7 ms·

Any idea how placebos work so well, what they are, and if we're doing anything to take advantage of the effect?

by matkam 12y ago

kazinator 12y ago
They work the same way that some speaker cables sound so damn great (to whomever paid the $299 for them). http://en.wikipedia.org/wiki/Confirmation_bias http://en.wikipedia.org/wiki/Confirmation_bias
- matkam 12y ago
  Don't placebos sometimes result in real physical benefits?
  - benbreen 12y ago
    Interesting two part article by a Harvard Med School professor on whether psychiatric meds rely on an "activated placebo effect" (i.e. a placebo with side effects). Some would argue this isn't necessarily a bad thing as long as they are perceived to be efficacious by those taking them. http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/ http://www.nybooks.com/articles/archives/2011/jun/23/epidemi... http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/ http://www.nybooks.com/articles/archives/2011/jul/14/illusio...
  - kazinator 12y ago
    Yes. For instance, the person with $300 speaker cables feels good about how they sound and that puts them into a good mood. This is a physical benefit.
    - skinnybatch 12y ago
      I'd argue this is a psychological benefit...
      - DigitalJack 12y ago
        So you think there is nothing physical about mood? Interesting.
        pessimizer 12y ago
        We don't even have ways in English (probably any language) to speak about internal states without resorting to dualism. The closest we can get is hardware/software analogies.
        Dylan16807 12y ago
        There is a distinction, though it's tricky to word. It's about what is a direct effect, and what is an indirect effect. There is a feedback loop between abstract thoughts and effects on the body, so to make a proper distinction you want to ignore the feedback loop and look at where the inputs are. A placebo's direct effect is not physical. The direct effect is that first thought that you are receiving treatment, before it even has a chance to affect your mood. A kidney transplant's direct effect is mostly physical. It's filtering your blood at a rapid pace. So technically mood has physical effects but by the time you reach that stage you've destroyed the meaning of the term "physical benefit" into meaning just "benefit". Feel free to suggest better terms, but please don't muddle the waters.
        kazinator 12y ago
        Yes, of course. A placebo headache medicine of course does not have the direct effect comparable to aspirin, acetaminophen or ibuprofen. It's direct effect is not physical, because it doesn't have one. "No physical effect" means the same thing as "no effect", unless we are willing to discuss metaphysical effects. The indirect effects are somehow the result of the user's expectation that there is a direct effect. That is to say, "placebo effect" is not "the effect of the placebo object", obviously. It's the emergent effect of the whole situation of someone being duped with a placebo. Being duped with a placebo has direct, physical effects, while the placebo object has no effect.
        12y ago
  - MarkPNeyer 12y ago
    If your mind calms down, your heart rate drops, your cortisol goes down, and your muscles become less tense. Those are all physical benefits.
83457 12y ago
There is actually a discipline of medicine dedicated to researching and promoting the use of placebos to cure ailments called homeopathy.
- tobinfricke 12y ago
  I assume you mean this as a joke, but homeopathic remedies are so popular here in Germany -- the pharmacy shelves are loaded with them!! -- that I wonder whether use of the placebo effect is an official component of the national healthcare strategy.
  - TillE 12y ago
    Yeah, it's extremely weird to see homeopathic "medicine" all over in a country with an otherwise excellent, modern medical system. Germany generally does a good job on evidence-based herbal medicine (like standardizing St. John's wort extract), but I worry that the line can easily be blurred between them and homeopathic products in the eyes of most consumers. You really have to look carefully - they're not clearly marked. So honestly, you're probably quite right about it being a deliberate exploitation of the placebo effect. Because otherwise, there's no reason not to ban them.
    - pluma 12y ago
      No kidding. I went to the doctor with sleeping problems one time and he suggested I look up a certain drug. He said I couldn't get a prescription for it and it was to be taken therapeutically (i.e. indefinitely) and at the normal dosage it would cost something like 50 bucks a month. I went home and looked it up: a homeopathic panacea with only a single "study". Not double blind, not even single blind -- they literally just gave the drug to some participants and the self-reported symptoms "improved". I'm still not sure whether the GP was just trolling me.
      - tobinfricke 12y ago
        I've had similar experiences. I find it very strange. You make a good point: the homeopathic remedies aren't even cheap.
DanBC 12y ago
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974.pub3/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974... > We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.
- pella 12y ago
  "Nevertheless, it is important to mention that according to an influential 2001 meta-analysis comparing placebo-treatment arms with no treatment, placebos make no clinical difference.[20] However, the methodological difficulties of combining diverse conditions in a single meta-analysis are serious, and the authors’ updated meta-analysis includes more nuanced conclusions.[21] Furthermore, the meta-analyses implicitly assume the biological reductionist definition of placebo, ignoring the psychosocial context of sickness and health. The subjects in those studies were entered into a research programme and received attention and care. Therefore, in the way that the studies of the meta-analysis were actually conducted, there was plenty of room for the placebo effect without the placebo, which would spuriously suggest that the placebo was no more effective than no treatment, though in fact both had the potential to produce a placebo effect." from "The moral case for the clinical placebo" http://jme.bmj.com/content/40/4/219.full http://jme.bmj.com/content/40/4/219.full
snowwrestler 12y ago
Jokes about homeopathy aside, if you can answer your own question, there's probably a Nobel prize in it for you. Mind/body interactions are incredibly complex and as yet pretty poorly understood. There are some known ways to take advantage of similar effects--for instance, helping patients find ways to lower stress as a means of mitigating risk factors like high blood pressure.
- Natsu 12y ago
  Same here in the US, they even put them in the pharmacy :( I remember one time I needed eyedrops. They were only listed as homeopathic in tiny print and were adjacent to real eyedrops in the pharmacy, so it was a bit hard to read them with my allergies going. And I've tried washing my eyes with water, but it's not as effective as real eyedrops. Moreover, these contained "aspis", allegedly some extract from bees, which I might be allergic to. One would hope that they'd diluted it enough, but it actually listed a fairly low dilution factor so I couldn't even be sure the damned things weren't harmful.
JacobJans 12y ago
I'd suggest you look into hypnosis and hypnotherapy. There are quite a few things the mind can do, given the right suggestions.
marincounty 12y ago
Right now they don't have a clue. In my world, the effect is the only existence of God--until proven differently. So believing strongly in something isn't as foolish as some "Intellectuals" would berate?

