Why the placebo effect works

[jickay]

Any who knows about this knows how mysterious it is. Lately things have become even more complicated with studies saying that the effect is growing. Sugar pills are increasingly effective. Yet another study regarding irritable bowel syndrome (IBS) say that even when informed that it is a placebo it still has the same effect.

So, what is going on exactly?

My take on it is not so much the placebo itself but its effect on behaviour. Science lately has been too focused on numbers that they miss out on the bigger picture. The difference between the control group and the test group isn’t what matters. What matters is the difference between having treatment and not having treatment.

If we have learned anything from psychology is that when variables change so does behaviour. Just having an observer in the room will change someone’s behaviour drastically from when they are alone regardless of the task itself. Having any form of treatment available, regardless of whether it is a placebo or not, is like having an observer. Just the simple addition of a bottle of pills makes the patient more self-conscious and self-aware about their condition. Their behaviour will change because they are being treated, and with anyone being treated they hope to improve. This anticipation of improvement is a significant factor that might create minor daily changes that actually lead to improvement.

Going back to the idea of an observer, having any sort of placebo means being part of a study, and being part of a study means being subjected to observation. There is an accountability towards the researchers to produce some sort of result.

I think that if you combine these two factors it can create significant changes in both mindset and behaviour of the participants, enough to generate noticeable levels of improvement. To me the placebo effect doesn’t seem like such a big mystery. It is simply a demonstration of the power of human expectations. When people expect something or have expectations imposed on them they are effected whether or not they are aware of it.

[jonquil]

Not too long ago I read a take on the placebo effect that, in essence, said that all treatments are, in essence, placebos. So it is the act and the thought of treatment that is the same in all instances. Thus, the placebo itself is not actually the determining factor in healing, while at the same time it is necessary. Some thoughts on what makes the difference are the quality of the healers, how they are perceived by the patient. If they are experienced as kind, friendly, calm, truly caring and positive, that can make a difference.

[Humpty]

@jonquil

Not too long ago I read a take on the placebo effect that, in essence, said that all treatments are, in essence, placebos.

what?

[Teddy]

Good. I agree with most of it I’d just like to look at this from a biological standpoint. I believe like you said when a placebo is taken it just goes through the body but the brain probably causes a chemical or hormone which we havent discovered yet to be released and that chemical causes a chain of reactions which i probably dont understand. What the chemicals do I dont know but I’m hypothesizing they play a role.

[Three_Times_Great]

@jickay

Any who knows about this knows how mysterious it is. Lately things have become even more complicated with studies saying that the effect is growing. Sugar pills are increasingly effective. Yet another study regarding irritable bowel syndrome (IBS) say that even when informed that it is a placebo it still has the same effect.

So, what is going on exactly?

My take on it is not so much the placebo itself but its effect on behaviour. Science lately has been too focused on numbers that they miss out on the bigger picture. The difference between the control group and the test group isn’t what matters. What matters is the difference between having treatment and not having treatment.

If we have learned anything from psychology is that when variables change so does behaviour. Just having an observer in the room will change someone’s behaviour drastically from when they are alone regardless of the task itself. Having any form of treatment available, regardless of whether it is a placebo or not, is like having an observer. Just the simple addition of a bottle of pills makes the patient more self-conscious and self-aware about their condition. Their behaviour will change because they are being treated, and with anyone being treated they hope to improve. This anticipation of improvement is a significant factor that might create minor daily changes that actually lead to improvement.

Going back to the idea of an observer, having any sort of placebo means being part of a study, and being part of a study means being subjected to observation. There is an accountability towards the researchers to produce some sort of result.

I think that if you combine these two factors it can create significant changes in both mindset and behaviour of the participants, enough to generate noticeable levels of improvement. To me the placebo effect doesn’t seem like such a big mystery. It is simply a demonstration of the power of human expectations. When people expect something or have expectations imposed on them they are effected whether or not they are aware of it.

But this doesn’t explain placebo effect, because there is no variable difference between the test and control groups - both groups receive identical treatment, to their own knowledge - those who eat the sugar pill think it is medicine, while those to eat medicine, think it is medicine… no difference in behavior of individuals of different groups would arise based on this, unless those with the sugar pills know they are taking sugar pills, in which case, it isn’t placebo effect er are talking about.

