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Placebos Work -- Even Without Deception
An anonymous reader writes "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 have found that placebos work even when administered without the seemingly requisite deception. The study was published on December 22 in PLoS ONE."
If deception isn't necessary for placebos to work, does this mean the homeopathic medicine advocates can admit it's bullshit now?
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The lack of misinformation doesn't negate the plethora of ignorance - their probably thinking "they're just saying this is a placebo to test if it's really working".
Study proves sugar pills alleviate IBS in 60% of patients!
A guy dressed in a white lab coat, doing an experiment, gives you some medicine and tells you: "This is a placebo. Trust me, there is no active component of any kind.". Then, as soon as you swallow the medicine he, and three other lab coated investigators watch you attentively for an hour, asking if you feel strange in any way.
What would be the chances of you believing them and having no doubts about the placebo nature of what you had taken?
The article suggests at the end that patients who responded to the placebos despite knowing that they were taking placebos might be benefiting from a "medical ritual", but I suspect it simpler than that. I suspect that the patients were just receiving some sort of psychosomatic benefit from having an actual human being pay attention to them for a little while. I can't prove it, but I suspect that a lot of modern chronic illnesses are psychosomatic and are a consequence of loneliness.
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From the actual study, the wording used to present the placebos to the patients seems to have been very carefully chosen to be utterly truthful, yet implicitly deceptive:
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A few years ago I made this image of a cough syrup bottle with the name "Placebo" written across the front. I never thought this would actually go to market until now. ;^)
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I have allergies each spring. After I tried several different medications, I finally found one which advertises as "non-drowsy" - essentially a low dose of loratadine. I started taking it and yeah, it both worked and didn't make me feel sleepy all day long.
A couple of months later, I talked to a friend who is a doctor, and he told me (not knowing that I take that medication) that clinical studies for the medication showed that it worked for about 50% of people who took the drug, as well as for around 50% of people who were on placebo (I can't remember if it was 50, but the percentage was about the same). I read some more upon it, and the conclusion most knowledgeable people made was that the dosage of loratadine in the drug is too low, and that it works only as a placebo.
Knowing what I know, I still take that medication and it still helps me. Perhaps the low dosage really works for me, but more likely, I keep being fooled by a placebo I know about...
I'm waiting for big pharma to patent placebos and to start suing makers of generics.
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I'm cured by just reading about these amazing placebos!
This is known information, and I don't understand why the Dr. was surprised by the result.
A placebo effect* doesn't fix anything,ever. It makes people feel better subjectively. When you couple that with things that getting better in a few days on their own. people start thinking they 'cured' them, when in fact it was just the bodies normal process.
*there are different types. Depending on the invasiveness of the fake treatment.
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You do realize they almost all of the 'natural' remedies are made by big pharma, right? As is most vitamins.
Which kind of removes the 'Big Pharma' argument.
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What about the possibility, I know it sounds crazy, but what if sugar pill is actually an effective treatment for IBS. Seems like they need to use the same placebo on test groups with other conditions to eliminate that possibility.
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After reading the slashdot summary, I got to wondering - do Placebos actually "work" or is it simply that the patients would get better all by themselves (immune system and other self-healing mechanisms in the body)? So, I did a few seconds of googling "placebo vs no treatment", and came upon a paper online at the NIH website:
http://www.ncbi.nlm.nih.gov/pubmed/12535498
The author of that paper concludes, "There was no evidence that placebo interventions in general have clinically important effects."
If the healing happens a certain percentage of the time regardless of whether treatment is even administred, then it makes perfect sense that placebo would work that same percentage of the time, even if people didn't believe they were being treated - e.g. "belief" has nothing to do with recovery - that is, it's very possible, and that NIH paper appears to confirm the hypothesis, that with "placebo effect", the conscious mind plays no role in the improvements witnessed.
No, you clearly don't understand the placebo effect.
Caner remission can happen with no pills medication at all. It's rare, but it happens. So Yes we would expect to see some remission from taking a non active ingredient pill, but in no case is it about the rates expected for 'spontaneous' remission.
EVERY test I have read about(100s) regard placebo effects show no real effect. Whether that placebo was administered by pill, fake surgery, acupuncturist, chiropractor, or prayer.
People believe they are better, they 'feel' better but when actually tested they don't actually perform better.
Look. I can read through a phone book, claim my magic powers heal people, and someone in the phone book will have gotten better. Does that mean I have magic powers, or their body was just able to heal itself?
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Well, it's not like he endangered the placebo group any more than the control group.
I should think it would be an interesting conversation ... "I'm going to do nothing with one group, and tell the other group I'm giving them a placebo and then I'm gonna see what happens".
Fun job though, medical studies without medicine. :-P
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I'm addicted to placebos!
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As pointed out by Orac, things are nowhere as simple here as they've been presented. There was still an establishment of expectation of the treatment working, which is exactly one would expect would elicit the placebo effect.
Yeah, I was thinking along the same lines. It’d be interesting to have a third group who were given the placebo pills and instructed to not take them, but instead to open up their medicine cabinet twice a day, look at their bottle of placebo pills, and think about all the people who had taken them and got imaginary benefits from them. I.e. don’t take the placebo pills – they don’t work – but think about it, since it appears to be the thought that counts. Literally.
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the guy who died from homeopathic medicine?
Yeah, he forgot to take it and overdosed!
Butseriouslyfolks... I'd like to see someone argue that homeopathy DOES work if you do a placebo-controlled trial. A homeopathic placebo-controlled trial, which means the placebo is actually undiluted. Hey, 100% of the patients given placebo arsenic died, and only 50% of the patients who took the diluted version! Whaddayaknow: a diluted dose of arsenic cures arsenic poisoning.
I've been to the doctor several times for things I know he won't prescribe for me for anything, but I go there just in case. Until I make the appointment, I feel crappy for an extended period of time, but the moment I do, I start to feel better. As a skeptical person, I know there's know magic to it, no strange force, no "God is looking after me," or whatever. But I do know my emotions and my mental attitude have a direct effect on my physical well being. I know is just all in my head, and my doctor is very helpful, sometimes not charging me and never prescribing me something I do not need (he's definitely old school!)
It's the emotions of dealing with the issue. I when I have any problem in front of me, it always feels best for me to deal with it, or put a plan into motion to deal with it. Putting off a fix or plan makes me feel crappy and annoyed.
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You don't have to take the word of the magazine as to what is in the article - you can read it for yourself
Conveniently enough the P in PLoS stands for Public - as in you can download the articles from anywhere without paying for a subscription.
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"work" is ambiguous and slightly deceptive. What we should say is there is a "reported effect". That is different (from my perspective) as having a clinical effect.
Hróbjartsson & Gøtzsche did an interesting meta-analysis of studies with both a placebo and no-treatment arm. For binary outcomes (except pain) there was no significant difference and for continuous outcomes and binary pain outcomes there was a difference but it increased inversely with sample size. They postulate that what people call the "placebo effect" is really just a form of reporting bias. People have been "treated" or have gone though the motions of treatment and as a result they change their expectations.
I mean, what is more likely some mysterious force which crosses every clinical boundary...or that people are (unintentionally) fudging things a bit.
No. You’re wrong. Just stop.
For example:
The same placebo can cause two exactly opposite effects on heart rhythm and blood pressure – both measurable, real things – depending on what sort of drug the person thought the placebo was.
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The general public were starting to learn what placebos are, and not believing in them any more, and the effect stopped; now that there is "proof" that they work, the skeptics can believe again, so the effect returns.
News in 10 years: "Placebos still work even when you learn that the 'placebos still work without deception' story was fake"
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