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”
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.
Interesting CNN article and video on the real -and growing – effects of fake pills. It concludes:
‘As most of us would guess, the placebo perceived by patients to be more expensive worked better than its seemingly lower-cost equivalent … Perceptions of cost are capable of altering the placebo response,.
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.
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.”
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.
… 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.
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.
An international expert on the “placebo effect” says with addiction and abuse of opioid prescription drugs on the rise, it may be time for doctors treating patients with chronic conditions or addictions to consider intermittently substituting substances like morphine with dummy pills.
With or without telling patients.
“Placebos are being used in routine medical practice now by many doctors in many circumstances, but the main goal is to reduce intake of drugs. If we are talking about narcotics and other drugs of abuse, the approach is, for example, give morphine on six consecutive days and then a placebo on the seventh day. There are three or four studies with good scientific approaches to this and in those three countries I mentioned, placebo prescribing is more common.”
Asked about the ethics of substituting pills, he said:
“If you want to reduce intake of certain drugs, why not? I think that’s perfectly ethical, but if you want to prescribe placebos so you aren’t bothered by hospital patients in the middle of the night, that’s a different situation.”
Benedetti told delegates that researchers now understand more about the psychosocial context for real drug or placebo treatment effects. Certain words spoken by the health professional (“This pill is really going to help you”), the rituals associated with treatment (such as needle injections) and other sensory experiences all influence whether patients have positive expectations of health improvement. Personality traits can be important factors in who responds to placebos; optimists are more susceptible to having a placebo response while skeptics may have a nil effect.
Full article here.
Many operations are no better than placebo, says a top surgeon. Orthopaedic surgeon Ian Harris believes millions of healthcare dollars are wasted on operations that may not work.
For a doctor who’s taking a metaphorical scalpel to the operating decisions of his colleagues, it’s surprising Sydney orthopaedic surgeon Ian Harris doesn’t have a target on his forehead.
In the past few months, Harris has been spreading the seedier secrets of the surgical world, chief among them that thousands of operations commonly performed in hospitals everywhere don’t actually work.