I think the psychological components can improve faster. We may be talking at cross-purposes. What kind of outcomes are you thinking of?
Linda
Help proving placebo effect.
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I think the psychological components can improve faster. We may be talking at cross-purposes. What kind of outcomes are you thinking of?
Linda
It's a reasonable hypothesis. But it's based more on the effect on biochemical markers in the presence of stress hormones, than clinical outcomes. It tends to get overblown as a contribution by woos.
Linda
Ivor the Engineer
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I was thinking about someone having minor to moderate asthma attacks using an inhaler with no active drug in it and possibly recovering lung capacity faster than if they were just monitored. So not a placebo affecting healing as such, more just management of symptoms.
I had a very quick look on the web for asthma and the only studies appeared to be active drug vs. placebo, rather than active drug vs. placebo vs. no treatment.
Thanks Linda. As usual, be it quantum entaglment or the nocebo effect, some people jump to the most sensational conclusions. Or in the case of the Reiki racket, it's junp up and run laughing all the way to the bank.
There's a somewhat balanced little article on hope and healing here:
http://serendip.brynmawr.edu/bb/neuro/neuro04/web1/mbond.html
Burner
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Asthma is believed to be a (partly) psychosomatic illness so by definition it should be susceptible to placebo effect. Also pretty much any sensory condition can be influenced if you can get to a level of consciousness where it's possible to control these processes. Just look at hypnotherapy. It is used in production of anesthesia in dentistry without any meds whatsoever. The patient can literally shut down input from his/her nerves.
http://en.wikipedia.org/wiki/Hypnotherapy#Evidence_from_Systematic_Reviews
Altho a different mechanism, placebo effect can probably produce the same results but on a less conscious level. I was told this by quite a few doctors. Seems it really does work miracles sometimes.
Abooga
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Hey thanks for all the answers.
So it´s all about the subjective perception of being sick? So all those positive results of homeopathy that are usually explained away with the placebo effect are just natural remissions and little more?
"Hyparxis:
We do know that stress influences the immune system. (Well, maybe we don't. Linda, if this 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.
Linda:
It's a reasonable hypothesis. But it's based more on the effect on biochemical markers in the presence of stress hormones, than clinical outcomes. It tends to get overblown as a contribution by woos."
Well, not woos but usually skeptics when arguing against Homeopathy. That´s how I came accross this stuff.
Summarising:
We have two different meanings for the plaebo effect:
Placebo effect 1 = When not being treated.
and
Placebo effect 2 = An actual improvement due (perhaps) to stress relief improving the body´s natural healing mechanism. (entailing a better or at least faster recovery than if left untreated and unplaceboed.)
Rather subtle.
The study mentioned by Linda shows that (at least in that case) Placebo Effect 2 doesn´t happen.
But I´m still not convinced...
What about those homeopathy studies (can´t find them right now) that show recovering of children after homeopatic treatment? In homeopathy trials supposedly they compare homeopathic treatments (placebos disguised as medicines) to placebos posing as such. If they get positive results with homeopathic remedies for objective symptoms (for example a rash), wouldn´t that show an instance of Placebo Effect 2?
But it´s still psychosomatic, you´d say... Well, the total extent of what is psychosomatic and not is a bit fuzzy but ...
How complicated....
So it´s all about the subjective perception of being sick? So all those positive results of homeopathy that are usually explained away with the placebo effect are just natural remissions and little more?
"Hyparxis:
We do know that stress influences the immune system. (Well, maybe we don't. Linda, if this 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.
Linda:
It's a reasonable hypothesis. But it's based more on the effect on biochemical markers in the presence of stress hormones, than clinical outcomes. It tends to get overblown as a contribution by woos."
Well, not woos but usually skeptics when arguing against Homeopathy. That´s how I came accross this stuff.
Summarising:
We have two different meanings for the plaebo effect:
Placebo effect 1 = When not being treated.
and
Placebo effect 2 = An actual improvement due (perhaps) to stress relief improving the body´s natural healing mechanism. (entailing a better or at least faster recovery than if left untreated and unplaceboed.)
