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The Placebo Effect

steenkh said:
This is again a confirmation that you can’t treat illnesses with placebo, but you can treat patients’ perception of the illnesses.
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Indeed, and this is what I've been saying all along. The problem is that if you're treating their perception of the illness, it might result in them not seeking necessary treatment because they feel that they don't need it. Far better to treat their perception of their illness by actually treating their illness.

This asthma study is a cornerstone of the "powerful placebo doesn't exist" argument, but it is far from being the only one. It looks like the articles are coming at a rate of about once a month, so I will continue to keep the forum informed :thumbsup::D
 
By the way, though Mike has found this thread (he's a web designer and obviously noticed the link in website analytics) and registered at the forum, he appears disinclined to respond directly. For my money that's completely okay. I can do it adequately enough.

One of the things he mentioned to me in our exchange on Twitter (and as they were DMs I will not quote directly) is that he was a bit surprised that people were bringing up Ted Kaptchuk in defence of the effect of the placebo. Kaptchuk is an acupuncturist with a degree in Traditional Chinese Medicine. Despite being at Harvard Medical School he has no medical degree. He has been called out on Science Based Medicine several times for overselling his research. And Kathryn Hall, the person who was bigging up the research on Adam Ruins Everthing is his employee.
 
We've had a bit of a wait, but the next article on the so-called "powerful placebo" is in:

Rather less than more: More or Less misses the mark on placebo effects

More or Less is an award-winning investigative radio show and podcast from the BBC. Presented by Tim Harford, the programme examines the accuracy of statistics in the news and popular culture. Their work is frequently praised by skeptics for its diligent deconstruction and debunking of misinformation. All of which made it more disappointing when, for their January 26th 2022 episode, More or Less seemed to get it so wrong in a brief conversation about the Placebo Effect.

The Powerless Placebo

The segment opened with a guest recounting the story of Henry Beecher, a US Army doctor who, we are told, ran into a shortage of morphine while working as a surgeon during World War Two. Forced to administer inert salt water injections instead, his patients nevertheless experienced – says More or Less – ‘an astonishing amount of pain relief.’

Unfortunately, there is little evidence this story is true. When the journalist Shannon Harvey set out to verify the tale, she was unable to find it anywhere in the corpus of Beecher’s published work, or in his personal archive held by Harvard. Rather the story appears to be a corruption of a case study where Beecher administered a sedative to a wounded man instead of a painkiller, reasoning his anxiety was contributing more to the pain than the wound itself. There was no morphine shortage, or inert injections.

That aside, Beecher is responsible for probably the single most influential paper in placebo effect research. Published by JAMA in 1955, The Powerful Placebo cites ‘fifteen illustrative studies’ involving 1,082 patients, which found that placebos have an average significant effectiveness of 35.2 ±2.2%, ‘a degree not widely recognised.’

In 1997, the Journal of Clinical Epidemiology published a modern re-analysis of Beecher’s fifteen papers. The authors, Kienle and Kiene, identify a raft of things which could give a false impression of a placebo effect...
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This article also covers the claim that the placebo effect has been getting more powerful over time (it hasn't - we're just better now at controlling for previously uncontrolled factors), and it covers the 2007 hotel-cleaner study in which cleaners who were told that the work they did counts as exercise lost weight and had better blood pressure (there were lots of poorly controlled effects and a later replication failed to reproduce the results).
 
From the Mitchell and Webb 'homeopathic medicine' sketch

"Sure, you can't save anyone with a true disease, but whenever someone comes in with a vague unease, a touch of the nerves or just more money than sense, you'll be there with what is basically water."
 
arthwollipot said:
By the way, though Mike has found this thread (he's a web designer and obviously noticed the link in website analytics) and registered at the forum, he appears disinclined to respond directly. For my money that's completely okay. I can do it adequately enough.

One of the things he mentioned to me in our exchange on Twitter (and as they were DMs I will not quote directly) is that he was a bit surprised that people were bringing up Ted Kaptchuk in defence of the effect of the placebo. Kaptchuk is an acupuncturist with a degree in Traditional Chinese Medicine. Despite being at Harvard Medical School he has no medical degree. He has been called out on Science Based Medicine several times for overselling his research. And Kathryn Hall, the person who was bigging up the research on Adam Ruins Everthing is his employee.
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Here’s report of a recent paper that might be relevant here: https://www.theguardian.com/science...eactions-not-caused-by-vaccine-study-suggests
 
Lukraak_Sisser said:
From the Mitchell and Webb 'homeopathic medicine' sketch

"Sure, you can't save anyone with a true disease, but whenever someone comes in with a vague unease, a touch of the nerves or just more money than sense, you'll be there with what is basically water."
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I also liked their nutritionist sketch.
 
This is worth reading in full, because it is a comprehensive summary of the issues with the so-called placebo effect.

More wishful thinking than medical reality: “Placebos” by Kathryn T. Hall

From the conclusion:

Much has changed in medical science since the 18th century and even again since the 1950s – but what hasn’t changed is the need for things like the placebo effect which offer the necessary comparison to determine an effective novel treatment or at least rule out something that doesn’t work. The latter is whether the placebo is most effective: if acupuncture does no better than placebo it means that acupuncture is not an effective intervention in that study – not that placebo is as effective.

