Placebo effect: a psychosomatic component, or only an aggregate of other biases?

[Keela Too]

I've been speculating about this evolutionary perspective, too, with a slightly different slant but ultimately similar.

Yes! We are definitely thinking along the same lines. I have also ruminated around those ideas, and it makes sense to me. How you’d test those ideas might prove more complex.

 

[Peter T]

Yes! We are definitely thinking along the same lines. I have also ruminated around those ideas, and it makes sense to me. How you’d test those ideas might prove more complex.

There is a risk of evolutionary arguments becoming circular: crudely put evolution is the survival of the fittest, but the only measure of what is the fittest is what survives. Some have even gone on to say that Darwinian theories of evolution are not truly scientific because of this.

So such speculation about the evolution of illness behaviours and societal response to long term conditions, albeit very interesting, may struggle to get beyond descriptions of varying degrees of accuracy unless one can get to the point of being able to make testable predictions.

 

[Sean]

The main, and possibly only, genuine benefit of 'optimism' is that it is more socially acceptable and hence rewarded – it attracts more resources and protection.

 

[Keela Too]

There is a risk of evolutionary arguments becoming circular: crudely put evolution is the survival of the fittest, but the only measure of what is the fittest is what survives. Some have even gone on to say that Darwinian theories of evolution are not truly scientific because of this.

So such speculation about the evolution of illness behaviours and societal response to long term conditions, albeit very interesting, may struggle to get beyond descriptions of varying degrees of accuracy unless one can get to the point of being able to make testable predictions.

Indeed. However the evolutionary idea does give one possible explanation to the awkward detail that subjective surveys often produce positive results not matched by objective measurements.

Accepting subjective answers at face value, without any consideration of how they may be skewed by other influences, is a much worse error in my view. Especially when objective measures suggest a very real bias towards optimistic self reporting.

The reason for the discrepancy may not be evolutionary, it may be a more recent cultural phenomenon, or simply a bias introduced in the way the questions are asked, but all of these are worthy of discussion, because they affect our choices about what we should be measuring.

In my view, objective measures are key, and subjective ones can only be a useful proxy if (and only if) they have been demonstrated to effectively match a relevant objective outcome.

So yeah, I agree we cannot easily confirm why subjective outcomes tend towards the optimistic, but we can discuss the many possible reasons. By doing so we remind ourselves, and others, that what people say is very subjective, and rarely a truly accurate picture.

Of course what we say might be swayed to the negative depending on our mood (or circumstance) but apparently this is less likely, and the most frequent bias seen is towards overly optimistic reporting.

So why is that? Perhaps it doesn’t matter why, only that we acknowledge that it does.

 

[Keela Too]

The main, and possibly only, genuine benefit of 'optimism' is that it is more socially acceptable and hence rewarded – it attracts more resources and protection.

Yes! Optimism in illness definitely is more socially acceptable, and more likely to be rewarded.

 

[Hutan]

I wonder if showing a relationship between 'agreeableness' and subjective improvements from placebo (or treatments that are essentially placebos) might help? Agreeableness is one of the Big 5 personality traits. So, there are tools to measure it. If it could be shown that more agreeable people were more likely to report an improvement, then I think that would suggest that the improvement is at least partly the result of people being obliging and polite.

Agreeableness is one of the five personality traits of the Big Five personality theory. A person with a high level of agreeableness in a personality test is usually warm, friendly, and tactful. ... A person who scores low on agreeableness may put their own interests above those of others.

Agreeableness is a personality trait that can be described as cooperative, polite, kind, and friendly. People high in agreeableness are more trusting, affectionate, altruistic, and generally displaying more prosocial behaviors than others.

 

[Hutan]

ha!

Agreeable? You’re More Likely to Benefit From Placebo
Your personality affects your likelihood to experience placebo effects.
https://www.psychologytoday.com/us/.../agreeable-you-re-more-likely-benefit-placebo

Whereas I'd say the people scoring high on the agreeable test are more likely to be polite about the benefit from a treatment, the writer of this article, and the authors of the study it refers to, think that agreeable people actually release more endorphins when they are told they have been treated.

It’s been shown before that personality can mitigate or enhance the placebo effect, but it was less clear how this was happening. This study suggests that personality affects the way our brains respond to medication. Resilient and agreeable people release more endorphins in the dorsal anterior cingulate than the average person when they believe they’ve taken medication.

Peciña and Zubieta suggest that agreeable people may have a stronger alliance with their doctor or treatment provider that compels them to desire better results. The tendency to want to please others seems to be related to release of endorphins in response to pain. It may be that the desire to feel better leads to release of endorphins that causes genuine relief.

It's always possible to put a BPS spin on things...

 

[DigitalDrifter]

Whereas I'd say the people scoring high on the agreeable test are more likely to be polite about the benefit from a treatment,

They won't be able to pull the wool over the medical profession's eyes forever, they'll be outed as the quacks they are.

In no other field have pseudoscientists flourished as prominently as in the field psychology. Oh Ben Goldacre your silence is deafening.

 

[Sean]

Agreeableness is a personality trait that can be described as cooperative, polite, kind, and friendly. People high in agreeableness are more trusting, affectionate, altruistic, and generally displaying more prosocial behaviors than others.

IOW, people who are more compliant, less confrontational and disruptive. Less 'difficult'.

Problem is that real change for the better is rarely done by such people. It is done by those who don't like what they see around them, and do something about it, including demanding that those in power do something about it.

