#Science-Based Medicine Science-Based Medicine » Feed Science-Based Medicine » Comments Feed Science-Based Medicine » The Placebo Effect Comments Feed -- o Media & CAM o Naturopathy o Placebo * Links * Recent Comments -- ____________________ Home → Articles → The Placebo Effect The Placebo Effect Posted by Steven Novella on January 16, 2008 (25 Comments) -- company was guilty of fraud and ordering them to pay 16 million dollars in fines. One of the key points for the company’s defense was that the Q-Ray Ionized Bracelet is legit because it exhibits the placebo effect. Judge Easterbrook was not impressed with this argument, writing: “Like a sugar pill it alleviates symptoms even though there is no apparent medical reason. Since the placebo effect can be obtained from sugar pills, charging $200 for a device that is represented as a miracle cure but works no better than a dummy pill is a form of -- number of fanciful treatments that do not have any “apparent medical” mechanism and that are claimed by its proponents to work through a placebo effect. In my experience the placebo effect, briefly defined as a measurable response to an inert treatment, is almost completely misunderstood by the public – a fact that is exploited by purveyors of dubious treatments such as the Q-ray. Already in the comments of this blog there has been discussion over the nature of the placebo effect. In order to demystify the placebo effect, I will try to first describe exactly what it is. The operational definition of a placebo effect is any health effect measured after an intervention that is something other than a physiological response to a biologically active treatment. In clinical trials the placebo effect is any measured response in the group of study subjects that received an inert treatment, such as a sugar pill. However, “the placebo effect” is a misnomer and contributes to confusion, because it is not a single effect but the net result of many possible factors. The various factors that contribute to a measured or perceived placebo effect vary depending upon the situation – what symptoms or outcomes are being observed. Subjective outcomes like pain, fatigue, and an -- they are likely to engage in more healthful behavior in other ways. A common belief is that the placebo effect is largely a “mind-over-matter effect,” but this is a misconception. There is no compelling evidence that the mind can create healing simply through -- are many non-specific factors that can biochemically suppress pain. For example, increased physical activity can release endorphins that naturally inhibit pain. For these reasons the placebo effect for pain is typically high, around 30%. But the more concrete and physiological the outcome, the smaller the placebo effect. Survival from serious forms of cancer, for example, has no demonstrable placebo effect. There is a “clinical trial effect,” as described above – being a subject in a trial tends to improve care and compliance, but no placebo effect beyond that. There is no compelling evidence that mood or thought alone can help fight off cancer or any similar disease. -- situations. The lack of any real biological placebo effect has led some to question the necessity of having a placebo control in clinical trials. However, I feel there is still a need for a double-blind placebo-controlled design for most clinical trials because that is the only way to minimize the effects of bias on trial outcomes. The factors I listed above will still create the illusion of an effect and the only way to control for this is with a placebo group. Therefore the placebo effect is fairly complex and is largely an artifact of observation and confounding factors. Any real benefits that contribute to the placebo effect can be gained by more straightforward methods – like healthy habits, compliance with treatment, and good health care. The placebo effect is not evidence for any mysterious mind-over-matter effect, but since the mind is matter (the brain) and is connected to the rest of the body, there are some known -- In light of all this, I do not feel that knowingly prescribing a placebo treatment is effective or ethical medicine. Modern scientific medicine should strive for interventions that physiologically are scientifically plausible and have sufficient evidence for safety and effectiveness. But I do think there are lessons to be learned from the placebo effect – there are aspects of therapy that do go beyond the physiological intervention. Medicine is not only an applied science; it is the art of humans treating other humans. As part of effective -- I therefore heartily agree with Judge Easterbrook that invoking the placebo effect is not a defense for making fraudulent health claims, for the Q-ray or any other implausible treatment. -- Leave a Comment (25) ↓ 25 thoughts on “The Placebo Effect” 1. PalMD says: January 16, 2008 at 8:53 am I agree that it is ethically impermissible for doctors to prescribe placebos, as it involves actively deceiving a patient. It is *not* ethically unsound to “hype” a treatment, in that if a patient has confidence in a treatment they are more likely to be -- not learned that yet (I’m working on it!). But creating confidence in a treatment/physician/relationship is not placebo—just good medicine. 