The point isn’t that those in both the control and test group get better, relative to individuals in neither group (getting no pills, sugar or medicine); the point is that individuals in both groups get better similarly. Sure, being treated in a treatment setting, taking fake medicine will change one’s behavior… but explain how someone receiving treatment and taking sugar pills gets better just as well as someone receiving the same treatment except the pills are real medicine… it implies that the medicine itself is redundant, or at least, that one can heal oneself independently of the actual medicine itself.

Sugar pills or not, we could certainly expect those participating in “treatment” to improve more than others who are not in treatment (as you say, through behavioral changes, expectations, etc). But would you not expect that, among those receiving treatment, those taking actual medicine would get better more, relative to those not taking actual medicine…?

[jickay]

@Three Times Great

But would you not expect that, among those receiving treatment, those taking actual medicine would get better more, relative to those not taking actual medicine…?

I think you are missing the definition of a placebo effect. When a study is created a real treatment (“actual medicine”) is compared to a fake treatment (“sugar pill”) so that there is some baseline comparison. Basically researchers assume that the placebo will do nothing. The placebo effect has nothing to do with the actual treatment and what it does. The actual drug doesn’t always help and sometimes it can be harmful. That’s why they need a placebo group to make the comparison.

The surprising thing that scientists found was that even when they were given a fake treatment, or placebo, they still got better. That is how the term placebo effect came into place. Basically it was strange that people got better when given a fake treatment when it should have done nothing.

[Three_Times_Great]

That’s exactly what I was saying.

[phyllo]

the point is that individuals in both groups get better similarly. Sure, being treated in a treatment setting, taking fake medicine will change one’s behavior… but explain how someone receiving treatment and taking sugar pills gets better just as well as someone receiving the same treatment except the pills are real medicine… it implies that the medicine itself is redundant, or at least, that one can heal oneself independently of the actual medicine itself.

The medicated group and placebo group don’t get ‘better just as well’. They have different results based on the effectiveness of the medicine. However, some percentage of the placebo group gets better, contrary to the expectation that the placebo should have no effect on their health.

[Three_Times_Great]

I am not intending to imply that there is no difference between medicated and placebo groups - my point is that placebo groups attain statistically significant improvements along with medicated groups. The actual relation between these will of course vary with every test and situation, but the important point is that statistically significant improvement is seen in both groups, medicated and placebo.

[Duality]

lets try utilizing some rational deduction here: the physical state is at least partly influenced by the psychological state of the individual.

see how simple that shit was?

[Calrid]

Because the mind has a powerful effect on the bodies natural systems. Something therefore doesn’t actually have to have a physical effect to provoke a physical effect. This is also why religion exists, we are kinda primed to believe in things despite reason telling us that we shouldn’t. Of course a placebo may well not work if you let someone know it is just a sugar pill. But you get the idea.

That said though with that in mind you might enjoy reading this:

[size=150]Placebos can work even when you know they’re fakes [/size]

There is little doubt that the placebo effect is real, but it has always been argued that a person feels better because they think the pill is the real deal. But what if it works even when you know it’s a fake?

According to Ted Kaptchuk at Harvard Medical School and his colleagues at least one condition can be calmed by placebo, even when everyone knows it’s just an inert pill. This raises a thorny question: should we start offering sugar pills for ailments without a treatment?

In the latest study, Kaptchuk tested the effect of placebo versus no treatment in 80 people with irritable bowel syndrome. Twice a day, 37 people swallowed an inert pill could not be absorbed by the body. The researchers told participants that it could improve symptoms through the placebo effect.

While 35 per cent of the patients who had not received any treatment reported an improvement, 59 per cent of the placebo group felt better. “The placebo was almost twice as effective as the control,” says Kaptchuk. “That would be a great result if it was seen in a normal clinical trial of a drug.”

Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, UK, thinks that “the size of the benefit is too small to be clinically relevant”. Kaptchuk agrees and wants to run some larger trials to get a better picture of the effect.

If a dummy pill can improve IBS, shouldn’t we be exploring its effect on other ailments? “It wouldn’t work on a tumour or kill microbes, but it’s likely to affect illnesses where self-appraisal is important, such as depression” says Kaptchuk.

