Science

Placebo Effect: Realer Than Real Deal Holyfield

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Not the newest of news, but anything that reminds us of how tenuous a business/science medicine is has great public policy implications today. From the Boston Globe:

You're not likely to hear about this from your doctor, but fake medical treatment can work amazingly well. For a range of ailments, from pain and nausea to depression and Parkinson's disease, placebos–whether sugar pills, saline injections, or sham surgery–have often produced results that rival those of standard therapies…..

But any attempt to harness the placebo effect immediately runs into thorny ethical and practical dilemmas. To present a dummy pill as real medicine would be, by most standards, to lie. To prescribe one openly, however, would risk undermining the effect. And even if these issues were resolved, the whole idea still might sound a little shady–offering bogus pills or procedures could seem, from the patient's perspective, hard to distinguish from skimping on care….

But according to advocates, there's enough data for doctors to start thinking of the placebo effect not as the opposite of medicine, but as a tool they can use in an evidence-based, conscientious manner. Broadly speaking, it seems sensible to make every effort to enlist the body's own ability to heal itself–which is what, at bottom, placebos seem to do. And as researchers examine it more closely, the placebo is having another effect as well: it is revealing a great deal about the subtle and unexpected influences that medical care, as opposed to the medicine itself, has on patients….

In the last decade-plus, however, the accumulating data have sparked a renewed interest in the placebo as a treatment in its own right. Numerous studies have shown that it can trigger verifiable changes in the body. Brain scans have shown that placebo pain relief is not only subjectively experienced, but that in many cases the brain releases its own internal painkillers, known as endogenous opioids. (This placebo effect can even be reversed by the opioid-blocker naloxone.) Another study, published in Science in 2009, found that patients given a topical cream for arm pain showed much less pain-related activity in the spinal cord when told it was a powerful painkiller. A 2009 study found that patients benefited as much from a fake version of a popular spinal surgery as they did from the real one; asthma patients have shown strong responses to a mock inhaler…..

One audacious tack would be to tell the truth: to notify patients that they are about to be given a fake pill. The idea sounds absurd, and doctors have long assumed that would ruin the effect. But there's almost no research on the question, and it may not be as unthinkable as it seems. One reason it could work involves "classical conditioning"–the notion that we can learn on a subconscious level, like Pavlov's dogs, to biologically respond to certain stimuli. This concept suggests that the brain could automatically react to the placebo in a way that doesn't require conscious faith in the drug. (The placebo effect has been observed in rodents, which bolsters this theory.) 

Whole thing worth reading, though it does drift off in a direction I find a bit off-putting: elevating and aggrandizing the ritual power of medical professionals themselves, which I think our culture (and politics) does too much of already. Read my Suck.com classic on the troubles with conflating health care and health.

NEXT: Mozart Effect: As Bogus As the Plot of Amadeus

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  1. And to keep down costs, we will now be giving sugar pills to sick people instead of real drugs.

    You know, come to think of it, during my campaign, I had a kind of placebo effect on the electorate.

  2. May I interest you in some Ambrotose?

  3. I thought I was the only person on earth whose Soma ration was low enough that I could remember when “health care” was just creepy managerial jargon.

  4. Maybe doctors should start offering a special treatment plan where they will randomly give you either real or placebo treatments without telling you which is which. As long as you agree to this plan beforehand, I don’t really see a problem.

  5. A Snoop Doggy Doo reference? Really?

    I suppose next you’ll tell me “it’s like this and like that and like this, and uh.”

  6. Oh, and look, now that’s the health care bill is safely passed, the CBO has had time to answer Rep. Jerry Lewis (R-CA, ranking member) House Appropriations Committee about the administrative costs.

    Surprise! It costs “about $115 billion more in discretionary spending over ten years than the original cost projections.”

    1. Maybe he should hold a telethon to pay for it.

    2. Plus the hidden tax changes that will mean tons of more paperwork. Short version: if you’re a business and buy more than $600 in goods or services in a year from anyone, you’ll have to issue them a 1099.

  7. Way to refer to your own work as a “classic”.

  8. You’re not likely to hear about this from your doctor, but fake medical treatment can work amazingly well.

    I saw Benny Hinn do that once.

