Placebo effect discussion thread

From a memoir piece in Guernica written by a doctor who treats chronic pain. He uses the hardware/software analogy. Feels like what's missing here is a discussion about regression to the mean?

 

Which electrical therapy--I'd like the author to come out with it.

 

You can ask the author of this article on Twitter. This tweet goes back to 2019.
https://twitter.com/user/status/1130510888849555457

 

How the hell does a profession that's supposed to be based on science believes in this crap? When it's described honestly it's as delusional as the humors or any of the obsolete stuff ever was.

Turn the argument: "the patient heals anyway" and apply it to literally every pseudoscience out there and it works out the same. Works with healing crystals, astral projection and basically any nonsense one can think of because they are irrelevant factors.

I would actually argue that it isn't the patient who is tricked by the "placebo", rather it's the physician, who somehow trick themselves into believing that, despite doing nothing, they changed something. Whereas anyone with common sense understands that there are other factors involved and when you don't know whether something is causing an effect, one cannot claim any effect.

Honestly we kind of have the exact same in anything having to do with computers. Anyone with computer skills will often be asked by family to help troubleshoot something, who will show us the problem but instead works as intended. Did our presence magically heal the problem? Of course not, it was simply an independent factor that did not happen this time. We often joke about being glad to help but we certainly don't go around actually thinking it. A rigorous investigation would find the cause. There is always one.

The idea of "the body acting in expectation" is some professional grade horse manure. This is basically The Secret. It's actually hard to take people seriously about anything when they go on about this stuff. It reveals serious scientific illiteracy.

And that's the gist of it: obviously it hasn't actually "helped", because whenever this pseudoscience is deployed, the definition of "works" is basically turned into nothing. That's the obvious answer, bias and confounding factors showing the illusion of an effect, which tricks the physician more than the patient, not some magical woo woo. But instead it's turned into an elaborate myth, where there's a perfectly rational and common explanation that applies to everything: unless all factors are controlled for, attributing a cause to an effect is not scientifically valid.

This is really no different than experiment testing the harm of EM waves but they're never turned so the people attribute something independent to a preferred explanation. It's the exact same.

 

When he can show that a study, any study, shows an objective measure being affected & improved by placebo, then he can start talking about people 'getting better'. Placebo's make people think they feel better, they dont actually 'get' better. Like @rvallee says this is just 'the Secret' ie a load of twaddle.

I cite as my evidence fr this the Albuterol trial Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma | NEJM

 

Merged thread
I would like a large placebo effect. Why can't I get one?

In another thread, @Jonathan Edwards said:

I try new things endlessly, if they seem likely to be harmless and might have some beneficial effect. But nothing moves the needle.

Where is my placebo effect? If I wanted to engineer a massive placebo effect for myself, how would I do it?

And, as ever, does the existence of a massive placebo effect in ME/CFS tell us anything about mechanism? Are there diseases that don't show massive placebo effects? Is it a clue?

 

I am obviously not a scientist but I am extremely skeptical about the capability of a placebo response to induce a large improvement in an illness as disabling as ME. Many studies where a large placebo was reported are infusions with saline as placebo, and many people with OI report big improvements in symtoms with saline.

As for recovery, I am especially skeptical as we have seen that some lucky people just go into remission and we don't know why. Ascribing improvement to a placebo effect seems as illogical to me as ascribing it to CBT.

But then I am extremely skeptical that the placebo effect is real in a situation beyond the brains capacity to trick itself out of feeling illness/pain.

 

In which thread did he say this? Don't think I agree with this statement.

 

If you click on the arrow next to his name above the quote-box, it will take you to his post on that thread (I only learned that trick this week!).

 

Thanks!

 

I've not even thought about a placebo effect. I'd like one too. I try a lot of things after hearing great results for others and then feel nothing myself.

My most recent is I got my vit D up to a great level.. Obviously healthwise that's better, but even that didn't give me any improved feelings.

 

From what I can tell, the placebo effect is very much overstated in popular culture. It only has decent evidence behind it for nausea and pain, both of which are subjective outcomes.

 

If the placebo effect actually works then it should have a biological mechanism by which it works. If pain is the result of a signal in the brain that produces a negative experience, how does a placebo block those signals from being processed?

 

There is no objective way to measure pain. So the placebo effect may simply be a cognitive bias, ie. nice doctor says you’ll get better so you imagine you’re better.

 

I don't think we know if there is an objective way to measure pain. If it is possible to produce AI that can feel pain then it could be measurable, but that is a little besides the point.

I agree that the placebo could be due to expectations about treatment and reporting better outcomes due to a variety of societal factors. But there could be some real biological mechanism(s) that explains the placebo too.

If placebo does work it isn't because of some mind/body influence. If there was a car heading straight for you, the information that is received from your eyes about that threat would cause the brain to release adrenalin and other chemicals that impact how you feel. There is nothing brain/body dualism about that and it seems possible that placebo could do the same.

I honestly don't know enough about placebos to know if we should think they work biologically, I'm just curious for those that do think they work how do they think they work.

 

Has any body actually demonstrated change in objective measures via a placebo effect, or are observed changes purely behavioural or in subjective outcome measures?

For example an elaborate experiment to convince people they can be made taller may get people to think they are taller, perhaps even get them to stand straighter and to hold their head higher, but it is going to add not one proverbial cubit to their height. (Though I had not realised till I Google it a cubit is quite long, the length of the forearm, perhaps a centimetre might be more convincing.)

 

I haven’t actually looked at the literature, but people often say there have been demonstrated changes in brain scans and painkiller molecules (like endorphins).

Brainscans is pretty easy to explain, I mean if you tell a person two different things their brain is going to fire different neurons. So telling someone nothing vs pretending a drug works is going to look different.

As far as painkilling molecules, I guess certain reflexes to external stimuli are more likely to release them? I don’t know.

 

Something like this?

Jockenhöfer, F., Knust, C., Benson, S., Schedlowski, M. and Dissemond, J. (2020), Influence of placebo effects on quality of life and wound healing in patients with chronic venous leg ulcers. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 18: 103-109.

Ashwin Mathur, Paul Jarrett, Elizabeth Broadbent, Keith J Petrie, Open-label Placebos for Wound Healing: A Randomized Controlled Trial, Annals of Behavioral Medicine, Volume 52, Issue 10, October 2018, Pages 902–908, https://doi.org/10.1093/abm/kax057

They both compare wound healing in placebo vs. controls. Small studies (n=20 and n=70), both find that placebo affects some subjective patient reported outcomes, but not the actual wound healing. Limited by statistical power.