A 2008 study found that around a third of physicians had prescribed a dummy pill to unwitting patients. “Now we have shown that there are ethical ways of harnessing the placebo effect,” says Kaptchuk.

Surely now you can make a case for using a placebo when there are no other treatment options? Kaptchuk feels there is still an ethical dilemma here. “I’m against giving patients something unless it’s been shown to work in that condition,” he says, though the individuals concerned may feel differently.

Journal reference: PLoS One, DOI: 10.1371/journal.pone.0015591

newscientist.com/article/dn1 … fakes.html

[Three_Times_Great]

@Duality

lets try utilizing some rational deduction here: the physical state is at least partly influenced by the psychological state of the individual.

see how simple that shit was?

Agreed.

But the question then is, why/how is this? I think the reason placebo effect is so intriguing is that whatever mechanisms allow for it are outside of current mainstream scientific understanding.

[Duality]

@Three Times Great

But the question then is, why/how is this?

read Freud, Jung, etc. Its all there

@Three Times Great

I think the reason placebo effect is so intriguing is that whatever mechanisms allow for it are outside of current mainstream scientific understanding.

because psychology is not scientific or empirical outside of basic biological processes. Psychological processes and experiences are too subjective for empiricism’s dogmas to grasp

[jickay]

It’s fine and dandy to say that the mind has mystical powers beyond our understanding, but that doesn’t really get us anywhere. This might be delving into some muddy territory, but since mind and body are part of the same world they are one and the same. Changes in mind affect body and body affect mind because there is no separation between the two. Basically just ignore dualism.

Anyway, there are tangible differences that can lead the the placebo effect is all I’m trying to say. Just simply being treated, even if you know it’s a placebo, will affect overall behaviour. I don’t believe it is some magical ability of the mind. Even something like religious beliefs cause some sort of bodily change and it creates obvious changes in behaviours (eg. restrictive diets, prohibiting substances use, etc).

To me the placebo effect isn’t all that mysterious. Science is just ignoring the bigger picture and focusing too much on the sugar pill itself…

[Calrid]

@Three Times Great

@Duality

lets try utilizing some rational deduction here: the physical state is at least partly influenced by the psychological state of the individual.

see how simple that shit was?

Agreed.

But the question then is, why/how is this? I think the reason placebo effect is so intriguing is that whatever mechanisms allow for it are outside of current mainstream scientific understanding.

I think you are wrong. I also doubt you are aware of research in this area but none the less will argue that we have no clue how this works despite a vast body of evidence showing a link between our neurology and our immune system. For example if you give someone steroids to depress their immune system and hence the nueral functioning in detection of disease or illness many patients become depressed, and like wise when depressed a less capable immune system is the result. It’s not really much of a leap to see how this might be also related to the placebo effect. In fact go to any science magazine and type in placebo effect and you’ll find that although science does not have all the answers it is far from mysterious nor is it out of mainstream understanding for that matter.

newscientist.com/article/dn1 … erves.html

Placebo effect caught in the act in spinal nerves

* 14:41 16 October 2009 by Ewen Callaway

The placebo effect is not only real; its ability to deaden pain has been pinpointed to cells in the spinal cord. That raises hopes for new ways of treating conditions such as chronic pain.

The researchers who made the discovery scanned the spinal cords of volunteers while applying painful heat to one arm. Then they rubbed a cream onto the arm and told the volunteers that it contained a painkiller – but in fact it had no active ingredient. Even so, the cream made spinal-cord neural activity linked to pain vanish.

“This type of mechanism has been envisioned for over 40 years for placebo analgesia,” says Donald Price, a neuroscientist at the University of Florida in Gainesville, who was not involved in the new study. “This study provides the most direct test of this mechanism to date.”

Indeed, the biggest obstacle to establishing the spinal cord’s role in placebo pain relief was measuring its activity with fMRI scanning, says Falk Eippert, a neuroscientist at the University Medical Centre Hamburg-Eppendorf in Germany, who led the study.
Squeezing a scan

FMRI scanning has long been used to image the brain, but the part of the spinal cord that Eippert’s team was interested in – the dorsal horn – is minuscule in comparison, and so is harder to image. It also swims around in cerebrospinal fluid, further complicating real-time measurement.

