Help proving placebo effect.

[Abooga]

Hello everyone.

I´m currently engaged in a little wikipedia argument (http://es.wikipedia.org/wiki/Discusión:Efecto_placebo)
with someone who questions the existence of the "placebo effect". He says that placebos are used in medical trials to compare the effects of medicines and the absence of medicines. He desn´t question placebos in this sense. But when it comes to the "Placebo effect", that which (due to suggestion etc.) accounts for large numbers of healings (see homeopathy), Carlos says there is no scientific proof about it.
Now, I thought that this "placebo effect" was something quite proven, but I can´t find references to rebate Carlos. I found something about big red pills being more effective than small white ones as placebos, which indirectly assumes the effect, but I need something more definite.
Can any of you help me here? I need links to studies demonstrating the Placebo Effect. Most studies are done comparing a medicine and a placebo, but Carlos says that doesn´t necessarily have anything to do with the placebo effect, rather than with natural remission of the illness. I know I´m not very inspired to explain myself clearly today. Damn monday. Anyway, I´d appreciate anyone´s help.

 

[Zep]

Natural remission of illness and placebo effect are not the same thing.

Wiki has lots of stuff to start with...

 

[fls]

Hello everyone.

I´m currently engaged in a little wikipedia argument (http://es.wikipedia.org/wiki/Discusión:Efecto_placebo)
with someone who questions the existence of the "placebo effect". He says that placebos are used in medical trials to compare the effects of medicines and the absence of medicines. He desn´t question placebos in this sense. But when it comes to the "Placebo effect", that which (due to suggestion etc.) accounts for large numbers of healings (see homeopathy), Carlos says there is no scientific proof about it.
Now, I thought that this "placebo effect" was something quite proven, but I can´t find references to rebate Carlos. I found something about big red pills being more effective than small white ones as placebos, which indirectly assumes the effect, but I need something more definite.
Can any of you help me here? I need links to studies demonstrating the Placebo Effect. Most studies are done comparing a medicine and a placebo, but Carlos says that doesn´t necessarily have anything to do with the placebo effect, rather than with natural remission of the illness. I know I´m not very inspired to explain myself clearly today. Damn monday. Anyway, I´d appreciate anyone´s help.

Sorry, I'm with Carlos on this one (assuming that you have accurately represented his view). The "placebo effect" doesn't seem to directly lead to healing, only to a change in subjective perceptions about the illness in the presence of natural remission. People given placebo are no more likely to heal than those given nothing.

Linda

 

[Ivor the Engineer]

What about CBT. Couldn't that be considered placebo-like treatment in a case of mild to moderate depression?

 

[Baron Samedi]

Sorry, I'm with Carlos on this one (assuming that you have accurately represented his view). The "placebo effect" doesn't seem to directly lead to healing, only to a change in subjective perceptions about the illness in the presence of natural remission. People given placebo are no more likely to heal than those given nothing.

Linda

What about the "nocebo effect"?

 

[Abooga]

Zep:
Yes, thanks, care to elaborate? I already looked at the link you offer. (duh!) but I still find nothing of the sort I´m looking for.

fls:
I´m not subscribed to that journal.
But anyway, when skeptics argue against homeopathy and mention that the healings statistics for homeopathy and placebos are equivalent, what do they mean? I don´t think it´s about natural remission, I´ve often heard talk about patients lowering their stress and allowing healing to occur and things like that. And that would be the placebo EFFECT.
And what about big red pills being more effective that small white ones? Doesn´t that assume such and EFFECT?

And the nocebo effect too, as Baron Samedy points out. It´s also related to the influence of faith or suggestion in our health. Innit?

 

[Professor Yaffle]

This is a sort of related query:

Does nayone have references to studies I was told about in undergraduate lectures (can't find the notes now) in which sugar water alone could produce an immunosuppressive effect if it had previously been associated with a real immunosupressant (classical conditioning)? I think the original study was with rats, but it may have also been replicated in humans?

Thanks.

 

[Cuddles]

There are different meanings that people use for placebo, and this causes a lot of confusion. The true placebo effect is, as Zep and Linda said, is purely psychological and does not heal people. It doesn't even neccessarily mean they feel better, they simply report that they feel better. However, while this is what placebo really is, it is not what most people mean when they refer to "the placebo effect", including most medical trials. In a placebo controlled trial, it does not matter what is causing any changes, real or otherwise, all that matters is differences between the medicated and control groups. There are many different effects that can be present, such as spontaneous recovery and regression to the mean. Everything that is not a result of the medication falls under the placebo category, whether it is a real recovery or purely psychological.

The point is that in the sense you seem to mean it, the placebo effect is certainly not proven. In fact there is good evidence that people given placebo heal no faster than anyone else, even though they report feeling better. And this is where the problem lies. How do you tell what a person is feeling without asking them? The fact is that for every objective measure, placebo is exactly the same as doing nothing, but when people think they are getting something they think they feel better. For some conditions, such as colds and mild headaches, this may be all that is required, but for conditions where there is a real, treatable problem all the placebo does is disguise it. It is like taking a paracetamol for a sprained ankle. You might feel a bit better for a time, but if you walk on it you'll really regret it later.

 

[steenkh]

The true placebo effect is, as Zep and Linda said, is purely psychological and does not heal people.

