I listened to an episode about the placebo effect on the "Only Human" Podcast awhile back. Its truly fascinating, and has made me question the power of the mind in a way I hadn't before. It also has some really interesting ethical problems, is it okay for doctors to lie about placebo treatments if it actually helps?<p>> Kallmes performs vertebroplasty, a surgery he has helped to develop and standardize, that involves injecting medical cement into the fractured bone to stabilize the fractured area and relieve pain. He says he gets great results from his patients, and teaches the method to other doctors at conferences.<p>> But here’s the thing: he has no idea why vertebroplasty works. So a few years ago, he decided to test it against a placebo. Kallmes found that pretending to perform vertebroplasty – making it seem like he was injecting a needle into the spine but without the cement – had similar effects. About 40 percent of both groups experienced immediate relief from pain after the surgery. He published his results in the New England Journal of Medicine.<p><a href="https://www.wnycstudios.org/story/real-doctors-fake-medicine-placebos" rel="nofollow">https://www.wnycstudios.org/story/real-doctors-fake-medicine...</a>
To counter some off the off-the-cuff comments here:<p>These researchers (specifically molecular biologist Kathryn Hall) seem to have found a link between an enzyme called COMT and response to placebo treatments. That is, people with a genetic pre-disposition for lower COMT-production will respond less to placebo effects and MORE to actual drugs whereas for people with higher COMT-levels the opposite holds true.<p>I think this is a fascinating finding and does a lot to do away with hand-waving explanations of the placebo-effect as 'it's all psychology' (just look in the comments here).<p>Unfortunately the article ends with a kind of esoteric tone of one of the researchers, in that he believes it would be unfortunate if we did away with the rituals and warmth and caring involved in more esoteric practices completely. I don't really get that: If we figured out why the placebo effect works and we can very effectively treat patients depending on their genetic pre-disposition that's awesome!
Whoever thought the placebo effect was a ‘trick’?<p>It’s well established that the mind controls the brain which controls the body. (And the other way around, too). A physiological problem in the mind can cause a chemical problem in the brain which can cause a ‘physical’ problem in the body. Or heal a problem in the body.<p>Quotes around physical because mind and body are both physical. If doctors are surprised by this it must be because they are still clinging to some form Cartesian dualism.
I find it unusual that many people will dismiss the placebo effect yet will happily accept that stress can cause lots of negative reactions physiologically. They seem like two sides of the same coin to me.
> the rituals embedded in the doctor-patient encounter that he thinks are fundamental to the placebo effect<p>> “Medical care is a moral act,” he says, in which a suffering person puts his or her fate in the hands of a trusted healer.<p>I have a friend who is a naturopath, and this is basically what she believes her job to be. Almost more of a therapist at times, a friendly ear to confide in.<p>The average experience with doctors isn't always that pleasant. It feels clinical and rushed, and very non personal. They are concerned with symptoms, not the actual person in front of them. They don't really listen, as a therapist would. And it's not their job too.<p>Contrast that with an alternative healer. They will sit and talk and listen and empathize with you for an hour. For a person in pain, it might be the first time they have ever felt like someone actually understands and cares. It's not surprising that they feel better afterwards. I think that goes a long way to explain the popularity of fake medicine.
The 'placebo effect' seems to be wholly the effect of the sum of biases and psychological effects on reported outcomes in the placebo (non-treatment) arm of medical trials. It doesn't mean there is an 'actual' effect, it is just that reported benefits by patients is affected by the situation. 'The nice doctor gave you pills, and trying to be helpful you might respond more positively when asked if you are any better.' Or 'patients with a temporary flare up in their condition were invited onto a trial, and - lo - they got better even without the active treatment.'<p>Placebo just refers to the bundled biases and other uncontrolled-for influences. It is not a real thing that can be used to make anyone actually better. Whenever there is a physical measurement that can be made about some affected body function, the placebo effect mysteriously disappears.