    1. Binny Hinn’s greatest hits

      http://www.youtube.com/watch?v=a54iqEr1flQ

      Ahhh Drowning Pool…

  9. The placebo effect is matched by psychogenic illness–which can often be induced from stressed emotional states, including fear, anxiety, depression. Many of us who don’t accept the HIV=AIDS paradigm believe that psychogenic illness among gay men, from the emotional assault of the religious right and social isolation from family and friends in the early 1980’s was one of three components of multifactorial causation of immune deficiency syndrome. The other two were unprecedented exchange of old disease pathogens among sexually incestuous, urban ghetto-ized gay males, and unprecedented ingestion of toxins in the form of recreational drugs. All three factors combined to create serious immunosuppression among a subset of gay males. Desperate to make a multi-factor syndrome a “disease that could affect anybody,” gay or straight, we gay men were accomodated by the ethically-challenged Dr. Robert Gallo, who simply conjured up what he called “HTLV-III”–one of the handful of retroviruses he had been studying for a decade and which he couldn’t make cause cancer, so he re-purposed it for the amorphous syndrome that was making ill and killing gay men.

    Should you care to challenge your certainty that the mysterious HIV causes the amorphous syndrome, there are thousands of sources on the web, and I have written a 7,700 word summary of the anomalies of HIV=AIDS theory.
    http://www.terrymichael.net/Ht…..eport.html

    And see the trailer for the excellent new documentary that questions the theory, House of Numbers:
    http://www.terrymichael.net/Ht…..eport.html

    And, be certain, the HIV-AIDS Industry storm troopers will engage in an ad hominem attack on me, calling me a “denialst”, along with anyone else willing to tell the truth about AIDS and the highly toxic chemotherapies used to “treat” so-called “HIV disease.”

    1. Chemtrails what?

    2. Cattle mutilations are up!

    3. All three factors combined to create serious immunosuppression among a subset of gay males.

      The concurrent holocaust caused by an identical syndrome among hemophiliacs recieving factor concentrate is less readily dismissed.

      1. Come on, nothing says “sexually incestuous, urban ghetto-ized” and “unprecedented ingestion of toxins in the form of recreational drugs,” and “unprecedented ingestion of toxins in the form of recreational drugs” like 1980s hemophiliacs.

        1. Tell that to the hemophiliac in Toronto with whom I am well-acquainted. He’s in his late 30’s now. When he was 16, he tested HIV “positive.” He was in a community of a dozen hemophiliacs in Toronto at that time. His mother intervened and kept him from taking AZT. He is not only alive, but very healthy, never having experienced any so-called “AIDS-defining opportunistic illness.” The other 11 are dead, victims of the iatrogenic illness caused by the chemotherapy, as are tens of thousands of others who succumbed to the “life saving treatments.” Do some reading. Don’t repeat urban myths. At the time AIDS appeared, the life span of hemophiliacs was relatively brief, since the blood factors with which they were treated had many health challenging side effects.

          1. Anti-retrovirals have done more to expand the lives of HIV infected patients than doing nothing, which is what you propose, Mr. Micheal. Sorry, I don’t buy it. People have the right to treat their disease processes as they wish, but to put an idea that forgoing accepted medical practice with evidence based TX and RX is reprehensible.

            1. This guy would rather us believe his own amateur, anecdotally-derived, and insanity-skewed medical assessments than the mountain of data easily available on pubmed.
              You’re right, what this guy says is reprehensible.

              1. There is virtually no data on PubMed, it’s just a database of citations. That’s important because too many researchers just use what is available – abstracts – and those are known to be dramatically skewed. Read the real scientific data (as have I and many other critics) and it becomes a lot more complex. Consider, for example, http://aras.ab.ca/haart.html (direct quotes from the science, beyond the abstracts and press releases).

    4. And, be certain, the HIV-AIDS Industry storm troopers will engage in an ad hominem attack on me, calling me a “denialst”, along with anyone else willing to tell the truth about AIDS and the highly toxic chemotherapies used to “treat” so-called “HIV disease.”

      Have you ever met Chris Kelly, AKA LoneWacko? I think you two would get along famously, unless you are of Hispanic ancestry.

