Musing on the placebo effect

[gurugeorge]

I thought the link between stress and the immune system was well understood and nothing more than the body prioritizing resources according to demand.

Well, the most interesting aspect is the connection with belief - clearly there's some sort of belief that the pill is going to help (harm), and that belief seems to have some effect on the body's subsystems in a way that's not yet fully understood, but ought to be.

 

[gurugeorge]

There is no mind-body interaction in the popular sense. 'Mind' is what we call the behaviour of the brain.

There's a sort of abstract sense in which that is true, but when you look at phenemena that are called "mental", it looks like what's being spoken about is distinct sub-systems that have a causal effect on other subsystems in the body - it's the body's cybernetic system.

 

[gurugeorge]

Your conclusion would follow from your premise only if the problem of providing short-term relief for manageable pain was more important than all the other challenges in medicine put together.

Not just short term pain relief but prophylaxis, and actual cure (placebo seems to show improvements in some conditions that go beyond pain relief - and then there's "spontaneous" remission, remember?) - in these terms, yes, for most people it is. And I think most general practitioners would probably agree What's "sexy" to practitioners isn't necessarily "sexy" to those who are ultimately paying their bills.

 

[gurugeorge]

Placebo means, literally "I please". Placebo makes people feel better, report feeling better. It does not make them objectively better except in the cases where their subjective well-being (or lack of same) is part of the disease. This was tested on cancer patients, where a lot of "positive thinking" experiments have been carried out during the last few decades. Positive thinking improves the quality of life for a lot of patients, but it does not improve their chance of cure.

In the context of placebo controlled trials, the term placebo effect covers all effects observed in the control group. This includes lifestyle changes, other forms of treatment than the one under test, plus the above-mentioned subjective improvements in well-being.

There is, however, no apparant self-curing power that depends on the administering on placebo medicine.

Hans

Well then, I guess some of the people you can find in the Google hits given by the first guy who responded to my first post are wasting their time

 

[Complexity]

There's a sort of abstract sense in which that is true, but when you look at phenemena that are called "mental", it looks like what's being spoken about is distinct sub-systems that have a causal effect on other subsystems in the body - it's the body's cybernetic system.

That's why I used the phrase 'in the popular sense'. Most people think of the mind as something apart from the brain. I obviously do not. There is no question that the body can be viewed as a set of interacting systems.

 

[Z]

I actually agree with this, and the last sentence would also be uncontroversial for certain schools of Buddhism, Daoistm, Hindu Advaita, and that ilk.

Heh - hadn't thought of it that way but... yeah, you're right.

My own school of spirituality runs along a sort of Deist/Buddhist/Taoist line, I suppose - that there's the 'All-That-Is', and there's stuff (like us), but nothing that survives us (that wasn't already part of 'All-That-Is'...

Kind of like the soul is just a piece of God, and when you die you really are gone - but in a sense, you were never here anyway. And God is not just 'everywhere' but 'everything'...

... but getting into that would get complicated, and I'm drunk.

 

[Jeff Corey]

If consciousness and emotion are involved, then you can call the phenomenon mind. Whatever belief is, if that is involved in people altering their medical condition (as it seems to be in both placebo/nocebo), then mind is involved. It's a nice philosophical question whether and to what extent materialist reductionism is tenable, to what extent mind is reducible to dispostions of matter, etc., but those points have to be argued for separately, you can't just assume the term away (well you can, but you risk making yourself look ridiculous).

I'll take that risk. A century ago, scientific psychologists found the term to be an impediment to the understanding of the causes of behavior. An immaterial agent or ghost in the machine belongs to pseudoscience, not science.
Many advances have been made since then in the science of behavior.
What then of the mind?

 

[Dr Adequate]

Not just short term pain relief but prophylaxis, and actual cure (placebo seems to show improvements in some conditions that go beyond pain relief -

You only mentioned the release of endorphins. The other things placebo can do ... a short list, please? Do they include any of the following:

(a) cure infectious diseases (eg HIV, CJD)
(b) cure cancer
(c) mend broken bones
(d) cure or treat metabolic failures such as diabetes
(e) cure or treat genetic conditions
(f) cure or treat autoimmune conditions?

If not, then diverting most of medical research into the placebo effect seems hasty and ill-thought out.

and then there's "spontaneous" remission, remember?

(1) You have given us no reason to believe that this has any relation to the placebo effect. Two forms of self healing do not necessarily share the same mechanism. For example, blood clotting and the immune system do not have the same mechanism.

