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The Placebo Effect

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Mention of "the placebo effect" on another thread got me wondering about its basis. Some web research shows that a fair number of studies have been conducted over some 50 years that indicate that the placebo effect is real -- patients given placebos have measurably better outcomes than those who are not. However, opinion is not unanimous. There are some scientists who challenge the existence of a placebo effect.

I found this article to be a good summary.

Any doctors or other experts here who have a perspective on the subject?

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Why wouldn't it? Stress has an effect on the body's health. And, for instance, if you are sick and you truly believe you won't get better, then most likely you probably won't (or at least the time of your recovery will be greater)--NOT b/c your mind is somehow controlling reality, but simply b/c the stressed caused from knowing you will not get better makes you worse.

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Mention of "the placebo effect" on another thread got me wondering about its basis. Some web research shows that a fair number of studies have been conducted over some 50 years that indicate that the placebo effect is real -- patients given placebos have measurably better outcomes than those who are not. However, opinion is not unanimous. There are some scientists who challenge the existence of a placebo effect.

I found this article to be a good summary.

Any doctors or other experts here who have a perspective on the subject?

As a scientist, in my opinion, the use of placebos is essential in testing the effectiveness of treatments for medically treatable ailments. In other circumstances, it is unethical. If part of the treatment is stress relief or other psychological device, then the patient should be so informed.

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As a scientist, in my opinion, the use of placebos is  essential in testing the effectiveness of treatments for medically  treatable ailments.  In other circumstances, it is unethical.  If part of the treatment is stress relief or other psychological device, then the patient should be so informed.

Linda, Thanks for the reply. My question was about the science of the placebo effect. Is "the placebo effect" real?

For instance, you say that "the use of placebos is essential in testing ". Would that break down into:

1) A "control group" is essential to testing; and,

2) A placebo should be administered to the control group

If so, the second point (above) would imply that scientists have good evidence to suggest that a placebo might have some real impact. Is there such evidence?

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Think of it this way:

Your body is a biomechanical machine, essentially, controlled in large part by hormones released from the pituitary gland, which runs your other glands. The pituitary gland is part of the brain. When you think something, or feel something, or whatever, it has a biochemical effect on your brain; thoughts are both the results of physical processes and the CAUSE of physical processes.

Electrochemical changes in your brain (caused by thoughts, emotions, etc, which are themselves caused by stimuli both internal and external) ramify into complex changes in overall body chemistry via their effects on the pituitary and other functional systems; bolstering or inhibiting your immune system, etc.

When you're talking about teeny microscopic changes such as your body's ability to successfully massacre some cancer cells or jack you out of chemical depression, any change can be significant. When you're talking about a test group numbering in the thousands, no two of which possess identical body chemistries, there is going to be some significant "noise" in the informational channels (i.e. your test results).

This "noise" is referred to as the placebo effect. When testing drugs etc. it is considered good statistics to allow for the existence of this effect when using statistical analysis to determine the efficacy of your drug, as well as the side effects. There have been studies showing that people will experience noticeable negative side effects when taking a placebo because they think they ought to!

The placebo effect is not a useful medical treatment method; it is an annoyance that introduces odd complications into medical data-collection. About the only useful thing that comes of it is the indication that having a positive bedside manner and a good atmosphere is important for treating marginal patients.

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This "noise" is referred to as the placebo effect.
That is not my understanding. A control group is devised to allow levels of "noise" to be at levels similar to those in the test group. If a study points to a placebo-effect, they do not just mean that some people took a non-medicine and got well. Such studies claim that people who took a non-medicine had significantly better outcomes than people who took no medicine. Folks who seriously suggest a placebo effect are suggesting that a correlation exists between taking a placebo and having a positive outcome, even when "controlling" for other factors.

I'm not saying it exists. I do not know. I need to do a better literature-survey.

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Linda, Thanks for the reply. My question was about the science of the placebo effect. Is "the placebo effect" real?

