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is the placebo effect a load of rubbish (apart from mind related probs, like depressi watch

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    I'm doing a talk, with a couple of others, on placebos (on a Ψ course). As I've looked further, I'm starting to think it's a bit of possibly rubbish, or I'm expecting too much from it. Where it's failing it seems is in physical changes.

    First, there's pharma, and what they usually deal with (depression, anxiety etc.) – mind stuff. The placebo effect in pharma is a real tangible issue. eg https://www.wired.com/2009/08/ff-placebo-effect/ My thinking is, it's not surprising the placebo effect (which is really about the whole package, from the patients' POV, in terms of their treatment, so it includes how friendly the doctor is, how proficient they're perceived as being etc, etc, etc. - the whole cultural perceptive package) comes into play with say depression. It's not surprising a way of thinking, current mentality, trust etc, affects someone's state of mind. Mind affecting mind. In fact, it's kind of more surprisng that a chemical/drug could affect it positively. Chemical -> mind. Vs mind -> mind.


    Then, there's next to nothing (that I can see) of any real concreteness that shows placebos have such an effect physically. There was a study talked about in a TED talk on placebos, and this study gave people skin prick alogy tests, a rash appeared, then a placebo (and nocebo) cream applied. Placebo, rash went down. Nocebo, rash got worse. On the face of it this study was amazing. But:

    https://mindthebrain.blog/tag/histamine-skin-prick-test/ Why I dismissed this study … With only 20 participants per cell, most significant findings are likely to be false positives. … Claims of placebo effects figures heavily in discussions of the power of the mind over the body. Yet, this power is greatly exaggerated by lay persons and in the lay press and social media. Effects of a placebo manipulation on objective physiological measures, as opposed to subjective self-report measures are uncommon and usually turn out to be false positives.

    It's kind of too much I reckon to expect the placebo effect to have such a quick physical effect.

    It seems to me that the placebo effect could well have big serious physical effects, but only down the road, as it were. Knock on effects. Time passing. You know, small change of direction early on, later yeilds big difference. But by that time, you can't put it down to the placebo effect really because there's so many other factors going on.

    I don't know. Starting to think placebos are a bit BS-ey. Yes they have an effect on mental states, but that's about it. Treat someone nice, and they repond well. You don't say.

    There is the animals issue though, they respond to placebos. Maybe that's where I should look.

    Any thoughts?
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    > There is the animals issue though, they respond to placebos.

    That's qusetionable too apparently.
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    I don't think what your saying is particularly contraversial - you would expect that it would influence self-report outcome measures (as these can be more biased).

    Your also right that there's likely to be issues with the quality of a lot of research (have you read https://www.nature.com/articles/s41562-016-0021 ?)... sounds like your right track for this talk...
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    How about the idea it could create physical changes down the road? That does seem very plausible. But, as I said, it's then tricky to put it down to the placebo effect because so much has gone on, iteratively, over time.

    A probably crap example of big physical difference from placebo effect: Placebo medical exprience leaves patient feeling calmer, better. Lower blood preasure. Later on less heart problem, no heart attack. Obviously not provable in so many ways, but that kind of knock on effect does seem quite possible? Reasonable?
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    Placebos can effect people’s state of mind. And given what a placebo is about, the whole experience and belief and expectations around some treatment, of course they can effect your state of mind. Placebo is just a label for a whole lot of stuff that affects how you think about some treatment.

    If what’s being treated is a broken leg, then it’s not going to make any difference to the healing of that leg (although while being treated for a broken leg it’s nice to be treated nicely, and have confidence in who’s treating you, too). If what’s being treated is a problem within the mind, eg anxiety, then placebos making a difference seems much more plausible, certainly on the self-reporting of such issues. The pharma companies’ experience and current behaviour bears this out.
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    Does anyone know of a study which involves people being given drugs (pharma style drugs or similar, not recreational) without being told in order to avoid them being affected by the placebo effect? I'm sure a read about such a thing recently, can't remember where. Any ideas? Thanks.
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    All drug trials involve an element of this, since neither the researchers nor the participants know who is taking the actual drug and who is taking the placebo. I certainly can't think of any studies where the participants were drugged without their knowledge. They may well exist, but they'd have to be very old, since no study that unethical would be funded today!
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    (Original post by Beth_H)
    All drug trials involve an element of this, since neither the researchers nor the participants know who is taking the actual drug and who is taking the placebo. I certainly can't think of any studies where the participants were drugged without their knowledge. They may well exist, but they'd have to be very old, since no study that unethical would be funded today!
    I know about the double blind placebo vs drug tests. That's not what I'm on about. Because, having learnt more about placebos and how they're really about people's whole mental state associated with their treatment, I now know that any and all treatment involves a palcebo effect, irrespective of whether there's a false pill or such like involved. So when someone is given an actual drug, by say a doctor, for say anxiety, there is very much a placebo effect coming along with that drug, and for those sort of drugs the placebo effect accounts for about 90% of the effect, drug about 10%.

