By the power of placebo!

[pendell]

Seen in the NYT (https://www.nytimes.com/2018/11/07/magazine/placebo-effect-medicine.html)



You can hand a patient with irritable bowel syndrome a sugar pill, identify it as such and tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention. Depression, back pain, chemotherapy-related malaise, migraine, post-traumatic stress disorder: The list of conditions that respond to placebos — as well as they do to drugs, with some patients — is long and growing.

...

But as many of the talks at the conference indicated, this might be about to change. Aided by functional magnetic resonance imaging (f.M.R.I.) and other precise surveillance techniques, Kaptchuk and his colleagues have begun to elucidate an ensemble of biochemical processes that may finally account for how placebos work and why they are more effective for some people, and some disorders, than others. The molecules, in other words, appear to be emerging. And their emergence may reveal fundamental flaws in the way we understand the body’s healing mechanisms, and the way we evaluate whether more standard medical interventions in those processes work, or don’t. Long a useful foil for medical science, the placebo effect might soon represent a more fundamental challenge to it.


So it appears there is not just a psychological, but a physiological/bio-chemical, response to care that goes over and above the medicine's effectiveness in and of itself. This may explain why "faith healing" traditions of all sorts have such resilience; while devoid of medical value in and of themselves, the mere fact of care *in and of itself*, by someone the patient regards as authoritative, can have a beneficial effect.

One of the most well-known faith healers was noted for saying to his patients that their faith had made them well. I wonder if it was the placebo effect he was alluding to?

Respectfully,

Brian P.

[Kato]

So in the end the study acknowledges that a psychological effect is a biochemical / neurological one? What did they assume it was? Magic? :smallconfused: I mean, I guess it's neat to know exactly but I don't know how much this will help with therapies.

Also, I think the idea that faith healing relies on the placebo effect has been around for a while (?) As you say, it explains somewhat why it is so persistent, along with other alternative medicine.

[halfeye]

The placebo effect is very powerful.

There's obviously a relationship with psychosomatic illnesses, but since in the wrong circumstances broken bones can be psychosomatic, that's not saying either isn't real.

[Keltest]

So in the end the study acknowledges that a psychological effect is a biochemical / neurological one? What did they assume it was? Magic? :smallconfused: I mean, I guess it's neat to know exactly but I don't know how much this will help with therapies.

Also, I think the idea that faith healing relies on the placebo effect has been around for a while (?) As you say, it explains somewhat why it is so persistent, along with other alternative medicine.

I think the big thing is the study is actually starting to isolate some of the placebo effect's actual processes, as opposed to just knowing it happens.

[Lvl 2 Expert]

The placebo effect also appears to be getting stronger. Medical studies have more and more problems with distinguishing from the placebo effect because of this.

If we assume a simple linear correlation with time placebo's will be the cure for cancer maybe a thousand years from now. :smallsmile:

[pendell]

The placebo effect also appears to be getting stronger. Medical studies have more and more problems with distinguishing from the placebo effect because of this.

If we assume a simple linear correlation with time placebo's will be the cure for cancer maybe a thousand years from now. :smallsmile:

So what you're saying is that in a thousand years time children will clap their hands because they believe in fairies and Morgan Le Fay will materialize in the room? :smallamused:

This is beginning to sound a lot like Shadowrun...

Tongue-in-cheek,

Brian P.

[veti]

Ben Goldacre, of 'Bad Science' fame (great book), has a lot of respect for the placebo effect. Like your study, he says it's not any chemical involved in the treatment that matters, but the care and tone in which it's delivered. Which is why it often works even when you tell the patient that it's a placebo.

And yes, faith healing and homeopathy and many other forms of quackery work the same way. So homeopaths are actually doing people good. It's all about spending time with the patient and making them feel they're being treated.

[pendell]

Ben Goldacre, of 'Bad Science' fame (great book), has a lot of respect for the placebo effect. Like your study, he says it's not any chemical involved in the treatment that matters, but the care and tone in which it's delivered. Which is why it often works even when you tell the patient that it's a placebo.

And yes, faith healing and homeopathy and many other forms of quackery work the same way. So homeopaths are actually doing people good. It's all about spending time with the patient and making them feel they're being treated.

