A recent ‘meta-study’ claims that placebo are NOT, in fact, on par with conventional antidepressant medications, as we have reported numerous times in this blog. It seems, however, that this study should be read with certain caveats, most particularly that “The review’s authors have acknowledged that almost 80% of the studies they analysed had been funded by the pharmaceuticals industry.” (Fawning Coverage of New Antidepressants Review Masks Key Caveats) Confirmation bias, anyone?
We know that communication matters – in regard to any human exchange and any human relationship. We can also consider the words we use, and the way we use them, in relation to their value as ‘placebo’. The effectiveness (or ineffectiveness) of communication can generate a placebo (or nocebo) effect, evidenced very clearly in the way that health practitioners interact with their clients, as illustrated in this article in the Irish Times, “Doctors Say One Thing. Patients Often Hear Something Else”.
“How patients frame questions and how doctors frame advice is an important element in successful health communication. Behavioural economists describe a phenomenon known as loss aversion: as humans, we are primed to feel losses nearly twice as heavily as we appreciate gains.
So for actions that we perceive as risky, a health message that presents the lack of action as an even greater risk is more effective. However, for actions that we don’t see as especially risky, presenting the action itself as beneficial has been shown to produce a better behavioural response.”
No, seriously, do they?
“Is the placebo effect biologically real? We’re not sure. But, if it is, then it is safe to say that it evolved over time, that it confers some survival advantage, and most importantly, it should also be able to be seen in other organisms. It has been reported in rats on occasion. But, what if we could study the placebo effect in lower organisms like fruit flies (Drosophila melanogaster) or worms (Caenorhabditis elegans)?
In the study of aging, these tiny, but powerful animals who age quickly, make it easier to do many experiments in a shorter period of time. Worms, in particular, are a fantastic model for the field of dietary restriction (DR), a programmed method of reducing calorie intake and the most scientifically sound method of extending lifespan. But in worms, the extended lifespan offered through DR is disrupted by the smell of food which tricks their bodies out of DR mode and stops the extension of life.”
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.
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.
The placebo effect is one of the most mystifying phenomena in medicine. When we expect a pill to make us feel better, it does. If we see others get better while using a medicine, we will too.
But the placebo effect has an evil twin: the nocebo. It can kick in when negative expectations steer our experience of symptoms and create side effects where none should occur.
This means, incredibly, that you can get side effects from a sugar pill. And sometimes these side effects are so severe that patients drop out of clinical trials. More info here.
Recent evidence suggests that the muscle aches might be a big nocebo.
Whether you know you’re taking a placebo pill or not, it will still have a beneficial effect, new research has revealed (Is the rationale more important than deception? A randomized controlled trial of open-label placebo analgesia.)
Scientists from Harvard University and the University of Basel prescribed a group of minor burn victims with a “treatment” cream, telling only some of them that it was a placebo.
After the cream was applied, both groups reported benefits, despite the placebo cream containing no medicine.
Read the full article here
On the subject of Open Label Placebos, here’s a link to research on their efficacy in chronic lower-back pain.
A new study finds that people who have a better handle on their negative emotions may be more likely to experience a stronger placebo effect. Researchers at the University of Luxembourg found that participants who were better at interpreting negative events in a positive light felt more relief from a placebo pain-relieving cream.
The placebo effect has traditionally been viewed in a negative light; however, within the last decade, researchers have investigated the placebo effect itself and found that placebos can trigger real biological changes in the body, including the brain.
“All participants reported less pain: the placebo effect was working. Interestingly, those with a higher capacity to control their negative feelings showed the largest responses to the placebo cream in the brain. Their activity in those brain regions that process pain was most reduced. This suggests that your ability to regulate emotions affects how strong your response to a placebo will be.”
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 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.
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.’
This is fascinating – well worth a 30 minute listen!