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The Placebo Effect

arthwollipot

Observer of Phenomena, Pronouns: he/him
arthwollipot
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For a long time here I've been telling people that the placebo effect is largely a sham - I've said in the past that "placebo effect" is merely shorthand for uncontrolled variables. When asked to back this statement up, I've had to say well, you kind of have to have listened to the last six years of the Skeptics With A K podcast, because Mike Hall on that podcast has talked about it a lot and presented evidence that the papers purporting to show a powerful placebo effect don't actually say that. But the problem is that this particular podcast is fairly badly indexed, which is quite deliberate - the hosts don't claim to be experts in anything outside their field of knowledge, and while they try to back up what they say with real evidence, they don't want anybody to be citing their show as an authority. So I can't point to specific episodes, and who wants to listen to a 45-minute podcast just for one point anyway? You should go subscribe to it, though. It's really good.

So I've never really been able to justify my statement that the placebo effect doesn't really exist. Until now. Mike has started to write up what he has learned in the British Skeptic magazine. So here you go, the first instalment of what he says should be an ongoing series:

Much ado about nothing: evidence of the ‘powerful placebo’ is far from convincing
 
I'm no expert, but the design of the control seems shoddy. Shouldn't those on the "wait list" have been given the equivalent of the post-op physio regime? Seems like a glaring miss.
 
Good article, I'll certainly read the rest of the series.

Yes, I've long suspected that 'the placebo effect' is just a collective name for confirmation bias, regression to the mean etc - all the sources of error which double blind clinical trials were invented to eliminate.
 
It depends on the definition and the expectations: Will the 'powerful placebo' make your cancer go into remission or cure your flu? No, it won't. Not in the slightest. Will it give you hope, calm you down and thus make you feel better? Yes, it will ... as the cancer is slowly killing you and the flu is doing what the flu does while your immune system is fighting it.

In general, going to the doctor in itself works as a placebo. If you go there thinking that you have come down with something really awful, the doctor telling you that it is nothing to worry about (even if it is a misdiagnosis) tends to make you feel better.
Two years ago, I went to a neurologist because I experienced a tremor in my left hand. I returned home relieved that it wasn't Parkinson's. (And the tremor diminished when I quit my much too stressful job.)

In my opinion, however, the medical profession doesn't exist to make us feel better. It exists (or should exist) to prevent, cure or alleviate disease. However, if doctors prescribe placebo medicines (for instance, most expectorants, I think) to patients who are desperate because of a flu or a cold that lasts a little longer than expected, I can live with that if the doctors have made sure that it really is nothing worse than influenza or the common cold.
My old doctor used to prescribe tea and rum in cases like that, stressing that it wouldn't cure anybody but would make you feel better! :)
 
The thing is, and this is something that he has gone into on the podcast, so I assume that it will be mentioned in a future article, if you actually measure objective outcomes, people who report feeling better after a placebo treatment actually aren't any better at all.

So they're actually thinking they're improving when they're not. That can be dangerous.
 
I remember Rolfe (a vet, for those who aren't familiar with her) posting about how a pet owner had bragged about some worthless alternative remedy they'd tried which they were sure had improved their pet's condition, when it was obvious to her the poor animal was actually worse. So even 'placebo by proxy' can be bad, in that effective help is delayed or even dispensed with altogether.
 
I think boys of a certain age (myself included) first learned the meaning of "placebo" after looking it up because of all those ads in the back of Playboy magazine. Oh, I actually read the articles, too...
 
Probably everyone else is wrong about the placebo effect, other than this guy.
 
The powerful placebo effect: fact or fiction?

False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. These factors are still prevalent in modern placebo literature. The placebo topic seems to invite sloppy methodological thinking.
Click to expand...
 
If you consider making you feel better, psychologically, to men working, then yes!
Even Randi probably felt better after this:
In an online video, Randi consumed an overdose of homeopathic sleeping pills to demonstrate that they have no effect, and skeptics elsewhere consumed large overdoses of other homeopathic drugs in similar demonstrations.
Magician James Randi, skeptics launch attack on makers of homeopathic ‘drugs’ (LA Times, Feb. 5, 2011)
Click to expand...
But the homeopathic sleeping pills didn't make him fall asleep, and if they were his cause of death, it took several years for them to kill him.
 
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arthwollipot said:
For a long time here I've been telling people that the placebo effect is largely a sham - I've said in the past that "placebo effect" is merely shorthand for uncontrolled variables. When asked to back this statement up, I've had to say well, you kind of have to have listened to the last six years of the Skeptics With A K podcast, because Mike Hall on that podcast has talked about it a lot and presented evidence that the papers purporting to show a powerful placebo effect don't actually say that. But the problem is that this particular podcast is fairly badly indexed, which is quite deliberate - the hosts don't claim to be experts in anything outside their field of knowledge, and while they try to back up what they say with real evidence, they don't want anybody to be citing their show as an authority. So I can't point to specific episodes, and who wants to listen to a 45-minute podcast just for one point anyway? You should go subscribe to it, though. It's really good.

So I've never really been able to justify my statement that the placebo effect doesn't really exist. Until now. Mike has started to write up what he has learned in the British Skeptic magazine. So here you go, the first instalment of what he says should be an ongoing series:

Much ado about nothing: evidence of the ‘powerful placebo’ is far from convincing
Click to expand...

He says he's not an expert. He avoids being cited for his claims. He eschews scientific peer review. Is it too much to ask that he do some actual science, before we start taking him too seriously?
 
Here’s the way I see it.

The body is very good at fighting most illnesses. For example, some people can fight off a flu with few or very mild outward symptoms. OR: Some people’s cancer just goes into remission spontaneously. This is down to genetics and other such factors.

Doctors and medical science are not perfect, either. Sometimes people are misdiagnosed. There are also ethical concerns in research. They can’t control every aspect of human behavior or define every variable.

We are also humans with biases and other cognitive errors. Our minds are very good at fooling us.

Any “placebo” effect is going to come down to some combination of these three things. Probably what Arth puts down to unknown variables or whatnot.

I think too many people think that a “placebo effect” is some mysterious process of the mind and body. Like, if we think we are getting treatment, our body acts as if it’s getting treatment and “mobilizes” it’s various systems to act differently than it would otherwise. Obviously, that’s misguided. It just comes down to not understanding everything about the body yet.

My father in law is the poster boy for this way of thinking. He thinks that if he simply meditates and directs his body to fight something, it will. He has been pretty healthy in his 78 years. But that’s down to genetics and other unknown variables in my opinion, not some mind-body mumbo-jumbo.
 
arthwollipot said:
For a long time here I've been telling people that the placebo effect is largely a sham
Click to expand...
It depends. A placebo is not likely to do much for you if you have cancer but if you believe that you are sicker than you really are then a placebo can work quite nicely - especially if administered by somebody you have a lot of faith in (that "good" family doctor).
 
psionl0 said:
It depends. A placebo is not likely to do much for you if you have cancer but if you believe that you are sicker than you really are then a placebo can work quite nicely - especially if administered by somebody you have a lot of faith in (that "good" family doctor).
Click to expand...


That implies that the placebo is doing “something.” A proposition for which there is no evidence.

What you are describing is what I would describe as “misdiagnosis” or “cognitive bias.”
 
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