Okay. I'm curious, though. Why is the effect getting stronger over time?

Respectfully,

Brian P.

[veti]

Okay. I'm curious, though. Why is the effect getting stronger over time?

I don't know. Maybe practitioners are improving the way they deliver it. Or maybe people's faith in all manner of interventions is getting stronger. But those are just possibilities off the top of my head, I'm not aware of any evidence for them.

[Mordar]

So what you're saying is that in a thousand years time children will clap their hands because they believe in fairies and Morgan Le Fay will materialize in the room? :smallamused:

This is beginning to sound a lot like Shadowrun...

Tongue-in-cheek,

Brian P.

Don't be silly.

That only works for Tinkerbell.

- M

[shawnhcorey]

A placebo does not cure anything. What changes is the way you respond. And a normal brain will change its biochemistry as the day goes on. Another technique for distracting you from your symptoms is comedy. Watch a fun movie and your pain will disappear. And your brain's chemistry changes. But it also changes for anyone who watches (or listens or reads) comedy.

[Rakaydos]

Okay. I'm curious, though. Why is the effect getting stronger over time?

Respectfully,

Brian P.
My guess, ironically, is Secularism.

With secularism, we believe that medicine from doctors helps people. (because it does, if the doctor knows what he's doing... reinforcing the belief) Faith-in-secular-medicine becomes self-hypnosis, and the more people trust doctors, the more their body will heal itself at the doctor's Placebo command.

[shawnhcorey]

My guess,...

...the more their body will heal itself at the doctor's Placebo command.

Nope, the placebo effect does not cure anything. Let's make that perfectly clear. Placebos effect only how you react to the symptoms. They do not heal.

[halfeye]

Placebos affect only how you react to the symptoms. They do not heal.

This is wrong, and right too, if the symptoms are the problem, as with allergic reactions, then placebos can make a critical difference.

[shawnhcorey]

This is wrong, and right too, if the symptoms are the problem, as with allergic reactions, then placebos can make a critical difference.

"Affect" has to do with planning and schedules only. "Effect" deals with results.

Allergies are when your immune system fights non-harmful substances. You have the same reactions when it fights harmful substances. And no, placebos do not suppress these reactions. They just make you think they're not as bad as before taking the placebo.

[halfeye]

"Affect" has to do with planning and schedules only. "Effect" deals with results.

No. I forget the exact names for the gramatical constructs, but effects are what happens, something that causes effects in something else affects the things the effects occur on or in. USAian English may be drifting, but I don't believe it has drifted so far on this yet that it differs significantly.


Allergies are when your immune system fights non-harmful substances. You have the same reactions when it fights harmful substances. And no, placebos do not suppress these reactions. They just make you think they're not as bad as before taking the placebo.

This is mistaken, otherwise placebo would not be a measure in the trials of new medicines.

[Kato]

Okay. I'm curious, though. Why is the effect getting stronger over time?

Respectfully,

Brian P.

Not to be overly cynical but... Poorly conducted studies?

[veti]

Nope, the placebo effect does not cure anything. Let's make that perfectly clear. Placebos effect only how you react to the symptoms. They do not heal.

Not quite. Sure you can argue all day about what it is that is doing the curing, but many trials have shown that patients treated with placebos respond with more than just symptom relief.

Goldacre cites a study with stomach ulcers. It's a good subject to study, because there's a very straightforward and clear test - either you have an ulcer or you don't, and the chances of mistaken diagnosis, given the correct test, are basically nil.

People with ulcers who were treated with placebos were significantly more likely to be cured - i.e. a followup test would show the ulcer had healed completely - than people who didn't get the treatment.

Sure, you can talk about the body doing the work, not the placebo, but that's just empty semantics. (You could make a similar argument about some seriously expensive drugs, come to that.) The bottom line in medicine is, does the treatment result in a better patient outcome? And, demonstrably, it does.

[Lord Torath]

No. I forget the exact names for the gramatical constructs, but effects are what happens, something that causes effects in something else affects the things the effects occur on or in. USAian English may be drifting, but I don't believe it has drifted so far on this yet that it differs significantly."Effect" is usually a noun, but can be a verb, as in "If we take action now, we can effect a decrease in global average temperatures." "Affect" is usually a verb, but can also be a noun, as in "His constant wearing of a monocle was an affect he used to get into character."

