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!
“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.
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.
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.
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.
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.
In his book, ‘Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal’ author Erik Vance explores placebos, hypnosis, and how beliefs influence bodily responses to pain.
“Placebos and beliefs generally is so much a part of our lives,” he tells Kishore Hari on a recent episode of the Inquiring Minds podcast. “It has an amazing power to change our bodies.”
Read the article here, or listen to the Podcast!
“I was just amazed that you could change what price you were going to launch a product at, and you could change what brand it was, and people would have dramatically different impressions of that product. And they would tell you incredibly different things about the product: they thought it was made of different materials, they thought it weighed more or it weighed less. Really out-there stuff that, at the time, we joked about but we couldn’t explain.”
More here. And meanwhile, for your listening pleasure …
This question/comment/assumption comes up a lot when we talk to people about placebos and the placebo effect. ‘It works’ (is the assumption) ‘if people believe it’s something else’ …
Like the ‘real’ thing, perhaps …? We’ve posted on this before, and it seems the research is becoming more robust and rigorous.
Once more, courtesy of Professor Kaptchuk … read Knowingly Taking a Placebo Still Reduces Pain, Studies Find …
NBC News reports:
“The study included about 300 kids aged 8 to 17, enrolled at 31 centers. They had 11 migraines on average in the month before the study began and were randomly assigned to take either of the drugs or placebo pills daily for six months. Migraine frequency in the study’s last month was compared with what kids experienced before the study. At least half of kids in each group achieved the study goal, reducing migraine frequency by half.”
The same report, with a couple of videos, is over at CBS.