In this article the author argues strongly against using the ‘double blind placebo controlled’ methodology in testing the effectiveness of the numerous vaccines now in the works.
” … the use of a placebo in a challenge trial for a Covid-19 vaccine is both pointless and ethically questionable.
We’ll use a deliberately simplistic analogy to help explain why. Suppose we need to test a new type of parachute during wartime, when a better parachute happens to be urgently needed. Sooner or later it will have to be tried in a real jump. But we won’t let that happen until we are already quite sure it is going to work. And we are certainly not going to give dummy parachutes to a control group, randomly selected from a group of volunteers. We already know what will happen to them.”
While this logic may hold, as far as testing vaccines go, but we wonder if there’s space to think that, at least for symptoms if not the condition itself, placebos might have a place? After all, nobody yet understands how an intangible input like a placebo actually seems to cause real effects in the material world …
We have posted for a while now on so-called ‘open label’ placebos, and the placebo effect engaged when someone actually knows they’re taking a sugar pill (or any other placebo treatment such as a saline injection).
This report, in Science Alert, claims that “across two experiments (…) during a highly arousing negative picture viewing task, non-deceptive placebos reduce both a self-report and neural measure of emotional distress.”
It seems that ‘open label’ placebos can also be described as ‘non-deceptive placebos’. This designation is of importance where researchers try to tackle the ethical issues involved in ‘lying’ to people about the test drug (or non-drug) being administered.
“What if someone took a side-effect free sugar pill twice a day after going through a short convincing video on the power of placebos and experienced reduced stress as a result?” says lead researcher and psychologist Darwin Guevarra from Michigan State University (MSU).
“The pancebo effect is when a person begins to worry that the worst is about to happen without valid evidence. It’s panic over logic.”
This article at Huffpost was written by a Canadian in the early days of the virus (where were you on the 2nd of March?). Of course it reads as naive and uninformed right now, in August, but we include it because it’s the first time we’ve come across the term ‘pancebo’, which remains topical. This was not, perhaps, the author’s intent, since he was referring to a kind of fear-panic (a ‘nocebo’) inspired by the emergence of Covid-19. Instead, these days, it might better refer to the rash of crazy conspiracy theories that crowd our newsfeeds. It’s still about fear, but the ‘pancebo effect’ of fear of the virus seems to have been translated into a generalised fear of authority figures, health officials, government and anyone who can be vaguely associated with the panglobal lizard people who are ‘really’ in control.
Our placebos make an appearance, and our motto NOTHING WORKS BETTER, is featured in the article What is the Value of Placebo Pills? which includes links to further placebo-related sites. Well worth checking out.
“If you believe pharmaceutical corporations hold the health of the general public in high regard, it’s time to reconsider. The industry is filled with examples of wrongful death, extortion, fraud, corruption, obstruction of justice, embezzlement, fake journals, harassment and hit lists that would make even the most hardened Mafia godfather blush.”
Scientists have known since at least the 1930s that a doctor’s expectations and personal characteristics can significantly influence a patient’s symptom relief. Within research contexts, avoiding these placebo effects is one reason for double blind studies — to keep experimenters from accidentally biasing their results by telegraphing to test subjects what they expect the results of a study to be.
Students in the doctor group had previously been conditioned to believe that one of the creams was pain reliever. But in reality both of the two creams that they administered were an identical petroleum jelly-based placebo. And yet, when the doctor actors believed that the cream was a real medication — the researchers even gave the pseudo-medication a name, “thermedol” — the patient actors reported experiencing significantly lower amounts of pain.
As well-documented as the placebo effect is, to see it play out so cleanly surprised the study’s authors themselves. “We did several more studies to convince ourselves it wasn’t just a fluke,” says the study’s primary author, Luke Chang of Dartmouth University. “I’m impressed at how robust the effect seems to be.”
It seems that this damned placebo effect is getting in the way of developing and authorising new psychiatric drugs. It creates a ‘therapeutic bias'(!) and so the experimenters are experimenting with ways of controlling for it in trials, for example ‘SPCD, sequential parallel comparison design’. These are proving to be not (yet) up to the task, sufficient to be acceptable by bodies such as the RDA. The following is from The Placebo Effect Is Hobbling New Psychiatric Drugs
“The FDA’s rejection cast doubt upon the design, still in use in more than a dozen trials, as a weapon against the placebo effect.
That’s big news because the effect, also called the placebo response, has been growing stronger over the years in clinical studies that randomly assign patients to either an active drug or placebo. When the effect is high, it’s hard to know if a drug just isn’t good enough, if there are errors in the data, or if the participants taking the placebo—an inert pill meant to make them believe they’re getting the real thing—fared unusually well because of their expectations.
It’s a testament to the power of our minds to improve our health, at least temporarily. Many factors boost placebo response. “Most people, whether they know it or not, are biased to believe that they will receive the active drug even if they are told that they have a 50 percent chance of getting placebo, and this ‘therapeutic bias’ increases the placebo response,” says John Krystal, the chair of the psychiatric department at the Yale School of Medicine in New Haven, CT.”