The team’s first breakthrough was to squeeze an fMRI signal out of the spinal cord. Then they quickly adapted the technique to study placebo pain relief.

This meant telling 13 volunteers a white lie. They were told that the researchers were testing how effective a painkilling cream was, with an inactive cream as a control on the trial.

In fact, neither cream contained anaesthetic. However, when Eippert’s team applied the alleged painkilling cream for the first time, they turned down the intensity of painful heat stimulation to 40 per cent of each volunteer’s pain threshold – 46 °C on average. When the team tested the alleged control cream, they kept the temperature set at 80 per cent of the pain threshold – an average of 47 °C.

Because of this “fixing” of the temperatures, the volunteers would think, “‘OK, this really seems to work, and it will work when I take it the next time,’” Eippert explains.
Feeling the heat

Later, with an fMRI scanner on, the researchers rubbed “control” and “painkiller” creams onto two different spots on each volunteer’s left forearm and applied the same level of heat to each spot, 15 times.

The fake “painkiller” cream worked: volunteers said they experienced 26 per cent less pain on the “painkiller”-treated patch of their arm, compared with the “control”-treated area.

Meanwhile, the fMRI scanner witnessed the placebo effect. When skin treated with the “control” cream was heated, an area of the dorsal horn located on the left side of volunteers’ lower necks lit up, suggesting increased neural activity there in response to pain. However, this signal disappeared in the “painkiller” trials.

Eippert’s team didn’t discover what caused this shift. He speculates that higher brain areas involved in buying into the bogus treatment trigger the release of endogenous opioids – chemicals our brain produces that work like opiates and may temper spinal cord activity.

Now that researchers know the neural hallmark of placebo pain relief, they could use it to develop treatments, cognitive or chemical, that take better advantage of belief, Eippert says.

Journal reference: Science, DOI: 10.1126/science.1180142

newscientist.com/article/dn1 … ients.html

Brain scans reveal placebo effect in depressed patients

* 13:00 02 January 2002 by Emma Young

Depressed patients who respond to anti-depressant drugs show a decrease in activity in a key brain region - but patients who respond to placebos show the opposite, say US researchers. The discovery could reveal alternative ways of treating depression, they say.

Many depressed patients report improvements in mood when given inert pills that they believe to be medication. “People have know for years that if you give placebos to patients with depression, many of them will get better,” says Andrew Leuchter of the University of California, Los Angeles, who led the new research.

“What this study shows, for the first time, is that people who get better on placebo have a change in brain function, just as surely as people who get better on medication,” he says. “We now know that placebo is, very definitely, an active treatment condition.”

Leuchter’s team used a brain imaging technique called quantitative electroencephalography (QEEG) to examine brain electrical activity in 51 patients with major depression. The patients were given either a placebo or one of two commonly prescribed antidepressants over a nine-week period.

Overall, 52 per cent of the people given active drugs and 38 per cent of the patients given a placebo reported improvements in mood.
Delayed reaction

In the patients who responded to the drugs, the QEEG scans showed a significant reduction in activity in the prefrontal cortex - an area linked to memory, information processing and attention. But the scans revealed an increase in activity in the same area in patients who responded to the placebo.

The team also found that changes in brain activity appeared almost immediately in patients given anti-depressants. The changes in the placebo group took about two weeks to appear.

“These findings show us that there are different pathways to improvement for people suffering from depression,” says Leuchter. “If we can identify some of the mechanisms that help people get better with placebo, we may be able to make treatments more effective.”

Journal reference: American Journal of Psychiatry (vol 159, p 122)

[Calrid]

@jickay

It’s fine and dandy to say that the mind has mystical powers beyond our understanding, but that doesn’t really get us anywhere. This might be delving into some muddy territory, but since mind and body are part of the same world they are one and the same. Changes in mind affect body and body affect mind because there is no separation between the two. Basically just ignore dualism.

Anyway, there are tangible differences that can lead the the placebo effect is all I’m trying to say. Just simply being treated, even if you know it’s a placebo, will affect overall behaviour. I don’t believe it is some magical ability of the mind. Even something like religious beliefs cause some sort of bodily change and it creates obvious changes in behaviours (eg. restrictive diets, prohibiting substances use, etc).

Quite it’s a good someone here knows what the hell he is talking about.