    So the only way to remove the placebo effect from the effect of a drug (that I know of) would be to give the drug to someone without them knowing they're consuming anything.

    I'm sure I've come accross such a thing somewhere. I know it'd be highly unethical, against the law etc. I'm sure I've come accross it though. Maybe it was in a particular situation, where it wasn't against the law or whatever. I don't know. Any thoughts? Thanks.
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    (Original post by BPBPBPBP)
    I know about the double blind placebo vs drug tests. That's not what I'm on about. Because, having learnt more about placebos and how they're really about people's whole mental state associated with their treatment, I now know that any and all treatment involves a palcebo effect, irrespective of whether there's a false pill or such like involved. So when someone is given an actual drug, by say a doctor, for say anxiety, there is very much a placebo effect coming along with that drug, and for those sort of drugs the placebo effect accounts for about 90% of the effect, drug about 10%.

    So the only way to remove the placebo effect from the effect of a drug (that I know of) would be to give the drug to someone without them knowing they're consuming anything.

    I'm sure I've come accross such a thing somewhere. I know it'd be highly unethical, against the law etc. I'm sure I've come accross it though. Maybe it was in a particular situation, where it wasn't against the law or whatever. I don't know. Any thoughts? Thanks.
    I don't know where you've got the idea that 90% of a drug's effect is due to placebo. Yes, there is likely to be a placebo effect with any medication, but the drugs used to treat anxiety, to use the example you gave, have a significant effect on the chemistry of the brain which could not be achieved through placebo alone. I'm also not sure why you think it would be necessary or even beneficial to remove the placebo effect altogether. The double blind method is perfectly sufficient - the point is to demonstrate that the drug is more effective than the placebo, regardless of how effective the placebo happens to be.
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    (Original post by Beth_H)
    I don't know where you've got the idea that 90% of a drug's effect is due to placebo. Yes, there is likely to be a placebo effect with any medication, but the drugs used to treat anxiety, to use the example you gave, have a significant effect on the chemistry of the brain which could not be achieved through placebo alone. I'm also not sure why you think it would be necessary or even beneficial to remove the placebo effect altogether. The double blind method is perfectly sufficient - the point is to demonstrate that the drug is more effective than the placebo, regardless of how effective the placebo happens to be.
    The 90% bit, yup I'm very much questioning that, depends on the situation it seems. There's a graph in Kirsch's The Emperor's New Drugs which compares Name:  Screen Shot 2018-02-19 at 10.29.42 am.png
Views: 16
Size:  74.7 KB amoung other things drug effect and placebo effect. And it's not so far off the percentages I mentioned. There's also a placebo effect talk on TedMed by a woman called Alia Crum, and there's a graph which backs up the percentage I mentioned, but the whole presentation is dodgy IMO, over zealous and BSity.

    So far as wanting to remove the placebo effect altogether, it's just an interesting thing, from a science point of view, to know what amount the drug effect is, and what amount the placebo effect is. In actualy practice, no you wouldn't want to remove the palcebo effect, definitley not.

    Great, thanks very much for your comments, v. useful/helpful
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    (Original post by BPBPBPBP)
    How about the idea it could create physical changes down the road? That does seem very plausible. But, as I said, it's then tricky to put it down to the placebo effect because so much has gone on, iteratively, over time.

    A probably crap example of big physical difference from placebo effect: Placebo medical exprience leaves patient feeling calmer, better. Lower blood preasure. Later on less heart problem, no heart attack. Obviously not provable in so many ways, but that kind of knock on effect does seem quite possible? Reasonable?
    You could prove this by measuring these outcomes. Compare a control, placebo and drug group on your main outcome and those other variables that you think mediate the effect of placebo effects (e.g. anxiety, attitudes, etc.). You could show how that any observed increase in the placebo vs control group on the main effect is statistically mediated by those psychological effects.
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    Yup OK great thanks
 
 
 
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