10 ms·

Yes, that's the reason RCTs are contrasted against placebo not no treatment. If you want too see how powerful this effect can become look no further than acupu

Yes, that's the reason RCTs are contrasted against placebo not no treatment. If you want too see how powerful this effect can become look no further than acupuncture. Or, for a nocebo result, people have actually died because they thought they had been cursed. Or, maybe less dramatic, people who are given an alcohol placebo still get drunk. Not all, but some do, and we don't know why they specifically and why at all.

allturtles 5y ago
> Yes, that's the reason RCTs are contrasted against placebo not no treatment. I don't think so. Placebo is used to blind participants to which study arm they are in. The placebo effect was then discovered after the fact.
- Pyramus 5y ago
  You are not wrong - placebos are a practical way to blind a study. The best way to blind, however, is no treatment, but no treatment only gives you the efficacy of the treatment, and not what you actually want to know, the efficacy of the 'active ingredient'. See e.g. https://en.wikipedia.org/wiki/Placebo-controlled_study#Natural_history_groups https://en.wikipedia.org/wiki/Placebo-controlled_study#Natur...
lotsofpulp 5y ago
> Or, for a nocebo result, people have actually died because they thought they had been cursed Source? I have yet to hear about an objective malady that can be fixed via placebo/nocebo, like stage 4 cancer, type 1 diabetes, etc.
- ChefboyOG 5y ago
  I don't know of people dying from a belief that they were cursed, but we do certainly know that placebos can have very real, measurable neurobiological effects. For example, there many studies looking at the body's response to placebo painkillers. The brain often releases neurotransmitters that bind to opioid receptors as if an actual painkiller had been taken: https://www.nature.com/articles/535S14a https://www.nature.com/articles/535S14a The original comment was about placebos bringing "powerful relief," which there is a great deal of scientific research to support. As far as I'm aware, there is no serious medical researcher advancing the hypothesis that stage 4 cancer or type 1 diabetes should or can be treated via placebos.
- cainxinth 5y ago
  https://en.wikipedia.org/wiki/Kurdaitcha#Bone_pointing https://en.wikipedia.org/wiki/Kurdaitcha#Bone_pointing
  - deleted 5y ago
    [deleted]
- kipchak 5y ago
  I'm not up to date on if there are any counter opinions to this, but I've heard that placebo's are similar in effect to SSRIs[1] - Though as always there's a lot of buts/ifs there.[2] My assumption is that a placebo causes people to expect things to get better and reduces stress levels, increases sleep quality and so on. I would figure a very supportive social network (family, prayer group) would probably have a similar effect. That being said like you say for something more severe the placebo alone isn't going to do much, but I would imagine if you gave people a placebo that they thought would improve their stage 4 cancer recovery you would probably see an effect. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/
- PaulDavisThe1st 5y ago
  "Objective malady" is a deliberately loaded term. Generally in medicine there's a distinction between acute conditions and chronic conditions. Allopathic (western) medicine has proved highly effective at treating acute conditions, including trauma/injury, certain forms of cancer and infection. However, chronic conditions are still one of the primary experiences of many humans relating to their health, and allopathic medicine has generally done quite poorly at addressing these conditions. Other styles of treatment, including placebo, have been shown to be effective in at least reducing the severity or incidence of the symptoms associated with chronic conditions. The fact that you don't want to consider someone's 20 year battle with chronic back pain, or neuropathy, or any other chronic condition, to be "an objective malady" doesn't make you the arbiter of what's real and what isn't.
