There are some preconceptions about placebos and the placebo effect. You might be surprised to read, for example, that ‘placebo pills’ are not needed to achieve a ‘placebo effect’. This article unpacks six perhaps surprising features of the placebo effect, namely:
Placebos have a dark cousin: nocebos
Placebos work even if people know they are placebos
Honest placebos are ethically acceptable
Placebo effects are part of most treatment effects
You don’t need placebos to have placebo effects
You can generate placebo (and nocebo) effects in yourself
It remains to be seen how the emerging field of Placebo Studies will incorporate the tidal surge in the use and application of Large Language Models and other forms of AI. It may be that an AI can learn to stimulate the placebo effect periodically, or as the output of some kind of trigger. It may be that the AI can also be used, consciously or not, to trigger a ‘nocebo’ effect. As with all things AI, it’s a balancing act between the extraordinary potential of the technology for benefit or for harm. But the genie is certainly out of the bottle. The graphic for this post was generated by Bing Image Creator purely from a text prompt: “The placebo effect in a world of advanced technology”
“لسبب ما أنا مغطاة بالدم”: لغة GPT-3 تضم تحيزات مزعجة ضد المسلمين
We’re creatures of our times here at Universal Placebos, so we had to get amongst ChatGPT on the topic of placebos.
Universal Placebos: Write a blog post on the pros and cons of using placebo medication.
ChatGPT: Introduction:
Placebo medication is a type of treatment that is often used in clinical trials to test the effectiveness of new drugs or treatments. It is a substance that looks and tastes like a real medication, but does not contain any active ingredients. The purpose of a placebo is to create a control group for comparison, allowing researchers to determine whether a new drug or treatment is truly effective. In this blog post, we will explore the pros and cons of using placebo medication.
Pros:
Creates a Control Group: One of the most significant benefits of using placebo medication is that it creates a control group that can be used for comparison. In clinical trials, researchers typically divide participants into two groups: one group receives the new drug or treatment, while the other group receives a placebo. By comparing the outcomes of the two groups, researchers can determine whether the new drug or treatment is effective.
Minimizes Bias: Another benefit of using a placebo is that it can help minimize bias in clinical trials. When participants know that they are receiving a new drug or treatment, they may have higher expectations for its effectiveness, which can skew the results. Placebos can help prevent this by creating a more objective comparison between the two groups.
Safe: Placebo medication is safe and has no side effects, which makes it an ideal choice for use in clinical trials. In contrast, some drugs and treatments can have serious side effects, which can be harmful to participants.
Cons:
Ethical Concerns: One of the main ethical concerns associated with using placebo medication is that it involves deceiving participants. Participants are often not informed that they are receiving a placebo, which raises questions about whether they have truly given informed consent. While some argue that this is necessary to ensure the integrity of the trial, others argue that it is unethical to deceive participants in this way.
Limited Use: Another disadvantage of using a placebo is that it can only be used in certain types of clinical trials. For example, it is not possible to use a placebo when testing the effectiveness of surgery or other invasive procedures. This limits the applicability of placebo medication as a research tool.
Reliability Issues: Finally, there are concerns about the reliability of placebo medication as a control group. Some argue that the placebo effect (the phenomenon in which a person experiences a perceived improvement in symptoms simply because they believe they are receiving treatment) can skew the results of clinical trials. This can make it difficult to determine whether a new drug or treatment is truly effective.
Conclusion:
In conclusion, placebo medication has both pros and cons when it comes to its use in clinical trials. While it can create a control group and minimize bias, it also raises ethical concerns and has limited use in certain types of trials. Ultimately, the decision to use a placebo should be made on a case-by-case basis, taking into account the specific circumstances of the trial and the ethical considerations involved.
Universal Placebos: For which conditions and under what circumstances might be consider a placebo treatment for a complaint?
ChatGPT: Placebo treatments are typically used in clinical trials as a control group to determine the effectiveness of a new drug or treatment. However, in certain cases, placebo treatments may also be used as a therapeutic intervention for a complaint. Here are a few examples of conditions and circumstances where placebo treatment may be considered:
Pain Management: Placebos have been shown to be effective in reducing pain in some cases. They may be used as a complementary treatment in conjunction with other pain management strategies, such as physical therapy or medication.
