Placebos Work -- Even Without Deception

An anonymous reader writes "For most of us, the 'placebo effect' is synonymous with the power of positive thinking; it works because you believe you're taking a real drug. But a new study rattles this assumption. Researchers at Harvard Medical School's Osher Research Center and Beth Israel Deaconess Medical Center have found that placebos work even when administered without the seemingly requisite deception. The study was published on December 22 in PLoS ONE."

Homeopathic Medicine

[Sonny Yatsen]

If deception isn't necessary for placebos to work, does this mean the homeopathic medicine advocates can admit it's bullshit now?

False deception

[Thanshin]

A guy dressed in a white lab coat, doing an experiment, gives you some medicine and tells you: "This is a placebo. Trust me, there is no active component of any kind.". Then, as soon as you swallow the medicine he, and three other lab coated investigators watch you attentively for an hour, asking if you feel strange in any way.

What would be the chances of you believing them and having no doubts about the placebo nature of what you had taken?

Re:Homeopathic Medicine

[happylight]

If it works, how can it be bullshit?

Re:Same Deception

[Monkeedude1212]

Moreover, I'm confused how on Earth they would manage to test something like this.

If you tell them it's a placebo, doesn't that, in a way, make it no longer a placebo? How can you observe a positive effect from placebos if they aren't even placebos anymore?

There's any number of things that could cause the "Positive thinking". They might be glad their Doctor is honest with them. They might like the sugar they put in them. They might be lessed stress knowing its not 100% necessary to get up at 6 in the morning to make sure you pop your placebo in time.

I'll read the full Article after this cup of coffee. I Can never seem to keep focused before having a cup of Decaf.

Re:Medical ritual, or just loneliness?

[Scubaraf]

Bingo!

But that's a huge point to prove. As obvious as it may sound, it's evidence that validating patients and their concerns may be among the best things we can do as physicians. It's absolutely not billable, so many docs don't do it - instead focusing on seeing the next person quickly or doing another billable procedure.

Maybe with more studies aimed at understanding the effect of doctor-patient interactions, we'll start reimbursing MD's for what works and patients find valuable.

Re:Homeopathic Medicine

[mcgrew]

TFA: data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients.

This isn't "ethically questionable" as TFA posits, it's a GOOD thing, especially with viral diseases like colds and flu. People insist on antibiotics, but antibiotics are no better than placebos on viral infections, and placebos don't cause antibiotic-resistant strains of bacteria to evolve.

Re:Homeopathic Medicine

[xystren]

Because the uninformed equate that placebo effect = not effective... where they should be thinking, placebo effect = effective without an identified factor/cause.

Honestly, if I have the choice between a placebo effect or some medication that has major side-effects (ie: damage to the liver/kidney), I will take the placebo. If one can elicit a placebo effect without the dangers of medication side-effects, why is that a bad thing?

For example, morphine does exactly zero for me with regards to pain management. When I had a pooched back (bulged lower lumbar), it did absolutely nothing, yet a regular ibuprofen did more. I tell you, I would have welcomed a placebo effect. All the morphine did was give me a headache and make my pi$$ stink like a S.o.B.

Cheers
Xyst.

Not so fast

[Suddenly_Dead]

As pointed out by Orac [scienceblogs.com], things are nowhere as simple here as they've been presented. There was still an establishment of expectation of the treatment working, which is exactly one would expect would elicit the placebo effect.

...the investigators deceived their subjects to induce placebo effects. Here's how they describe what they told their patients:

Patients who gave informed consent and fulfilled the inclusion and exclusion criteria were randomized into two groups: 1) placebo pill twice daily or 2) no-treatment. Before randomization and during the screening, the placebo pills were truthfully described as inert or inactive pills, like sugar pills, without any medication in it. Additionally, patients were told that "placebo pills, something like sugar pills, have been shown in rigorous clinical testing to produce significant mind-body self-healing processes." The patient-provider relationship and contact time was similar in both groups. Study visits occurred at baseline (Day 1), midpoint (Day 11) and completion (Day 21). Assessment questionnaires were completed by patients with the assistance of a blinded assessor at study visits.