  - lotsofpulp 5y ago
    > The fact that you don't want to consider someone's 20 year battle with chronic back pain, or neuropathy, or any other chronic condition, to be "an objective malady" doesn't make you the arbiter of what's real and what isn't. Objective means measurable, definable, quantifiable. It has nothing to do with real or not. The human body is so complex with so many possibilities, I find it uninteresting to speculate about unknowns, hence restricting my request to what I am interested in. Dying is an objective condition observable by others, so it piqued my interest as to how it was determined someone died due to a nocebo.
    - PaulDavisThe1st 5y ago
      Most/many chronic conditions cannot be measured, defined, or quantified. The sufferer can give you some estimate on some scale that you describe that relates to the intensity and nature of their experiences. I'm very glad to have seen an increasing number of health care professionals say things along the lines of "we have no idea what is causing their experience, and in fact, we think most it may be entirely psychogenic, but that doesn't change the fact that this is what they are actually experiencing, and that's as real for them as a puncture wound or an infection."
deleted 5y ago
[deleted]
wyager 5y ago
Placebos probably don’t do much of anything compared to no treatment. It’s almost all mean reversion. https://pubmed.ncbi.nlm.nih.gov/12535498/ https://pubmed.ncbi.nlm.nih.gov/12535498/
- FabHK 5y ago
  Exactly. Thanks, I had forgotten where I had read that, this is a nice source. Here's the TL'DR: The placebo effect is maybe not quite as powerful as it is sometimes made out to be. And the reason is spontaneous remission or reversion to the mean. 1. Initially, researchers tested a treatment, and when the patients got healthier, it was assumed that it was the treatment. 2. Then researchers got smarter, and tested a treatment against a placebo (control), ideally double blind and randomised etc., and when the control group got better, it was assumed to be the placebo effect, and when the treatment group got even better, the difference was the treatment effect. 3. Then researchers got even smarter, and tested a treatment against a placebo (control) and against no treatment at all, and when the no-treatment group got better, it was assumed to be reversion to the mean or spontaneous remission; when the control group got even better, that difference was the placebo effect; and when the treatment group got even better, that difference was the treatment effect. Going from 1. to 2., it was realised that many treatments are not quite as potent as hoped, and that the placebo effect is quite strong. However, going from 2. to 3., it was realised that the placebo effect is not quite as potent either, and that there is considerable spontaneous remission or reversion to the mean.
- PaulDavisThe1st 5y ago
  If you're going to reference papers from 2004, you should likely follow up on their subsequent citations and refutations: 2007 paper that specifically cites Hróbjartsson et al., but claims that they overlooked certain specific effects: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-5-3 https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-... 2019 review that also cites Hróbjartsson et al., but catches up on subsequent and broader placebo/nocebo research and concludes that both still seem efficaceous in the right contexts. https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00365/full#B29 https://www.frontiersin.org/articles/10.3389/fpsyt.2019.0036...

