Tag Archives: Mind and Body

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.

Want to think outside of the box? Try sniffing a placebo

We usually think of placebos as tools for therapy, or perhaps as marketing strategies, but here’s an idea about the placebo effect and creative thinking.

“The placebo effect is best known in medicine for making people feel better when they are given sham treatments. Now there is growing interest in using placebos to boost athletic and cognitive abilities.

Previous studies have found that people lift more weight and cycle harder when they take medicines with no active ingredients that are falsely labelled as performance-enhancing substances. Placebo pills have also been shown to improve scores in memory tests.

These findings prompted Lior Noy and Liron Rozenkrantz at the Weizmann Institute of Science in Israel to test whether the placebo effect can stimulate creativity too.

They asked 90 university students to sniff a substance that smelled of cinnamon. Half the students were informed that the substance had been designed to enhance creativity.

The participants then completed a series of tasks designed to test their creativity. One involved rearranging squares on a computer screen into different shapes. Another required them to think up new uses for everyday items like shoes, pins and buttons.

Those who were told the smelly substance increased creativity scored higher on measures of originality. For example, they came up with more unusual shape configurations and novel applications for the everyday items. “The improvements weren’t enough to turn you into the next Picasso, but they were significant,” says Noy.”

Read the full article here.

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.’

Yes, the placebo effect is all in your mind. And it’s real.

It seems that the research on the placebo effect is broadening and deepening.

“Over the last several years, doctors noticed a mystifying trend: Fewer and fewer new pain drugs were getting through double-blind placebo control trials, the gold standard for testing a drug’s effectiveness.”

This recent article, which includes some useful links for further reading, points to the degree in which the placebo effect (classified by the writer as a ‘family of overlapping psychological phenomena’) is being studied and considered. The family of placebo effects ranges ‘from the common sense to some head scratchers’, and include:

1) Regression to the mean
2) Confirmation bias
3) Expectations and learning
4) Pharmacological conditioning (‘This is where things get a little weird’)
5) Social learning
6) A human connection

Interestingly, it seems that at least in pain studies, ‘there’s evidence that placebos actually release opioids in the brain’.

In another article in Mother Jones, What the Heck Is a Placebo Anyway?, the authors propose ‘… we now know that they (placebos) often involve real chemicals produced by the body—real drugs from your “internal pharmacy.” Some of these chemicals are used by the brain to make sure that your expectation meets reality. When expectation doesn’t meet reality, the brain steps in and forces it to fit.’

Over at Fox News (of all people), quoting the Wall Street Journal, they’re suggesting ‘Placebo drugs really work, evidence suggests‘.

Placebo ‘drugs’? Come on, folks, that misses the point a bit!

‘Mind Body’ Healing: The placebo effect and exercise

Damien Finniss was working as a physiotherapist when, on a still winter’s afternoon in 2001, he set up his treatment table in a shed at the perimeter of a Sydney footy ground.

As players came off with sundry aches – a pulled hammy here, a calf strain there – Finniss ministered to them with therapeutic ultrasound, a device that applies sound waves to the injured area with a handheld probe.

“I treated in excess of five or six athletes during the training session. I’d treat them for five or 10 minutes and they’d say ‘I feel much better’ and run back on to the training field,” recalls Finniss, now a medical doctor and Associate Professor at the University of Sydney’s Pain Management and Research Institute.

“But, at the end of the session, I realised that I’d, basically, had the machine turned off.”

Read the whole article here.

Meanwhile, in Germany, researchers reveal some convincing evidence of the impact of the placebo effect, discovering that “a person’s expectations have a major influence on just how strenuous they perceive exercise to be.”

 

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.

‘Psychological Interventions’

A recent meta-study in the World Journal of Gastroenterology (March 28 2017) – Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

Aim – “To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome.” (Six studies, with a total of 555 patients met the inclusion criteria.)

… and the placebo effect, unsurprisingly, figures significantly:

“Contrary to our expectations, the PRR (Placebo Response Rate) in studies on psychological interventions was comparable to that in studies on pharmacological, dietary and alternative medical interventions.”

Download the whole study in PDF here.

Placebo response and “Mindsets”

The research effort on the placebo effect deepens and widens.

“In a report published online Feb. 15 in The BMJ, researchers at Stanford call for more health care providers to place emphasis on the importance of individual mindsets and social context in healing … (and) to develop more studies that measure the physical effects of these psychosocial elements to understand and quantify patients’ subjective experiences of expectations, connection and trust.”

“We have long been mystified by the placebo effect,” Crum said. “But the placebo effect isn’t some mysterious response to a sugar pill. It is the robust and measurable effect of three components: the body’s natural ability to heal, the patient mindset and the social context. When we start to see the placebo effect for what it really is, we can stop discounting it as medically superfluous and can work to deliberately harness its underlying components to improve health care.”

Read the article here.