2. Apreche says: January 16, 2008 at 10:19 am I also agree that it is unethical to prescribe placebos to people who have true illness. However, I am torn on whether it is ethical to prescribe them to hypochondriacs. If someone believes they are ill, when they are not, then perhaps a placebo is a good treatment as long as it is in combination with proper psychological treatment as well. One alternative seems to be to either give them a real treatment for a condition they only -- 3. daedalus2u says: January 16, 2008 at 12:16 pm As someone who has thought a great deal about the placebo effect in the context of my NO research I have a slightly different perspective. I would distinguish between non-physiological effects, such as investigator bias, and what I consider to be the “true” placebo effect mediated through physiology. I appreciate that this distinction may be difficult (if not impossible) to make experimentally unless specifically looked for (which most trials don’t). In the context of treatment the distinction doesn’t much matter. In the context of clinical trials it can. A single blinding (of patients) might work to correct for the physiological placebo effect mediated though patient physiology, investigator blinding is necessary to correct for investigator bias. In clinical trials double blinding corrects for both, which is why it is the gold standard for clinical trials. I completely agree that prescribing placebos has no place in any treatment modality. There are plenty of lifestyle changes that can be prescribed, diet, exercise, weight loss, stress relief that will do the same things and much more reliably than a placebo medication. Learning how to relax via the relaxation response http://www.mbmi.org/about/default.asp invokes all of these same pathways (as I understand them), and again more reliably than any placebo. I know that my views of the mechanisms and magnitude of the physiological effects of the placebo effect are larger than what is considered “main stream”, however the most I see the placebo effect doing is restoring physiology to the “default” base-line state of normal health. I can think of no mechanism(s), by which the placebo effect would be effective at treating cancer, infections, trauma, or any disorder not caused by chronic stress. Even then it works as -- tests do not show anything, that the patient is a hypochondriac. They prescribe therapies to get the patients to “shut up,” hoping the “placebo effect” will give the patients relief. This discussion about the placebo effect and how it is unethical to prescribe therapies mostly (or wholly) intended to get a patient to stop calling the doctor miss the fact that it happens often in real -- clinical practice. I firmly believe that clinical trials with double-blinded, placebo-controlled designs are the only validation for therapies. Just because someone “thinks” a therapy might be effective doesn’t make it so, even if the therapy is a new application for an -- January 16, 2008 at 4:35 pm I have a relative (now long since retired) who used to prescribe placebos for particularly troublesome patients whom he deemed to be hypochondriacs — only they weren’t just sugar pills, they actually were a drug that caused mild nausea. He would warn patients to -- evidently what he gave the patient actually did have an affect, and an unpleasant one at that. 6. Pingback: Placebo–tool or weapon? « WhiteCoat Underground 7. Roy Niles says: January 16, 2008 at 5:26 pm -- January 16, 2008 at 8:54 pm Thanks for the interesting write-up. I also found Mark Crislip’s podcast about the placebo effect informative, if anyone else is looking for more information on misconceptions about the placebo effect: http://www.quackcast.com/QuackCast/Podcasts/Entries/2006/5/22_Quack -- even “harmless” ones, your conceptualization of reality breaks down and it becomes unreliable. In the context of administering placebos, if you started to do it and saw that they “worked”, it wouldn’t take much rationalization to ascribe mechanisms beyond that of the placebo effect. It is a slippery slope that could take you down into the abyss of quackery. 14. Roy Niles says: -- 15. rjstan@together.net says: January 19, 2008 at 7:22 pm I think one of the best ways to start to understand the placebo effect is to speak with scientists who develop drugs or with the stock brokers who follow the industry. The scientists tell tales of -- When you deal with an organism as complex as a living human being, there are many unknown variables which affect the course of a disease. The placebo effect is an umbrella term used to cover them all. While double-blind clinical trials will tell you if a drug is effective, they will not tell you what has caused significant improvement in any particular test subject receiving a placebo. In my experience it is very difficult for many people, especially many people in engineering and the “hard sciences” to accept and -- 17. Pingback: Science Based Medicine » The Ethics of Deception in Medicine 18. Pingback: Transparent Eye » Blog Archive » The Placebo Effect 19. Pingback: Science-Based Medicine » The Role of Anecdotes in Science-Based Medicine 20. Pingback: Science-Based Medicine » Homeopathy and Evidence-Based Medicine: Back to the Future Part V 21. Pingback: NeuroLogica Blog » The Price of Placebos 22. 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