IOW, they are intentionally disagreeable, but for very good reasons.

The capacity and preparedness to be disagreeable, confrontational, and disruptive is one of humanity's most important traits. No progress would have been achieved without it.

Never tolerate incompetence, corruption, or cruelty. Just don't expect to be thanked for it.

 

[Hutan]

Problem is that real change for the better is rarely done by such people. It is done by those who don't like what they see around them, and do something about it, including demanding that those in power do something about it.

IOW, they are intentionally disagreeable, but for very good reasons.

And of course, I should have said: This whole construct of agreeable people and disagreeable people is a nonsense. Because you can't properly categorise people on the basis of a handful of questions that can be interpreted in different ways that are answered at one point of time.

And, very often, prosocial, cooperative, altruistic behaviour is standing up for what is right.

 

[Saz94]

IOW, people who are more compliant, less confrontational and disruptive. Less 'difficult'.

Problem is that real change for the better is rarely done by such people. It is done by those who don't like what they see around them, and do something about it, including demanding that those in power do something about it.

IOW, they are intentionally disagreeable, but for very good reasons.

The capacity and preparedness to be disagreeable, confrontational, and disruptive is one of humanity's most important traits. No progress would have been achieved without it.

Never tolerate incompetence, corruption, or cruelty. Just don't expect to be thanked for it.

And of course, I should have said: This whole construct of agreeable people and disagreeable people is a nonsense. Because you can't properly categorise people on the basis of a handful of questions that can be interpreted in different ways that are answered at one point of time.

And, very often, prosocial, cooperative, altruistic behaviour is standing up for what is right.

Yes. I learned recently, that in the famous Milgram Experiment, people who score highly for "agreeableness" are more likely to agree to inflict pain upon other people!

 

[Sean]

that can be interpreted in different ways that are answered at one point of time.

And, very often, prosocial, cooperative, altruistic behaviour is standing up for what is right.

Context matters.

 

[Keela Too]

Yes. I learned recently, that in the famous Milgram Experiment, people who score highly for "agreeableness" are more likely to agree to inflict pain upon other people!

And, as another community I am part of recently discovered, one of the most agreeable & likeable individuals can hide behind a highly agreeable front, to harbour some very dark disagreeable traits. (Revealed only after the court outcome. )

Edited to add the quote I was responding to.

 

[Mithriel]

Yes. I learned recently, that in the famous Milgram Experiment, people who score highly for "agreeableness" are more likely to agree to inflict pain upon other people!

The milgram experiment was another failure of psychology. The results are not to be taken seriously. Like so many, good newspaper headlines, bad science.

 

[rvallee]

And of course, I should have said: This whole construct of agreeable people and disagreeable people is a nonsense. Because you can't properly categorise people on the basis of a handful of questions that can be interpreted in different ways that are answered at one point of time.

Sure you can! You can even make a good living out of coaching people with it. Of course you can't do that ethically in the context of medicine but that's where statutory authority cleans up any loose ends. Don't you want a life of love, not fear?

See, life is just that simple if you reduce it to simple things. It's not really "life" anymore, sure, but it sure is simple.

 

[Barry]

Of course what we say might be swayed to the negative depending on our mood (or circumstance) but apparently this is less likely, and the most frequent bias seen is towards overly optimistic reporting.

I suspect that subjective biases are heavily influenced by mood, and therefore can be manipulated by managing people's moods.

If somebody were to tell me day in day out how rubbish I looked and how bad things looked for me, then I will feel rubbish, and any questionnaire I fill in will reflect that. By contrast if I'm told day in day out how fantastic I'm doing and how promising things look for me, then I will no doubt answer much more optimistically.

If you wanted to deliberately skew findings then you would likely do nothing to foster optimism at baseline measurements (maybe even foster pessimism), and then of course, as we know, do everything to boost people's morale as part of the 'treatment'.

 

[Helene]

I wonder how adrenaline fits in. Or is this encompassed in mood?

I find adrenaline can completely change my perception of how ill I am. Earlier in my illness I felt fine in stressful situations, such as bringing a child to the hospital after a fall for stitches, to the extend I wondered if I really was ill.

 

[5vforest]

Perhaps related: https://neo.life/2021/10/the-promise-of-pills-that-do-nothing/

“You are the active ingredient.”
So proclaims the chic, sleek website of Zeebo Effect, a South Burlington, Vermont, company that sells elegant light blue and white capsules packaged in stylish silver-capped bottles. The pills are guaranteed to contain absolutely nothing that can alter a consumer’s physiology, but as the ad copy suggests, taking them may nonetheless help remedy a variety of ills.

I can't quite believe that this is a real thing.

 

[Sean]

Nobody can say they lied about what was in the bottle.

 

[Mithriel]

I wonder how adrenaline fits in. Or is this encompassed in mood?

I find adrenaline can completely change my perception of how ill I am. Earlier in my illness I felt fine in stressful situations, such as bringing a child to the hospital after a fall for stitches, to the extend I wondered if I really was ill.

It would be good if they researched this to see if it is adrenalin or what causes this. It is a very real effect in ME and I have wondered if the adrenalin helps release more ATP into the system to make more available. Julia Newton did experiments on isolated muscle cells and when they were stressed some of them converted ADP to AMP to release energy but this is not a reversible reaction like ATP to ADP so the cells were worse off in the end.

Of course, this sudden normalness, for want of a better word, is a superficial change with the underlying illness still there and a crash likely, definitely not proof that it is our attitude that is making us ill!