We now return you to your regularly-scheduled discussion on placebos.

[Tyndmyr]

One of the most well-known faith healers was noted for saying to his patients that their faith had made them well. I wonder if it was the placebo effect he was alluding to?


Placebo effects can be a result of that, or just about anything else. The only important thing about a placebo is the belief and the feeling of having had something done. The placebo effect doesn't entirely vanish, after all, even if one is told about it. So, the latter part's there independent of belief.

However, faith healing isn't just a placebo effect. In some instances, the apparent results come from a difference in understanding. Most deaf people, for instance, have at least some hearing remaining. It may not be much, but loud, deep sounds can be felt elsewhere than the ears, for instance. Thus, it's possible for someone whooping a loud "hallelujah" or similar word in fairly close proximity to a deaf person, even if behind them, to be heard by the deaf person, startling them. This creates the illusion of being "cured" of deafness, despite no actual physiological change.

[Brother Oni]

This is wrong, and right too, if the symptoms are the problem, as with allergic reactions, then placebos can make a critical difference.

Could I ask for some clarification on what you mean by this please? I'm not aware of any placebo having an effect on allergic reactions, which are an immune response, unless there's a mental component which exacerbates the issue eg a person panicking about having an allergic reaction makes the allergic response worse by hyperventilating.


This is mistaken, otherwise placebo would not be a measure in the trials of new medicines.

I can confirm this - a new medicinal product must display a statistically significant improvement in patients when compared to placebo, otherwise it fails efficacy. This can happen quite late in the development process, causing the collapse of the entire project (and often the company shortly after).

The only exception to the placebo comparison is in patient populations where it's not ethical to give them placebo (eg cancer patients), in which case the new product is compared to the current gold standard treatment, which makes statistical comparisons harder.


Sure, you can talk about the body doing the work, not the placebo, but that's just empty semantics. (You could make a similar argument about some seriously expensive drugs, come to that.) The bottom line in medicine is, does the treatment result in a better patient outcome? And, demonstrably, it does.

Any medicine which involve monoclonal antibodies (pretty much anything ending with the suffix -mab) involves tagging cells for destruction by the immune system (there's a whole host of cancer treatments which do this), so falls under your definition.


A much greyer area is in the field of psychosomatic disorders and treatments like antidepressants and similar medicines. If a placebo makes a person feel better, is it treating the symptoms or the disease?

Suppose a person is uncomfortable in unfamiliar social situations which results in panic attacks. If taking a sugar spray calms them down mid-attack then the placebo is having a measurable effect on the symptoms, but if merely having the sugar spray in their pocket makes them comfortable enough not to have a panic attack in the first place, then the placebo of the placebo is having a measurable effect* on the disease.
The sugar spray placebo can't be having a physicological effect as they haven't taken it in the first place and since they're not panicking, there are no symptoms to treat.

*This makes the pharmaceutical scientist in me wince. Give me a good measurable assay test any day. :smalltongue:

[halfeye]

Could I ask for some clarification on what you mean by this please? I'm not aware of any placebo having an effect on allergic reactions, which are an immune response, unless there's a mental component which exacerbates the issue eg a person panicking about having an allergic reaction makes the allergic response worse by hyperventilating.

There does seem to be a mental/cultural aspect to allergies. There is apparently a serious risk of someone dying of melon allergies in (was it France? Greece? the whole of western mainland Europe?) whereas in the UK and I think the USA it's mainly nuts that are the dangerous allergy. Don't ask me how, but if that's the case, it sounds as if placebo ought to work, I have no idea whether anyone has studied this.


A much greyer area is in the field of psychosomatic disorders and treatments like antidepressants and similar medicines. If a placebo makes a person feel better, is it treating the symptoms or the disease?

Suppose a person is uncomfortable in unfamiliar social situations which results in panic attacks. If taking a sugar spray calms them down mid-attack then the placebo is having a measurable effect on the symptoms, but if merely having the sugar spray in their pocket makes them comfortable enough not to have a panic attack in the first place, then the placebo of the placebo is having a measurable effect* on the disease.
The sugar spray placebo can't be having a physicological effect as they haven't taken it in the first place and since they're not panicking, there are no symptoms to treat.