Any idea how placebos work so well, what they are, and if we're doing anything to take advantage of the effect?

by matkam 12y ago

Any idea how placebos work so well, what they are, and if we're doing anything to take advantage of the effect?

They work the same way that some speaker cables sound so damn great (to whomever paid the $299 for them). http://en.wikipedia.org/wiki/Confirmation_bias http://en.wikipedia.org/wiki/Confirmation_bias

matkam 12y ago
Don't placebos sometimes result in real physical benefits?
- benbreen 12y ago
  Interesting two part article by a Harvard Med School professor on whether psychiatric meds rely on an "activated placebo effect" (i.e. a placebo with side effects). Some would argue this isn't necessarily a bad thing as long as they are perceived to be efficacious by those taking them. http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/ http://www.nybooks.com/articles/archives/2011/jun/23/epidemi... http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/ http://www.nybooks.com/articles/archives/2011/jul/14/illusio...
- kazinator 12y ago
  Yes. For instance, the person with $300 speaker cables feels good about how they sound and that puts them into a good mood. This is a physical benefit.
  - skinnybatch 12y ago
    I'd argue this is a psychological benefit...
    - DigitalJack 12y ago
      So you think there is nothing physical about mood? Interesting.
      - pessimizer 12y ago
        We don't even have ways in English (probably any language) to speak about internal states without resorting to dualism. The closest we can get is hardware/software analogies.
      - Dylan16807 12y ago
        There is a distinction, though it's tricky to word. It's about what is a direct effect, and what is an indirect effect. There is a feedback loop between abstract thoughts and effects on the body, so to make a proper distinction you want to ignore the feedback loop and look at where the inputs are. A placebo's direct effect is not physical. The direct effect is that first thought that you are receiving treatment, before it even has a chance to affect your mood. A kidney transplant's direct effect is mostly physical. It's filtering your blood at a rapid pace. So technically mood has physical effects but by the time you reach that stage you've destroyed the meaning of the term "physical benefit" into meaning just "benefit". Feel free to suggest better terms, but please don't muddle the waters.
        kazinator 12y ago
        Yes, of course. A placebo headache medicine of course does not have the direct effect comparable to aspirin, acetaminophen or ibuprofen. It's direct effect is not physical, because it doesn't have one. "No physical effect" means the same thing as "no effect", unless we are willing to discuss metaphysical effects. The indirect effects are somehow the result of the user's expectation that there is a direct effect. That is to say, "placebo effect" is not "the effect of the placebo object", obviously. It's the emergent effect of the whole situation of someone being duped with a placebo. Being duped with a placebo has direct, physical effects, while the placebo object has no effect.
        12y ago
- MarkPNeyer 12y ago
  If your mind calms down, your heart rate drops, your cortisol goes down, and your muscles become less tense. Those are all physical benefits.

