Sex differences for placebo effects not only exist, but they follow some rules, as it appears:
* Despite higher pain sensitivity in females, placebo analgesia is easier to elicit in males;
* It appears that conditioning is effective specifically to elicit nocebo effects;
* Conditioning works well to elicit placebo and nocebo effects, but only in females;
* Verbal suggestions are insufficient to induce placebo effects in women but work in men.
It is becoming increasingly clear that the placebo effect has a great influence on medical treatment. An international, interdisciplinary team of researchers led by Professor of Health Psychology Andrea Evers from Leiden University has now written a first set of guidelines on how to apply the placebo effect in clinical practice, published in Psychotherapy and Psychosomatics.
It was the result of the first official conference of the Society for Interdisciplinary Placebo Studies (SIPS), which was held in Leiden last year. During an interdisciplinary workshop led by Evers, a group of leading international researchers reached the consensus that knowledge about placebo and nocebo effects could lead to better treatment results with fewer side-effects. According to the researchers, it is crucial that patients receive more information about these effects, and that doctors receive training on the best doctor-patient communication to maximise placebo effects and minimise nocebo effects.
Read the full article here.
Could brain stimulation slow cancer?
The idea is that ‘the placebo effect’ activates the same ‘Reward Circuit’ in the brain as that “activated by food, sex and social interactions (as well as gambling and addictive drugs)”. This in turn stimulates the immune system and generates ‘anti-tumor immunity’ against pathogens.
This is Scientific American, dear readers, and the claim is based on the kind of clinical experimentation that placebos are now inspiring. Placebo Studies!
“It’s like doing immunotherapy without medication.”
At the moment it’s just been shown in mice, and the ‘data are preliminary’, but even if it turns out only partly to be shown in humans, the implications are profound.
Open Label Placebos (OLPs) are becoming a Thing, reinforced once more by Ted Kaptchuk’s placebo research group at Harvard Medical School. This article – Open-Label Placebo (OLP): Take This, It Is A Sugar Pill, It Will Help You! – provides us with a succinct update on the current clinical research scene, including valuable reference to two meta-studies which attempt to summarise the current state of our understanding. Importantly, the writers note that formal studies to date “have shown that while openly-applied placebos affect symptoms (depression, motor activity, pain, fatigue, etc.), none have yet shown that it may also affect disease biomarkers. Secondly, patient (self-)selection has to be tested for biases, e.g., whether the recruited patients are prone to respond to placebo, while others not recruited are not. Last but not least, it would be important to know how OLP compares to effective drug treatment of the same condition and in the same patients.”
Are aphrodisiacs placebos? What would happen if you spent a whole day eating them?
Read about Insider writer Sara Hendricks’s experiment with binge-eating foods claimed to have aphrodisiac properties, leading up to (spoiler alert) her conclusion that “at the end of the day, whether or not an aphrodisiac food works might simply depend on how much faith you have in the placebo effect. Aphrodisiacs, as it turns out, may very well be in the eye of the beholder.”
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.
You know that something’s popular when it pops up in the Reader’s Digest. This article comments on the “growing scientific interest in the placebo effect”, and notes:
Because placebos are believed to work only on condition of expectation of positive relief, they were considered to be good only for psychosomatic ailments and not real physical ailments.
But this does not seem to be borne out by recent studies, nor by years of experience of many people around the world. Placebos have been shown to result in the real cure of physical ailments such as a broken heel or torn ligament, not only psychological ones.
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.”
Check out Simon C. Harvey, Chris J. Beedie, “Studying placebo effects in model organisms will help us understand them in humans” Biology Letters. 29 November 2017 or read the ACSH article here.