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Even when we know they’re “fake,” placebos can tame our emotional distress

213 点作者 akeck大约 2 年前

35 条评论

thecrash大约 2 年前
It is said that a visitor once came to the home of Nobel Prize–winning physicist Niels Bohr and, having noticed a horseshoe hung above the entrance, asked incredulously if the professor believed horseshoes brought good luck. “No,” Bohr replied, “but I am told that they bring luck even to those who do not believe in them.”
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vonnik大约 2 年前
The key thing we should update on, as a society, is that placebo effects are huge (often as large as the treatment effects established for drugs in RCTs), and through specific actions, the placebo effect can be maximized.<p>In fact, it used to be part of a medical doctor&#x27;s training to take on the mantle of an authority capable of producing placebo effects, back when they had little else to give.<p>The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect.<p>It&#x27;s hard for people to do this to themselves, deliberately -- like turning the knob on a pressure cooker while you&#x27;re inside the cooker... But obviously being credulous helps a lot!!<p>There is actually a literature on this, but it&#x27;s adjacent to the medical journals:<p>Daniel Moerman describes himself as a medical anthropologist. He wrote a book called “Meaning, medicine and the ‘placebo effect&#x27; “.<p><a href="https:&#x2F;&#x2F;www.amazon.com&#x2F;Meaning-Medicine-Placebo-Cambridge-Anthropology&#x2F;dp&#x2F;0521000874" rel="nofollow">https:&#x2F;&#x2F;www.amazon.com&#x2F;Meaning-Medicine-Placebo-Cambridge-An...</a>
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johndhi大约 2 年前
Open placebo studies are super interesting to me. One of the difficulties of pharma is proving efficacy over placebo... because placebo is a very strong factor! I feel like we could, as a medical community, leverage placebo to improve health outcomes much better than we do today. Why not? It seems the only reason not to is some weird Victorian notion about the capital-T Truth.
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smeej大约 2 年前
This reminds me of the &quot;homesickness prevention pills&quot; my mom sent with me to sleep away camp.<p>They were just unlabeled M&amp;Ms, <i>and I knew that</i>, but I&#x27;ll be darned if those things didn&#x27;t cure the homesickness right up!
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bell-cot大约 2 年前
I&#x27;d bet the same applies to both old social and religious rituals - but sugar pills are well-suited to and culturally accepted by modern scientific study. So nobody&#x27;s likely to study mailing a paper-based note of apology (to the friend you&#x27;re distressed over hurting), nor praying to $Deity (who you might not really believe in), etc.
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treeman79大约 2 年前
My dad used to joke about how placebos helped my mom and older sisters many body ache complaints. I just thought severe pain was normal until I was diagnosed with autoimmune, MS and a few other things. Doctors told me for years it was just in my head and that I just needed medication for anxiety.<p>Proper medication and diet changes resolved pain and anxiety.<p>My mom and sisters all have same issues. Dad and doctors gaslight them and me for decades.<p>The highlight when I was in the ER coughing up blood. ER doctors explaining how I was faking it since my blood work was normal. Until chest X rays came back. Then doctor also went pale.
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taeric大约 2 年前
Placebos are a ripe topic. Specifically of interest to me, is that it is clear that placebos can work even when you know they are placebos for &quot;solving&quot; things; this implies that they can also work for making things worse.<p>And letting that sink in is terrifying. Just telling people that they are going to do worse on something can, in fact, cause them to do worse at said thing. Even if the reasons are completely wrong.<p>That is, placebos aren&#x27;t limited to cures.