Hall’s book is exactly this. It is illustrative in its portrayal of the placebo effect for how the public hears it. However, they only hear it that way because of books like this and shoddy reporting on medical science in the English-speaking world. Hall is trying to claim that there is something extra-normal going on; that belief somehow shapes reality, but reality always wins. The placebo effect cannot make anyone better, just as Hall does not make the case here.
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Interesting indeed. But I was also shocked to read the quote where dr. Hall says: “The key finding was not that these strange and bewildering remedies didn’t work; it was that the sham devices worked just as well as the real ones.” I thought that everybody with a medical education would know that it means that the sham treatment did not work at all.

It casts a different light on a phrase commonly used by doctors: “There is no documentation that this treatment works”. I always thought that it was a careful phrasing of “this treatment does not work”, but if more doctors are like dr. Hall, it could mean “the treatment works, but we still haven’t got the documentation”.
 
Indeed. If the placebo works just as well as the intervention, that doesn't indicate that the placebo works, it indicates that the intervention does not.
 
Here we go. This is a long video (42:11), but in it, Mike Hall outlines the main evidence for the so-called "powerful placebo" effect being a myth. Enjoy.

 
Great lecture, but the text is bloody awful:
The placebo effect is one of the most powerful medical responses there is. It can cure your knee pain, relieve your asthma, or even help you lose weight. This isn't wishy-washy alternative New Age nonsense, it works in animals, it works in children, and it even works when you think it won't. So why, asks Mike Hall, does the best evidence tell us that none of this is true? Why does the data show that placebos perform no better than doing nothing? And how is this myth so deeply ingrained and unquestioned in modern medicine?
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No, it's not a powerful medical response, it doesn't cure your damaged knee, it does nothing for your asthma, and it doesn't make you lose weight. Claiming that it does is actually alternative New Age nonsense. And it also doesn't work in animals or children.
It should have started with: "We are told that ..."
The second half of the paragraph is great, and the lecture itself makes it clear that placebo may have a powerful psychological effect - in both patients and doctors - but no real physiological effect.
 
steenkh said:
Interesting indeed. But I was also shocked to read the quote where dr. Hall says: “The key finding was not that these strange and bewildering remedies didn’t work; it was that the sham devices worked just as well as the real ones.” I thought that everybody with a medical education would know that it means that the sham treatment did not work at all.
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arthwollipot said:
Indeed. If the placebo works just as well as the intervention, that doesn't indicate that the placebo works, it indicates that the intervention does not.
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This is made very clear in the QED video.
 
arthwollipot said:
I believe Mike has spoken about the nocebo effect, but I don't recall specifically what he has said. As I understand it though, nocebo effects are a vastly different thing from the purported Powerful Placebo effect.
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You can see the impact of the nocebo effect on the 'Havana syndrome' sufferers and other cases of patients being told by their doctors that they suffer from something much more serious than they actually do.
I can recommend neurologist Robert Baloh's book Medically Unexplained Symptoms: A Brain-Centered Approach (2021), which I'm currently reading.
 
dann said:
This is made very clear in the QED video.
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Not so fast.

The first example in the QED video showed a placebo response almost as powerful as the real treatment. It only 'disappeared' when an objective measurement was made. If this isn't done then the study has failed to collect the necessary data. But getting truly objective data can be difficult.

It would be a pity if an effective treatment was discarded for being 'no better than placebo' when the real failure was the study itself. Where a strong placebo effect is found it should be investigated to find the cause(s). You should not merely presume that the treatment was ineffective.
 
Roger Ramjets said:
Not so fast.

The first example in the QED video showed a placebo response almost as powerful as the real treatment. It only 'disappeared' when an objective measurement was made. If this isn't done then the study has failed to collect the necessary data. But getting truly objective data can be difficult.

It would be a pity if an effective treatment was discarded for being 'no better than placebo' when the real failure was the study itself. Where a strong placebo effect is found it should be investigated to find the cause(s). You should not merely presume that the treatment was ineffective.
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Right, but the placebo effect disappeared in those cases where there was an objective measure of efficacy - for example, in the asthma study. The difference between what people self-reported and what was actually measured was clear.

"Yes, I felt that I could breathe more easily" when actual measurement of lung capacity was unchanged. That sort of thing. That's where the Placebo Effect disappears.

I was actually a little disappointed that Mike didn't mention Ted Kaptchuk and the Harvard school of "placebo studies", since that's the source of a lot of incorrect information about the so-called "powerful placebo effect".
 
arthwollipot said:
"Yes, I felt that I could breathe more easily" when actual measurement of lung capacity was unchanged. That sort of thing. That's where the Placebo Effect disappears.
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I always thought that “Yes, I felt that I could breathe more easily" was the placebo effect, and that of course the lung capacity was unchanged, or worsened.
 
steenkh said:
I always thought that “Yes, I felt that I could breathe more easily" was the placebo effect, and that of course the lung capacity was unchanged, or worsened.
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Yes, and it can be explained by a number of things, like (for example) the person knowing that they are part of a trial and feeling obligated to report a positive result.
 
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