 9 October 2009 (UTC)

"All that's needed is a treatment of any kind that's recognised as a treatment or intervention at a wider cultural level" doesn't really make sense. The whole point of placebo is that it works because the patient believes it will. If the patient doesn't believe the treatment will work, or is aware that's it's only being offered as a placebo, it will not have a placebo effect, even if others believe it will be effective. Wéáśéĺóíď^{Methinks it is a Weasel} 18:37, 9 October 2009 (UTC)

If I remember correctly there was an experiment where patients were told it was placebo and it still worked.--Bob^{Not Jim} 19:24, 9 October 2009 (UTC)

I think the effect goes beyond mere belief, at least on the conscious level. I think the process of psychological validation has something to do with it as well. Генгис^{Is the Pope a Catholic?} 19:31, 9 October 2009 (UTC)

Aye. There's plenty of people who feel better simply by being able to talk at length to someone about how ill/tired/stressed/anxious they feel. GPs are starting to prescribe sessions of, say, acupuncture or aromatherapy because it gives patients more "sympathetic ear" time than the GPs can offer themselves. --Robledo 19:43, 9 October 2009 (UTC)

All true, but what I'm getting at is the observation that the colour of a pill often changes the effect of the placebo; blue sugar pills worked well as anti-anxiety medicine, red and yellow work better for depression (IIRC). And this simply can't be explained by "oh, the patient expects it to work" or "they're told red pills are better for x, blue pills are better for y". And this is what I mean by a much wider cultural meaning. A lot of it really does work at the subconscious level and I think it's wrong to state that a placebo has zero effect on someone who "doesn't believe in it" as its much more complex than that. ^{d hominem} 20:58, 18 October 2009 (UTC)

The effect has/has not been observed in animals and babies.

Let us agree in some way by finding sources? ħuman 03:22, 19 October 2009 (UTC)

Done. ^{d hominem} 15:38, 4 November 2009 (UTC)

Placebo Effect Caught In the Act In Spinal Nerves

I won't add this to the article because the article linked to is subscription only, but the Slashdot abstract is interesting: [1] –SuspectedReplicant^{retire me} 14:30, 4 November 2009 (UTC)

I'd be inclined to add it. The Slashdot link would suffice, surely. _& marmite^chat 14:36, 4 November 2009 (UTC)

Is patient belief essential to the placebo effect?

The article currently has:

For example, a homeopathic prescription of water containing a minute dilution of powdered oyster shell may bring some improvement to a patient who has faith in the homeopathic method, while a patient who is skeptical of homeopathy will not experience any effect from it.

Is there any evidence for this black-and-white claim? It seems to discount or disregard half of the placebo effect, i.e., the belief -- or knowledge -- of the practitioner, or of others in the community. I only have anecdotal evidence on this, as relates to black magic, a story told by a writer who investigated it. Essentially, black magic apparently took down a man who was a firm skeptic in it. He was informed that a ritual was being done to kill him, which he, of course, dismissed. He was then told, through agents in his household staff, that he wasn't looking well, and he did get sick, and of course his staff reinforced that, and he died. Now, of course, people die all the time, so an anecdote proves nothing, but ... I don't "have faith" in homeopathy, I'm convinced that the official theory is utterly bogus, yet I've experienced improvement in my own condition from the use of a homeopathic remedy. I think that it's possible that homeopathy works, to the extent that it works, through what might be called "community consciousness," about which we know little. Dismissing it as the "placebo effect" neglects that there may be more effective ways to drive the placebo effect, and less ineffective ways. Is homeopathy an effective way? Not easy to study, but also not impossible. I'm not aware of any studies that would provide clear evidence on this, but perhaps they exist.