There are also experiments that prove some really interesting things about the effect of prayer suffice to say the placebo effect is of course a big part of it, but ironically (in cardiology patients) some interesting counter research came to light. Even if patients didn’t know they were being prayed for and even though seemingly the results appear to defy causality by going backwards in time so to speak, in the study they got better more than statistically averagely. Which doesn’t show that God exists only that hope is a powerful placebo or that the methodology itself was flawed. Of course ardent God botherers will say clearly God works backwards in time to help people but then they are idiots.

The vast bulk of evidence shows prayer is no more likely to benefit a patient either proactively or retroactively than not praying at all or a that isn’t medication that actually works.

To me the placebo effect isn’t all that mysterious. Science is just ignoring the bigger picture and focusing too much on the sugar pill itself…

No it isn’t. It’s focusing on the psychology of mind and the relation to the physiology of matter actually, as is hard science like nuerochemistry and nuerophysiology for that matter. If you’ll pardon the pun.

[Duality]

@jickay

Changes in mind affect body and body affect mind because there is no separation between the two.

Please show me where changes in mind and body affect all persons similarly, and where changes in body or mind affect the body or mind of all persons similarly. Or keep knocking down that strawman

[Three_Times_Great]

If you believe you will get better, you have greater chances of actually getting better. That is all placebo is saying.

This correlation between belief and physical health is something outside of science - of course we can understand it because we grasp that mind and body are unified in a way that modern science, at least medical mainstream science, does not yet understand fully (simply because the exact mechanisms of how this works cannot yet be identified or explained in scientific terms…)

[Calrid]

See what I mean, it doesn’t matter what you say this chump can’t be wrong about anything ever or his head would explode. You are wrong shut the fuck up please.

Did you even read the links or did you just skim the post and then decided you are right by default as usual.

Honestly dude you have to get over the fact that you can be as wrong as everyone else, you are nothing special here.

We don’t understand exactly why SSRIs or NSAIDs work but that doesn’t mean it is beyond science or that there aren’t some damned good theories out there.

[jickay]

@Calrid

@jickay

It’s fine and dandy to say that the mind has mystical powers beyond our understanding, but that doesn’t really get us anywhere. This might be delving into some muddy territory, but since mind and body are part of the same world they are one and the same. Changes in mind affect body and body affect mind because there is no separation between the two. Basically just ignore dualism.

Anyway, there are tangible differences that can lead the the placebo effect is all I’m trying to say. Just simply being treated, even if you know it’s a placebo, will affect overall behaviour. I don’t believe it is some magical ability of the mind. Even something like religious beliefs cause some sort of bodily change and it creates obvious changes in behaviours (eg. restrictive diets, prohibiting substances use, etc).

Quite it’s a good someone here knows what the hell he is talking about.

Thank you for that first of all. It’s good having people who read carefully especially in a forum focused on something as picky as philosophy.

Now I want to address this first:

@Duality

@jickay

Changes in mind affect body and body affect mind because there is no separation between the two.

Please show me where changes in mind and body affect all persons similarly, and where changes in body or mind affect the body or mind of all persons similarly. Or keep knocking down that strawman

I seems like you’re a big fan of dualism ahem but you are making a fallacy of your own. You are already postulating there is a separation between the mind and the body when you say they can affect one another. What I am trying to say is that they are one and the same from the very beginning. A kind of singularity. So what we call changes in the “body” is a change in the “mind” and vice versa. I’ve come to learn that dualism doesn’t do us any good. Singularity is the way to go. That way when we talk about something like a placebo effect we aren’t saying that it affects the “mind” or the “body” and try to find a causal chain out of that and instead we say it affects the person/patient as a whole.

Now in terms of the affect of prayer it kind of follows the same line of thought. It might seem strange that even thought the patient isn’t doing the praying they are affected, but it’s not as strange as it may seem if you take into account the larger context. There have been studies about social epidemiology saying that things like happiness or eating habits spread within social circles. For example, if you have friends who are obese you are more likely to be or become obese. I think that the prayers have an indirect effect wherein the sense of hope or optimism travels amongst people you are involved with. Maybe it makes the patient or the healthcare workers feel more hopeful as well.

The big message here is that we have to stop finding causal chains. That’s outdated. We have causal networks and that is what makes certain things so difficult to study.