Placebo effect

[Rasmus]

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.

We're talking about a hospital here, so there isn't much of a problem getting things organized and coordinated with the doctors, etc.

"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.

I think it is an important issue. I decide for or against a treatment based on what I know (i.e. what my doctor tells me about) about it's effectiveness, side effects etc. compared to possible alternatives.

I just don't see room for the doctor to introduce a placebo into the mix without risking that I suffer from it. (Offer me a placebo against a headache and I might refuse the asperin. It is unlikely that I will chose two different medications at first.)

What are you, the antichrist?

Or just severely antireligious - and with a violent streak?

I am slightly anti-religious. But anyone who decides to walk in on me and perform their rituals on me without my consent and without my knowledge of what they are doing to begin with will be stopped. What would you do if I walked into your room and started rubbing my hands over you?

I am not a violent person at all, mind you, and the prest would probably keep his hands for future use - but i do have a very low tolerance when someone invades the least bit of "my space" that I feel entitles to claim, especialyl when i am sick or defenceless.

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).

There is a lot wrong with what doctors do. Shame on them for not being perfect. But to address these issues doesn't mean that you should open the door for untested alternatives. A doctor can be more assertive about what he does without resorting to placebo and without resorting to misinforming their patients.

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.

I never said I wasn't. I am just saying that facilitating the effect doesn't require a conspiracy against me.

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

No, I just see problems if explicit placebos are entered into the picture just for the sake of using placebos. I am very much in favour of using the effect to benefit the patients - but that has to happen under certain constraints.

 

[0oTITANo0]

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.

I disagree with the premise that doctors do not use the placebo effect in the first place. While this example is drug oriented I believe that wise doctors have been using the placebo effect for centuries. Its called bedside manner. Simply believing that you are under the care of a competent physician should produce some sort of placebo effect. Since the palcebo effect is largely psychological and rests on the subjective perception of the patient there is a lot of room for creative use of the placebo effect. Giving a patient a sugar pil and telling them it is going to help is unethical but fostering a belief in the patient that they are going to get better is not. This can be done environmentally, via bedside manner etc... Remember the key is that the patient believe that they will get better and there are a lot of ways to do this without lying.

 

[joobz]

No, I just see problems if explicit placebos are entered into the picture just for the sake of using placebos. I am very much in favour of using the effect to benefit the patients - but that has to happen under certain constraints.

While I would agree with you, I think we'd be inviting more trouble than helping. think about antibiotics.
Drs prescribed antibiotics for years as a type of placebo since they knew it wasn't really going to help, (except block secondary bacterial infections) but it made patients feel like they were being treated. Now, we are encountering the problems with this excessive antibiotic useage in terms of the antibiotic resistant strains.

So if we prescribe medicines that have an indication that "may, but unlikely" help except for a placebo type response, we may be introducing problems yet unexpected.

 

[saizai]

Okay, several people are making a fundamental confusion:
* placebo : a sugar pill that has no pharmacological effect, but does have psychological effect
* placeboe effect : the reason for the sugar pill's effect; also increases the effect of psychoactive drugs

I am advocating for an increase in #2.

Here are four hypothetical thought-problems for the moral questions. (I'm exaggerating the placebo effect of course for the sake of moral simplicity.)

#1 Suppose that a patient with, say, depression, given a sugar pill, will experience complete recovery if told by the prescriber that it will definitely work, and no effect at all if not told so.

Is it a lie to tell the patient that it will work?
Is it unethical to tell the patient that it will work?

#2 Same situation, except that the pill is composed of a drug that cures depression in 10% of nonbelievers also. (Assume this is the best treatment available.)

Is it a lie to tell the patient that it will work?
Is it unethical to tell the patient that it will work?

#3 & 4: Same as #1 & 2, but now the believers group only experience recovery 30% of the time (still more than the nonbelievers). Same questions.

 

[SteveGrenard]

Is it possible to OD on a placebo and then just think you died?

 

[drkitten]

Double Blind trials aren't performed just because of a placebo effect. They are done to rule out ANY bias that may exist in the participants.

Um.... Given that the definition of "placebo effect" is "bias that may exist in the participants," I'm not exactly sure what you're saying here.

 

[joobz]

Um.... Given that the definition of "placebo effect" is "bias that may exist in the participants," I'm not exactly sure what you're saying here.

no, the definition of placebo effect by the american heritage is

The beneficial effect in a patient following a particular treatment that arises from the patient's expectations concerning the treatment rather than from the treatment itself.

This is stating that a beneficial effect DOES occur by belief it will. this is only one type of bias other types include

pleasing an authority figure: Not letting down the Dr. if it doesn't work. Ie, lieing about getting better.
Dr. Pleaseing his finacial Backers of the experiment
Dr.'s Hedging bets to aide his presumed hypothsis: Changing protocol on the fly to adjust data.
Patient Selection Bias: giving the treatment to patients who look (by other indicators) to be most likely to heal or get better naturally


There are a ton of biases that double blind attempts to negate. not just placebo effect.

 

[drkitten]

This is stating that a beneficial effect DOES occur by belief it will.

Then the dictionary has it wrong. Because the "desire not to contradict the guy in the lab coat" (and so forth) is part of what's attributed to the placebo effect by the folks who study it.

There are a ton of biases that double blind attempts to negate.

Yes. And "placebo effect" is the general term for {i]all[/i] of them.

 

[Morrigan]

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).