Rather subtle.
The study mentioned by Linda shows that (at least in that case) Placebo Effect 2 doesn´t happen.
But I´m still not convinced...
What about those homeopathy studies (can´t find them right now) that show recovering of children after homeopatic treatment? In homeopathy trials supposedly they compare homeopathic treatments (placebos disguised as medicines) to placebos posing as such. If they get positive results with homeopathic remedies for objective symptoms (for example a rash), wouldn´t that show an instance of Placebo Effect 2?
But it´s still psychosomatic, you´d say... Well, the total extent of what is psychosomatic and not is a bit fuzzy but ...
How complicated....
Perhaps simplifying it too much?
The "placebo effect" is the difference between how well a patient thinks they feel, and how well they actually are. Any factors influencing one or the other will therefore come into play.
1) Any studies involving measuring medicinal effects on children (and animals, for that matter) may often rely on the assessment by a third party, often a highly worried and concerned parent or physician. Therefore the assessments can easily be highly subjective. That is, biased.
2) Homeopathy studies done by homeopaths are usually notoriously unreliable. Their idea of trial controls, accurate reporting, consistent objective measurement, etc, etc, usually leave a lot to be desired. Like existance... Very often, their "trials" are actually a compilation of unsubstantiated anecdotes, often second- and third-hand, done up to look like a real study.
The "placebo effect" is the difference between how well a patient thinks they feel, and how well they actually are. Any factors influencing one or the other will therefore come into play.
Two points:burner said:
1) Any studies involving measuring medicinal effects on children (and animals, for that matter) may often rely on the assessment by a third party, often a highly worried and concerned parent or physician. Therefore the assessments can easily be highly subjective. That is, biased.
2) Homeopathy studies done by homeopaths are usually notoriously unreliable. Their idea of trial controls, accurate reporting, consistent objective measurement, etc, etc, usually leave a lot to be desired. Like existance... Very often, their "trials" are actually a compilation of unsubstantiated anecdotes, often second- and third-hand, done up to look like a real study.
It seems pretty clear that placebos have a significant effect on perception, however perception is a poor indicator of healing. Even relatively objective measures (like lung capacity) are dependent upon effort, so subjective perceptions can influence the results.
There were three asthma studies in the meta-analysis I referenced earlier (placebo vs. no treatment). Two showed no difference and one showed a slight difference, but I don't know what the outcome measure was. I can dig up the references if you're interested, but I don't know if there's much information available on-line (e.g. I could only find the title for one of them in PubMed, no abstract).
Linda
The article clearly (I think) makes the point that the effects are related to how someone feels, not actual healing. The huge leap that is made by others, that is currently without evidence, is that feeling better somehow allows someone to heal better. I think she could have made that distinction more explicit, or given a clearer indication of just how big that leap is. But maybe that wasn't the purpose of the paper.
Linda
Has someone pointed out the discussions that have already dealt with this issue in this forum?
There is no evidence of a "placebo effect" curing anything. There are plenty of anecdotes which suggest that people are willing to believe anything.
Sorry to burst your bubble, but you're barking up the wrong tree here.
M.
JoeTheJuggler
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I think people are thinking of placebos in a weird way. The placebo group in a test is strictly another control group.
A no-treatment control group accounts for things like regression to the mean, rates of spontaneous remission, etc.
The placebo group is meant to eliminate more of those unknowns that might affect the outcome.
Sure, a lot of those unknowns are sort of known (things like expectation, perception compared to no treatment.) But some of them might be real things that actually affect the outcome, but aren't the treatment we're interested in testing. For instance, maybe the extra glass of water taken with the capsule is changing the outcome. Who knows? That's the point, we don't know--we want to make it as much like the treatment group as possible to control for everything else we haven't thought of.
I'm not sure it's even possible to "test the placebo effect"--because whatever you're testing is by definition the treatment, right?
A no-treatment control group accounts for things like regression to the mean, rates of spontaneous remission, etc.