allturtles 5y ago

> Yes, that's the reason RCTs are contrasted against placebo not no treatment. I don't think so. Placebo is used to blind participants to which study arm they are in. The placebo effect was then discovered after the fact.

Pyramus 5y ago
You are not wrong - placebos are a practical way to blind a study. The best way to blind, however, is no treatment, but no treatment only gives you the efficacy of the treatment, and not what you actually want to know, the efficacy of the 'active ingredient'. See e.g. https://en.wikipedia.org/wiki/Placebo-controlled_study#Natural_history_groups https://en.wikipedia.org/wiki/Placebo-controlled_study#Natur...

lotsofpulp 5y ago

> Or, for a nocebo result, people have actually died because they thought they had been cursed Source? I have yet to hear about an objective malady that can be fixed via placebo/nocebo, like stage 4 cancer, type 1 diabetes, etc.

ChefboyOG 5y ago
I don't know of people dying from a belief that they were cursed, but we do certainly know that placebos can have very real, measurable neurobiological effects. For example, there many studies looking at the body's response to placebo painkillers. The brain often releases neurotransmitters that bind to opioid receptors as if an actual painkiller had been taken: https://www.nature.com/articles/535S14a https://www.nature.com/articles/535S14a The original comment was about placebos bringing "powerful relief," which there is a great deal of scientific research to support. As far as I'm aware, there is no serious medical researcher advancing the hypothesis that stage 4 cancer or type 1 diabetes should or can be treated via placebos.
cainxinth 5y ago
https://en.wikipedia.org/wiki/Kurdaitcha#Bone_pointing https://en.wikipedia.org/wiki/Kurdaitcha#Bone_pointing
- deleted 5y ago
  [deleted]
kipchak 5y ago
I'm not up to date on if there are any counter opinions to this, but I've heard that placebo's are similar in effect to SSRIs[1] - Though as always there's a lot of buts/ifs there.[2] My assumption is that a placebo causes people to expect things to get better and reduces stress levels, increases sleep quality and so on. I would figure a very supportive social network (family, prayer group) would probably have a similar effect. That being said like you say for something more severe the placebo alone isn't going to do much, but I would imagine if you gave people a placebo that they thought would improve their stage 4 cancer recovery you would probably see an effect. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/
PaulDavisThe1st 5y ago
"Objective malady" is a deliberately loaded term. Generally in medicine there's a distinction between acute conditions and chronic conditions. Allopathic (western) medicine has proved highly effective at treating acute conditions, including trauma/injury, certain forms of cancer and infection. However, chronic conditions are still one of the primary experiences of many humans relating to their health, and allopathic medicine has generally done quite poorly at addressing these conditions. Other styles of treatment, including placebo, have been shown to be effective in at least reducing the severity or incidence of the symptoms associated with chronic conditions. The fact that you don't want to consider someone's 20 year battle with chronic back pain, or neuropathy, or any other chronic condition, to be "an objective malady" doesn't make you the arbiter of what's real and what isn't.
- lotsofpulp 5y ago
  > The fact that you don't want to consider someone's 20 year battle with chronic back pain, or neuropathy, or any other chronic condition, to be "an objective malady" doesn't make you the arbiter of what's real and what isn't. Objective means measurable, definable, quantifiable. It has nothing to do with real or not. The human body is so complex with so many possibilities, I find it uninteresting to speculate about unknowns, hence restricting my request to what I am interested in. Dying is an objective condition observable by others, so it piqued my interest as to how it was determined someone died due to a nocebo.
  - PaulDavisThe1st 5y ago
    Most/many chronic conditions cannot be measured, defined, or quantified. The sufferer can give you some estimate on some scale that you describe that relates to the intensity and nature of their experiences. I'm very glad to have seen an increasing number of health care professionals say things along the lines of "we have no idea what is causing their experience, and in fact, we think most it may be entirely psychogenic, but that doesn't change the fact that this is what they are actually experiencing, and that's as real for them as a puncture wound or an infection."

deleted 5y ago

[deleted]

wyager 5y ago

Placebos probably don’t do much of anything compared to no treatment. It’s almost all mean reversion. https://pubmed.ncbi.nlm.nih.gov/12535498/ https://pubmed.ncbi.nlm.nih.gov/12535498/

FabHK 5y ago
Exactly. Thanks, I had forgotten where I had read that, this is a nice source. Here's the TL'DR: The placebo effect is maybe not quite as powerful as it is sometimes made out to be. And the reason is spontaneous remission or reversion to the mean. 1. Initially, researchers tested a treatment, and when the patients got healthier, it was assumed that it was the treatment. 2. Then researchers got smarter, and tested a treatment against a placebo (control), ideally double blind and randomised etc., and when the control group got better, it was assumed to be the placebo effect, and when the treatment group got even better, the difference was the treatment effect. 3. Then researchers got even smarter, and tested a treatment against a placebo (control) and against no treatment at all, and when the no-treatment group got better, it was assumed to be reversion to the mean or spontaneous remission; when the control group got even better, that difference was the placebo effect; and when the treatment group got even better, that difference was the treatment effect. Going from 1. to 2., it was realised that many treatments are not quite as potent as hoped, and that the placebo effect is quite strong. However, going from 2. to 3., it was realised that the placebo effect is not quite as potent either, and that there is considerable spontaneous remission or reversion to the mean.
PaulDavisThe1st 5y ago
If you're going to reference papers from 2004, you should likely follow up on their subsequent citations and refutations: 2007 paper that specifically cites Hróbjartsson et al., but claims that they overlooked certain specific effects: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-5-3 https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-... 2019 review that also cites Hróbjartsson et al., but catches up on subsequent and broader placebo/nocebo research and concludes that both still seem efficaceous in the right contexts. https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00365/full#B29 https://www.frontiersin.org/articles/10.3389/fpsyt.2019.0036...