The Placebo Effect

[HansMustermann]

Until very recently there were also decades of common wisdom that placebos actually cause actual healing in actual illnesses. In fact, we even had a highly similar explanation for how it supposedly works, as what is proposed now for pain: see, stress level modulates the activity of your immune system, so by telling people you're giving them an antibiotic you reduce their stress level, which makes their body better at actually curing the infection.

We didn't actually have a meta study to say that no, it really doesn't have any measurable effect, until this decade. And that convoluted explanation was just tooth fairy science, as in, it was explaining something that doesn't actually exist.

Which also takes care of your statement that, "The reason why we have control groups in drug trials is to eliminate the placebo effect." No, for most drugs, thanks to the aforementioned meta studies we actually know that there is NO actual placebo effect. In a treatment for asthma or for pneumonia or chemotherapy for cancer, exactly 0% of the cases were actually cured by placebo effect. The control group is really to compare it mostly to your immune system doing its job, rather than because we actually expect a placebo effect to cure anything there. Yes, we still use the conventional phrasing that some antibiotic worked better than placebo, but that just means it worked better than the control group, in which we actually expect 0% of infections to be actually cured by placebo effect in the meantime.

 

[dann]

Placebo Deluxe

The Long-Covid edition with Stephen Colbert:

 

[psionl0]

No, for most drugs, thanks to the aforementioned meta studies we actually know that there is NO actual placebo effect. In a treatment for asthma or for pneumonia or chemotherapy for cancer, exactly 0% of the cases were actually cured by placebo effect.

Exactly what Harvard professor Professor Ted Kaptchuk states in the article I linked to.

The extension that there is NO placebo effect for ANY ailment whatsoever is unfounded.

 

[Lithrael]

I would expect placebo would be ‘effective’ in exactly the same ways as meditation etc.

Meaning, anything you can affect with intentional thought, you can affect with unintentional thought. A pretty narrow window though. I would have thought physically measurable stuff would be along the lines of can you calm yourself down enough to release less adrenalin than if you let a panic attack run away with you.

I heard an npr program (TAL?) or something a while back claiming that someone’s serious digestive ailments went away due to placebo until they found out it was placebo and they came back. And they were working on tricking her ‘being cared for’ sympathetic system into turning back on. I was, let’s say, skeptical. That sounded highly testable and I thought it would make a pretty big splash if it panned out.

 

[HansMustermann]

Exactly what Harvard professor Professor Ted Kaptchuk states in the article I linked to.

The extension that there is NO placebo effect for ANY ailment whatsoever is unfounded.

Actually, considering that "ailment" actually means "a physical disorder or illness, especially of a minor or chronic nature" (my highligh,) then yes, there is

1. We never found any actual placebo effect for the actual ailments we did a meta-study on,

and

2. We have no evidence that it works any different for the ones we didn't make such a meta-study on.

In the absence of evidence, the default Occam-conform position for #2 is that it doesn't either.

What we do have is a possible placebo effect in the perception of some symptoms, which is quite different from actually treating the underlying physical ailment.

Even in the placebo surgery mentioned in the link in the OP, nobody says that those bone growths in the joint (you know, the PHYSICAL part of it) actually go away by placebo. You can just apparently convince someone that they hurt less when they move their arm around.

 

[HansMustermann]

I would expect placebo would be ‘effective’ in exactly the same ways as meditation etc.

Meaning, anything you can affect with intentional thought, you can affect with unintentional thought. A pretty narrow window though. I would have thought physically measurable stuff would be along the lines of can you calm yourself down enough to release less adrenalin than if you let a panic attack run away with you.

I heard an npr program (TAL?) or something a while back claiming that someone’s serious digestive ailments went away due to placebo until they found out it was placebo and they came back. And they were working on tricking her ‘being cared for’ sympathetic system into turning back on. I was, let’s say, skeptical. That sounded highly testable and I thought it would make a pretty big splash if it panned out.

Just to make it clear, Adrenalin DOES affect the immune system, by pretty much suppressing parts of it. Which is why that explanation about how placebo actually cures a tumour or infection actually lasted that long, until it was discovered that there is no actual measurable effect to explain.

However, the flip side -- and presumably also a part in why you don't actually see any net effect -- is that other stress hormones like norepinephrine, epinephrine and corticosterone actually boost the immune system majorly. (See, for example, https://www.sciencedaily.com/releases/2012/06/120621223525.htm )

It turns out that evolution isn't as dumb as we thought. When the animal goes into fight or flight, it means that statistically there's a high chance of injury happening next. So there's actually an evolutionary advantage in having the immune system go into overdrive at that time, rather than shutting down.

So anyway, the supposed positive effect of soothing someone's stress on their health in an actual illness may be at best neutral, and at worst a net negative. So even meditation, I would guess it may be good for you in other aspects, but it might not really help save your life if you have an actual illness.

(Edit: with some emergency exceptions. Like, if you go into circulatory shock, high enough stress will kill you. But that kind of emergency is not what you'd treat with placebos anyway.)

 

[Thermal]

Late to the thread and might have been discussed already, but has anyone studied subjects who respond to the placebo effect, to determine if they have some trait that could be identified beforehand and remove them from the study, as they are the proverbial monkey wrench?

