What Is The Placebo Effect, And Is It Getting Stronger?

[HuckleB]

Placebo appears to be a topic of the day, and I may to blame for that, but I do think that these pieces address and correct some misconceptions being offered on the topic. Thus, I am offering them up as an OP, despite their age (the piece that they are in response to, is, of course, just as old). Yes, they are long, but that can be necessary at times.


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What is the Placebo Effect, and is it getting stronger?
http://scienceblogs.com/gregladen/2009/09/what_is_the_placebo_effect_and.php

"...

Silberman points out additional difficulties that modern pharm is having with testing, inluding finding people who are not already drugged up in one way or another. He also discusses proposed new research designs. You should look at the article.

And as you read Silberman's article, please do this. Imagine the whole thing ... the descriptions of the studies, the discussions of the "placebo effect" ... redone with the idea that there are two separate result-changing outcomes from placebo controls: Those that are artifacts of the process or system that do not in fact actually have any curative properties at all ever (type 1 ... "no effect") and those that do. The first type are strong, ubiquitous, known of, but not fully understood, and the second type are probably rare, weaker, probably often don't exist, and are very poorly understood. The problem is that many people assume that the whole "placebo" effect is this second type, while it is certainly mainly or wholly the first type.

...

Silberman ends: "Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine."

Maybe potent. But only a small percentage of what is happening to people taking treatments, and only a small percentage of the cause of the incredible shrining difference between treatment and placebo that may be happening in some areas of research."


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Placebo is not what you think it is
http://scienceblogs.com/whitecoatunderground/2009/09/placebo_is_not_what_you_think.php

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The author of the Wired article doesn't get it in a very profound way. I'll give you a few laughable examples:

"The fact that taking a faux drug can powerfully improve some people's health--the so-called placebo effect--has long been considered an embarrassment to the serious practice of pharmacology."

ORLY? That's not even wrong. Clinical pharmacology research depends on placebo controls to make sense of the data. The fact that certain data is affected in placebo groups does not, for example, mean everything we understand about the cytochrome P450 system is wrong.

He asserts that more and more drug studies are crapping out due to the placebo effect: "It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger."

No, it's not like that at all. Perhaps the studies are just that well done, or maybe the drugs being developed suck, or maybe companies are studying more candidate drugs and screening for efficacy. Just about any explanation that doesn't involve aliens is better than "placebo is getting stronger".

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Despite centuries of investigation, scientists still have much to learn about the origins and meaning of the placebo effect
http://seedmagazine.com/content/article/overhyped_placebos_of_doom/

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The problem with headlines is actually part of a much larger set of effects found in nearly every type of research involving human participants, called the subject-expectancy effect. The placebo effect is the probably best known of these, and it’s indeed a powerful factor in medical and pharmaceutical research.

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This is the primary misconception about placebos: that the placebo itself is somehow “working” to treat a medical condition. You can see it even in the headline for an otherwise well-crafted article that appeared in Wired last August: “Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.” As internist and medical professor Peter Lipson noted on the Science-Based Medicine blog, placebos by definition have no medical effect. The “placebo effect” is due to the subject’s (and sometimes, the experimenter’s) expectation that a treatment will work. And, of course, a patient sometimes recovers simply due to chance or because his or her immune response handled the problem. Researchers observe an improvement, and this gets attributed to the placebo. In the case of the Wired article, the misconception in the headline is cleared up by the text of the report: The placebo effect may be getting stronger for reasons that are unclear to researchers. Placebos themselves, as ever, remain ineffective.

The anonymous blogger and UK-based neuroscientist Neuroskeptic also addresses the Wired report in a post entitled ”Deconstructing the Placebo.” Neuroskeptic points out that many of the issues we have with placebos are more properly directed at the medical conditions a placebo could supposedly address. If a placebo is just as effective at reducing anxiety as a drug designed for that purpose, what does that tell us about the nature of anxiety? Is participation in a research study motivating people to do other ostensibly anxiety-reducing activities? How exactly are these additional activities helping the problem? Even if placebos aren’t cures, we should be able to learn more about real medical conditions by investigating how people respond to a fictional “treatment.”

In a separate post, Neuroskeptic brings up another problem with placebos: Just as drugs have side effects, people can also report side effects when given a placebo. In an experimental trial, participants are given the same set of instructions—including warnings about side effects—whether they are given a placebo or the treatment being tested. This is an important part of the testing process because in order to test for the placebo effect, both the experimenter and the patient must be unaware of whether a placebo is being administered. After being warned of side effects, people receiving a placebo in trials for an antidepressant said they experienced side effects ranging from dry mouth to impotence. But in a test for a migraine drug, people receiving the same placebo reported different side effects: sleepiness and dizziness.

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:hi:

[MADem]

1. The human brain is an amazing thing. nt

[HuckleB]

4. Yes, it is.

[Lint Head]

2. Reads like a placebo headline.

[HuckleB]

3. .

:shrug: