Tag Archives: Medicine

PLACEBO AND FAKE SURGERY

Two thought-provoking articles relating the placebo effect to ‘sham surgery’, which has been canvassed in these pages previously.

In this meta-study, the authors point out that ” the literature is not chock full of studies comparing a surgical procedure to placebo. While the study of a drug versus placebo is standard practice, the picture changes radically when the placebo is a sham operation involving incisions and anesthesia …  Of about 3000 articles, 53 full-text articles were selected. They represented randomized controlled studies, with both an active intervention and a placebo arm involving a sham procedure. The authors defined a surgical outcome based on three elements:

•    The critical surgical component – the anatomic changes felt to result in a therapeutic effect

•    Placebo component – the patient’s expectations

•    Non-specific effects – changes in the natural history of an illness that might impact the outcome, the experience of being in a hospital, interactions with staff – the multitude of other factors.

In this study, the author admits that sham (placebo) srugery already occurs. Because it can work.

How?

“How can sham surgeries work? Bigness. In the same way that placebo pills and other modalities make people get better, the clinical evaluation, workup, stress and travel of surgery day, surgical prep, etc. all make for an almost unbeatable set of placebo-instituting conditions. And with some of the data which exist, sham surgeries perform better in the patients’ minds than a drug treatment that’s a comparator for the same condition.

Placebos and acupuncture

Here’s a link to a fascinating meta-analysis of the effectiveness of acupuncture in the treatment of chronic pain, controlling for some of the dodgy and unscientific ‘studies’ out there.

In this article, the outcomes of the study are listed and discussed, and it’s good news for acupuncturists.

‘When comparing legit acupuncture to standard care, there was a statistically significant benefit to acupuncture … “We saw a measurable effect there,” he explains. “If acupuncture were a drug, we’d say the drug works.”’

…and later, in relation to the placebo effect:

‘Many people equate placebo effects with scams. “The term placebo has always had this very negative connotation,” says Vitaly Napadow, director of the Center for Integrative Pain Neuroimaging at Harvard Medical School. But Napadow says our poor opinion of placebo needs revising. The human body has built-in systems for stoking or calming pain and other subjective sensations. “If a placebo can target and modulate these endogenous systems, that’s a good and a real thing,” he says.’

Meanwhile, in two comprehensive studies into the value of acupuncture treatment in treating women’s health issues, we see mixed results.

‘These studies shed new light on when and when not to consider using acupuncture,” Dr. Josephine Briggs and David Shurtleff, of the U.S. National Center for Complementary and Integrative Health, wrote in an editorial to accompany the studies.

The research done to date on acupuncture has shown that, generally, its benefits are limited to outcomes that are subjective, such as pain, Briggs and Shurtleff wrote. People’s positive expectations and the reassurance they feel from the procedure likely contribute to the benefits. “Clearly these ancient practices are helping reveal the complexity of the links between the mind and the body,” the editorial said.’

Meta-Analysis: Data on placebo effect and antidepressants in children and adolescents

Although the clinical efficacy of antidepressants in children and adolescents is proven, it is frequently accompanied by side effects. In addition, the influence of the placebo effect on the efficacy of antidepressants is unclear. A meta-analysis of data from over 6,500 patients has now shown that, although antidepressants are more effective than placebos, the difference is minor and varies according to the type of mental disorder. The results were obtained by the University of Basel and Harvard Medical School and were published in the journal JAMA Psychiatry.

The results of the meta-analysis show that, although antidepressants work significantly better than placebos across the range of disorders, the difference is small and varies according to the type of mental disorder. However, the results also showed that the placebo effect played a significant role in the efficacy of antidepressants. The study also found that patients treated with antidepressants complained of greater side effects than those who received a placebo. The side effects included everything from mild symptoms such as headaches to suicidal behavior.

Placebos and surgery

“Certain types of elective surgery only benefit patients because of placebo effect, says Prof Andy Carr.”

We’ve posted on this previously, on the mater of ‘sham srugery’ for knee pain actually having a substantial impact on lessening pain. In this case, a senior orthopaedic surgeon in Britain, says “The correct thing has got to be to do … trials – not to continue doing operations where we don’t know whether or not there’s a strong placebo component or an entire placebo component because that means that tens or hundreds of thousands of patients are having unnecessary operations,” he said.

That’s right – ‘tens or hundreds of thousands’.

Another professor, also from Oxford, points out the opinion, which we have seen has been gathering momentum (and scientific respectablity) over the past couple of years, that ‘deception’ is not a requirement for the engagement of the placebo effect. “In the modern world where we’re trying to limit the amount of time physicians spend with patients we’re going in the opposite direction of what the science is telling us, which is that [expectation] is really important physiologically and therapeutically and we’re throwing that away.”

Read the whole Guardian article here.