 

[Darat]

If you read what was quoted from that link you would see that it is about "decades of wisdom" that suggest that the placebo effect is real and not imaginary.
You are free to provide links to research that debunks this idea but a mere podcast won't cut it.

Not seen that claim.

 

[HansMustermann]

Late to the thread and might have been discussed already, but has anyone studied subjects who respond to the placebo effect, to determine if they have some trait that could be identified beforehand and remove them from the study, as they are the proverbial monkey wrench?

Not sure, but as I was mentioning before, some did find a correlation between expectation and the placebo effect. So if you strongly believe that medicine WILL help you, it will. Or at the very least you will report that it did.

There are however other monkey wrenches in that too:

1. where that correlation is the strongest is in the HEALTHY people in the test. So basically in a practical situation (i.e., you actually went to the doctor, as opposed to someone poking you in a test lab because you volunteered) you get the most out it if you were a hypochondriac who never had any actual problem in the first place.

2. in a lot of people (especially the #1 kind) actually a placebo works best. Actually having an effect, like from actually getting an active substance, can actually reduce how much they think it worked.

People are weird, basically...

 

[Darat]

...snip...

(Edit: with some emergency exceptions. Like, if you go into circulatory shock, high enough stress will kill you. But that kind of emergency is not what you'd treat with placebos anyway.)

Are you sure:

 

[psionl0]

Actually, considering that "ailment" actually means "a physical disorder or illness, especially of a minor or chronic nature" (my highligh,) then yes, <--snip-->

Do you really think that you can alter my argument by with a dictionary?

Just to reiterate, placebos are most effective for conditions like "pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea". You can't prove that they are purely psychological effects and any attempt to make it appear that I am suddenly arguing that they can cure cancer is just dishonest strawmanning.

 

[arthwollipot]

I tend to place slightly greater weight on Harvard based research than on the opinions of a dissenting podcaster.

The reason why we have control groups in drug trials is to eliminate the placebo effect.

I suspect that if you had heard Mike's careful, thoughtful and thorough coverage of the subject, you would be as convinced as I am that the mind-over-matter "powerful placebo" effect is largely nonexistent, despite what research has been done before.

 

[steenkh]

I don’t have time for videos and podcasts, unfortunately. I can read a text in a fraction of the time it takes to listen to it.

Does Mike Hall argue that the concept mind-over matter “powerful placebo” exists outside the circles of pop science?

I have never heard of such a thing, only that placebo alters the perception of the seriousness of an ailment that can make people live with pain - or in the case of woo-woo treatments, postpone the perception of seriousness until it is too late to treat.

I can’t understand why we are having this discussion among people who generally agree.

 

[arthwollipot]

I don’t have time for videos and podcasts, unfortunately. I can read a text in a fraction of the time it takes to listen to it.

This is why it's great that Mike has started writing it up.

Does Mike Hall argue that the concept mind-over matter “powerful placebo” exists outside the circles of pop science?

I have never heard of such a thing, only that placebo alters the perception of the seriousness of an ailment that can make people live with pain - or in the case of woo-woo treatments, postpone the perception of seriousness until it is too late to treat.

I can’t understand why we are having this discussion among people who generally agree.

Yes, there is absolutely a common perception that placebo has magic effects over and above what can be accounted for. Mike's basic argument is that we just haven't been accounting for enough.

His other basic argument, of course, is that science is widely misreported, and this is partially responsible for the common perception of placebo.

 

[psionl0]

I suspect that if you had heard Mike's careful, thoughtful and thorough coverage of the subject, you would be as convinced as I am that the mind-over-matter "powerful placebo" effect is largely nonexistent, despite what research has been done before.

We don't need clever sounding arguments. We need properly analyzed data.

 

[HansMustermann]

We don't need clever sounding arguments. We need properly analyzed data.

I'll even drink to that. (Well, I'll drink to anything. Or even without the anything.)

 

[arthwollipot]

We don't need clever sounding arguments. We need properly analyzed data.

We have properly analysed data. The properly analysed data is widely misinterpreted, and misrepresented as saying that there is an effect where in fact there is no such effect.

 

[HansMustermann]

We have properly analysed data. The properly analysed data is widely misinterpreted, and misrepresented as saying that there is an effect where in fact there is no such effect.

To some extent. I have yet to personally see ANY medical study where they even acknowledge the distorting reporting effects that sociology knew about literally since the '50s, much less the even bigger distorting effects that are textbook anthropology.

And to be fair, when comparing TO placebo, they get evened out. If a source of error in testing an actual analgesic is people telling you falsehoods, then you're as probable to see that effect in both the actual test group and the control group. So basically you don't need to do anything special to compensate for it. You'll have about as many people distorting the result in both groups, so if the group that took the active substance still had more remissions than the control group, that's been automatically taken care of.

It's only when we're talking about the efficacy of placebo, that I'd like to see someone talk to the sociologists too first.

 

[arthwollipot]

To some extent. I have yet to personally see ANY medical study where they even acknowledge the distorting reporting effects that sociology knew about literally since the '50s, much less the even bigger distorting effects that are textbook anthropology.

With Hans' appropriate caveat, of course.

 

[psionl0]

We have properly analysed data. The properly analysed data is widely misinterpreted, and misrepresented as saying that there is an effect where in fact there is no such effect.

Which particular data are you claiming that Harvard researchers totally messed up?