Irritable Bowel Syndrome (IBS): IBS is a condition that can be difficult to treat, and many patients experience symptoms that are not fully relieved by medication or other therapies. Placebo treatments have been shown to be effective in reducing symptoms in some patients with IBS.
Depression: Placebo treatments have been used in clinical trials to test the effectiveness of antidepressant medication. However, some studies have also shown that placebo treatments can be effective in reducing symptoms of depression on their own.
Anxiety: Placebos have also been used in clinical trials to test the effectiveness of anti-anxiety medication. However, some studies have shown that placebos can also be effective in reducing symptoms of anxiety.
Sleep Disorders: Placebos have been used in clinical trials to test the effectiveness of sleep medication. However, some studies have shown that placebos can also be effective in improving sleep quality.
It is important to note that the use of placebo treatments as a therapeutic intervention is still controversial, and there are ethical considerations to take into account. In general, it is important to discuss the potential risks and benefits of placebo treatments with a qualified healthcare provider before considering this type of intervention. It is also important to note that any use of placebo treatments should be transparent and fully informed, with patients fully understanding the nature of the treatment they are receiving.
Universal Placebos: Do you have an opinion on the efficacy of placebo treatments?
ChatGPT: As an AI language model, I don’t have personal opinions or beliefs. However, I can provide information on the scientific consensus regarding the efficacy of placebo treatments.
Placebo treatments have been shown to have some level of effectiveness in reducing symptoms in various conditions, including pain, depression, anxiety, and sleep disorders. The exact mechanism by which placebo treatments work is not fully understood, but it is thought to involve a combination of psychological and physiological factors.
Some studies have found that the placebo effect can be quite powerful, with some patients experiencing significant improvements in symptoms even when they are aware that they are receiving a placebo. Other studies have suggested that the placebo effect may be more modest, and that factors such as the severity of the condition being treated and the expectations of the patient may play a role in determining the magnitude of the effect.
It is important to note that while placebo treatments may be effective in reducing symptoms, they are not a substitute for evidence-based treatments. In some cases, placebo treatments may be used in combination with other therapies, such as medication or cognitive-behavioral therapy, to provide additional symptom relief.
Overall, the scientific consensus is that placebo treatments can be effective in reducing symptoms in some cases, but the exact magnitude of the effect may vary depending on the specific condition being treated and the individual patient. It is also important to note that the use of placebo treatments as a therapeutic intervention raises ethical concerns, and should be done with full transparency and informed consent.
“If a person believes an exercise program has been optimized and created specifically for them, the regime will have a positive effect, regardless of the content of the program.”
It follows that one of the first tasks of a fitness coach is to instill confidence that their exercise program is designed for YOU, that it’s tailored to your particular body shape, age, fitness level and so forth.
Forty people participated in this study. After a series of physical tests in the laboratory, they were all given different training programs.
Half of the participants were told that the training program they received had been specially adapted to them based on the tests that were carried out. This was the intervention group.
The other half, the control group, did not receive such a message.
The participants were all given training programs that varied with regard to weight and the number of repetitions, but on average the programs of the two groups were similar.
After completing the eight to 10 weeks of training, the participants were again tested in the laboratory.
“It turned out that those who thought they had received an individually adapted training program got better results on average than the control group. Even though the two groups had followed the same program on average.”
From Plato right down to ‘open label’ or ‘honest’ placebos, this counter-intuitive cure has found ready prescribers and users. And let’s not forget the Bible. In Saint Jerome’s fourth-century translation of the Bible into Latin, Verse 9 of Psalm 114 became: placebo Domino in regione vivorum. “Placebo” means “I will please”, so the verse in English reads: “I will please the Lord in the land of the living.”
The first directly medical implementation of placebo treatment is recorder in 1752 by the Scottish obstetrician William Smellie, who wrote, ““… It will be convenient to prescribe some innocent Placemus, that she may take between whiles, to beguile the time and please her imagination”.
“Whither placebo?