It gets quite strange:<p><i>A prominent placebo researcher, Dr. Fabrizio Benedetti, was able to show just how peculiar the placebo effect really is. After inducing pain in participants for seven days whilst treating them with morphine, Benedetti secretly switched the pain medication to salt water. Luckily for him, the participants’ reports of pain went unchanged. Then things got weirder. Benedetti didn’t want to stop there, so he [secretively] gave the participants a morphine blocker and, bizarrely, the participants found that their pain returned, suggesting a form of biochemical reaction to the salt water placebo.</i><p>So you give people morphine and it works (to block pain). Switch it secretly with salt water and it still works. Secretly add a real morphine blocker and it no longer works. Bizarre.
The headline reminds me of my high school math teacher that would say that the difference between <i>tricks</i> and <i>methods</i> is that <i>methods</i> are <i>tricks</i> that have been used more than three times.<p>By the same token, it's only a <i>trick</i> as long as the underlying mechanism is unknown.
I had a really hard time with medical anxiety after my dad almost died from pancreatitis suddenly. Stomach pains, heart palpitations, numbness in various places. I was convinced I had 10 different fatal diseases. I wasn’t making up symptoms. I had real pain, a chronic cough, and real pvcs that showed up on ekgs. It took a lot of doctors and a lot of tests to convince me that I was okay. And then i started to understand that all of my symptoms matched a single disease— “anxiety”. And I started focusing on letting things go and not thinking about it and avoiding triggers like caffeine and all of my symptoms just ... stopped. A miraculous cure of like 10 different things I was utterly convinced I was dying from. Even the pvcs and my non-stop post nasal drip stopped almost entirely.<p>The body is fucking weird.
What's the most impressive placebo effect recorded in a study? Is it always limited to mild pain relief?<p>For stories like this, people always predictably discuss how ethical it is for doctors to knowingly prescribe placebos for stories and how different interventions have different impacts.<p>If placebo alone can't cure anything and only gives mild pain relief, I'm surprised nobody mentions it's overhyped.
I believe that placebo-like effects extend to other areas of life, outside of health. Tell people that they are victims of some historical injustice or discrimination and such, and these victim's beliefs will keep people from advancement to their best capacity. They genuinely can't advance. Similarly, in situations of domestic abuse or sexual abuse: whatever happens on psychological or biochemical level, keeps these people down, genuinely unable to properly recover or move on.<p>Seems to me that attitude is 90% of success in this world...
Does anyone know of a study that finds an <i>actual</i> placebo effect?<p>As far as I can tell, there are two distinct effects, and both are meaningless. The first "placebo effect" is observed everywhere, and is simply reversion to the mean. Nobody studies a treatment on healthy people, because treating people for a condition they don't have makes for a very expensive study. But some of those people get better spontaneously, and some weren't even sick, but had the right symptoms. Their improvement without actually being treated was originally called the placebo effect.<p>The other "placebo effect" is the one where treatment with a placebo (preferable an expensive placebo labelled "forte" and administered by the chief of medicine) is more effective than no treatment. But that effect only happens where the only way to measure the outcome is by asking the patient. A human is a very unreliable instrument. A human may report that the irritable bowel is gone because he doesn't take the symptoms as seriously anymore after the treatment, or maybe because he just wanted attention and there had never been an irritable bowel.<p>So, does anyone know of a study that finds a placebo effect that isn't explained by "bad instrument" aka. self reporting?
Has anyone studied whether there is an opposite anti-placebo effect? Like if a patient lacks confidence in their doctor and doesn't believe that a real medicine will actually work, is it less likely to be effective?
<i>"Open label placebo: can honestly prescribed placebos
evoke meaningful therapeutic benefits?"</i><p><i>"Results from small clinical trials suggesting that placebos can be ethically and effectively used in
clinical practice warrant further study, argue Ted Kaptchuk and Franklin Miller"</i><p>BMJ 2018;363:k3889 doi: 10.1136/bmj.k3889 (Published 1 October 2018)<p><a href="http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-MillerBMJOLP2018.pdf" rel="nofollow">http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-...</a><p>"Key messages:<p>- Placebo pills in randomised trials can significantly benefit patients’ subjective symptoms<p>- Using placebo pills clinically is an ethical challenge as prevailing wisdom asserts that deception or concealment is required<p>- Recent small randomised trials suggest that openly prescribing placebo can evoke meaningful therapeutic benefits<p>- More research is required to determine the role for open label placebo and the conditions in which it is effective.<p>"
It isn't a trick. It's why pharmaceutical trials have a placebo control, not a nothing-control.<p>There's been studies done on the effect of different placebos: bigger pills, with bigger markings, administered by professionals in professional settings etc work better.<p>My pet theory is that, since almost all medicine merely assists the body's own healing (e.g. a plaster cast doesn't heal the bone), the belief of safety and being looked after is enough for your body to switch resources away from dealing with a threat towards healing. (You can't afford to heal while your attacker is still around.)<p>A placebo signals safety.