      I have read your missives and find them quite uncompelling at best, and of the garden variety lunacy. Yes, garden variety. In fact, I would go so far as to say hack, scaremonger, and little more than the tin-foil hat equivalent of a race huckster, and certainly lacking in flair.

      That said, sir, you are a kook!

      1. You make my case precisely. You use about 60 words to engage in a personal attack on me, without making a single argument.

        1. I had to make your disclaimer worthwhile. 🙂

      2. This troubled man has commented on the boards here before. The only scary part about his lunacy is that he might convince some really feeble-minded person to stop taking their HAART drugs and then die (This is a hypothesis confirmed in every HIV clinic in the world when patients don’t show up for followup). I wouldn’t care otherwise.
        This guy would probably tell someone with lymphoma to forego chemotherapy, because in his mind lymphoma’s really just a scam dreamed up by scientists to help Big Pharma sell their toxic drugs.
        Either this man is stupid, disturbed, or malevolent.

        1. marlok…
          Another fine example of The HIV-AIDS Industry attempt to quash dissent with name-calling. Perhaps he might want to see this report by New York Magazine from last November and watch the accompanying video of the horrific “side effects” of HAART:
          http://nymag.com/health/features/61740/

          My views are informed by three years of intense research and reading–16 books, scores of science and medical journal articles, thousands of words of alternative media reporting–and now, 7,700 words of my own at:
          http://www.terrymichael.net/Ht…..eport.html

          I am a 62-year-old gay man who never had a doubt about the HIV=AIDS paradigm until three years ago this past February, when I stumbled on the dissent of thousands of medical, science, and epidemiological professionals around the world who challenge the orthodox beliefs–stumbled onto it right here at Hit & Run in a post by the very same Brian Doherty whose post of the “placebo effect” started this comment thread. He wrote then (Feb 07) about an egregious case of criminal prosecution of an “HIV positive” heterosexual male in Australia, in which Brian linked to one of the many HIV-AIDS re-thinkers web sites.

          If people like “marlok”, hiding behind their cloak of anonymity, want to spread their vitriol, I can take it. What I can’t take is sitting by and watching the HIV=AIDS Industry and the drug companies that fund it take their toll on the health of millions of gay men and now black Africans.

  10. Even we couldn’t make it past that first paragraph, so we’ll give you a pass today.

    Next time, full scale Godwin on you though!

    1. Pretty good. The brand names mentioned are Sucrosa, Appeasor, Inertra, and Pacifex. Years ago the Journal of Irreproducible Results had a funny list of suggested names for placebos, but the only one I can remember is Confusalum.

  11. That dude is still way cool no matter how you cut it.

    Lou
    http://www.anon-posting.tk

  12. I’m real too! (I’m always forgotten)

  13. though it does drift off in a direction I find a bit off-putting: elevating and aggrandizing the ritual power of medical professionals themselves, which I think our culture (and politics) does too much of already.

    Love you too Doherty!

    The next time you are in my neck of the woods and you need invasive surgery, I’ll be more than happy to schedule you for a procedure. No anesthesia. Your anesthesia provider will be a hypnotist. Your post-op PX meds will be sugar pills. Hell, let’s make ’em Flinstone’s vitamins! Cherry flavored. That should control your pain real nicely. BTW, the prescribing of placebos is, while not illegal and given as part of drug trials, very unethical IMO and tantamount to fraud and undermines the doctor/patient relationship. Why would a patient knowingly ask his or her physician to prescribe something that they know will not have measured therapeutic benefit?

    Classical conditioning is temporary at best.

    1. Non sequitur, Groovus Maximus. You’ve totally failed to respond to the part you quoted. I’ll quote it again.

      though it does drift off in a direction I find a bit off-putting: elevating and aggrandizing the ritual power of medical professionals themselves, which I think our culture (and politics) does too much of already.

      How do you disagree with this? This has nothing to do with placebos. This has to do with things like “medical marijuana,” where one can get pot, but only if a doctor says so.

      Or small portable cottages for elderly members being allowed by disrupting stupid zoning laws– but only with a doctor’s order.

