Placebos work -- even without deception

[Lord Cataplanga]

It is often the case that people take better care of their health when they are participating in a medical study.
Also, people have a tendency to get better or worse during the course of an illness irrespective of any treatment at all.
There are many components to the placebo effect besides deception and optimism.

[Requia ☣]

That's what the control group is for (only in this case, the control group got no placebo).

[Mesozoic Mister Nigel]

Soooo what? Isn't that the point of the study? To better understand the placebo effect?

I kind of think that maybe you don't understand the placebo effect.

Yeah, you're right. But, I guess I figured that this isn't/shouldn't be news. I've always thought the placebo effect was more somatic than psychological anyway.

The general understanding most people have of the placebo effect, afaik, is that in order for it to happen the patient has to believe that what they're taking is somehow a biomedically active drug. This study suggest that general understanding may be at least partially incorrect/incomplete.

The idea that a placebo is effective even when the patient knows there's nothing going on in terms of biochemical effects of the pill they're taking is pretty newsworthy.

Yeah, but I've always thought of it as the idea of a placebo is to trick the body, not necessarily the mind. Deceiving the mind is helpful to that end, I just never thought it was completely necessary.

Back to the topic at hand, something that may not be accounted for is if the people participating in the study think they are being given a real drug, but being told it's a placebo. Say, a person has a good week, right after they start the placebo. They might think that it's a double dupe. I mean, really, who would tell you they were giving you a placebo, unless they wanted you to think it wouldn't work? Hence my earlier statement of "confirmation bias". If someone deceives themselves into thinking the placebo isn't really a placebo, then how do we interpret that?

Giving someone real drugs while telling them they are a placebo would be illegal (well, unless they had signed a form consenting to that sort of thing)  giving them a placebo and telling them it is real drugs is not (not for a study anyways, it is for a doctor)

In many such studies, neither groups knows whether they are receiving the placebo. All participants are told that they MAY receive drugs OR a placebo, and they won't know which until the end of the study.

[Kurt Christ]

I actually intentionally placebo myself with some regularity, normally when I have a stuffy nose and I've run out of decongestant. Normally this takes the form of drinking something, normally tea or water, that I normally drink along with taking pills when my nose is stuffed up, though sometimes I'll take other pills I happen to have (aspirin or something similar, nothing very powerful, but I don't keep a stock of sugar pills). I've found that it helps me feel better to pretend to do something about the illness than to do nothing.

[Requia ☣]

Hmm, I wonder if it could be a kind of Pavlovian effect?  People are so used to taking pills in order to get better that the very act of taking a pill triggers some kind of involuntary placebo reaction?

*Ponders a test where both groups know they are getting placebos, one group gets a pill and the other gets something unusual.  So the ritual is still there but its a totally unique ritual in the control group.

[Kai]

Placebos work -- even without deception
http://www.medicaldaily.com/news/20101223/4831/placebos-work--even-without-deception.htm

For most of us, the "placebo effect" is synonymous with the power of positive thinking; it works because you believe you're taking a real drug. But a new study rattles this assumption.

Researchers at Harvard Medical School's Osher Research Center and Beth Israel Deaconess Medical Center (BIDMC) have found that placebos work even when administered without the seemingly requisite deception.

The study published on December 22 in PLoS ONE.

Placebos—or dummy pills—are typically used in clinical trials as controls for potential new medications. Even though they contain no active ingredients, patients often respond to them. In fact, data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients.

Because such "deception" is ethically questionable, HMS associate professor of medicine Ted Kaptchuk teamed up with colleagues at BIDMC to explore whether or not the power of placebos can be harnessed honestly and respectfully.

To do this, 80 patients suffering from irritable bowel syndrome (IBS) were divided into two groups: one group, the controls, received no treatment, while the other group received a regimen of placebos—honestly described as "like sugar pills"—which they were instructed to take twice daily.

"Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had 'placebo' printed on the bottle," says Kaptchuk. "We told the patients that they didn't have to even believe in the placebo effect. Just take the pills."

For a three-week period, the patients were monitored. By the end of the trial, nearly twice as many patients treated with the placebo reported adequate symptom relief as compared to the control group (59 percent vs. 35 percent). Also, on other outcome measures, patients taking the placebo doubled their rates of improvement to a degree roughly equivalent to the effects of the most powerful IBS medications.

"I didn't think it would work," says senior author Anthony Lembo, HMS associate professor of medicine at BIDMC and an expert on IBS. "I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them."

The authors caution that this study is small and limited in scope and simply opens the door to the notion that placebos are effective even for the fully informed patient—a hypothesis that will need to be confirmed in larger trials.

"Nevertheless," says Kaptchuk, "these findings suggest that rather than mere positive thinking, there may be significant benefit to the very performance of medical ritual. I'm excited about studying this further. Placebo may work even if patients know it is a placebo."

HAHA CHI STRIKES AGAIN!

[Faust]

80 people is quite a small once off test group though. I wonder would the results be consistent if repeated ten or twenty times.

[Jasper]

Agreed, more testing is warranted. But these are fascinating results nonetheless. 

[Golden Applesauce]

Hmm, I wonder if it could be a kind of Pavlovian effect?  People are so used to taking pills in order to get better that the very act of taking a pill triggers some kind of involuntary placebo reaction?

*Ponders a test where both groups know they are getting placebos, one group gets a pill and the other gets something unusual.  So the ritual is still there but its a totally unique ritual in the control group.

I think somebody did a study on something similar already - they gave people real blood-pressure medications, and wonky flavored milkshakes to use to swallow the pill.  After a period of this "training," drinking the milkshakes by themselves had a physiological effect.  IIRC the effect was opposite to what the blood pressure pills would have done, as if the body were anticipating the effect of a foreign substance and working to counter it.

[Mesozoic Mister Nigel]

I want them to do studies involving waving feathers and chanting.

[The Good Reverend Roger]

I want them to do studies involving waving feathers and chanting.

I myself prefer "faith-beatings".

Decades ago, we stopped beating the demons out of people out of a misguided sense of compassion, and it's been cats and dogs fucking in the streets ever since.

[Cain]

To dismiss the results as being meaningless or insignificant because it's "still just placebo effect" seems to blithely dismiss placebo effect as being without medical value, when the reason it's being studied in the first place is because it's been proven to have medical value.

Uhh...I dunno how you read that from what I said. I didn't say "just" or dismiss anything. I was trying to make the point that this doesn't reveal some new psychosomatic process separate from placebo effect - rather, it reveals another level or aspect of the placebo effect. That's how it seems to me, anyway. I find it very interesting.

It's placebos, all the way down!

[Mesozoic Mister Nigel]

I want them to do studies involving waving feathers and chanting.

I myself prefer "faith-beatings".

Decades ago, we stopped beating the demons out of people out of a misguided sense of compassion, and it's been cats and dogs fucking in the streets ever since.

We should beat the cancer out!

[The Good Reverend Roger]

I want them to do studies involving waving feathers and chanting.

I myself prefer "faith-beatings".

Decades ago, we stopped beating the demons out of people out of a misguided sense of compassion, and it's been cats and dogs fucking in the streets ever since.

We should beat the cancer out!

You just have to make sure that the beating kills the cancer faster than it kills the patient.

[Mesozoic Mister Nigel]

I want them to do studies involving waving feathers and chanting.

I myself prefer "faith-beatings".

Decades ago, we stopped beating the demons out of people out of a misguided sense of compassion, and it's been cats and dogs fucking in the streets ever since.

We should beat the cancer out!

You just have to make sure that the beating kills the cancer faster than it kills the patient.

That's basically how we do it already, so why not?