Placebos work -- even without deception

[Celebration]

http://www.physorg.com/news/2010-12-placebos-deception.html

Placebos—or dummy pills—are typically used in clinical trials as controls for potential new medications. Even though they contain no active ingredients
, patients often respond to them. In fact, data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients.

Because such "deception" is ethically questionable, HMS associate professor of medicine Ted Kaptchuk teamed up with colleagues at BIDMC to explore whether or not the power of placebos can be harnessed honestly and respectfully.

To do this, 80 patients suffering from irritable bowel syndrome (IBS) were divided into two groups: one group, the controls, received no treatment, while the other group received a regimen of placebos—honestly described as "like sugar pills"—which they were instructed to take twice daily.

"Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had 'placebo' printed on the bottle," says Kaptchuk. "We told the patients that they didn't have to even believe in the placebo effect. Just take the pills."

For a three-week period, the patients were monitored. By the end of the trial, nearly twice as many patients treated with the placebo reported adequate symptom relief as compared to the control group (59 percent vs. 35 percent). Also, on other outcome measures, patients taking the placebo doubled their rates of improvement to a degree roughly equivalent to the effects of the most powerful IBS medications.

[tridim]

1. IMO IBS is mostly in the head.

:hide:

I "cured" mine with yogurt and cutting out soda. At least my brain thinks I did.

Last time I took Immodium it locked up my gut for 5 miserable days. That stuff is awful.

[bemildred]

2. Oh good.

:popcorn:

[customerserviceguy]

3. Early humans needed the witch doctor to shake a rattle

Today's people just need a pill to swallow, to believe they're being "cared for".

[valerief]

4. People watch Fox and think they're getting news. That's a placebo effect. nt

[trotsky]

5. And here are the key words: "reported adequate symptom relief"

This is not an objective study - it basically consisted of asking the participants, "do you feel better?" Terrible design. But it says what the woo charlatans who peddle worthless herbs WANT you to believe, so it is lapped up.

[Celebration]

6. Isn't that the goal?

Making people feel better?

There aren't generally any blood tests for IBS.

But, one would think that doctors would want IBS patients to feel better anyway. Like I said, one would think.

And, LOL, this does not involve herbs. This is a PLACEBO!

[laconicsax]

7. I would think the goal is actually treating illness, not fooling people into thinking they're better

[Celebration]

8. .................

http://www.nlm.nih.gov/medlineplus/ency/article/000246.htm

Most of the time, your doctor can diagnose IBS based on your symptoms, with few or no tests.

.........snip......................

There is no test to diagnose IBS, but tests may be done to rule out other problems:

..........snip................

Treatment

The goal of treatment is to relieve symptoms.

[trotsky]

9. Feeling better vs getting better

Those often go together, but not necessarily. And it's a well known phenomenon that people in a study will often *want* to report favorable results to a researcher. It's called response bias and affects everything from surveys to medical studies.

So yeah, I'd rather people actually GET better than just FEEL better. Treat the cause, not the symptoms.

And, LOL, I know this was about a placebo and I also know that the supplement pushers like to use these results to peddle their woo as well. So, LOL, try to follow along.

[Celebration]

10. the very definition of IBS is based on symptoms

Sometimes a virus can trigger it, and sometimes it is related to stress. Other than that there are no known causes. People get assigned that diagnosis when the doctors fail to find a specific cause such as Crohn's. In this case, reduction of symptoms IS both getting and feeling better. In other words, you are not making sense.

And, even with Crohn's, medications don't treat the cause-- people still have to avoid wheat products. They only relieve symptoms. Yet, there are medical treatments that reduce symptoms that are thought to be effective by reducing the symptoms.

If anything, if these results hold up, people won't try either herbs OR medication first--they'll try a sugar pill. If anything it would hurt herbal supplement sales.

[trotsky]

11. And hey, that's great.

But it doesn't change the fact that response bias is real AND there are a whole host of other confounding factors here.

[Celebration]

12. responses are the

only way to measure efficacy, since the illness is based on symptoms.

There are confounding factors in every study. And this will have to be replicated.

Very interesting, though.

[trotsky]

13. You left off a key word at the beginning of your subject line / first sentence.

"Currently"

And the fact that it's currently the only way to gauge the effectiveness of a treatment like this makes the study even MORE problematic.

