Tag Archives: Medicine

When you know you’re taking a placebo …

This question/comment/assumption comes up a lot when we talk to people about placebos and the placebo effect. ‘It works’ (is the assumption) ‘if people believe it’s something else’ …

Like the ‘real’ thing, perhaps …? We’ve posted on this before, and it seems the research is becoming more robust and rigorous.

Once more, courtesy of Professor Kaptchuk … read Knowingly Taking a Placebo Still Reduces Pain, Studies Find …

Arthritis medication: placebo beats supplements

Many people take glucosamine and chondroitin supplements for arthritis pain, but a controlled trial has found no evidence that the combination works. In fact, in this study, the placebo worked better.

Spanish researchers randomized 164 men and women with knee osteoarthritis to take a single daily dose of 1,500 milligrams of glucosamine and 1,200 of chondroitin, or an identical looking placebo. The study is in Arthritis & Rheumatology.

Read the full article here.

 

Placebo Effect Works for Heart Procedures, Too

New research has shown that patient’s envisioning and expecting positive results from major surgery, including open heart surgery, will over time actually recover and heal more effectively.

“Optimizing patients’ expectations pre-surgery helps to improve outcome 6 months after treatment. This implies that making use of placebo mechanisms has the potential to improve long-term outcome of highly invasive medical interventions”

On Placebos and Depression Drugs

We note an interesting ‘counter narrative’ emerging – that is, scepticism about the commonly held view that drug treatments designed for mood disorders such as depression often engage the Placebo Effect. In this counter-narrative,

“Drug trials don’t show much in the way of classic placebo effects. The rise in placebo responses over the years is more likely due to the supportive factors in drug trials…and increasing problems with enrollment.”

The new finding—no upward trend in placebo responses—is unexpected and certain to be contested. Meanwhile, it stands as a rebuke to a popular narrative. By that account, drug effects had been hyped, expectations soared, and the inflated hopes were reflected in rising placebo response rates.”

This is fine, except the counter-narrative also resonates with challenges about the efficacy of conventional ‘gold-standard’ ‘blind’ ‘placebo controlled’ drug trials, where it has been shown that trials funded by drug companies (who by definition have a vested interest in their outcome) are 30% more likely to return ‘favourable’ results than trials which are not funded in this way. The ‘placebo effect’ might be the design and execution of the trial itself, not the actual function and efficacy of the placebo …!

Read the whole article here.

Taking placebo pills may ease chronic back pain

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Quite a buzz lately about the placebo effect and back pain, extending from a randomized control trial in Portugal.

“Our findings demonstrate the placebo effect can be elicited without deception. Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered.” – Lead author Claudia Carvalho, Ph.D., ISPA

“It’s the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our healthcare system,” (says placebo researcher Ted Kaptchuk, Professor of Medicine at Harvard Medical School). “The body responds to that.”

While this study focused on chronic pain, Kaptchuk says it is possible that patients with other conditions that involve self-observation – such as fatigue, depression, or digestive problems – may benefit from open-label placebo treatment.

“You’re never going to shrink a tumor or unclog an artery with placebo intervention,” notes Kaptchuk. “It’s not a cure-all, but it makes people feel better, for sure. Our lab is saying you can’t throw the placebo into the trash can. It has clinical meaning, it’s statically significant, and it relieves patients. It’s essential to what medicine means.”

Read the whole article here, and another here.

‘Useless’ surgery is still popular

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It seems that the placebo ‘hierarchy’ still plays out – a pill is trumped by a saline injection, which is trumped by ‘surgery’. Studies suggest that patients in the USA are opting for ineffective knee surgery in the belief this will relieve pain, even though it is likely that such an effect is … well, a placebo effect

“I personally think the operation should not be mentioned.” … But if a doctor says anything, Dr. Guyatt suggests saying this: “We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications.”

Prescribe a placebo?

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In Why Placebos Really Work: The Latest Science the Wall Street Journal points to the increasing frequency of ‘serious’ science envisioning health interventions that consciously include placebos and invoke the placebo effect. It seems the mind-body divide is something of an illusion!

Nevertheless, even though at least 50% of doctors actively prescribe placebos – often active drugs in such low doses that there is no apparent therapeutic benefit, or vitamins, antibiotics or over-the-counter analgesics like aspirin – they are still disinclined to prescribe a sugar pill. I guess they feel like it’s cheating, somehow.

Placebos DO work: Bogus pills ‘trigger similar healing process to real drugs’

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… and have helped people with migraines, IBS and Parkinson’s.

Placebos have been shown to work for migraines, toothache and IBS

Parkinson’s patients continued to get relief after switching to placebos

After drugs, body becomes pre-conditioned to expect treatment and reacts

50% of American doctors found to prescribe placebos instead of drugs

New studies in the Boston suggest that placebos may causes changes in the body as well as the mind. Even with patients knowing they are being given a non-medicinal drug substitute they have still reported reduced pain and other symptoms in everyday, debilitating conditions such as irritable bowel syndrome or migraines.

The ethics of placebo use in medicine

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As practitioners become a little more ‘open’ about their use of placebos, it’s time now to discuss the ethics of such use. From Glackin’s abstract:

It is widely supposed that the prescription of placebo treatments to patients for therapeutic purposes is ethically problematic on the grounds that the patient cannot give informed consent to the treatment, and is therefore deceived by the physician. This claim, I argue, rests on two confusions: one concerning the meaning of ‘informed consent’ and its relation to the information available to the patient, and another concerning the relation of body and mind. Taken together, these errors lead naturally to the conclusion that the prescription of placebos to unwitting patients is unethical. Once they are dispelled, I argue, we can see that providing ‘full’ information against a background of metaphysical confusion may make a patient less informed and that the ‘therapeutic’ goal of relieving the patient of such confusions is properly the duty of the philosopher rather than the physician. Therapeutic placebos therefore do not violate the patient’s informed consent or the ethical duties of the doctor.

The whole paper can be found here. It seems the article has stirred up something of a hornet’s nest among ‘psychopharmacologists’ – see the recommendations listed at the foot of the website.