Placebo effect

[saizai]

As mentioned, there is an assumption being made that there actually is a placebo effect. When we can demonstrate one, medicine might consider it.

Are you claiming that it doesn't exist? You'd be waaaaaay on the wrong side of the evidence if so, unless you're attempting to make a much subtler point than you stated.

Not ironic, no. Just immoral.

Is it immoral to lie to someone if doing so is known to increase their likelihood of becoming healthy? (And thereby making the lie true...)

(Not intended as a flippant reply - that's the crux of it after all.)

 

[Dancing David]

So, when the patient asks "why are you sacrificing that goat" or "so, does it matter if I step outside of this circle of salt you have just pored whilst you where Calling the Quarters?" what does the doctor tell them?

Lets sacrifice a non-virgin!

 

[Dancing David]

Are you claiming that it doesn't exist? You'd be waaaaaay on the wrong side of the evidence if so, unless you're attempting to make a much subtler point than you stated.



Is it immoral to lie to someone if doing so is known to increase their likelihood of becoming healthy? (And thereby making the lie true...)

(Not intended as a flippant reply - that's the crux of it after all.)

The problem is establishing what the placebo effect is.
First of all , most times it would be attributable to random chance.
Second the potential causes of the placebo effect are studied, and the most likely one is what you call 'regression to the mean', most people in the uSA only seek treatement in the eleventh hour, they wait until they are seriously ill before they get help, so guess what happens a certain percentage of the population gets well because the course of thier illness is at it's peak and begins to diminish.

You are assuming that the placebo effect is from someone taking tha placebo, which might not be the case.

If the placebo effect was stronger then homeopathy would be more effective, as would prayer.

 

[saizai]

(re Placebos
You are, quite simply, mistaken.

Really? Please show me a prescription for a placebo from clinical use (i.e. not a research trial), or other proof that it's done. I'd be quite interested.

Especially if it's something that says blatantly SUGAR PILL on the prescription.

(PS: sugar pills in birth control monthlies don't count - that's a mnemonic device rather than placebo)

I, too, would be interested to learn how you would go about that without intentionally lying to your patient about the treatment you are giving them.

As mentioned above, there are other aspects to it than lying. Basically anything that gets the patient to believe more in it, or be more psychologically invested, is fair game. Suppose - as a hypothetical - you were to do:
* standard prescription, go to pharmacy, pop it at home vs
* identical medicine, but administered by a priest during a laying on of hands or some similar ceremony

I'd bet on #2.

please, let us stay with one subject. Don't go dragging homoeopathy into a subject like placebo treatment. Nobody uses homoeopathy as placebo. People use it like exorcisms and voodoo.

He has a point - you could. Just so long as you make sure it's not given without the main treatment.

What is the effectiveness difference between (standard + homeopathy) - (standard)? It's probably positive...

 

[Smart_Cookie]

But what if the placebo effect does exist, and it has something to do with our own immune systems? Humans do have quite an ability to heal ourselves. For instance: fevers to combat infection, vomiting to rid the digestive system of toxins, and, of course, our ability to heal wounds, etc.

So, when we think something is going to heal/help us, perhaps some brain/body link is triggered? I think the whole idea of the placebo effect really does need study. But yes, it has to be part of a controlled study investigating the placebo effect. Not just your doctor saying "here, I think these will help you".

This thread was really interesting, because I'm just reading Daniel Dennett's new book "Breaking The Spell", and part of his hypothesis is that before religion, the local "shaman" or healer, through the use of rituals, actually made use of that "placebo" effect, meaning those who believed they were being helped, were more likely to survive and reproduce. Meaning, over time, a greater percentage of us may have become genetically predisposed to being susceptible to "believing". Very interesting stuff.

 

[Rasmus]

Really? Please show me a prescription for a placebo from clinical use (i.e. not a research trial), or other proof that it's done. I'd be quite interested.

Especially if it's something that says blatantly SUGAR PILL on the prescription.

(PS: sugar pills in birth control monthlies don't count - that's a mnemonic device rather than placebo)

You need to trust me here, or rather trust my mom. She's a therapist and she told me that patients are sometimes offered a placebo treatment for strong or chronic pains.

The patient will first be given regular medication and eventually be switched over to a placebo - with their full consent and no knowledge of the precise time.

So a doctor can let a patient make an informed decision and still treat with placebos effectively.

As mentioned above, there are other aspects to it than lying. Basically anything that gets the patient to believe more in it, or be more psychologically invested, is fair game.

I disagree. Lying to a patient isn't good. It might help sometimes, but that's not the end of it.

Suppose - as a hypothetical - you were to do:
* standard prescription, go to pharmacy, pop it at home vs
* identical medicine, but administered by a priest during a laying on of hands or some similar ceremony

I'd bet on #2.