83457 12y ago

There is actually a discipline of medicine dedicated to researching and promoting the use of placebos to cure ailments called homeopathy.

tobinfricke 12y ago
I assume you mean this as a joke, but homeopathic remedies are so popular here in Germany -- the pharmacy shelves are loaded with them!! -- that I wonder whether use of the placebo effect is an official component of the national healthcare strategy.
- TillE 12y ago
  Yeah, it's extremely weird to see homeopathic "medicine" all over in a country with an otherwise excellent, modern medical system. Germany generally does a good job on evidence-based herbal medicine (like standardizing St. John's wort extract), but I worry that the line can easily be blurred between them and homeopathic products in the eyes of most consumers. You really have to look carefully - they're not clearly marked. So honestly, you're probably quite right about it being a deliberate exploitation of the placebo effect. Because otherwise, there's no reason not to ban them.
  - pluma 12y ago
    No kidding. I went to the doctor with sleeping problems one time and he suggested I look up a certain drug. He said I couldn't get a prescription for it and it was to be taken therapeutically (i.e. indefinitely) and at the normal dosage it would cost something like 50 bucks a month. I went home and looked it up: a homeopathic panacea with only a single "study". Not double blind, not even single blind -- they literally just gave the drug to some participants and the self-reported symptoms "improved". I'm still not sure whether the GP was just trolling me.
    - tobinfricke 12y ago
      I've had similar experiences. I find it very strange. You make a good point: the homeopathic remedies aren't even cheap.

DanBC 12y ago

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974.pub3/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974... > We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.

pella 12y ago
"Nevertheless, it is important to mention that according to an influential 2001 meta-analysis comparing placebo-treatment arms with no treatment, placebos make no clinical difference.[20] However, the methodological difficulties of combining diverse conditions in a single meta-analysis are serious, and the authors’ updated meta-analysis includes more nuanced conclusions.[21] Furthermore, the meta-analyses implicitly assume the biological reductionist definition of placebo, ignoring the psychosocial context of sickness and health. The subjects in those studies were entered into a research programme and received attention and care. Therefore, in the way that the studies of the meta-analysis were actually conducted, there was plenty of room for the placebo effect without the placebo, which would spuriously suggest that the placebo was no more effective than no treatment, though in fact both had the potential to produce a placebo effect." from "The moral case for the clinical placebo" http://jme.bmj.com/content/40/4/219.full http://jme.bmj.com/content/40/4/219.full

snowwrestler 12y ago

Jokes about homeopathy aside, if you can answer your own question, there's probably a Nobel prize in it for you. Mind/body interactions are incredibly complex and as yet pretty poorly understood. There are some known ways to take advantage of similar effects--for instance, helping patients find ways to lower stress as a means of mitigating risk factors like high blood pressure.

Natsu 12y ago
Same here in the US, they even put them in the pharmacy :( I remember one time I needed eyedrops. They were only listed as homeopathic in tiny print and were adjacent to real eyedrops in the pharmacy, so it was a bit hard to read them with my allergies going. And I've tried washing my eyes with water, but it's not as effective as real eyedrops. Moreover, these contained "aspis", allegedly some extract from bees, which I might be allergic to. One would hope that they'd diluted it enough, but it actually listed a fairly low dilution factor so I couldn't even be sure the damned things weren't harmful.

JacobJans 12y ago

I'd suggest you look into hypnosis and hypnotherapy. There are quite a few things the mind can do, given the right suggestions.

marincounty 12y ago

Right now they don't have a clue. In my world, the effect is the only existence of God--until proven differently. So believing strongly in something isn't as foolish as some "Intellectuals" would berate?