UK: Workshop - CBTReach - CBT for Persistent Physical Symptoms, Chalder - 9 May 2023

You forgot to say "Simon says"...

 

I didn't go that deep into the subject. But from your point of view, can the placebo effect be evidence?
In the case of the placebo, the patient recovers without medical intervention, but only through the power of suggestion.
I have also heard of cases where people have recovered from cancer, even if medicine has given up on them.
I do not insist on the absolute accuracy of psychosomatics. However, it does have a vengeance. People once attributed thunder and lightning to some deity or fiction. Now people can relate to psychosomatics in the same way.

 

Of course not. Organic injuries and virus interference in the human body are a different story.

 

Not without that! People are great inventors and dreamers. And that's cool, actually. It's made progress for mankind, hasn't it?

 

'placebo claim' is also based on the assumption that the entire effect of what happens in a trial ie a trial effect is down to 'patient's unconscious thought' rather than the staff and patients wanting the whole thing to succeed and everything that can therefore tending to lean towards that. It is not - it is there and used to be subtracted (which it isn't for therapist-delivered treatments) to remove bias just associated with being on the trial, and all things associated with that, by having blinded controls where the investigator doesn't know they didn't have the treatment but otherwise acted the same in every way to them.

The reality is that the bigger a 'placebo effect' someone is getting from their trial the more inaccurate and problematic it is as a design ie it is a measure of error/bias/inbuilt nudges. But you could see why those whose trials all don't [have to] subtract this, and therefore maximise it, might want to let people think differently and try and sell it as if it is 'a benefit'.

Some of it is understandable and can happen even on objective trials - either just patient being conscientious because they feel 'on the job' (so is particularly on the ball about meds, exercise and diet vs normal 'vices' or habits) or because you can read of the fact that with most trials even if something works they have to hit a 'threshold effectiveness' in order to be funded to the next stage. If you thought that something could work and not be approved based on 1% off then it might sway you straining to walk that extra 10m or carefully consider when you think about should I give it 6 or 7 for that question the risk assessment associated with selecting this re: big picture.

Lying to achieve that e.g. a 'fake trial' or a boss lying there will be a promotion on offer to short-term increase productivity isn't the same 'overall effect' - imagine what any sector or boss believing that is how to treat people based on one short-term lie might actually create as an effect medium-long term or if done repeatedly?

Some of it is simple situational/coercion/fear-risk at the point of submitted responses if there is a right or wrong answer associated with a certain perceived threat or risk of it then that isn't really placebo in the 'actually feel better' sense. Like saying 'thanks I love it' after a bad haircut just to stop them cutting any more and get out of there. If someone is setting out 'expectations of how you will improve/answer' at the start, and there is a power differential or just social pressure, it's a pretty different actual thing to the claimed 'expectation effect' wishfully believed by those employing it. I'm surprised this is never required to be addressed/safeguarded in methods, and e.g. a business would normally triangulate with drop-outs, repeat custom, online reviews etc. for this 'red flag'

Using 'nudge' - manipulation - in a design of an experiment to give little choice on behaviour or answers, and 'techniques' on how staff treat wording of questions and therapies to lead to certain answers or preferences is not the same as patient's subconscious/unconscious. It is bad survey design, and in other subjects would be criticised as such. There is no research showing that tricking someone to tick a box saying they were more satisfied than they might have if it were worded differently makes them actually more satisfied (nevermind it changing their disease or whatnot).

I've never heard of someone being proven to recover from cancer based on the power of suggestion. And I'm pretty sure if there were proof of it with some not dodgy methods then BPSModel would have not needed to iteratively produce so much with dodgier methods for so many years but would have just shown that slam-dunk?

At the moment I've seen little proof to show 'good placebo' (as they claim it) be proven vs all of the other less savoury/exciting possibilities and other explanations that don't really count towards being down to the credit of the investigator above.

There are further 2 steps missing: prove it actually changes people's thoughts not just answers, but then more importantly 'in a way that is beneficial to the claimed 'issue' and shows it has changed their health and not harmed them physically or psychologically' due to this. Moving to make sure there are no diagnostics of what people have means this isn't even defined they've chosen to even step away from bothering to make it about anything more than influencing responses to their own forms - what else are they measuring?

 

Did I understand correctly that you think that taking a placebo has no effect?

 

I think what I wrote in the comment

 

Well, if it's No, then the placebo has an effect. Because it can't be both Yes and No at the same time.

 

Ok. Let it be so. Thanks for the clear answer

 

Yes.

Certainly no one is permitted to check whether what you the researcher says and you do matches up with what we all might commonly expect as a picture of good intentions or not.

If anyone looks they might find your intentions seem to align rather well with what looks like bad intentions, to go with bad actions.

And whether these bad looking intentions of yours appear malicious or simply self-serving that’s definitely not something you want studied is it?

 

She needs to clarify, which she wont want to do, that this is not associated with pathology found in OTHER diseases. We know thousands of things are wrong with us, but what we do not understand is causation or the full impact of these myriad problems. Its a problem with determining significance/impact, not an issue with zero pathology.