Back to the claim in the article, is that based on a study? It seems like a reasonable idea, but "reasonable idea" isn't evidence as to fact, just as to some sort of idea of possibility. To be more specific, suppose that an individual is skeptical of homeopathy, but is surrounded by people who trust it? Which is more powerful, the individual belief or the community belief? --Abd (talk) 18:41, 18 February 2012 (UTC)

We don't even have to address the reality or lack their of in a "community conciousness." A proper double-blind controlled study easily controls for that as well. Random assignment, placebo controlled studies can look at the efficacy of a treatment regardless of the mechanism of action, whether magic, water memory, collective conciousness, or microscopic pink elephants playing poker. Tmtoulouse (talk) 18:45, 18 February 2012 (UTC)

I agree that sentence simplifies the issue. If we took 100 homoeopathy skeptics, fed half of them sugar pills and did nothing to the other half, we'd see almost certainly see a statistical effect where the "treatment" group improved in whatever it was we were testing. It's the exposure to the treatment and what it involves more than just swallowing a pill that does 95% of the work - i.e., Randi just casually popping Traumeel on stage is a world away from someone undergoing a lot of consultation and attention. Your apparent skepticism of a treatment isn't going to alter that. ^{d hominem} 19:05, 18 February 2012 (UTC)

placebo effect nonsense

This article is very, very poorly researched and written and as a result has many simple misunderstandings, omissions, and errors.

Let's begin at the beginning. It says: "The placebo effect is a psychosomatic phenomenon in which symptoms of a disease or condition lessen".

Placebo effect is a real, measurable, physical phenomenon. At the simplest analysis, if a placebo administered by a doctor, causes the patient to feel better, that is a 'real, measurable result'. Feeling better has physical attributes. We could argue, for example, that painkillers only have a placebo effect, because they make the patient 'feel better'.

The information on Wikipedia about placebo effect is also very poor quality and non-scientific, although it has an air of science about it. It does at least discuss SOME of the very real complexity of the placebo effect, however, many important points are missed.

The sentence 'placebos are not effective on all patients', repeated on the Wiki page and here, is clearly pseudoscience. In order to demonstrate that "placebos are not effective on all patients", one would need to test all patients, and all placebos. A more accurate, but less useful statement, would say "specific placebos do not appear to affect all patients equally", but you would need to add "specific drugs (and other treatments) do not appear to affect all patients equally".

and the follow-on clause "and would have no effect on patients unfamiliar with or skeptical of the treatment offered." is meaningless. Frankly, most patients are unfamiliar with and many are skeptical of all treatments.

Any serious analysis of the placebo effect must take into account 'regression to the mean', although it is seldom mentioned. If plot the severity of symptoms of all patients on a graph, and measure again in a week, we will find the the people with most severe symptoms will have 'regressed to the mean', the mean being people with no symptoms, eg the mean of the entire population of people, not the mean of the test group. So, non-treatment will appear to have 'placebo effect' due to the normal effect of regression to the mean. In anecdotal analysis, regression to the mean can easily demonstrate 'more powerful effects' than 'placebo effect'.

The statement: "The placebo effect can also hinder the scientific method, since the observed effects of a treatment may be greater than the treatment's real medical benefit. This is especially the case with alternative medicine, since the vast majority of patients undergoing alternative treatments are people who believe in their effectiveness, and may experience the same therapeutic effect as a placebo patient." is a simplification to nonsense. Some important points: 1. If it 'hinders the scientific method', then the scientific method is faulty. Frankly, the placebo effect is real and must be part of any scientific analysis that claims to be scientific. Ignoring real effects is not science. 2. "especially the case with alternative medicine" - is nonsense. Any unexplained medicine (alternative or not) is often knocked with the words 'placebo effect'. This is a failure of science to understand represented as 'placebo effect'. This type of nonsense use of the word placebo effect is, simply, a pseudoscience.

The statement "Because the placebo effect is so powerful". I love it. An entire post that attempts to claim the placebo effect is useless, a nuisance to 'true science' and in the middle of the post it says "Because the placebo effect is so powerful". Have your cake and eat it too.

Is goal setting a placebo effect? Should Olympic athletes stop setting goals to excel? We know that setting goals has no real 'physical effect'. But it does. When we go to a doctor, and she prescribes a placebo - setting a treatment goal. If the patient adopts the goal - that alone is a powerful clinical tool. It is clear that most discussions of placebo effect are shallow and divisive.

"Often, proponents of alternative medicine will reject placebo controlled experiments for any number of excuses, but such trials have been done (very rarely does the alternative medicine world foot the bill for these), and they invariable come up negative." NONSENSE. WOO. Give me the reference to support the word 'invariable' - and spell it correctly please.

"The strangeness of the placebo effect" A large part of the strangeness of the placebo effect has nothing to do with the placebo effect, it has more to do with our 'medical mindset'. 'Strange and interesting quirks' is not a scientific analysis, it is simply astonishment as something that is not understood.