For instance, you say that "the use of placebos is  essential in testing ". Would that break down into:

1) A "control group" is essential to testing; and,

2) A placebo should be administered to the control group

If so, the second point (above) would imply that scientists have good evidence to suggest that a placebo might have some real impact. Is there such evidence?

Quite clearly, the placebo has no medical effect, thus it is called a placebo.

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Quite clearly, the placebo has no medical effect, thus it is called a placebo.

Then why give a placebo?

You did say "the use of placebos is essential in testing".

Why is it essential?

Why not give nothing at all. Why not give the test group the medication; give the control group none.

It is done with the idea that while the placebo as such does not have a medical effect, the patient's belief in its effectiveness, does have an effect. Also, perceived outcomes in not what some studies are measuring "Yes, I'm doing better". Rather they are using measurable outcomes.

So, the placebo is not so much what was administered but that something was attempted, and that the patient fully thought it was a real cure. For instance, one study reports sham surgery being done to a control group of Parkinson's patients. At the end of a year, those people also reported improvement. That's one aspect (i.e. reported improvement) that is easy to understand. However, the study also reports improvement in what they claim to be "objective ratings of neurological functioning by medical personnel".

I don't trust every science research paper. So, I'm still sceptical.

As an aside: Even if a placebo effect were to exist I do not see any philosophical impact. (At least, no more than any other medical discovery.)

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Btw, placebos aren't given to the "control" group. The "control" group is given nothing. If you're conducting an experiment using placebos, there will be 3 groups.

The noise I was explaining that needed to be ruled out was the simple beneficial effect of telling someone that a medication will help them feel better; some people will start to feel better psychologically, which does affect you physically.

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As far as I see it, placebos are the best-tested medicine we have, because every medicine is tested against them. Do they work? Of course they do. Your mental state seriously affects your physical state and the other way around. These two are interconnected. Placebos are used because the very fact of taking a pill produces an effect in your body that corresponds to what the doctor tells you it does.

I read of a test where they gave people amphetamines, telling people they were getting barbituates (downers). Then they took these people's blood and found that they (who were getting sleepy despite the amphetamines) had produced hormones that caused them to be sleepy in such an amount that beat the effects of the amphetamins.

Even if your mind doesn't affect the outer world, it tremendously affects your body. Of course the placebo-effect is proportionate to the degree of belief. For example big red pills affect you stronger, because they look that way. And if you don't believe that it works, it won't.

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Here's a nice book about the effects of prayer etc. on the human body, written by a real scientist without any afflictions to a certain religious belief. I haven't read it myself, but it seems to be a classic on the subject.

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Then why give a placebo?

You did say "the use of placebos is essential in testing".

Why is it essential?

Why not give nothing at all. Why not give the test group the medication; give the control group none.

The purpose of this is to eliminate the psychological aspects, I think. If the control group knows they are the control group they might interpret whatever conditions might occur differently than if they think they are on the drug that is being tested. Only when all the patients in the study, and the doctors as well, do not know who gets the real drug and who gets a fake drug can you tell what difference the real drug actually makes. Ultimately, you are not interested in studying the effect of administering a drug, but the effects of that particular drug.

I think it is another way of reducing the number of variables in your study. If both groups believe that they are being treated with real drugs there is no difference in that psychological aspect any more, and you get closer to the scenario where you just look at the effects of the actual drug.

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A recent study points to psychological effects even when the subject knows consciously that they are imagining, without doing anything else.

 

Here's a summary from a study. The article is interesting. Could it be that positive thinking works in such a directly physical way?

 

Regular mental imagery exercises help preserve arm strength during 4 weeks of immobilization, researchers have found. Strength is controlled by a number of factors -- the most studied by far is skeletal muscle. However, the nervous system is also an important, though not fully understood, determinant of strength and weakness. In this study, researchers set out to test how the brain's cortex plays into strength development.

As a related moral issue, I wonder if there are implications that doctors should lie (provide positive spin) in some contexts.

Edited by softwareNerd

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