      One reason why health care (and many other things) is very expensive in this country is that it requires a doctor’s permission to do lots of things and get certain drugs. Hypothetically, that could reduce the number of people taking quack medicine. In practice, people just keep going to different doctors until they find one that will prescribe what they want (or get it on the grey or black market), and it all just adds to unnecessary costs.

      The doctor cartel can be as bad as politicians and lawyers.

      1. True, but I had his entire post in my mind, so I do apologize if I didn’t address the quote directly, but I was alluding to, albeit in a snarky way, the notion of “aggrandizing”.

        Not going to deny that JT. There is a bit more than just the Doctor Cartel. There is the state board, which has more to do with the regulation of doctors than anyone else, with the possible exception of the malpractice insurance industry. Factor in Federal oversight, both direct, such as the DEA, and indirect, such as the Joint Commission (JCAHO). And all these bodies make licensure very expensive to maintain. I have given this subject much brooding, and about the only thing I can figure, is let’s say there are more ARNP’s and Pharmacists were given prescriptive authority (neither of which I have a major problem with, particularly pharmacists prescribing) and with more liability floating around out there, their costs of service providing will increase, to cover, you guessed it, their increased malpractice premiums. And if you think doctors malpractice insurance is going down, especially with such a litigious society that we have (and it’s good, there must be recourse and why there are so many regulations it’s not even remotely humorous) actuaries are not going to lower rates willingly. But that’s a supposed non-issue thanks to Obamacare

        To lower the cost of medical care, even with division of labor is dubious to me, as we spend more time being educated and trained than either the ARNP or the Pharmacist. And our cost of schooling is much higher than either. You do get what you pay for.

        As far as requiring a scrip or order for every little piece of medical whatever, government and private insurers has had more influence on prices and requiring orders so we can get reimbursed for what the insurer (CMS or third party) will agree to pay. More of that eliminating “fraud and abuse”. By keeping the supply of us small (bunch of factors there too, not just the AMA) keeps the price high.

        As I did state on another thread, if you want to go to Web MD and DX yourself and self-medicate, be my guest. Odds are you’ll make a mistake.

        It took me quite a while to be open to the idea of medical marijuana, and the decriminalization of “illicit” drugs as medical school plugs into our heads the politics of it, with a massive dose of biased science. Medical MJ is going to be first place to gain any legitimacy, and even then, with Marinol available, some states just aren’t going to jump on board. I support the total legalization of pot and most recreational drugs, as prohibition has been a manifest failure.

        1. Fuck Off rent-seeking guilds man!

      2. One reason why health care (and many other things) is very expensive in this country is that it requires a doctor’s permission to do lots of things and get certain drugs.

        Fucking guild system.

  14. the problem is when doctors give patients placebos (not as part of a clinical trial) under the understanding its real medicine.
    while I do believe the placebo effect is heavily linked to the endogenous opioid and endocannabinoid system, there are just some things and some people its not going to work on. they say some people in pain or in opioid withdrawal can be tricked into thinking they feel better, but there are clearly times when they endogenous systems aren’t going to be able to overpower the pain signals/whatever the problem is. there is some things about the placebo effect in a book called The Holographic Universe, in a section where they talk about the brain working holographically.

  15. Anyway, this explains the success of supplements industry, today’s snake oil.

    1. yeah I was thinking the same thing, why don’t more medicines and supplements that don’t really work cause the placebo effect? but don’t write off all supplements, much of our modern medicine comes from plants or is synthesized from plant compounds. a lot of supplements are bs, but not all are.
      but what bubba says bellow is right on, homeopathy is bs, they are selling water, homeopathy is different from non-homeopathic supplements.

  16. Isn’t that the whole basis of homeopathy?

    1. Not according to homeopaths, but yeah.

  17. The better question to be asking is: what does this say about the effectiveness of all those “real” medicines we all take? Particularly the ones we take for a really long time, well past the point where any placebo-controlled efficacy data are available?

    1. that is why you should research any medicine you take. for example a drug like prozac may be no better than placebo for depression, but many other drugs significantly outperform placebos and other drugs used to treat the same condition.

