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."

Comments

Homeopathic Medicine

[Sonny Yatsen]

If deception isn't necessary for placebos to work, does this mean the homeopathic medicine advocates can admit it's bullshit now?

Re:Homeopathic Medicine

[happylight]

If it works, how can it be bullshit?

Re:Homeopathic Medicine

[Sonny Yatsen]

The theory is bullshit. They dilute a compound until they're essentially giving somebody water and claiming that the water will have some memory of some compound being dissolved in it and that will cure people of their illnesses. Placebos might work, but the theory is pure bunkum.

Re:Homeopathic Medicine

[Scubaraf]

But he has a point. Several psychiatric drugs have been shown to be no better or worse than placebo. We didn't hear about it because these negative trials were suppressed by the drug companies. They only published the positive ones - do enough studies and one will work!

Even the open placebo used in this study appeared as good as the leading therapy for IBS (although they weren't compared head-to-head).

Re:Homeopathic Medicine

[mcgrew]

TFA: data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients.

This isn't "ethically questionable" as TFA posits, it's a GOOD thing, especially with viral diseases like colds and flu. People insist on antibiotics, but antibiotics are no better than placebos on viral infections, and placebos don't cause antibiotic-resistant strains of bacteria to evolve.

Re:Homeopathic Medicine

[xystren]

Because the uninformed equate that placebo effect = not effective... where they should be thinking, placebo effect = effective without an identified factor/cause.

Honestly, if I have the choice between a placebo effect or some medication that has major side-effects (ie: damage to the liver/kidney), I will take the placebo. If one can elicit a placebo effect without the dangers of medication side-effects, why is that a bad thing?

For example, morphine does exactly zero for me with regards to pain management. When I had a pooched back (bulged lower lumbar), it did absolutely nothing, yet a regular ibuprofen did more. I tell you, I would have welcomed a placebo effect. All the morphine did was give me a headache and make my pi$$ stink like a S.o.B.

Cheers
Xyst.

Re:Homeopathic Medicine

[ColoradoAuthor]

I like to think of homeopathy as optimized placebo effect.

I still haven't figured out why homeopathic pills have been so very effective in pets (mine, and those of friends), however. Does my dog sense my confidence? How does that affect measures such as thyroid levels, joint inflammation, or ability to climb stairs? As with many alternative therapies, the commonly-spouted theory makes no sense, but nevertheless there's something going on which deserves investigation.

Re:Homeopathic Medicine

[nospam007]

"Actually with the placebo effect people don't just feel better but get the same results they would have had they had the real medicine."

Actually no. 'Real' medicine is considered real only if it works _considerably_ better than the placebo sugar pill the other half in the double blind tests are getting.

Re:Homeopathic Medicine

[locofungus]

Don't understand your comment.

I have to say I wasn't aware that "placebos work even without deception" was new but perhaps this is the first rigorously controlled trial.

I've seen stuff before like "What should you tell your patient?" with suggestions like:

"Nobody understands why it works but in one in three cases, just taking one of these sugar pills three times a day can help with the symptoms."

For that matter, "Nobody understands why it works but in one in three cases, taking homeopathic remedies helps with the symptoms" ought to be equally valid, especially for things like chronic pain where conventional medicine doesn't really have an answer and is just used to mask the symptoms. If homeopathy works for someone then it's almost certainly a better option than morphine.

The main objection to homeopathy is that some people recommend it over conventional therapy that is known to be both required and effective in treating the particular problem.

Article on BBC today: http://www.bbc.co.uk/news/health-12060507

Alternative remedies 'dangerous' for kids says report

"In 30 cases, the issues were "probably or definitely" related to complementary medicine, and in 17 the patient was regarded as being harmed by a failure to use conventional medicine.

"The report says that all four deaths resulted from a failure to use conventional medicine."

Tim.

Re:Homeopathic Medicine

[Angostura]

Obligatory hilarity:

Homeopathic Accident & Emergency

Re:Homeopathic Medicine

[MartinSchou]

People insist on antibiotics, but antibiotics are no better than placebos on viral infections, and placebos don't cause antibiotic-resistant strains of bacteria to evolve.

Well, sure, you say that now, but just you wait until we get placebo-resistant strains of bacteria! What'll you do then?!? ;)

Re:Homeopathic Medicine

[EllisDees]

From the New England Journal of Medicine:

"Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive."

Re:Homeopathic Medicine

[Abcd1234]

Bullshit.

Re:Homeopathic Medicine

[Chris Burke]

I like to think of homeopathy as optimized placebo effect.

Yeah, optimized for the profits of those selling these pills with nothing in them.

Does my dog sense my confidence?

Yes, of course dogs can sense the attitudes of their owners, and owners will subconsciously give their dogs extra encouragement when they expect them to get better (which is why real medical studies are double-blind wherever possible).