(2) Indeed, it would be simplistic to treat "spontaneous remission" as a single phenomenon. For example, you may have read recently about a man who appears to have undergone spontaneous remission from HIV. Obviously scientists want to study him very closely. But what they find (I will wager any money) will have no bearing on the mechanisms for spontaneous remission of different diseases such as cancer. "Spontaneous remission" just means "the patient got better and we don't know why", and the reason why is going to differ from patient to patient and disease from disease.

Finally, could I point out that the human race has been benefitting from the placebo effect ever since the first shaman said "take one of these twice a day and the thunder god will heal you". It is not placebos that make our society healthier and longer lived than all the others before it. It's all the other medical knowledge we've accumulated, which is therefore not to be despised.

 

[Jeff Corey]

And "spontaneous remission" seems to mean the immune system that other animals share with us doesn't need no stinkin shamans to jump start it.

"She turned me into a newt."
"Hmmm?"
"Well, I got better.'

 

[blutoski]

You're taking an odd-looking (to me) position on this, and I don't think most of the other people I'm arguing with here would take it (most of them seem to more or less agree with the way I'm talking about the effect - as a phenomenon that is clearly partly a result of belief and emotion). If you don't mind I'll bow out of going down this line of arguments with you.

Okaaayyy... let me get this straight... you asked for opinions about how placebo may be used clinically. I answered with my experienced opinion (I'm a clinical immunologist who does double-blind controlled placebo trials as an occupation, and my master's thesis was in placebo design). But you don't want my thoughts on the subject?

Why did you ask, if you don't want to explore ideas? Just looking for an echo chamber?

The truth is that *we don't have any idea what causes this mathematical difference that we call the 'placebo effect'*. The most reasonable guess is that it's an unconscious skew on reporting by the subjects, because they have expectations. This would explain why it's prominent in results where the subject gets to report how much effect they observe.

Most experiments do not show a placebo effect.

 

[NeilC]

Ghost in the machine, Splossy. The conscious entity IS the brain. There's nothing 'in there' noticing anything.

Common idealist/dualist mistake.

You have NO IDEA whether that is true. It is a question that has and continues to confound the world's greatest philosophers, scientists and everyone else.

 

[Z]

You have NO IDEA whether that is true. It is a question that has and continues to confound the world's greatest philosophers, scientists and everyone else.

Personally, I think it's false. But using logic and reason - it's true. Only intuition and imagination suggest to me that I might be something other than the active matter I'm comprised of. Until evidence to the contrary exists (I mean something more than the contraversy of OBE/NDE or 'psi'), there is little reason to suppose otherwise.

Besides, I don't feel like I'm inside a brain - I feel like I am a brain... and a body... etc. I feel integrated fully in the physical. Of course, I also like who I am, and suppose that makes quite a bit of difference. I'd love a qualified shrink to take a stab at what makes me tick, and decide if this somehow influences my rational acceptance of materialism... and why I still maintain irrational beliefs in dualism, even with that rational acceptence in place.

 

[NeilC]

I tend to believe the same thing but I cannot prove it by a long way and I wouldn't be surprised if I were wrong.

It doesn't have to be a seperate entity living in the brain but it could be that somehow when you get past a number of connections that the complexity takes the mind from being like firmware into the realms of software capable of writing itself, even if only partially.

Maybe like comparing what my Satnav unit is capable of with a what a programmer can come up with using the same processor and memory. One is very limited in function and tied closely to the h/w, the other whilst limited by the h/w, has massive possibilities. Maybe the mind is a layer of abstraction capable of transceding the hardware somewhat?

 

[gurugeorge]

I'll take that risk. A century ago, scientific psychologists found the term to be an impediment to the understanding of the causes of behavior. An immaterial agent or ghost in the machine belongs to pseudoscience, not science.
Many advances have been made since then in the science of behavior.
What then of the mind?

I think you'll find if you look into philosophy and cognitive science nowadays, it's the general consensus that behaviourism has been left behind. "Mind" isn't an impediment, it's something to be explained. That's not to say it can't be understood in physicalist terms - reductionism of some sort is a very live option - but behaviourism is far too simplistic a form of physicalism to encompass most of what we mean by "mind".

 

[gurugeorge]

You only mentioned the release of endorphins. The other things placebo can do ... a short list, please? Do they include any of the following:

Someone else mentioned endorphins, I'm not convinced it's the whole story (my personal opinion is that there are some as-yet-poorly understood properties of the fascia, such as are currently being investigated in the course of investigation into acupuncture, that may be responsible for some of these effects - there's a connection here with Qigong and some of the phenomena associated with what has been called "chi" or "qi" in the East, prana and pneuma in the West - I'm not saying there is such a thing, I'm saying that certain recondite properties of the mind/body may have been interpreted as evidence of a mysterious "life force").