“For centuries, the word “placebo” was closely linked to deception and pleasing people. Recent studies of open-label placebos show that they need not be deceptive to work. Contrariwise, studies of placebos show that they are not inert or invariable and the basis for the current World Medical Association position has been undermined. The recent history of placebos seems to pave the way for more placebo treatments in clinical practice and fewer in clinical trials.”
It seems the placebo effect is ubiquitous. With all the recent excitement and ocnjecture about rapid advances in Artifical Intelligence and Machine Learning, it seems that our belief that a decision is backed by an AI will not only enhance our confidence in the veracity of that decision, but also make for better decisions! This research shows that:
“Participants were asked to solve word puzzles while being supported by no system or an adaptive AI interface. All participants experienced the same word puzzle difficulty and had no support from an AI throughout the experiments. Our results showed that the belief of receiving adaptive AI support increases expectations regarding the participant’s own task performance, sustained after interaction. These expectations were positively correlated to performance, as indicated by the number of solved word puzzles.”
Professor Ted Kaptchuk, who studies the effect, explains:
“The placebo effect is more than positive thinking — believing a treatment or procedure will work. It’s about creating a stronger connection between the brain and body and how they work together” …
Placebos won’t, for example, cure cancer. But when a disease affects the brain-body relationship, as Angelman does, the placebo response can confound research, as we saw above. We learn from the National Library of Medicine that “Migraines, joint pain, arthritis, asthma, high blood pressure, and depression are some disease conditions that are more sensitive to the placebo effect.”
Research has shown that a vast array of different conditions benefit from placebos. This includes acne, Crohn’s disease, epilepsy, ulcers, multiple sclerosis, rheumatism, Parkinsons’s disease and colitis. A recent study also found that placebos had a highly significant effect on erectile dysfunction.
But it may be that an account of the placebo (and nocebo) effect can be sought, if not found, in a science expanded beyond the simply neurological, which is to say, in a science that understands ‘mind’ as integrated in the complex web of energies interacting with the brain.
Further to our most recent post about the likelihood that the frequency of adverse side effects may be attributable to the placebo effect (or more appropriately, the nocebo effect), here’s some more detail provided by reknowned placebo research Ted Kaptchuk, in an article from the Harvard Medical School, ‘Power of Placebo: Some COVID-19 vaccine reactions may result from placebo response’.
“Nonspecific symptoms like headache and fatigue—which we have shown to be particularly nocebo sensitive—are listed among the most common adverse reactions following COVID-19 vaccination in many information leaflets,” said senior author Ted Kaptchuk, HMS professor of medicine and director of the Program in Placebo Studies at Beth Israel Deaconess.
“Evidence suggests that this sort of information may cause people to misattribute common daily background sensations as arising from the vaccine or cause anxiety and worry that make people hyperalert to bodily feelings about adverse events,” he said.
Kaptchuk and colleagues are known for a large and growing body of evidence showing that full disclosure of placebo treatment, what he calls “open-label placebo,” can actually improve common chronic conditions without any nocebo effects. Kaptchuk believes it is ethically necessary to fully inform participants about the vaccines’ potential adverse reactions.
“Medicine is based on trust,” said Kaptchuk. “Our findings lead us to suggest that informing the public about the potential for nocebo responses could help reduce worries about COVID-19 vaccination, which might decrease vaccination hesitancy.”
Dr Krakow takes pains to emphaise that the placebo effect is a physical phenomenon. There’s nothing magical about it. It will seem magical (as Isaac Asimov once wryly observed) until there’s sufficient science.
First, the placebo has a negative ‘flipside’. This is the nocebo effect, and it’s noted and discussed elsewhere on this site (check the tags column). A placebo effect can have either positive or negative outcomes.
Second, and very weirdly (if not ‘magically’) the placebo effect seems to become stronger and more proncounced over time. Placebos seem to get stronger!
Thirdly, the placebo effect does not necessarily require deception – that is, the practitioner lying to a patient that the (inert placebo) treatment is actually the ‘real’ treatment. We cover this too, on this site – look for ‘white label placebos’ in the tags.