"More dramatic placebos are more effective. Injections work better than pills. A full consultation session with a doctor prior to a placebo is more effective than just giving a patient a pill dismissively." - this post does not distinguish between the very important concepts of 'active placebos' vs 'passive placebos'. The passive placebo, like the sugar pill, has a very different effect than a drug that is not the correct treatment for the illness - but has a physical effect that is perceptible by the patient.

"The placebo effect has a somewhat less well-known, slightly evil cousin; the nocebo effect"

- a this point, my woo detector blew up and I've stopped reading. How does the phrase 'slightly evil cousin' belong in a RationalWiki post? woo

This post is bunk. That's my opinion. tracy^{— Unsigned, by: Tracychess / talk / contribs}

Please sign your comments using four tildes (~~~~) or by clicking on the sign button: on the toolbar above the edit panel. (You can indent successive talk page comments using one more colon (:) for each line.) Thank you.--ZooGuard (talk) 19:03, 3 September 2012 (UTC)

Most of this is random conjecture and opinion. Hitting a few high points, "psychosomatic" does not exclude there being a physiological effect so our definition is perfectly aligned with what your discussing. Science is about isolating all possible variables, and anything that adds an uncontrolled variable to a study is a "hindrance." By definition it has to be "real" and does not make science faulty that we have to control for it. This just seems mostly like a stream of consciousness screed I am not even sure what point your trying to make over all other than you think there is something more magical about placebo than we are saying in the article. 50.130.133.249 (talk) 19:07, 3 September 2012 (UTC)

To your first point, "psychosomatic" refers to something very real. Nobody is saying you can't measure the placebo effect. For the rest, I'll take a look at the article and make any corrections later, if they're necessary.--"Shut up, Brx." 19:44, 3 September 2012 (UTC)

You wait so long for an anonymous user to make specific criticisms, and when one does come along, most of it is wrong and seems to miss the point entirely. Seriously, you need to not just look up what "psychosomatic" means - it means precisely that the "effect is a real, measurable, physical phenomenon", but that's not the same as saying it's a chemical effect caused by an active ingredient. The expectation of treatment is a part of a complex intervention, which is why placebo controls exist; to ensure an observed effect is due to the working nature of a treatment and not because of the expectation effect of the intervention. It doesn't mean "the placebo effect is not real" (lest we require a serious deconstruction and unpacking of what "real" means). For anyone who has done casual reading into the effect they'd know this and this is not what the article says at all.

Now, "regression to the mean" is a fair point, I'll give you that, but in many cases it's completely irrelevant to the placebo effect because regression is what plays a part in selective reporting, and doesn't come into play in placebo-controlled RCTs because all groups, including the control, will be experiencing regressions simultaneously. Only if you focus on anecdotal evidence only does regression to the mean come into play - this has little to do with the placebo effect because the placebo effect is mostly observed on a statistical level, indiviudals are affected by a complex dynamic of actual treatment, expectation effect (placebo) and regression, all of which is difficult if not impossible to quantify from one individual to another.

As for the rest, it seems to be mostly arguing semantics because how dare anyone write with a little imagination-sparking flavour rather than sheer mundane language. If you want it translated into Lojban, have at it. ^{d hominem} 20:15, 3 September 2012 (UTC)

What is the Placebo effect?

Sorry, think I asked this question in the wrong place... Um... What is it? If you believe it, you will get better? Um... What force drives that then? What actually causes the placebo to work? Just saying "they believe it" is not very scientific now is it? What is the mechanism??? Currently it looks like it's "magic" ? 2.101.140.64 (talk) 20:26, 19 November 2012 (UTC)

It's complicated, as there's no one mechanism that explains the whole thing. Basically, it's a combination of factors. 1) where you wnat to feel better and actually do because of it (mind over matter, notably pain is most effectively blocked in the brain, not at the nerve source) 2) psychosomatic effects, whereby various biological processes are actually causing you to improve, through either adrenaline or hormonal or neurotransmitter releases 3) expectation effects where you attribute simple "regression to the mean" as part of the treatment. ^{d hominem} 21:54, 19 November 2012 (UTC)

Thanks for trying to explain, but with respect, I'm not sure you actually answered my question at all. I see no explanation of the mechanism. It still sounds like "magic" to me... I think the point is that we don't know what the Placebo effect is. I think this article should acknowledge that fact. It does not...

