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The Placebo Effect
June 20, 2010 By 36 Comments
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So… Who’s going to say it first?
What? That Jeeeeeeezus is a good placebo?
Was thinking more about homeopathy tbh.
Yeah, homeopathy’s the first thing I think of when I hear the word ‘placebo’ these days.
Though that may be because I work at a natural/homeopathic drugstore. None of my friends seem to have known the slightest thing about the subject (until I started ranting about it, at least).
Placebo has a documented effect. That’s more than homeopathy has.
To my knowledge, homeopathy perfoms exactly the same in trials as placebos do.
Indeed.
Which does make me wonder…. Why bother going to the expense of using homeopathy when a 0.05p sugar-pill will do the same thing?
It’s not (so much) the content (placebo, homeopathy, real medicine) as the way it’s given and the projected belief of the giver and others involved. In placebo trials, the recipient is never told that they’re getting a placebo. They believe that they’re getting a real medicine that will help them. And because of that belief (from the giver and the recipient), it works.
I’d be interested to see whether the opposite has ever been tested. That is, give a patient a real medicine and somehow let slip that it’s a placebo. Will the real medicine prove ineffective because the recipient now “knows” that it’s fake?
Len,
The real med would have been tested in placebo controlled trials before it was approved, so we know it would still be effective. In order to get on the market it had to prove it had effects beyond placebo. It would likely reduce efficacy, and you could probably get a ballpark of how much just finding the original placebo controlled trials of the drug on Pubmed and picking out the gap between the drug and placebo.
Len, although I don’t have any evidence offhand, I believe such studies have been done, where people are given placebos and know that they are placebos, and I am fairly sure that they are totally ineffective. That is, you take one group and give them placebos and tell them they are placebos, and use a control group whom you give nothing. There should be no difference between the groups, regardless of what you are “treating.”
Limbs re-grown daily! But oooops, God is so camera-shy. Scientific method: 1 more, christians: 0
The placebo effect probably “works on everybody” because it most likely doesn’t exist. No matter what your medical problem is, from hangnails to cancer, a certain percentage of people will experience spontaneous remission of symptoms if nothing is done. The proper experiment is to take two very large groups of people with similar medical problems, and give one group a placebo treatment and do nothing with the other. Follow the results over time and see how many people in each group get better, then crunch the numbers to see if they differ to any degree of statistical significance. A nice variation on that theme would include a similarly matched third group that gets standard medical care for whatever medical problem ails them.
That’s been done and the conclusion is that the placebo effect does occur.
There you have it. :)
There you have what?
There is no placebo effect. Or so I would conclude after reading the studies and determining that they had a proper experimental design and data analysis. To be honest, until I have done that, I have to fall back on my original statement that the placebo effect *most likely* doesn’t exist, based on facts I already know about the world.
… but studies have been already been performed that meet the criteria you wanted. That showed that the effect is real. I’m sort of not sure what your point is here?
The point is that I haven’t read the relevant medical literature personally, so my sources are secondhand, and I’m being honest in the way I state my position, and not claiming definitive knowledge on the topic that I don’t have. I find it highly likely that there is no placebo effect, based on extrapolation from things that I do definitively know. And there is always the possibility that one or more of the placebo studies you allude to were badly designed crap that can’t answer the question. History is full of those.
Ursa, you sound like a religious zealot, “I haven’t read it so it doesn’t exist”. That seems to be the gist of your argument.
@Aleks:
No.
1. I strongly suspect that the placebo effect does not exist. Personal opinion, nothing more, based on my knowledge and experience as a biologist.
2. I strongly suspect the medical literature will confirm that there is no placebo effect, but I am open to the possibility that I am wrong. Either way, data are needed to come to a firm conclusion- data more substantial than an offhand assertion by a third party that such data exist, no matter how plausible that assertion is. I do in fact find Jabster’s assertion highly plausible- but it is not a substitute for doing my own homework.
3. I have only secondhand or thirdhand knowledge of placebo studies in the medical literature. I never said that these studies do not exist, or that I do not believe that they exist. I simply said I haven’t read them. When I do, I will examine the experimental design and the data analysis with the eye of a professional scientist. If they are appropriate, I will accept the findings. If they are wanting, I will reject them and look for a better-designed study that can give me a reliable answer.
4. Since I have not read said articles yet, it would be improper and dishonest for me to assert “the medical literature proves the placebo effect doesn’t exist”, because I do not know that it actually does say that. The best I can say is “I’ve heard that the medical literature disproves the placebo effect.” Hence my provisional statements about my beliefs on the matter.
I’m not neutral or wishy-washy on the subject, but I am not willing to claim certainty as I have no defensible basis to do so. So much for attempts at intellectual honesty.
Update:
I have done what any serious participant in a debate should do, and looked for more data.
A perusal of medical abstracts tells me that there are enough proper double-blind studies, with enough participants to yield meaningful results, analyzed with proper statistical methods, to show beyond reasonable doubt that the placebo effect is real and measurable in humans (at least for certain subclasses of ailments like pain, anxiety, and depression).
I therefore cheerfully, in full view of the public, and without any trace of embarrassment, say that my former opinion was wrong, and that it was wrong because it was based on incomplete data. It’s a big world, and I’m not in full possession of all the facts on every possible topic. Like all people, I concentrate on the things that are most immediately important to me.
I don’t deny that I have strongly held opinions. I just don’t present them as incontestable facts. And I’m willing to examine them when challenged. and change them if the data warrant it.