I would love to see some more advanced psychological manipulation experimental results for medicine ... “I proscribe you to not take this pill twice a day. By that I mean, here’s a bottle of pills which have been shown to alleviate your ailment, however I believe your case is best addressed by you deciding not to take this medicine. Therefore, twice a day, please follow these directions: remove a pill from the bottle, place it in your hand, look in the mirror and then put back in the bottle and close the lid.”<p>Many Trippy effects are possible.
Can anyone help me figure out if I'm of the variant of the rs4680 allele that is most placebo respondent if I have my 23andme results (I am variant G)?
I had a psychologist tell me about a case once where a person had a condition (I forget which, I think it was mild diabetes) but only when they were living at home with their family.<p>They tested positive for this condition. It wasn't all in their head. But then again it was in some sense. They spent time away from their family and their condition would stabilize to the point that they'd no longer test positive. I asked about things like diet and sleep and the guy telling me the story said that this was of course the first thing they checked and the person's diet and sleep habits hadn't changed.<p>The psychologist who told me this story wasn't particularly "woo-woo" and was personally blown away by it. He said you can find other cases like this in the literature.<p>Anecdotes like that aren't proof, but they're interesting in that they agree with some of this placebo effect research. It looks as if the brain has more influence over the body than we realize or understand.
Something interesting is that numerous studies have shown that a number of psychotropics, including the monstrosity that's fluoxetine/prozac, perform at levels that is hardly better than placebo. In many cases the difference is not statistically significant. This [1] paper/article provides an overview of a variety of data. It also goes into how these sort of drugs manage to get approved in spite of negligible performance. The paper gives the example of vilazodone/viibryd. That drug went through 5 trials. They showed absolutely 0 effect. In some of the trials the placebo outperformed the drug. Undeterred, the company continued running trials. In the next two they managed to show a very small effect, probably similarly to how if you flip a fair coin enough eventually you'll get heads 10 times in a row 'proving' the coin isn't fair. Anyhow those two trials showing a minuscule effect were enough for the FDA which now states, <i>"The efficacy of VIIBRYD was established in two 8-week, randomized, double-blind, placebo-controlled trials.".</i><p>I find this just completely fascinating. That prozac shows a negligible effect over placebo in blind studies is even more interesting to me because of the side effects. It has some really serious side effects - you'd know if you were getting the 'real' stuff, at least if you were allowed to communicate with the others who were. And the prozac brand alone was, at its peak, reaching profits of $2.6 billion a year. This creates a nasty incentive for pharmaceutical companies to target 'drugs' at conditions that can be treated by placebo. Because in these cases, you can always prove the drug works, without actually having to go through all that nasty work involved in creating a drug that actually works.<p>[1] - <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/" rel="nofollow">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/</a>
It's important to note that placebo effect does not work at all on stuff like infectious diseases. There are clear categories of diseases where your psychological state will have absolutely close to no influence on the outcome.
FDA Approves Sale Of Prescription Placebo<p><a href="https://www.theonion.com/fda-approves-sale-of-prescription-placebo-1819567087" rel="nofollow">https://www.theonion.com/fda-approves-sale-of-prescription-p...</a>
It's important to understand that if a clinical trial shows some improvement in the control group that received placebo, this does not need to be due to some placebo 'effect' at all.<p>The status of patients usually changes all the time. If the control group had some minor improvement in some endpoint, this might be due to wide variety of reasons. For example, the disease might just get somewhat better by itself. This does not necessarily imply that this was due to patients that were given placebo experiencing a placebo effect. They might just as well have gotten better without the placebo.
A hundred and thirty comments and zero uses of the words "gene" or "genetic." Nobody else thinks evidence connecting the presence of a gene with susceptibility to the placebo effect is interesting?