*This makes the pharmaceutical scientist in me wince. Give me a good measurable assay test any day. :smalltongue:

Yeah, psychosomatic illness is weird.

[snowblizz]

There does seem to be a mental/cultural aspect to allergies. There is apparently a serious risk of someone dying of melon allergies in (was it France? Greece? the whole of western mainland Europe?) whereas in the UK and I think the USA it's mainly nuts that are the dangerous allergy. Don't ask me how, but if that's the case, it sounds as if placebo ought to work, I have no idea whether anyone has studied this.


Wouldn't that largely hinge on people's genetics being different? Scandinavians are much more higly tolerant towards lactose as adults than most others. And yet seem to be the most prolific instigators of lactose free alternatives. (That latter part is just a feeling. But there must be 15 diffierent lactose free variants to 1.5 variants of regular milk)
Apparently Germans are more sensitive to onions (well some compound also found in other stuff) which has a funny story about a co-workers husband and his surprise German ancestry attached to it. Asian populations have a much higher degree of reacting to even small amounts of alcohol in what I've seen described as allergy-sort-of.
All of this falls under what I crassly call the "you aren't allergic to the most important local foodstuffs and pass on those genes a lot" theory.

Now see, that nuts thing is widely accepted. People with nut allergies go nuts about there being nuts in stuff. Even in Europe.

I've never heard of anyone dying of melons. Though as someone who suddenly (after months of eating the same kind of melon) experienced what I can only describe as an allergic reaction to melon I might be willing to consider it.

If there's a cultural part I would see it as overblown reaction to incidents. Say the litigation fuelled Anglo-Saxon anxiety response to potential issues (Warning hot coffe is hot).

[halfeye]

Wouldn't that largely hinge on people's genetics being different?

Possibly, but since something like 1850 people have been moving around a lot. There are a lot of emigres and immigrants, and you'd think that it would sort out, extreme allergies are rare anyway.

I'm not finding a useful reference at the moment, I remember a story from a couple of years or so ago, but I don't remember where it was.

In the story I remember someone was saying that the difference seemed to be cultural.

[Brother Oni]

There does seem to be a mental/cultural aspect to allergies. There is apparently a serious risk of someone dying of melon allergies in (was it France? Greece? the whole of western mainland Europe?) whereas in the UK and I think the USA it's mainly nuts that are the dangerous allergy. Don't ask me how, but if that's the case, it sounds as if placebo ought to work, I have no idea whether anyone has studied this.

I suppose you could argue that the hygiene hypothesis, where a lack of exposure to a sufficient range of allergens during childhood due to the much cleaner nature of modern western life has been associated with an predisposition of developing an allergy to foodstuffs like nuts, could be cultural but it's very specific. Children associated with farming and the lifestyle around it in First World countries tend not to have such allergies.


Wouldn't that largely hinge on people's genetics being different? Scandinavians are much more higly tolerant towards lactose as adults than most others. And yet seem to be the most prolific instigators of lactose free alternatives. (That latter part is just a feeling. But there must be 15 diffierent lactose free variants to 1.5 variants of regular milk)

Yes, curse you lactase persistence gene mutants. :smallsigh:

1.5 varieties of regular milk? I know of at least 4 types of cow milk - skimmed, semi skimmed, whole milk and gold label (extra creamy).


If there's a cultural part I would see it as overblown reaction to incidents. Say the litigation fuelled Anglo-Saxon anxiety response to potential issues (Warning hot coffe is hot).

If you're referring to Stella Liebeck's suing MsDonalds (https://en.wikipedia.org/wiki/Liebeck_v._McDonald%27s_Restaurants), McDonalds were warned that their coffee was too hot but did it anyway to increase the product shelf life (most of their coffee drinkers were commuters who drank their coffee some time afterwards). 79 year old Stella Liebeck spilled coffee over her lap, resulting in third degree burns to her groin and thighs (6% of her skin) and lesser degree burns elsewhere (a further 16% of her skin).

I'm not saying whether the case was frivolous or not, just that the finer details can sometimes be forgotten.

