Sex And The Placebo Effect: Women Learn, And Men Just Listen!

Sex differences for placebo effects not only exist, but they follow some rules, as it appears:

* Despite higher pain sensitivity in females, placebo analgesia is easier to elicit in males;

* It appears that conditioning is effective specifically to elicit nocebo effects;

* Conditioning works well to elicit placebo and nocebo effects, but only in females;

* Verbal suggestions are insufficient to induce placebo effects in women but work in men.

Read the whole article, in Science Trends.

Emerging Guidelines for Using Placebos in Clinical Practice

It is becoming increasingly clear that the placebo effect has a great influence on medical treatment. An international, interdisciplinary team of researchers led by Professor of Health Psychology Andrea Evers from Leiden University has now written a first set of guidelines on how to apply the placebo effect in clinical practice, published in Psychotherapy and Psychosomatics.

It was the result of the first official conference of the Society for Interdisciplinary Placebo Studies (SIPS), which was held in Leiden last year. During an interdisciplinary workshop led by Evers, a group of leading international researchers reached the consensus that knowledge about placebo and nocebo effects could lead to better treatment results with fewer side-effects. According to the researchers, it is crucial that patients receive more information about these effects, and that doctors receive training on the best doctor-patient communication to maximise placebo effects and minimise nocebo effects.

Read the full article here.

PLACEBOS and the immune response

Could brain stimulation slow cancer?

The idea is that ‘the placebo effect’ activates the same ‘Reward Circuit’ in the brain as that “activated by food, sex and social interactions (as well as gambling and addictive drugs)”. This in turn stimulates the immune system and generates ‘anti-tumor immunity’ against pathogens.

This is Scientific American, dear readers, and the claim is based on the kind of clinical experimentation that placebos are now inspiring. Placebo Studies!

“It’s like doing immunotherapy without medication.”

At the moment it’s just been shown in mice, and the ‘data are preliminary’, but even if it turns out only partly to be shown in humans, the implications are profound.

Five myths about placebos

1. The placebo effect is all in the mind.

“In reality, placebo treatments can cause measurable, biological changes similar to those triggered by drugs.”

2. Placebos work only if patients think they’re real.

“Over the past few years, however, scientists have found that this isn’t true. Honest (‘open label’) placebos work, too.”

3. Neurotic, suggestible people are more likely to respond to placebos.

“It’s not neurotic people who see benefits … but rather those who are optimistic, altruistic, resilient and straightforward.”

4. You have to take a placebo to get a placebo effect.

“It’s true that placebos won’t shrink a tumor, cure an infection or replace insulin in someone with diabetes. But many “real” medical treatments — particularly those that modify symptoms like pain, fatigue, nausea or depression — rely on the placebo effect.”

5. Drugs are always more effective than placebos.

A rigorous recent study of 152 trials found that placebo effects are often about the same as drug effects.

For more detail on all of the above, and references to research, read the Washington Post article.

More on ‘Open Label’ Placebos

Open Label Placebos (OLPs) are becoming a Thing, reinforced once more by Ted Kaptchuk’s placebo research group at Harvard Medical School. This article – Open-Label Placebo (OLP): Take This, It Is A Sugar Pill, It Will Help You! – provides us with a succinct update on the current clinical research scene, including valuable reference to two meta-studies which attempt to summarise the current state of our understanding. Importantly, the writers note that formal studies to date “have shown that while openly-applied placebos affect symptoms (depression, motor activity, pain, fatigue, etc.), none have yet shown that it may also affect disease biomarkers. Secondly, patient (self-)selection has to be tested for biases, e.g., whether the recruited patients are prone to respond to placebo, while others not recruited are not. Last but not least, it would be important to know how OLP compares to effective drug treatment of the same condition and in the same patients.”

Let’s Talk About Sex

Are aphrodisiacs placebos? What would happen if you spent a whole day eating them?

Read about Insider writer Sara Hendricks’s experiment with binge-eating foods claimed to have aphrodisiac properties, leading up to (spoiler alert) her conclusion that “at the end of the day, whether or not an aphrodisiac food works might simply depend on how much faith you have in the placebo effect. Aphrodisiacs, as it turns out, may very well be in the eye of the beholder.”

The Man Who Overdosed on Placebo

The Nocebo effect, dramatically illustrated …

Several years ago, a published case study describes a 26-year-old man who was taken to the emergency room. After arguing with his ex-girlfriend, he attempted suicide by swallowing 29 capsules of an experimental drug that he obtained from a clinical trial that was testing a new antidepressant. When he arrived at the hospital, he was sluggish, shaking, and sweating and had rapid breathing. His blood pressure was extremely low at 80/40, and his pulse was 110.

Doctors were successful at raising his blood pressure. Over the course of four hours, they injected him with 6 liters of saline solution. His blood pressure increased to 100/62, which is at the lower end of the normal range, but his pulse remained high at 106.

What finally cured the patient wasn’t anything the emergency room staff did. Instead, a doctor from the clinical trial arrived at the hospital. He told the patient that those antidepressant pills weren’t antidepressants because he had been randomized into the control arm of the trial. Yes, that’s right: He overdosed on placebos.

Oh.

Within 15 minutes, the patient’s blood pressure stabilized at 126/80, and his heart rate dropped to a perfectly normal 80 beats per minute.

Read the entire article here.

Patients may be experiencing placebo effect, but it’s still an effect: “Placebo is active treatment”

 

In Respect the Needle in OA (osteoarthritis),  a rheumatologist says:

“… Dealing with osteoarthritis, both patients and their physicians often have a hard time understanding what to make of novel “cures” such as platelet-rich plasma (PRP), stem cell treatments, and so-called prolotherapy.

Although these are typically marketed as halting or reversing joint degeneration in OA, there is virtually no evidence that they actually do. Yet it’s impossible to discount the countless reports from patients that the treatments helped them in terms of pain and function.

The explanation may very well lie in the placebo effect, said Joel Block, MD, a well-known osteoarthritis specialist at Rush University, speaking at the American College of Rheumatology’s 2018 State of the Art Symposium.

But the thrust of Block’s 30-minute talk can be summed up in two words: So what?

The placebo effect is still an effect and a very important one, he argued repeatedly in addressing current knowledge about therapies, largely unregulated, now marketed nationwide in newspapers and online as “disease-modifying.”

It’s “extraordinarily strong” in osteoarthritis, Block said, for reasons that aren’t entirely clear. The experience from randomized trials is that one normally expects a 40% response rate with placebo with large effect sizes. Moreover, the improvements in patient-reported pain do not quickly disappear: the trial data indicates that placebo responses last beyond a year, he said.

“Placebo is active treatment,” Block said.

Placebos in the Reader’s Digest

You know that something’s popular when it pops up in the Reader’s Digest. This article comments on the “growing scientific interest in the placebo effect”, and notes:

Because placebos are believed to work only on condition of expectation of positive relief, they were considered to be good only for psychosomatic ailments and not real physical ailments.

But this does not seem to be borne out by recent studies, nor by years of experience of many people around the world. Placebos have been shown to result in the real cure of physical ailments such as a broken heel or torn ligament, not only psychological ones.

Much Ado … About that New Antidepressant Study

A recent ‘meta-study’ claims that placebo are NOT, in fact, on par with conventional antidepressant medications, as we have reported numerous times in this blog. It seems, however, that this study should be read with certain caveats, most particularly that “The review’s authors have acknowledged that almost 80% of the studies they analysed had been funded by the pharmaceuticals industry.” (Fawning Coverage of New Antidepressants Review Masks Key Caveats) Confirmation bias, anyone?