The placebo group is meant to eliminate more of those unknowns that might affect the outcome.
Sure, a lot of those unknowns are sort of known (things like expectation, perception compared to no treatment.) But some of them might be real things that actually affect the outcome, but aren't the treatment we're interested in testing. For instance, maybe the extra glass of water taken with the capsule is changing the outcome. Who knows? That's the point, we don't know--we want to make it as much like the treatment group as possible to control for everything else we haven't thought of.
I'm not sure it's even possible to "test the placebo effect"--because whatever you're testing is by definition the treatment, right?
Yeah, I think it gets mentioned by both sides. I think its usefulness is overblown, as it has yet to be demonstrated to make an objective difference in clinical outcomes.
Regardless of whether or not you personally are convinced, I don't think you should be contributing an opinion that is not backed by evidence to a Wikipedia article.
I don't know which trials you are referring to, but homeopathy studies are rarely adequate to accurately elucidate or measure the placebo effect (let alone differentiate between placebo and treatment).
Linda
Professor Yaffle
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This is an interesting article I found on the neurochemical effects of placebo, and different pathways placebo can take depending on the cues.
http://www.jneurosci.org/cgi/content/full/25/45/10390
http://www.jneurosci.org/cgi/content/full/25/45/10390
That is basically what we are saying. The claim (that we are disputing) was that rather than a bunch of known and possibly unrecognized effects, the placebo effect is also a specific healing effect.
Linda
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Feeling better is very subjective and the same placebo or merely placebo type treatment does not have consistant results, even subjectively.
It should be ovious then, that Placebo isn't medicine. Should be.
To muddy the waters, the word 'healing' is used in a different way in the Alternative Medicine Industry. I's Body/Mind you know. so healing is said to include subjective factors, such as a person's recovery oof her semse of wellness.
But, if the baby is crying because he's hungry, a placebo isn't the solution, even if it does shut him up a few minutes.
Ivor the Engineer
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I hadn’t figured in the role play aspect of how ill someone thinks they are affecting a lung capacity test.
That’s probably the problem with most tests of the placebo effect where it might be expected to have a significant effect i.e. testing it in such a way that it is possible to separate the purely psychological benefits from objective measurements that cannot be influenced by the bahaviour of the patient.
No, it’s ok.
JoeTheJuggler
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But what does that mean?
There surely isn't one universal placebo effect.
In the example I mentioned earlier (taking a glass of water with a fake pill), maybe the water had a hitherto unknown effect on whatever it was they were measuring. Wouldn't you call that a real effect? The point is that the study wasn't set up to examine the effect of the water, but of a drug (in the real pill).
In recent acupuncture tests they did a mock acupuncture (fake needles that felt the same as real ones) as a placebo. Any effect this had (compared to no treatment) were equal to the test group (real acupuncture). What caused the effect? We don't know, but we can say that it wasn't the treatment (using real needles). Maybe lying down in a certain posture during the treatment sessions alleviated back pain. Or maybe it was something to do with perception and reporting of pain as a subjective measure. We simply don't know.
Yeah, Bendetti has done some really amazing/interesting work in this area, and he represents the kind of pursuit I think will be useful.
Linda
Yeah, I think it helps to force people to be specific when examining these claims. Otherwise people can gloss over issues like "the baby is still hungry".
Medical research tends to be concerned with a hierarchy of the 5 D's - in order: Death, Disability, Disease, Discomfort, Dissatisfaction. Something that affects dissatisfaction or discomfort without addressing disease or disability is seen as relatively undesirable from a medical perspective. But from an individual perspective, it is the discomfort or dissatisfaction that impacts their quality of life.
Linda
I don't think there is. Which is why I said that it was a bunch of effects.
I'm not sure what I need to clarify.
Yes, I would call that a real effect. Do you think the water would have a different physiologic effect depending upon the power of suggestion?
I think I mentioned several times that there do seem to be effects specific to placebos, so I agree with you. I just get the impression that you think we disagree on something, but I'm not clear on what it is.
Linda