[halfeye]

1.5 varieties of regular milk? I know of at least 4 types of cow milk - skimmed, semi skimmed, whole milk and gold label (extra creamy).

I'm also seeing four, but a different four. I remember gold top, from Channel Islands breed cattle, low yield, higher fat content, doesn't seem to be available any more here, probably doctors objected due to obesity concerns. The four I see are skimmed (0.1% fat to 0.5% fat, depending on brand), 1% fat (not available in all brands), semi-skimmed (? 2.0-3.x% fat?), and full fat (theoretically whatever comes from the cow, but homogenised).

[Brighteyes]

Ben Goldacre, of 'Bad Science' fame (great book), has a lot of respect for the placebo effect. Like your study, he says it's not any chemical involved in the treatment that matters, but the care and tone in which it's delivered. Which is why it often works even when you tell the patient that it's a placebo.

And yes, faith healing and homeopathy and many other forms of quackery work the same way. So homeopaths are actually doing people good. It's all about spending time with the patient and making them feel they're being treated.

Now if only you could ensure some level of effective care and tonal delivery in care providers and GP's then imagine how wonderful the medical system would be. In my experience, licensed medical practitioners have the opposite effect....

[snowblizz]

Possibly, but since something like 1850 people have been moving around a lot. There are a lot of emigres and immigrants, and you'd think that it would sort out, extreme allergies are rare anyway.

It most definitely hasn't. On an invdividual case by case maybe but we are nowhere near it more broadly speaking.

Also it can work the other way around. Like my coworkers husband with his Germanic inherited onion allergy.

There's no universal law ensuring we only get the good traits.


I suppose you could argue that the hygiene hypothesis, where a lack of exposure to a sufficient range of allergens during childhood due to the much cleaner nature of modern western life has been associated with an predisposition of developing an allergy to foodstuffs like nuts, could be cultural but it's very specific. Children associated with farming and the lifestyle around it in First World countries tend not to have such allergies.
Now there's something that is most likely true. And I guess we could file it under "cultural", though I've seen that discussion take ugly turns (ie what nation or peoples fail at hygiene). Very few children in the places I know would actually be exposed to a farming lifestyle, arguably due to the culture having turned urban. When I was young medicine thought having pets made you allergic, and dad tried his darndest to not let us have one. Turns out his profession was wrong on that bit. And we got a cat anyway.



Yes, curse you lactase persistence gene mutants. :smallsigh:

1.5 varieties of regular milk? I know of at least 4 types of cow milk - skimmed, semi skimmed, whole milk and gold label (extra creamy).
We may not be in Marvel comics, but one day we will rule the world!

1.5 types average, because they'll always fail to stock at least one of them when you want it ;). Fatfree (~0.5), light (1.5%) and regular (~3% iirc) is what there used to be. There was a 1% for awhile so kids wouldn't grow obese drinking the school's regular 1.5% version (I'm not joking, apparently the fastfood and candy at home doesn't count). But they had to stop with that. There was something about EU subsidies for schoolmilk tied into it but no longer can say if it required the 1% or the opposite. The dairy simply couldn't make it viable though, most people are used to Light from their own time in school.

To put the point I was trying to make a different way, if the back wall in the store where the milk is, is 15m across, 12m of shelfspacethat will be specialty milks of various lactosefree or vegan varieties (also known as not actually milk at all). In a place lactose intolerance should on average be much rarer than anywhere else. At one point it was "hip" to be lactose intolerant too. So cultural reverse-placebo for a 180 degree turn back onto topic :D.




If you're referring to Stella Liebeck's suing MsDonalds (https://en.wikipedia.org/wiki/Liebeck_v._McDonald%27s_Restaurants), McDonalds were warned that their coffee was too hot but did it anyway to increase the product shelf life (most of their coffee drinkers were commuters who drank their coffee some time afterwards). 79 year old Stella Liebeck spilled coffee over her lap, resulting in third degree burns to her groin and thighs (6% of her skin) and lesser degree burns elsewhere (a further 16% of her skin).

I'm not saying whether the case was frivolous or not, just that the finer details can sometimes be forgotten.
Actually the finer details of it being forgotten is why it's so "effective". And why I mentioned it. Because people tend to remember only as a silly frivolous suit (which it probably wasn't).