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ggm大约 2 年前
There&#x27;s a famous incident on Australian TV where a TV presenter is told about how well a placebo works, and he assumes its a brandname or drug name and asks if they could be made available on the Pharmaceuticals Benefit Scheme (the national subsidy for expensive pharmacy cost sharing) and what&#x27;s holding back GP&#x27;s from prescribing them.<p>Certainly made me laugh but if you catch your wind its a bit of a Yogi Berra wisdom moment: if we did routinely prescribe placebos then they might actually help reduce the cost burden of real drugs with comparable efficacy, which are subsidised.
gnatman大约 2 年前
There&#x27;s a great episode of NPR&#x27;s Hidden Brain about the placebo effect called &quot;All The World&#x27;s A Stage—Including The Doctor&#x27;s Office&quot;.<p><a href="https:&#x2F;&#x2F;www.npr.org&#x2F;transcripts&#x2F;718227789" rel="nofollow">https:&#x2F;&#x2F;www.npr.org&#x2F;transcripts&#x2F;718227789</a>
PaulDavisThe1st大约 2 年前
For years (decades, actually), I&#x27;ve been a believer in the idea that deliberately and systematically harnessing the placebo effect will be the biggest medical development of the first half of the 21st century.<p>However, I&#x27;ve become aware of studies and claims that actually the placebo effect itself is an illusion caused by poor statistical understanding and poor study design (sometimes necessitated by the study matter).<p>At this point I am deeply unsure what to make of things.
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Maursault大约 2 年前
<p><pre><code> Jesus rebuked the demon, and it came out of the boy, and he was healed at that moment. Then the disciples came to Jesus in private and asked, “Why couldn’t we drive it out?” He replied, “Because you have so little faith. Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.”[1] </code></pre> [1] Matthew 17:18-20
DoreenMichele大约 2 年前
<i>The twist: The pill was a form of deception. It contained only lactose, sucrose, and glucose; it was a placebo.</i><p>Sugar is not chemically inert. It actually takes the edge off pain and general misery.<p>I wish they would stop publishing results indicating that &quot;We believe sugar does absolutely nothing whatsoever in the body, so if you consume sugar pills, clearly any reaction to it is complete bullshit made up by your mind because you believed in it.&quot;
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pbourke大约 2 年前
&gt; In one placebo group, people were told by a friendly, trustworthy, and empathetic researcher that the videos had a physiological impact that activated “early conditioned emotional schemata through the color green.”<p>&gt; “It was a fake idea, a fake rationale behind it,” Gaab said. “And it worked, people loved it.” It worked as well as a group psychotherapy treatment Gaab and his colleagues used with study subjects a few years earlier.<p>Were people explicitly told that it was a fake idea at the outset, and went along with the ruse?<p>Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work? Or do I need to receive “Problem X pills” from some authority in order to see a placebo effect?<p>I had always assumed that a key component of the placebo effect is not knowing whether you’re receiving the treatment or the control.
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hollerith大约 2 年前
Question for those that welcome the placebo effect: does it worry you that if placebos can affect you strongly, that fact is a sign that you are <i>broken</i> in some fundamental way?<p>I mean, you have emotional distress, and straightforward ways of dealing it do not work, so you have to pay some authority figure to prescribe a placebo. Does that not make you want to investigate how deep your brokenness goes?<p>(Actually, I think that the placebo effect is not strong enough and does not apply to enough real-world situations to be worth paying much attention to and that there are just a lot of bad studies in some fields.)
assbuttbuttass大约 2 年前
&gt; research published this year from Gaab and his colleagues showed even taking imaginary pills could reduce test anxiety<p>I&#x27;d be curious how effective it is versus deep breathing, or any other anxiety-calming practice. The mind is extremely susceptible to the power of suggestion, but I&#x27;m not convinced there&#x27;s anything special about a &quot;placebo&quot; versus ordinary mindfulness.
coding123大约 2 年前
I&#x27;d like to see a placebo study where they have 2 placebos:<p>1. This medicine will cure your muscle pain, but it has very bad side effects: Insomnia, depression, back pain, knee pain - but don&#x27;t worry only a small percentage of people see these issues (like 1%)<p>2. This medicine will cure your muscle pain, and has no side effects, in fact it will make you happy and help you sleep better.
cycomanic大约 2 年前
An interesting aspect of placebo is that supposedly the strength of the effect has been increasing in the last decades. So much so that quite a few approved medications would likely not get approved anymore, because their effect would not be strong enough compared to the placebo effect.