‘I knew they were sugar pills but I felt fantastic’

And more on the efficacy of so-called ‘open label’ placebos (like ours!)

Linda Buonanno had suffered 15 years of intense cramps, bloating, diarrhoea and pain she describes as “worse than labour”. She was willing to try anything to get relief from her irritable bowel syndrome (IBS) and leapt at the chance to take part in a trial of an experimental new therapy. Her hope turned to disappointment, however, when the researcher handed her a bottle of capsules he described as placebos containing no active ingredients.

Nonetheless, she took the pills twice daily. Four days later, her symptoms all but vanished. “I know it sounds crazy,” says Buonanno, of Methuen, Massachusetts. “I felt fantastic. I knew they were just sugar pills, but I was able to go out dancing and see my friends again.”

Placebos have a reputation problem. It is widely believed they are only effective when those taking them are deceived into thinking they are taking real drugs. As such, prescribing dummy or fake treatments is unethical. Yet in Buonanno’s case there was no deception. And she is not alone. A review of five studies, involving 260 patients, published last month found that “open-label” placebos – those that patients know contain no active medication – can improve symptoms in a range of conditions. This growing body of evidence raises a number of important questions. How do open-label placebos work? Which conditions do they work for? And should doctors prescribe them?

Read the whole article here.

A steroid shot for your knee pain? Just skip it!

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. They have been commonly prescribed for sufferers of knee pain and inflammation, called synovitis, or knee osteroarthritis. In common with most steroids, these drugs are associated with a wide variety of adverse side effects. Depending on the dose, these may include:

Elevated pressure in the eyes (glaucoma)
Fluid retention, causing swelling in your lower legs
High blood pressure
Problems with mood, memory, behavior and other psychological effects
Weight gain, with fat deposits in your abdomen, face and the back of the neck

Taking the drugs over a longer period may produce:

Clouding of the lens in one or both eyes (cataracts)
High blood sugar, which can trigger or worsen diabetes
Increased risk of infections
Thinning bones (osteoporosis) and fractures
Suppressed adrenal gland hormone production
Thin skin, bruising and slower wound healing

A recent study (full text here) has shown that a group of patients injected with a corticosteroid medication over two years showed no decrease in pain, relative to a group taking placebos. However, the ‘placebo group’ did not suffer the loss of cartilage (indicating progression of the condition) over that period.

‘CONVERSATION’ AND THE PLACEBO EFFECT

From the earliest days of placebo research the practitioner-patient relationship has been at the heart of theorising about its effectiveness in therapy (and in life!)

Here’s an article that explores ‘the conversation’ and its beneficial placebo effects.

” … it’s no surprise that chronic arthritis and back pain are the second and third most common non-acute reasons that people go to the doctor and that pain costs America up to $635 billion annually. The pain remedies developed by the pharmaceutical industry are only modestly effective, and they have side effects that range from nausea and constipation to addiction and death.

What’s often overlooked is that the simple conversation between doctor and patient can be as potent an analgesic as many treatments we prescribe.”

… and …

“It’s clear that how doctors and nurses communicate their treatment can have profound effects on how patients experience the results of that treatment. Yet the conversation between doctors and patients is one of the least valued aspects of medical care. Insurance reimbursements for tests and medical procedures dwarf reimbursements for talking to patients or spending time thinking about what ails them. And the pharmaceutical industry, with its direct-to-consumer advertising, has promulgated the fallacy that every ailment must be met with a pill — brand name, of course.”

Is acupuncture a placebo?

In a report published in the National Institute for Health Research (NIHR) Journals Library, the researchers showed that there is significant evidence to demonstrate that acupuncture provides more than a placebo effect.

Professor of Acupuncture Research, Hugh MacPherson, working with a team of scientists from the UK and US, brought together the results of 29 high quality clinical trials focused on patients treated with acupuncture and standard medical care.

In the majority of these trials, patients with chronic pain treated with acupuncture and standard medical care were tested against those who were provided with standard medical care alone, such as anti-inflammatory drugs and physiotherapy. The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.

The report shows that the addition of acupuncture compared to standard medical care alone significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain. It also showed that acupuncture reduced the pain and disability of osteoarthritis, which led to patients being less reliant on anti-inflammatory tablets to control pain.

Read the full article here.

Broken heart? You need a placebo!

All over the interwebs right now!

Researchers at the University of Colorado-Boulder studied 40 recently jilted volunteers and found they displayed less physical pain and felt better emotionally — even after receiving a fake drug.

“Breaking up with a partner is one of the most emotionally negative experiences a person can have, and it can be an important trigger for developing psychological problems,” said the study’s lead author, Dr. Leonie Koban.

“In our study, we found a placebo can have quite strong effects on reducing the intensity of social pain,” she said.

Among the myriad stories covering this, check out the New York Daily News, MedicalExpress, and Science Daily.