Oh, I agree, #2 would be a lot more effective in making me feel better. I'd get to break the priests hands, after all

He has a point - you could. Just so long as you make sure it's not given without the main treatment.

How can you ensure that the patient will not believe that it was the voodoo that helped him and chose to not seek proper treatment the next time around? This is what does happen now, and people are dying because of it! (If people would just treat common colds with homoeopathy it would just be ridiculous, but nothing to worked up over. But that is not what is happening.)

What is the effectiveness difference between (standard + homeopathy) - (standard)? It's probably positive...

I believe i posted that elsewhere here. My last doctor (who will never ever get near me again for treatment or otherwise) did try and upsell me on soem homoeopathic remedies when i was suffering from a bad angina (and mononucleosis, but it took a real doctor to figure that out ...)

Now, at the time I could barely speak, and was unable to swallow. He was still trying to take money to get me to go through the useless and painful act of swallowing a bunch of sugar pills.

You think that would have helped? I think I would have sued him for malpractice - if he hadn't told me in advance it was homoeopathy he was trying to use on me - so i could just chose to refuse his quackery and i have also chosen to take my business elsewhere from now on.

He was going to let me suffer just to get hold of my money! Even after I had informed him what I thought of this particular brand of quackery. (So there is a chance that he's just a stupid fool rather than after my moneys, I guess ...)

Either way, that is the kind of help I'll gladly do without.

 

[saizai]

You need to trust me here, or rather trust my mom. She's a therapist and she told me that patients are sometimes offered a placebo treatment for strong or chronic pains.

The patient will first be given regular medication and eventually be switched over to a placebo - with their full consent and no knowledge of the precise time.

So a doctor can let a patient make an informed decision and still treat with placebos effectively.

That's interesting. I have spoken to several therapists and none of them acknowledged doing so.

How exactly does that conversation go? "Well... I could prescribe you some fluoxetine HCl... or just some sugar... sugar's ok with you?"

For that matter, how do you prescribe for it? You'd have to have some sort of in-house vending - at least IME all prescriptions are phoned in to a separate pharmacy or taken in on paper, which would make that quite problematical.

I disagree. Lying to a patient isn't good. It might help sometimes, but that's not the end of it.

"Fair game" was referring to the other psych-influencing stuff (not necessarily inclusive of deception).

Though I think the question of morality of lying in this case is quite gray at best.

Oh, I agree, #2 would be a lot more effective in making me feel better. I'd get to break the priests hands, after all

What are you, the antichrist?

Or just severely antireligious - and with a violent streak?

How can you ensure that the patient will not believe that it was the voodoo that helped him and chose to not seek proper treatment the next time around? This is what does happen now, and people are dying because of it! (If people would just treat common colds with homoeopathy it would just be ridiculous, but nothing to worked up over. But that is not what is happening.)

That is indeed a problem. Which is why I'm more for increasing the other aspects that would go WITH normal treatment (eg docs being more gungho and not just "enh, maybe it'll work"), not necessarily giving some separate adjunct (because people might skip out to just that - hardly the first time).

Now, at the time I could barely speak, and was unable to swallow. He was still trying to take money to get me to go through the useless and painful act of swallowing a bunch of sugar pills.

You think that would have helped? I think I would have sued him for malpractice - if he hadn't told me in advance it was homoeopathy he was trying to use on me - so i could just chose to refuse his quackery and i have also chosen to take my business elsewhere from now on.

Well, obviously it wouldn't help you 'cause you lack faith.

But don't fool yourself - you're still susceptible to placebo effect; it just needs to come in a framing that's compatible with your worldview.

He was going to let me suffer just to get hold of my money! Even after I had informed him what I thought of this particular brand of quackery. (So there is a chance that he's just a stupid fool rather than after my moneys, I guess ...)

Either way, that is the kind of help I'll gladly do without.

Note - I'm not advocating placebo-effect-only treatment, which is what you seem to be describing...


Smart_Cookie: That's exactly what I meant in the OP saying that it's a subset of the mind/body problem.

How exactly it works is not known in anything approaching a rigorous way.

Ohand one quibble (that always annoys me): Evolution does not dictate that all current traits are or were adaptive. It only dictates that if it's so maladaptive compared to a competitor that their kids survive and yours don't, then that trait dies out.

It's a major fallacy (engaged in by both sides of the woo, btw) to try to find the evolutionary "reason" for a particular trait - that leads to "just so stories" (as my psych prof liked to call 'em).