That plus coincidence and confirmation bias explain the anecdotal evidence.

but nevertheless there's something going on which deserves investigation.

There is nothing going on. No scientific study has demonstrated homeopathic preparations to have an effect greater than a placebo. Because they are placebos. So there's nothing which deserves investigation, except the placebo effect itself, which can easily be studied while completely ignoring the particular kind of placebo called homeopathy.

Re:Homeopathic Medicine

[losfromla]

I call bullshit on your bullshit. I also call bullshit on snopes.com

I read the books, he based his findings on research (not reading as snopes.com claims). Clinical research on people who got better following his regiment.
I myself have been diagnosed at various times with asthma, post-nasal drip (cough) which would require surgery to fix...
After finding out about "The Water Cure" and drinking the requisite 8+ glasses of (purified/filtered) water per day, the cough (which was the primary manifestation of my dehydration) has stayed away for now about 3 years. I had a lapse not too long ago where I stopped taking water for a while (too busy) and the damn cough came back. So, believe what you want to believe but just know that most of what you believe about healing and your health is based on the claims of corporations and doctors (who learned what they know from the same corporations) who benefit from your poor health. I think the placebos would work great if the patients were advised to take them 3 times a day with a full glass of water in between meals. That's how the water is best absorbed and metabolized by your system.

Re:Homeopathic Medicine

[Abcd1234]

I'm glad the internet can prove me wrong. But try it. It's shocking how much energy you have.

Ironic you should cite your anecedotal claims, based on personal, subjective perception, in an article about the placebo effect...

Re:Homeopathic Medicine

[sorak]

People insist on antibiotics, but antibiotics are no better than placebos on viral infections, and placebos don't cause antibiotic-resistant strains of bacteria to evolve.

Well, sure, you say that now, but just you wait until we get placebo-resistant strains of bacteria! What'll you do then?!? ;)

I'm waiting for placebo-based biological weapons. Some guy blows up a box full of flour on a bus and fifty people die of Anthrax. How would the court case play out on that?

Re:Homeopathic Medicine

[Abcd1234]

Well that's easy: I don't tolerate pseudo-scientific bullshit.

The idea that drinking water is a miracle cure for lethargy, headaches, etc, let alone asthma and respiratory ailments, is bunk, unsupported by evidence. And, as a rational, evidence-based thinker, I attack such bogus claims, because I feel anti-science garbage should be debunked before people start running around drinking water instead of using their inhalers.

I also believe it's necessary to attack irrational thinking. In this case, that would be how I would characterize your insistence that your one anecdote, based on entirely subjective observations, is somehow equivalent to solid evidence. And the fact that you posed such arguments in a discussion about the placebo effect was too hilarious *not* to point out.

Same Deception

[Anonymous Coward]

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".

Re:Same Deception

[Monkeedude1212]

Moreover, I'm confused how on Earth they would manage to test something like this.

If you tell them it's a placebo, doesn't that, in a way, make it no longer a placebo? How can you observe a positive effect from placebos if they aren't even placebos anymore?

There's any number of things that could cause the "Positive thinking". They might be glad their Doctor is honest with them. They might like the sugar they put in them. They might be lessed stress knowing its not 100% necessary to get up at 6 in the morning to make sure you pop your placebo in time.

I'll read the full Article after this cup of coffee. I Can never seem to keep focused before having a cup of Decaf.

False deception

[Thanshin]

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?

Medical ritual, or just loneliness?

[Lilith's Heart-shape]

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.

Re:Medical ritual, or just loneliness?

[Scubaraf]

Bingo!

But that's a huge point to prove. As obvious as it may sound, it's evidence that validating patients and their concerns may be among the best things we can do as physicians. It's absolutely not billable, so many docs don't do it - instead focusing on seeing the next person quickly or doing another billable procedure.

Maybe with more studies aimed at understanding the effect of doctor-patient interactions, we'll start reimbursing MD's for what works and patients find valuable.

Not necessarily without deception.

[Thornae]

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:

...open-label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes”

Re:Not necessarily without deception.

[Thornae]

Addtional: The researchers themselves note something along the lines of what I'm talking about:

The placebo response in this trial (59% on IBS-AR) was substantially higher than typical reported placebo responses of 30–40% in double-blind IBS pharmaceutical studies. [15] This finding seems counterintuitive. We speculate that it is an indication of the credibility of our open-label rationale. Patients in our study accepted that they were receiving an active treatment, albeit not a pharmacological one, whereas patients in double-blind trials understand that they have only a 50% chance of receiving active treatment. It may be that one hundred percent certainty that one is receiving the “treatment of interest” (in this case open-label placebo) is more placebogenic than a fifty percent probability of receiving an inactive control.

I can relate...

[dejanc]

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 feel better already!

[boristdog]

I'm cured by just reading about these amazing placebos!