I do not agree. The Wikipedia article that Zep referred to, states that

Experimenters typically use placebos in the context of a clinical trial, in which a "test group" of patients receives the therapy being tested, and a "control group" receives the placebo. It can then be determined if results from the "test" group exceed those due to the placebo effect. If they do, the therapy or pill given to the "test group" is assumed to have had an effect.

According to this use, any effect that happens to the placebo group is the "placebo effect". That includes natural remission. I would even say that natural remission is one of the most common reasons for a placebo effect, as when people are healed of cold after a week on homoeopathic pills.

 

[Ivor the Engineer]

Surely all you need to say is that placebos are only of use in illnesses with psychosomatic symptoms?

 

[fls]

fls:
I´m not subscribed to that journal.

Sorry. I missed that I got signed in automatically and thought the full text was freely available. You should be able to access the abstract.

But anyway, when skeptics argue against homeopathy and mention that the healings statistics for homeopathy and placebos are equivalent, what do they mean? I don´t think it´s about natural remission, I´ve often heard talk about patients lowering their stress and allowing healing to occur and things like that. And that would be the placebo EFFECT.
And what about big red pills being more effective that small white ones? Doesn´t that assume such and EFFECT?

Placebos represent "what was going to happen anyway". So it's mostly a combination of natural remission, regression and other effects related to participation in a study, and psychological effects, rather than an effect specific to the placebo. "Placebo effect" is just a shorthand way of referring to other things that already have a name, that come into play whenever we are ill or we think we are ill.

Stress hormones can lead to changes in the immune system. It tends to get overblown as an effect. People are more likely to think a big red pill has more/stronger medicine than a little white pill, so the idea that they should feel better is stronger.

And the nocebo effect too, as Baron Samedy points out. It´s also related to the influence of faith or suggestion in our health. Innit?

Nocebo effect is similar to placebo effect - the idea that one should feel ill leads to sensations of illness and illness is attributed to the nocebo.

Linda

 

[fls]

I do not agree. The Wikipedia article that Zep referred to, states that

According to this use, any effect that happens to the placebo group is the "placebo effect". That includes natural remission. I would even say that natural remission is one of the most common reasons for a placebo effect, as when people are healed of cold after a week on homoeopathic pills.

I think it's a matter of semantics. Placebo effect lumps everything that happens in the placebo group together. However, the outcome in this group on everything except maybe some subjective measures would be the same regardless of whether or not a placebo was given. So even though it has the word "effect" in it, it doesn't really mean that the placebo directly effected any of the changes. I think that's what Cuddles, Zep and myself are trying to get at.

Linda

 

[fls]

This is a sort of related query:

Does nayone have references to studies I was told about in undergraduate lectures (can't find the notes now) in which sugar water alone could produce an immunosuppressive effect if it had previously been associated with a real immunosupressant (classical conditioning)? I think the original study was with rats, but it may have also been replicated in humans?

Thanks.

I think you mean this?

Linda

 

[Ivor the Engineer]

I think it's a matter of semantics. Placebo effect lumps everything that happens in the placebo group together. However, the outcome in this group on everything except maybe some subjective measures would be the same regardless of whether or not a placebo was given. So even though it has the word "effect" in it, it doesn't really mean that the placebo directly effected any of the changes. I think that's what Cuddles, Zep and myself are trying to get at.

Linda

While the ultimate outcome may be the same in a self limiting illness, wouldn't the placebo effect be the reduced time to achieve this effect? Are you saying there are no or very few cases of placebo groups recovering faster than non-treatment groups?

 

[Professor Yaffle]

I think you mean this?

Linda

Thank you very much - I was telling someone about it and they didn't believe me, so that should sort him out!

 

[Cuddles]

I do not agree. The Wikipedia article that Zep referred to, states that

According to this use, any effect that happens to the placebo group is the "placebo effect". That includes natural remission. I would even say that natural remission is one of the most common reasons for a placebo effect, as when people are healed of cold after a week on homoeopathic pills.

And if you read my post you'll find that's exactly what I said.

 

[steenkh]

And if you read my post you'll find that's exactly what I said.

You are right, but I am a little dense, and I focused too much on the part I quoted - where you said the opposite, IMO. Nevertheless, I think the point has come across

 

[fls]

While the ultimate outcome may be the same in a self limiting illness, wouldn't the placebo effect be the reduced time to achieve this effect? Are you saying there are no or very few cases of placebo groups recovering faster than non-treatment groups?

If you are talking about objective measures of recovery, then yes, that is what I'm saying.

Linda

 

[Ivor the Engineer]

If you are talking about objective measures of recovery, then yes, that is what I'm saying.

Linda

I find that amazing! Even for chronic conditions with significant psychological components such as asthma?

 

[Apathia]

"Recovery" from the patient's point of view has a significant subjective component. The treatment may be the occasion of her feeking better and temporariily more energetic, though the cause hasn't been removed yet. A gets a Reiki session for her flu. She feels better and that she can go to work the next day. However the flu hasn't run its full course yet and she's still a carrier.

We do know that stress influences the immune system. (Well, maybe we don't. Linda, if this is just Dr. Wiel type woo-woo, correct me.)
So you might get a situation where the placebo lessens an individual's anxiety and the immune system is able to deal more efficiantly, and in general the body being able to relax, recovery isn't as obstructed.