(a) cure infectious diseases (eg HIV, CJD)
(b) cure cancer
(c) mend broken bones
(d) cure or treat metabolic failures such as diabetes
(e) cure or treat genetic conditions
(f) cure or treat autoimmune conditions?

If not, then diverting most of medical research into the placebo effect seems hasty and ill-thought out.

I think b), c) (to a limited extent - i.e. faster mending), d) and f) are possible, the others seem unlikely.

(2) Indeed, it would be simplistic to treat "spontaneous remission" as a single phenomenon. For example, you may have read recently about a man who appears to have undergone spontaneous remission from HIV. Obviously scientists want to study him very closely. But what they find (I will wager any money) will have no bearing on the mechanisms for spontaneous remission of different diseases such as cancer. "Spontaneous remission" just means "the patient got better and we don't know why", and the reason why is going to differ from patient to patient and disease from disease.

Sure, no major disagreement here.

Finally, could I point out that the human race has been benefitting from the placebo effect ever since the first shaman said "take one of these twice a day and the thunder god will heal you". It is not placebos that make our society healthier and longer lived than all the others before it. It's all the other medical knowledge we've accumulated, which is therefore not to be despised.

I'm far from despising good old Western medicine. I just think it doesn't actually help as much as we would like to believe (ah, there's that term again), and at the end of the day it's not all that much better than Voodoo or shamanism for most of the common ailments and aches and pains that people would really like to have ameliorated. It seems to me that most of the statistically bulky improvement in public health has come from public health measures informed by medical science, not medical interventions per se.

 

[gurugeorge]

And "spontaneous remission" seems to mean the immune system that other animals share with us doesn't need no stinkin shamans to jump start it.

"She turned me into a newt."
"Hmmm?"
"Well, I got better.'

But if states of belief or emotion can affect the capability of the immune system ... ?

Then it seems to me that the first priority is to enhance that effect. That should be the base of the pyramid - it should be utilised well before intervention, or rather thought of as the first "tool" in the doctor's arsenal.

 

[gurugeorge]

Okaaayyy... let me get this straight... you asked for opinions about how placebo may be used clinically. I answered with my experienced opinion (I'm a clinical immunologist who does double-blind controlled placebo trials as an occupation, and my master's thesis was in placebo design). But you don't want my thoughts on the subject?

Why did you ask, if you don't want to explore ideas? Just looking for an echo chamber?

The truth is that *we don't have any idea what causes this mathematical difference that we call the 'placebo effect'*. The most reasonable guess is that it's an unconscious skew on reporting by the subjects, because they have expectations. This would explain why it's prominent in results where the subject gets to report how much effect they observe.

Most experiments do not show a placebo effect.

I'm sure you know what you are talking about, it's just that most other people I'm talking with here seem to accept that it's not just a statistical phenomenon, that there's a real effect here (states of belief affecting immune system, etc.). So seeing as arguing against a purely statistical interpretation of the phenomenon would take me too far from what I'm interested in, and take too much time, I'm not interested in going down that path, sorry.

 

[Capsid]

Have a look at this thread which discusses a UK BBC programme investigating the placebo effect. In Parkinson's patients a placebo injection resulted in the release of dopamine in the brain in expectation of a benefit which translated into an improvement because increasing dopamine levels is known to help Parkinson's disease. How increased dopamine levels help as a placebo for other conditions is unclear. Here's the article abstract of the Parkinson's study.

 

[blutoski]

I'm sure you know what you are talking about, it's just that most other people I'm talking with here seem to accept that it's not just a statistical phenomenon, that there's a real effect here (states of belief affecting immune system, etc.). So seeing as arguing against a purely statistical interpretation of the phenomenon would take me too far from what I'm interested in, and take too much time, I'm not interested in going down that path, sorry.

OK: I appreciate that you started the thread for a purpose. I'll duck out, unless everybody else wants me to continue.

Be mindful that there's a bit of cart-before-the-horse going on here. Speculating on mechanism before demonstrating the phenomenon's real. A common definition of healthfraud is "practice from hypothesis instead of practice from findings"


As a sign of good faith, I think I can locate a pdf copy of the paper Capsid referenced. I have an analysis paper for it that I presented at a conference, as well. Would it be helpful if I uploaded them to the thread?

 

[Jeff Corey]

I think you'll find if you look into philosophy and cognitive science nowadays, it's the general consensus that behaviourism has been left behind. "Mind" isn't an impediment, it's something to be explained. That's not to say it can't be understood in physicalist terms - reductionism of some sort is a very live option - but behaviourism is far too simplistic a form of physicalism to encompass most of what we mean by "mind".

You apparently know very little about behaviorism. It's quite alive and well, thank you.