 

[Blue Wode]

It seems that the problem with placebos is that they’re unreliable. Apparently one of the best ways to deliver their effects ethically - in addition to standard treatments - is to use empathy, sympathy and conviction at the point of consultation. See here:

http://www.arc.org.uk/newsviews/arctdy/131/Mindovermatter.htm

 

[Deetee]

Doctors prescribe placebos with relative frequency.
They do not prescribe them as the product below, but rather they do it when they accede to prescribing a medical product that they know is ineffective (like an antibiotic for a viral sore throat, for example). I do remember reading that one product was named "Obecalp" and was prescribed for a time, however.

 

[andyandy]

You do know that the NHS already has 3 fully funded homeopathic only hospitals don't you?

i knew there was some tie-up between homeopathic and NHS, but i wasn't aware that they were fully funded....is it justified purely for placebo?

 

[brodski]

i knew there was some tie-up between homeopathic and NHS, but i wasn't aware that they were fully funded....is it justified purely for placebo?

No, these are run by dyed in the wool homeopathic nuters, who believe that they can cure all manner of ailments with large doses of nothing. I have no doubt that some GP 's send their "heartsink" patients there, just to make them somebody else's problem, but these hospitals do try and cure real diseases there, with imaginary medicine.

 

[ponderingturtle]

That's not what I'm suggesting (except for hypochondriacs).

Placebo effect, as pointed out above, is additive to the 'base' effect of the treatment. I'm suggesting that it be increased - not that patients not be given standard, effective medicine.

The placebo effect is that something works when you believe it is going to work. The only way to use it is to lie, as you need to convince patients that ineffective treatment will be effective.

 

[thaiboxerken]

Why try to keep it out of medicine? If anything, I think that it should be studied *more* (as its actual mechanism is not understood, being a subset of the mind-body problem which is itself unsolved) and applied.

There is enough of that going around with the alternative "medicine" industry that there is no need.

 

[andyandy]

THe point is you are intentionaly missleading them. So doctors need to make their patients fraudulently think that something will help but not actualy lie, but why is that ethicaly different from lieing?

the NHS is governed by utilitarian principles, so why would we expect such ethical considerations to be an issue? In absolute terms, if the placebo effect can provide a beneficial improvement in an individual's condition, and that benefit is reliant upon that individual not being aware of that fact, then that is what should be done. To claim that this is immoral or unethical is to miss the fundamental purpose of medical care.

 

[andyandy]

No, these are run by dyed in the wool homeopathic nuters, who believe that they can cure all manner of ailments with large doses of nothing. I have no doubt that some GP 's send their "heartsink" patients there, just to make them somebody else's problem, but these hospitals do try and cure real diseases there, with imaginary medicine.

but do you think that the NHS justification for the funding is as a vehicle for placebo?

 

[Mojo]

The placebo effect is that something works when you believe it is going to work. The only way to use it is to lie, as you need to convince patients that ineffective treatment will be effective.

If you give a patient a therapy that is proven to be effective, You can tell them that it works without lying. Then they get the benefit of the placebo effect as well as the therapy.

 

[ponderingturtle]

the NHS is governed by utilitarian principles, so why would we expect such ethical considerations to be an issue? In absolute terms, if the placebo effect can provide a beneficial improvement in an individual's condition, and that benefit is reliant upon that individual not being aware of that fact, then that is what should be done. To claim that this is immoral or unethical is to miss the fundamental purpose of medical care.

So you reject the concept of informed consent and think you should do what ever your doctor says simply because he says so?

 

[ponderingturtle]

If you give a patient a therapy that is proven to be effective, You can tell them that it works without lying. Then they get the benefit of the placebo effect as well as the therapy.

And they are getting that, that is not the placebo effect. So as that is going on what exactly are you suggesting change? Doctors not informing patients about the side effects?

 

[andyandy]

So you reject the concept of informed consent and think you should do what ever your doctor says simply because he says so?

it's not a case of informed consent. If the doctor gives you a sugar pill and tells you that "you may find this helps - it works for some patients" how is that in any way immoral? If the doctor was to say, "there's nothing we can do, but you can take this sugar pill" then of course that would negate any benefit of the placebo effect. There shouldn't be any place for woolly idealism in the NHS - from a pragmatic, utilitarian perspective the first approach is the best one to take.

 

[ponderingturtle]

it's not a case of informed consent. If the doctor gives you a sugar pill and tells you that "you may find this helps - it works for some patients" how is that in any way immoral? If the doctor was to say, "there's nothing we can do, but you can take this sugar pill" then of course that would negate any benefit of the placebo effect. There shouldn't be any place for woolly idealism in the NHS - from a pragmatic, utilitarian perspective the first approach is the best one to take.

Only for patients who don't ask what it is, and why they are getting it. You are advocateing for a more passive rather than an active roll in treatment for the patient.