Not all that interesting, though. Placebos often have great success with relieving pain or mild symptoms. They're not so great at curing cancer, healing broken bones, or treating fatal diseases.

[Celebration]

14. uh

There has never been a study showing that a placebo worked even when patients KNEW it was a placebo. That is a FIRST!

[trotsky]

15. And uh...

if you read the study abstract you'll see the placebo was presented as being “made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes”.

They were still deceived by being told that the medicine was "like" sugar pills but HAD BEEN SHOWN in studies to produce improvement in symptoms. This is not a significantly different placebo study - the patients were still lied to.

[Celebration]

16. not true

Taking a placebo and knowing it is a placebo is significantly different from taking a placebo and thinking it is a medication. The patients are not being deceived and there is no ethical dilemma prescribing it.

The placebo response in this disease has always been high, but the patients were being deceived in the past. This time, they were given the information that studies such as the one below have found the placebo response high in IBS.

http://www.ncbi.nlm.nih.gov/pubmed/20412064

Now, doctors will be able to ethically give placebos to patients, particularly if this study is replicated. That makes this study a VERY BIG DEAL (if confirmed).

[trotsky]

17. Nope, your study was busted.

Sorry.
http://scienceblogs.com/insolence/2010/12/more_dubious_statements_about_placebo_ef.php

[Celebration]

18. "not a single objective measure"

What a dumb criticism, since there is not a single objective measure of IBS, LOL. Amazing it's even medically labeled.

[trotsky]

19. Busted.

LOL

[Celebration]

20. here

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=222&topic_id=97378&mesg_id=97397

Again, IBS is a diagnosis of exclusion. It is what is leftover after objective tests don't find any abnormalities. It is also legitimate diagnosis with objective symptoms--

Some gastrointestinal diseases can be seen and diagnosed with the naked eye, such as ulcers of the stomach when visualized with certain methods. Thus, ulcers can be seen at surgery, on X-rays, and at endoscopy. Other diseases cannot be seen with the naked eye but can be seen and diagnosed with the microscope. For example, celiac disease and collagenous colitis are diagnosed by microscopic examination of biopsies of the small intestine and colon, respectively. In contrast, gastrointestinal functional diseases cannot be seen with the naked eye or with the microscope. In some instances, the abnormal function can be demonstrated by tests, for example, gastric emptying studies or antro-duodenal motility studies. However, these tests often are complex, are not widely available, and do not reliably detect the functional abnormalities. Accordingly, by default, functional gastrointestinal diseases are those involving the abnormal function of gastrointestinal organs in which abnormalities cannot be seen in the organs with either the naked eye or the microscope.

http://www.medicinenet.com/irritable_bowel_syndrome/article.htm

[trotsky]

22. Lovely red herring you're offering.

But I ain't taking it.

This is about the basic premise of the study: that the placebo works even if patients are TOLD it's a placebo. But that is wrong - the study itself clearly states that NOT ONLY were the patients pre-screened and selected for individuals who already believed in an alleged "mind-body" connection, they were told that this "placebo" was SHOWN IN STUDIES to use a mind-body connection to heal.

Busted. :rofl:

[Orrex]

21. This has been one of my chief objections to placebo over the years

Though claimed as a "mind over matter" panacea, such impact as they have is always limited to either purely perceptual symptoms or else to conditions that are largely psychosomatic. Nothing wrong with mitigating discomfort in such cases, but to claim that placebo (or, by extension The Mind) has some magical healing power is irresponsible at best, if not unethically fraudulent.

[Celebration]

23. A question

Is the mind body connection real to you or magical, because you are the only one using the term magical.

[Orrex]

24. The mind-body connection is an illusion

Not because there is no connection between one and the other but rather because there is, ultimately, no distinction between one and the other.

[bemildred]

25. What does it mean for something to be "purely perceptual" if mind and body are not distinct?

To be clear, I agree that the distinction between mind and body is imaginary, but then it seems to me that the notion of the "purely perceptual" is also imaginary, and likewise imaginary the "purely physical". The mind's effects on the body are just as real and the bodies effects on the mind, in fact they are different aspects of the same thing, and which one chooses is a pragmatic issue. If one is to abandon the false dichotomy, one must abandon it altogether.

[HuckleB]

26. You wouldn’t lie to me, would you?

http://scientopia.org/blogs/whitecoatunderground/2010/12/24/you-wouldnt-lie-to-me-would-you/