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thenerdhead大约 2 年前
I&#x27;ve read up a bit about this topic, but is there any books or recommendations that really cover the idea of what is popularized as the &quot;mind-body connection + placebo effect&quot;? There&#x27;s obviously the best sellers &#x2F; self-help crap in the world and even books on back pain being healed from this general &quot;placebo&quot; effect or at least the new awareness of it.<p>I&#x27;ve noticed this personal effect to be a constant theme in my life. I&#x27;m a chronic overthinker (OCD perhaps) and when I become aware enough of said &quot;placebo effect&quot;, my problems go away and new ones take their place. Maybe that&#x27;s just life, but there&#x27;s such a strong power to placebo I&#x27;d love to learn more about.
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ookblah大约 2 年前
Makes me think about the &quot;ASMR&quot; effect and how some videos center around intentional stuff or just alternative medicine. It&#x27;s like you know these crystals aren&#x27;t doing jack but it&#x27;s still relaxing on some level.
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kilbuz大约 2 年前
The book &quot;Bad Science&quot; has wonderful discussions and examples of the placebo effect as it relates to medical research. Highly recommended.
furyofantares大约 2 年前
I&#x27;ve tried to internalize an understanding that placebo effects are real and can be large, with the expectation that this understanding should increase placebo efficacy without sacrificing my commitment to truth (that is, I don&#x27;t seek out woo, but I do expect some woo is actually a real, strong placebo effect and I&#x27;d like to be able to replicate it myself sans-woo.)
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partiallypro大约 2 年前
This is going to sound stupid, but I&#x27;ve always wondered if one day we just find out that sugar pills do have medicinal value.
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segasaturn大约 2 年前
Yeah I&#x27;ve known this for a while, I suffer from anxiety and obsessive compulsive disorder and am well aware that my compulsions are total placebo and have no connection to my obsessions but still find they calm the anxiety almost completely. I think people are just drawn to ritual, be it religion or placebo&#x2F;quack medicine or OCD.
intalentive大约 2 年前
If the placebo effect comes down to the power of suggestion, then hypnotism is potentially a valid form of treatment.
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j45大约 2 年前
I wonder if the placebo effect can extend to learning, where you imagine taking a placebo that helps relieve your stress about having to learn something new after a long time.<p>If anyone is familiar with research and reading at the intersection of placebos&#x2F;psychology&#x2F;learning, it would be great to read!
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Zigurd大约 2 年前
Humans evolved in a world of arbitrary danger. That we evolved an affinity for coping mechanisms to the extent they have undeniable physical manifestations seems likely.
pknerd大约 2 年前
There is a very interesting book &quot;you are a placebo&quot; discusses the placebo effect. The author cured himself by practicing it.
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luckylion大约 2 年前
For some definition of “we” and “know”.
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__MatrixMan__大约 2 年前
This is why I keep my mouth shut when I run into somebody who is into crystals or homeopathy or some other pseudoscientific thing. As long as their &quot;solution&quot; isn&#x27;t likely to cause additional harm, and they&#x27;re not being overly greedy re: how much money they&#x27;re making, then the hope they&#x27;re selling is real even though it might be of dubious justification.
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halfjoking大约 2 年前
Placebos can also work in reverse - if you strongly believe a medication or procedure is harmful then you will be harmed by it.<p>That&#x27;s why it&#x27;s entirely unethical to force a medical product on a population.<p>Take for example the mRNA covid vaccine. Let&#x27;s say it did what they claimed at the start and stopped transmission 100% without ever causing a side effect. Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don&#x27;t want it still outweighs any benefit.<p>People who believe a vaccine is dangerous but take it to save their job will get harmed whether it caused a side effect or not. The emotional distress alone can be debilitating. If the mind is so powerful it can strongly affect health outcomes, how could anyone think it&#x27;s ethical to punish someone for making their own medical decision?