@UrsaMinor
… good for you! I think the placebo effect is truely wierd especially when there has been the odd study that indicates it is more that just self reporting i.e. it may have physical effects.
I thought placebo effect is a guage to the effectivenes of that that is being tested under contolled deception to without.
“Does the Placebo Effect Exist?” or “Do Placebos Actually Do Anything?”
Pretty much depends on what your definition of “exist” or “anything” are. As I understand it the research points to placebos having a measurable effect on subjective measures, but no impact on objective ones. It’s purely psychological biases.
No, placebos are even effective against objective symptoms. As the video pointed out, stomach ulcers are a good example of an objective symptom that is treated to great effect by placebos. Why this happens is not at all clear.
I’m aware of a few studies that have positive results for objective effects of placebos, but I’m under the impression that they are the vast minority, so that the evidence of objective effects for placebo is very weak. If you do enough studies you’ll get false positives (for example, if you use a 95% likelyhood the result isn’t random chance, 1 in 20, studies will give a false positive). I certainly could be wrong about the balance of the evidence, but my impression was that it was strongly against objective effects of placebos.
http://en.wikipedia.org/wiki/Placebo#List_of_medical_conditions gives a list of medical conditions on which the placebo effect has been studied. I haven’t checked out very many papers, but at least in the cases of pain, asthma, and ulcers there is strong evidence for a significant placebo effect.
This is pretty much standard procedure. I learned recently that the ‘placebo effect’ is the difference between doing nothing (which usually results in some overall improvement unless we are talking killer diseases) and the improvement in the placebo group. Likewise the ‘drug effect’ is the difference between the placebo group and the drug group.
That’s the first time I hear the claim that the placebo effect works in animals. Did anyone heard that before. I have no idea about the procedures for licensing a veterinary drug, does it include a placebo controlled test?
I think the placebo trials in animal medicine involves them eating around the pill hidden in their food and getting better anyway.
When dealing with pets I guess you may have an indirect placebo effect through the owners but again I have no idea if vet drugs are tested this way at all. Any vets out there?
The explanation I’ve heard for the placebo effect in children and animals is that the effect acts upon the observers. Which in adult trials includes both the patient and doctors (one reason why double blinding is used instead of just single blind). In young children and animals the patient doesn’t have the expectations that drive the placebo effect, but the researchers still do. You can also get the effect, depending on how the study is run, if more attention is given to the treatment group. Animals and small children generally like attention.
I wholeheartedly understand and believe the placebo effect and this presentation was quite informative. To give credit where credit is due, I have been quite impressed with the many doctors, nurses, etc. I’ve seen in Group Health. I think they are certainly practising the sincerety and positive thinking and approach with patients. I always leave feeling they truly care about how I’m feeling and hope for my speedy recovery.
But with regard to the placebo effect and me, lately I feel like I’ve developed the opposite response. I’ve been dealing with low back flare-ups for several years and lately I’ve been getting them more often, more intensely and they last longer than the usual 2 to 3 days.
This flare-up I’m in right now seems to respond VERY LITTLE to the maximum dose of anti-inflammatories, PLUS narcotics PLUS muscle relaxers. It’s very discouraging, obviously.
The doctor says, “Well, you can take 2 of said pills, that should do the trick.” So, I take two, and nope, still in pain, but can’t take any more. Then they try a shot of something, “This will definitely make you feel better in a about an hour.” Several hours later, I’m in the SAME amount of pain as I was before the shot.
So, now it would appear that even the REAL stuff is having no effect on me! :-(
Either I really need someone to do a dummy pill or shot on me, or they already are and having no effect!
Sorry, I just needed to vent. Really didn’t have much to do with the post.
Perhaps because you have had these flare-ups in the past you expect the medications to work less effectively than they should. I’m a medical student in Australia and we recently spent a series of lectures discussing the placebo effect. It occurs with all medications, even those that have a documented effect. If you prescribe a sugar pill placebo as analgesia it will relieve symptoms of pain up to about 40% (or that’s what the studies we were shown indicated). If however you give proper analgesia that removes pain up to 60%, this is only 20% more than the placebo effect, the other 40% change in pain reduction still comes from the placebo effect. This is why the placebo effect is so impressive, because it causes improvements in real drugs just as much as in sugar pills.
My point being, that if you don’t expect the drugs to have an effect, then you will likely lose out on the placebo effect of the drugs you are taking. If it is pain medication that improves pain by 60% and you believe it to be non-functional then you will lose the placebo effect and it might only have a 10-20% change, which will do very little. Then of course there is the whole fact that you are dealing with brain chemistry to reduce pain which is often very unpredictable.
On a completely unrelated topic, we were also told that if we are to ever prescribe an alternative medicine that it should be homeopathy. Simply because as being simple water it can’t harm anyone, you know, unless they are already in serious renal failure, then it might. Because all drug related alternative therapies have some form of ingredient in them they can be dangerous, especially in combination with actual medications. So if you want an alternative medicine, take homeopathy: first do no harm.
“lately I’ve been getting them more often, more intensely and they last longer than the usual 2 to 3 days.”
The good news, I suppose, is that your pain at least goes away for a while.
On the other hand, I’ve had fairly continuous sciatic pain for the past few months. Except for moments like this morning, when I heard the sound of the street cleaning truck and realized I hadn’t moved my car from that side of the street. That sound of the truck meant I probably already had a $75 ticket on sitting on the windshield of the car.
After leaping out of my chair, rushing outside, finding no ticket, parking my car safely in my driveway, then reading this post, I realize my back felt fine while I was worried about the parking fine.