Moreover, the investigators recruited subjects thusly:

Participants were recruited from advertisements for "a novel mind-body management study of IBS" in newspapers and fliers and from referrals from healthcare professionals. During the telephone screening, potential enrollees were told that participants would receive "either placebo (inert) pills, which were like sugar pills which had been shown to have self-healing properties" or no-treatment.

Even the authors had to acknowledge that this was a problem:

A further possible limitation is that our results are not generalizable because our trial may have selectively attracted IBS patients who were attracted by an advertisement for "a novel mind-body" intervention. Obviously, we cannot rule out this possibility. However, selective attraction to the advertised treatment is a possibility in virtually all clinical trials.

In other words, not only did Kaptchuk et al deceive their subjects to trigger placebo effects, whether they realize or will admit that that's what they did or not, but they might very well have specifically attracted patients more prone to believing that the power of "mind-body" interactions. Yes, patients were informed that they were receiving a placebo, but that knowledge was tainted by what the investigators told them about what the placebo pills could do.

Re:Homeopathic Medicine

[locofungus]

Don't understand your comment.

I have to say I wasn't aware that "placebos work even without deception" was new but perhaps this is the first rigorously controlled trial.

I've seen stuff before like "What should you tell your patient?" with suggestions like:

"Nobody understands why it works but in one in three cases, just taking one of these sugar pills three times a day can help with the symptoms."

For that matter, "Nobody understands why it works but in one in three cases, taking homeopathic remedies helps with the symptoms" ought to be equally valid, especially for things like chronic pain where conventional medicine doesn't really have an answer and is just used to mask the symptoms. If homeopathy works for someone then it's almost certainly a better option than morphine.

The main objection to homeopathy is that some people recommend it over conventional therapy that is known to be both required and effective in treating the particular problem.

Article on BBC today: http://www.bbc.co.uk/news/health-12060507 [bbc.co.uk]

Alternative remedies 'dangerous' for kids says report

"In 30 cases, the issues were "probably or definitely" related to complementary medicine, and in 17 the patient was regarded as being harmed by a failure to use conventional medicine.

"The report says that all four deaths resulted from a failure to use conventional medicine."

Tim.

Re:Nope

[icebraining]

Look. I can read through a phone book, claim my magic powers heal people, and someone in the phone book will have gotten better. Does that mean I have magic powers, or their body was just able to heal itself?

The placebos work by improving the body's ability to heal itself, by changing some process in the brain. Just like vaccines work by strengthening the immune system without actually fighting any diseases.

Re:Did you hear about

[Chris Burke]

Yeah. The only positive thing homeopathy did for the world was prevent people from dying from their "medicine" in a time when things like significant dosages of mercury were considered "medicine". It turns out not dosing people with mercury is better than doing so. Medical fact.

Too bad it wasn't a "let's not give people poisons" movement and instead was a "hey since giving people less mercury is better for them than giving them lots of mercury, maybe that means the more dilute any solution is, the better for you it will be!"

Re:Homeopathic Medicine

[Chris Burke]

I like to think of homeopathy as optimized placebo effect.

Yeah, optimized for the profits of those selling these pills with nothing in them.

Does my dog sense my confidence?

Yes, of course dogs can sense the attitudes of their owners, and owners will subconsciously give their dogs extra encouragement when they expect them to get better (which is why real medical studies are double-blind wherever possible).

That plus coincidence and confirmation bias explain the anecdotal evidence.

but nevertheless there's something going on which deserves investigation.

There is nothing going on. No scientific study has demonstrated homeopathic preparations to have an effect greater than a placebo. Because they are placebos. So there's nothing which deserves investigation, except the placebo effect itself, which can easily be studied while completely ignoring the particular kind of placebo called homeopathy.

Re:Homeopathic Medicine

[Abcd1234]

Well that's easy: I don't tolerate pseudo-scientific bullshit.

The idea that drinking water is a miracle cure for lethargy, headaches, etc, let alone asthma and respiratory ailments, is bunk, unsupported by evidence. And, as a rational, evidence-based thinker, I attack such bogus claims, because I feel anti-science garbage should be debunked before people start running around drinking water instead of using their inhalers.

I also believe it's necessary to attack irrational thinking. In this case, that would be how I would characterize your insistence that your one anecdote, based on entirely subjective observations, is somehow equivalent to solid evidence. And the fact that you posed such arguments in a discussion about the placebo effect was too hilarious *not* to point out.