Simply saying things like alternative medicine are not "real" because it's "Placebo" is rather poor IMO. It appears to me that just because we have a term "Placebo effect" then many feel that they can dismiss every "alternative" method which they don't understand simply because they have a "label". Until we have a solid definition for exactly how the Placebo effect works I don't think that's fair... As you can probably tell, I'm not a regular on this Wiki, and I will not edit this article... I'm just pointing something out hoping that you guys take what I am saying on-board. I know you guys don't like things you don't understand but... Well... This is one of them. Others would respect you more if you acknowledged that fact. Take care... 2.101.140.64 (talk) 22:22, 19 November 2012 (UTC)

There is an extremely huge difference between 'it exists, we cannot identify any one factor but we have identified an orchestration of factors and we have yet to figure out any one mechanism (if such a thing exists) that makes them act in concert,' and 'poof, magic.' With that logic, any unidentified system or chain of events observed throughout history would be said to have been dismissed as 'magic' when the fact of the matter is that they didn't know yet. Magic implies that we don't know and it's mysterious and we can't ever understand it because it doesn't follow any rules we know. Admitting that we don't know just says that we don't know, yes it's mysterious, but we can still try to discover the rules it does follow even if we don't know what they are yet.±KnightOfTL;DR^{walls of text while-u-wait} 22:48, 19 November 2012 (UTC)

Read up on complex interventions - you're wrong completely in thinking that the "placebo effect" is one thing and it's shrouded in magical mystery. It's far from it. I pointed out above three mechanisms that contribute to the effect. You'll also note that no one really says alternative medicines aren't "real", they're described as having no more effect than a similarly administered placebo; i.e., if you strip the part out that they claim to cause the effect (e.g., potentisation in homeopathy) and administer something virtually identical but with similar attributes in the complex factors (e.g., tap water) you see no difference. In that respect we can say that the claim is false, as we've controlled for it and found it lacking. But there is a significant difference between the action of complex interventions and attributing a cure to a specific claim. And you cannot understand the "placebo effect" unless you know this. ^narchist 01:20, 20 November 2012 (UTC)

Oh my goodness... I'm not suggesting it's "magic". I'm not suggesting that witches fly around on broomsticks either... Please try to understand my point. I'm suggesting this article should admit more that we don't know what it is... No one understands the placebo effect. You should not pretend that you do. You do... Don't. 92.233.49.173 (talk) 10:54, 24 November 2012 (UTC)

We do understand the placebo effect; it's what happens when you simply expose someone to aspects of a treatment that aren't part of the claimed mechanism. Saying "this article should admit more that we don't know what it is" is entirely misrepresenting it. It's not some mysterious or strange force, it's just simply psychosomatic effects of treatment exposure and cultural expectation effects. There is no mystery. ^{d hominem} 11:09, 24 November 2012 (UTC)

Placebo overpowering an actual drug

I recall reading a Yahoo article that cited a study showing how a nausea-inducing drug actually reduced nausea, because the subjects were told it would. I'll see if I can find it. [--Krej^talk 21:05, 18 February 2013 (UTC)

It's in Bad Science, but not the blog as far as I can find it. ^theist 00:15, 19 February 2013 (UTC)

It's "Wolf S. Effects of suggestions and conditioning on the action of chemical agents in human subjects - the pharmacology of placebos. J Clin Invest 1950;29:100-9." PubMed--Krej^talk 12:08, 19 February 2013 (UTC)

Bad Science also talks about Placebos overcoming pain-increasing drugs. (Can't remember the technical name for such things.) That is to say the patient was given a drug which would increase the sensation of pain but was told it was an analgesic - and it worked like an analgesic.--Bob^{"I think you'll find it's more complicated than that."} 12:44, 19 February 2013 (UTC)

Hmm... It seems he only tested two women in the study. Is it good enough to be added to the article?--Krej^talk 12:47, 19 February 2013 (UTC)

Yes, it was a two-person study, but it's an interesting finding nonetheless. The low sample size (if two can even be considered a "sample"!) doesn't really say anything other than "we're not sure we can generalise this to the entire population". ^narchist 13:20, 19 February 2013 (UTC)