I believe that the placebo effect is significant enough that I have told my wife that if I ever become ill then she should discuss the possibility of giving me a placebo treatment with a doctor without my knowledge. Although it works when people know it is a placebo it seems to work better if people don't know. So for example, if I get ill and they aren't sure what to do, give me a placebo and tell me it is medicine for my illness, whatever it is, and see how that goes. If it works dont ever tell me it was a placebo. Its got to be worth a shot.
It seems to me that the medical profession already has enough bias to defend the fruits of their own research and claim ownership over a capacity to offer that which cannot be achieved through other means.<p>The idea that a placebo is as effective as some intervention is not evidence of efficacy of placebo — it’s evidence of lack of efficacy of the interventions ... if what you have to offer can’t beat doing nothing, then you shouldn’t be charging for it ...
I'm surprised no one is commenting on how poorly this article is written. It lost me at paragraph four.<p>Paragraphs three and four completely misrepresent the placebo effect. They suggest that it cures problems. That's not what it is. It changes <i>perception</i>. Mental effects, like pain, are what placebo changes. It never cures underlying physical problems.
For anyone interested in further reading on the topic of the placebo effect, I'd recommend the book 'Cure'[0] by Jo Marchant<p>[0]:<a href="https://www.amazon.com/Cure-Journey-into-Science-Mind/dp/0385348177" rel="nofollow">https://www.amazon.com/Cure-Journey-into-Science-Mind/dp/038...</a>
From The Secrets of Consulting by Gerald M. Weinberg<p>> <i>The First Great Secret of the Medical Profession: 90% of all illness cures itself with absolutely no intervention from the doctor. Each of us, after all, is the direct descendant of innumerable unbroken lines of survivors</i>
For anybody curious, the placebo gene + variation is COMT (A;A). I build a gene reporting tool to help with this if you have 23andme it should work:<p><a href="https://gene.meports.com" rel="nofollow">https://gene.meports.com</a>
I am amazed by this.<p>I've also read if a parent gives some home treatment (e.g. a warm cup of milk) to a kid and caringly says that it'll cure his cold, the immunity of the kid actually increases, effectively curing the cold with love.
Is there some way for us to administer a mind-altering drug that induces suggestibility and alter the way we think about our diseases as a way to combat them?
That was one good read.<p>Scanning the comments, surprised no one has brought up religion.<p>Specifically why religions, all religions, need rituals. Not just narratives/imagery/a priest class etc.<p>Rituals, to the scientist or non believer look totally meaningless and crazy even, but to the believer it's a fundamental part of the dance that renews faith. Faith in what? Faith in the fact that tomorrow will be a better day.<p>Visit a cancer hospital and for a lot people that is still the best medicine on offer. I like this Ted Kaptchuk dude and it's good to see the work he has done.
Something else that could make the placebo effect seem real: Only publishing positive results. There seems to be this unspoken agreement that once the efficacy of a treatment is shown in scientific studies there is no placebo "factor" contributing to it helping people. But of course after a successful study the placebo effect of that treatment is <i>stronger,</i> because it convinces even more people (doctors, sceptics) that it's effective.<p>Consider umpteen variants of the same treatment being tested, and one of them showing strong results (<a href="https://www.xkcd.com/882/" rel="nofollow">https://www.xkcd.com/882/</a>). That medicine then surfs on its own placebo effect until its efficacy is refuted (if that ever happens) by another study or it's replaced by something with a stronger result.
I'd be curious to hear HN's thoughts about this in relation to the chronically ill, such as those featured on Netflix's Afflicted series (<a href="https://www.netflix.com/title/80188953" rel="nofollow">https://www.netflix.com/title/80188953</a>).<p>> Wi-Fi and electricity trigger Carmen's strange symptoms. Jamison hasn't left his room in two years. Bekah lives in a van in the desert to avoid mold. Star has been diagnosed with a dozen different conditions.<p>How much of it is real, how much of it is the mind making it real?
The beauty of placebo effects is that like weight loss or quitting smoking, the health benefits are pleitropic, suggesting that we are impinging on fundamental health-promoting biological pathways.