Yes, this even happened to me recently. I had a throat infection and went to the doctor, he prescribed me antibiotics. But then I read a bit about it, and saw that to detect if the infection is bacterial rather than viral the doctor has to do a test on sample cells. He, of course, took no sample nor made any such tests, so he wouldn't even know if it was bacterial or viral. That never stopped him from prescribing the medication, though. :\

A bit of that is my fault, since I should have asked, and didn't think of it until after. And I know that many, many patients always "expect" a prescription or medication after a visit at the doctor's, so I know that doctors could just prescribe something to shut them up. But, it doesn't change the fact that it's bloody irresponsible. The doctors should educate the patients, not just send them off with something like that... Especially since bacteria are getting more resistant to antibiotics.

Oh yeah - I DID get better very quickly after taking the medication... Even if I almost immediately suspected it was such. Could I still be affected by the placebo effect despite my skepticism? Or maybe the doctor was lucky (or just right by instinct, somehow) and the infection *was* bacterial...

Um.... Given that the definition of "placebo effect" is "bias that may exist in the participants," I'm not exactly sure what you're saying here.

Doesn't the placebo effect also entail objective physical effects in the patients? I could be wrong, though. I think it has not been demonstrated 100% that there are never objective physical improvements.

 

[drkitten]

Doesn't the placebo effect also entail objective physical effects in the patients?

I believe that sometimes it does.

If nothing else, "regression to the mean" will also entail objective physical effects in the patients, so I see no reason that an effect that explicitly includes "regression to the mean" as a course of actions couldn't.

People sometimes get better, for strange and unknown reasons. If you get better while taking green Kool-ade, you will attribute your recovery to green Kool-ade.

 

[ponderingturtle]

I believe that sometimes it does.

If nothing else, "regression to the mean" will also entail objective physical effects in the patients, so I see no reason that an effect that explicitly includes "regression to the mean" as a course of actions couldn't.

People sometimes get better, for strange and unknown reasons. If you get better while taking green Kool-ade, you will attribute your recovery to green Kool-ade.

I find that unlikely everyone knows that red is a far better flavor for curing things than green. Green is for maintaining health only.

 

[joobz]

Then the dictionary has it wrong. Because the "desire not to contradict the guy in the lab coat" (and so forth) is part of what's attributed to the placebo effect by the folks who study it.

Yes. And "placebo effect" is the general term for {i]all[/i] of them.

I hate to get into a semantic debate but
5 (1 irrelevant) seperate sources state the same definition.
http://dictionary.reference.com/search?q=placebo+effect
As does medline (which actually uses the Webster's def.)

improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used

This all states that the patient's condition IMPROVES. Not lied about. It get's hairy with things that are tough to measure,like headache, depression... But for measurable things like reduction in fever, clearance of acne...

Now we can argue whether there is a placebo effect or if it all is just lies. However, my original stance, not all biases fall into the placebo definition.

 

[drkitten]

This all states that the patient's condition IMPROVES. Not lied about.

Um,.... and just how do you propose that a researcher distinguish between genuine improvement and simply lying to the white lab coat?

And how do you know whether the patient is lying to himeself and truthfully reporting his false belief that he feels better?

You are trying to draw -- literally -- a distinction without a difference.

And that's why the placebo effect includes all of those effects, as well as others that you haven't measured.

Now we can argue whether there is a placebo effect or if it all is just lies.

It would be a very short argument, since there are a number of known biases -- e.g. "regression to the mean" -- that are known not to be lies, but are part of the placebo effect.

However, my original stance, not all biases fall into the placebo definition.

... and you're still wrong.

 

[joobz]

... and you're still wrong.

now you are just being silly.


So a Dr. knowingly selecting patients, excluding known subjects that don't perform the way he wishes to adjust the desired outcome is placebo effect?

You are merely now throughing everything into placebo to discredit it. If it doesn't exist as it was stated by definition, then it is not real. Then all we are talking about are inherent bias in study.

But to discredit a presumed effect doesn't change it's definition to mean all other things.

Are we now to call experimental bias the "placebo effect" because the original concept of placebo was wrong?

Here's an example(although poor one): I state that invisible flying monkeys are the reason for objects in motion to be in motion, the invisible monkey effect. It's decided, That the invisible monkey effect is just inertia and there is no such thing as the invisible monkies.
So we now must call inertia the invisible monkey effect

now, I'm just being silly

 

[Jeff Corey]

A single blind study controls for the placebo effect, while a double blind controls for experimenter bias, also.
And I don't think that stat regression is part of the placebo effect - it is a separate confounding variable that is controlled through the use of groups randomly assigned to treatments.
( Campbell and Stanley, 1963 for "Threats to internal validity", i. e., confounding variables.)

 

[Nightlord]

How can you make a double blind study for placebo?
As long as the researcher doesn't know who is getting the placebo you get a single blind study, but How can you make the patients blind?

 

[Jeff Corey]

How can you make a double blind study for placebo?
As long as the researcher doesn't know who is getting the placebo you get a single blind study, but How can you make the patients blind?

You need a researcher who randomly assigns the subjects to either the drug or placebo group and records who got what. Then you need another who doesn't know whether the subjects got the drug or placebo to perform the measurements of the effect. After this is done, the records kept by the first researcher are opened and the data can be analyzed.
Some have stated that the data should be analyzed by a third person who doesn't know which group the subjects are in. Voila - a triple blind study.
The old joke was a triple blind study was when the grad student lost the data.

 

[saizai]

Jeff - That's a placebo-control study. Nightlord was asking for how to test *placebo* itself (against eg no treatment one presumes).

 

[Jeff Corey]

OK, I didn't understand the question. The answer is, you can't because you are testing the effect of not being blinded to the fact you are getting. or not getting, a pill or injection. But the potential experimenter bias must be eliminated.

 

[robinson]

http://www.nytimes.com/library/magaz...g-talbot7.html