Nothing new here - and they don't 'work'

[geekoid]

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.

Re:Nothing new here - and they don't 'work'

[Rich0]

I'd need to see a cite for your claim.

Just look up the results for any drug clinical trial, and you'll see objective clinical results in the placebo arm of the trial. Give somebody a statin and it will lower their LDL by 30%, but give them a placebo and it will probably drop it around 5-10%. No need to ask the patient how they're feeling, just take a blood sample and send it to a lab, all in a blinded trial where nobody doing the testing knows how it will turn out.

Placebos achieve all kinds of documented clinical outcomes. You could probably improve the lives of poor people tremendously while not raising healthcare costs a dime if we just gave them all placebos for their ails. The question is which is more unethical - letting poor people die because we're unwilling to spend money on their care, or letting fewer poor people die by lying about the fact that we're unwilling to spend money on their care... If you look at it objectively, that's a pretty potent question. Of course, people will point to the third option - simply spending more money on their care, but if we were willing to do that we wouldn't be talking about the topic in the first place, and there will always be a limit beyond which we could still gain marginal improvements by using placebos (give somebody a statin, and a "Super Statin" placebo).

Re:I await ...

[geekoid]

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.

Nope

[geekoid]

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?

Re:Nope

[radtea]

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

You've missed some really important and classic placebo studies then. Google "placebo opiate production" and see what you'll find. There is ample evidence that placebos are capable of increasing endogenous endorophin production, which is why they are particularly effective against pain and inflamation.

This effect of placebos has been known for decades, so it kind of harms your credibility that you aren't aware of it.

Not so fast

[Suddenly_Dead]

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.

...the investigators deceived their subjects to induce placebo effects. Here's how they describe what they told their patients:

Patients who gave informed consent and fulfilled the inclusion and exclusion criteria were randomized into two groups: 1) placebo pill twice daily or 2) no-treatment. Before randomization and during the screening, the placebo pills were truthfully described as inert or inactive pills, like sugar pills, without any medication in it. Additionally, patients were told that "placebo pills, something like sugar pills, have been shown in rigorous clinical testing to produce significant mind-body self-healing processes." The patient-provider relationship and contact time was similar in both groups. Study visits occurred at baseline (Day 1), midpoint (Day 11) and completion (Day 21). Assessment questionnaires were completed by patients with the assistance of a blinded assessor at study visits.

Moreover, the investigators recruited subjects thusly:

Participants were recruited from advertisements for "a novel mind-body management study of IBS" in newspapers and fliers and from referrals from healthcare professionals. During the telephone screening, potential enrollees were told that participants would receive "either placebo (inert) pills, which were like sugar pills which had been shown to have self-healing properties" or no-treatment.

Even the authors had to acknowledge that this was a problem:

A further possible limitation is that our results are not generalizable because our trial may have selectively attracted IBS patients who were attracted by an advertisement for "a novel mind-body" intervention. Obviously, we cannot rule out this possibility. However, selective attraction to the advertised treatment is a possibility in virtually all clinical trials.

In other words, not only did Kaptchuk et al deceive their subjects to trigger placebo effects, whether they realize or will admit that that's what they did or not, but they might very well have specifically attracted patients more prone to believing that the power of "mind-body" interactions. Yes, patients were informed that they were receiving a placebo, but that knowledge was tainted by what the investigators told them about what the placebo pills could do.

Re:Used to be called "Magick"

[clone52431]

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.

Did you hear about

[Jay L]

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.

Re:Did you hear about

[Chris Burke]

Yeah. The only positive thing homeopathy did for the world was prevent people from dying from their "medicine" in a time when things like significant dosages of mercury were considered "medicine". It turns out not dosing people with mercury is better than doing so. Medical fact.

Too bad it wasn't a "let's not give people poisons" movement and instead was a "hey since giving people less mercury is better for them than giving them lots of mercury, maybe that means the more dilute any solution is, the better for you it will be!"

Re:Did you hear about

[bill_mcgonigle]

It turns out not dosing people with mercury is better than doing so. Medical fact.

My grandfather was in medical school in the 1910's. They had a few cadavers in the gross anatomy class where when they sawed open the long bones, mercury spilled out.

I know this works on me

[hellfire]

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.

Real Journal Articles Work -- Even Without Summary

[damn_registrars]

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.

Re:placebos work only on certain conditions.

[clone52431]

No. You’re wrong. Just stop.

For example:

A placebo presented as a stimulant will have this effect on heart rhythm, and blood pressure, but when administered as a depressant, the opposite effect. Kirsch I (1997). "Specifying non-specifics: Psychological mechanism of the placebo effect". In Harrington A. The Placebo Effect: An Interdisciplinary Exploration. Cambridge: Harvard University Press. pp. 166–86. ISBN 978-0674669864.

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.