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permo-w大约 2 年前
reminds me of public apologies
thomastjeffery大约 2 年前
Emotions are an association between &quot;fake&quot; and &quot;real&quot;.<p>We can take advantage of this with objectivity: if you have an objective perspective on emotion itself - as a process that transfers data between imaginary thought and physical feeling - then you can alter the surrounding circumstances of emotions, and actively pursue specific thoughts that are connected to desirable feelings.<p>But the utility doesn&#x27;t end there: you can also directly hijack the process itself.<p>Emotion is only truly understood from an <i>implicit inference</i> perspective: the explicit definition I just gave is not provable the way a mathematical theorem is. The only available evidence is from experiencing the result. It&#x27;s a soft science, but it&#x27;s still useful enough to construct reliable tools.<p>Here&#x27;s my testing method: breathing.<p>I know that the physical act of breathing is not functionally different, whether it&#x27;s intentional or automatic. I know that physically, my lungs are filtering oxygen from my environment into my blood (with a breath in), and CO2 from my blood into my environment (with a breath out). Simply breathing does not have a noticeable effect on my emotional state, save for providing a baseline of functional cardiovascular support. I can feel happiness, anger, depression, pain, euphoria, or any other physical sensation: all the time breathing in and out with the same fundamental process. These elements of the breathing process have been <i>explicitly</i> proven, much like a mathematical model.<p>So how can breathing hijack emotion? Story.<p>The associations that an emotion is made of are volatile. They can be changed. We all experience emotional change that is unintentional: based on the experience of our surrounding circumstances. We can also make emotional changes that are <i>intentional</i>: based on the experience of our own imagination: by playing out a story.<p>Here&#x27;s an example: Imagine the feeling of ice on your skin. It feels cold to the touch, even the air nearby it. The rest of your body is comfortably warm: blissfully unaware of the chilling sensation from ice in that one place. Your lungs are not for filtering oxygen and CO2 anymore: now they draw in that sensation of cold touch, and filter out the sensation of warm comfort. Each breath in draws another lungful of chill into the bloodstream. Your heart pumps, and your blood meticulously draws out (like the CO2 before) the warm comfort from the body, to be replaced by the chilling touch of ice. Each breath out releases that warmth out into the air around you, to be scattered away in the wind. Do you <i>feel</i> it? Now replace the cold touch with heat. Excitement. Peace.<p>The Rolling Stones told us that love is, &quot;just a kiss away&quot;; but it&#x27;s even closer than that: you can find it in a breath.
macawfish大约 2 年前
Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? Something unsettling about this for me. So much of illness wrapped up in distress. We need reassurances, however irrational the ritual that brings them. Why is there no space for this in conventional medicine?
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agumonkey大约 2 年前
I think a lot of this psychological layer has been ignored because it wasn&#x27;t phenomenologically interesting to study as a science, but the important of the semantic&#x2F;emotional layer is hard to ignore. A simple thought (say someone tells you something regarding your child that is not true but you believe it) can fuck up your biology down to physiological death.<p>Sadly, and obviously, the reverse isn&#x27;t true, you can rarely cure infections through neurons triggering pathway cascades. But still.
misssocrates大约 2 年前
It could be argued this is why wearing masks can be helpful, for some, even though there is no evidence they protect against respiratory viruses.<p>&gt; Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)&#x2F;COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza&#x2F;SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence).<p><a href="https:&#x2F;&#x2F;www.cochranelibrary.com&#x2F;cdsr&#x2F;doi&#x2F;10.1002&#x2F;14651858.CD006207.pub6&#x2F;full" rel="nofollow">https:&#x2F;&#x2F;www.cochranelibrary.com&#x2F;cdsr&#x2F;doi&#x2F;10.1002&#x2F;14651858.CD...</a>
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