  18. Fake surgery? WTF?!

    My problem is that I’m a perpetual skeptic. I don’t think anything’s going to have the desired effect (probably causing it not to in light of this study).

    So more gullible people would seem to have better outcomes from health care.

    figures. Happy dumbasses.

  19. Religion is a placebo, too. Instead of a pill, you have a priest giving you Baby Jesus. All the believers are happy, and the priest gets his take.

  20. Since medicine is mostly quackery anyway, I doubt a doctor prescribing me a placebo would do me any good.

  21. For a range of ailments, from pain and nausea to depression and Parkinson’s disease, placebos–whether sugar pills, saline injections, or sham surgery–have often produced results that rival those of standard therapies…..

    This is hardly news. We’ve been down this road with Acupuncture for years.

    The problem– or the reason that no one wants to delve into is that it’s not that sham, “fake” or placebo treatments work really well, it’s that so many ailments are shams and fakes to begin with. Nothing treats a fake ailment better than a fake procedure.

    In a world where almost everything is ‘medicalized’, we now have large swathes of the population suffering from ‘syndromes’, untracable pain and myriad symptoms that don’t coalesce into anything that can really be detected through any abnormal lab result.

    People (especially libertarians) were horrified when insurance companies started to buckle and pay for acupuncture and other bogus non-evidence based treatments.

    However, when you look at it from a standpoint of economics, it begins to make sense.

    The insurance company would rather pay $20 to an acupuncturist to relieve Disability Dan’s “backpain” than send him to a real doctor for $300 a visit plus $125 worth of medication for the same result.

    1. How can you call accupuncture fake when it helps so much with my fibromyalgia?

  22. Why not test for the placebo effect in reverse? Tell patients receiving the real drug and patients receiving the sugar pill that they’re in the placebo group.

  23. The truly sad thing about whackaloon Terry Michael? Reason has him as a contributor.

    Nice way to conflate libertarianism with lunacy …

    1. dbcooper…

      Still another fine example of The HIV-AIDS Industry attempt to quash dissent with name-calling. Perhaps he might want to see this report by New York Magazine from last November and watch the accompanying video of the horrific “side effects” of HAART:
      http://nymag.com/health/features/61740/

      My views are informed by three years of intense research and reading–16 books, scores of science and medical journal articles, thousands of words of alternative media reporting–and now, 7,700 words of my own at:
      http://www.terrymichael.net/Ht…..eport.html

      I am a 62-year-old gay man who never had a doubt about the HIV=AIDS paradigm until three years ago this past February, when I stumbled on the dissent of thousands of medical, science, and epidemiological professionals around the world who challenge the orthodox beliefs–stumbled onto it right here at Hit & Run in a post by the very same Brian Doherty whose post of the “placebo effect” started this comment thread. He wrote then (Feb 07) about an egregious case of criminal prosecution of an “HIV positive” heterosexual male in Australia, in which Brian linked to one of the many HIV-AIDS re-thinkers web sites.

      If people like “dbcooper”, hiding behind their cloak of anonymity, want to spread their vitriol, I can take it. What I can’t take is sitting by and watching the HIV=AIDS Industry and the drug companies that fund it take their toll on the health of millions of gay men and now black Africans.

  24. and now, 7,700 words of my own

    Good lord. You actually believe that you’re capable of reviewing the scientific literature, don’t you?

    *speechless*

  25. Understand, that when you question anything about the HIV-AIDS cult, they go into full character assassination mode, in an attempt to stifle any discussion of their belief system. Try to find one instance where they attempt to make an argument. They just attack, like “dbcooper.” This is a libertarian web site, advocating a philosophy in which people challenge authority and think for themselves. The HIV-AIDS Industry is authoritarian, so unconvinced of its own dogma that it allows no dissent.

    1. You forgot to mention dbcooper “cloak of anonymity.”

      Repetition makes your point better than anything else. Repetition makes your point better than anything else. Repetition makes your point better than anything else. Repetition makes your point better than anything else. Repetition makes your point better than anything else.

      See?

  26. Excellent new report on the anomalies from HIV=AIDS theory and the outright lies of those who continue to suppress dissent from the madness…by Liam Scheff, an independent investigative journalist who has done excellent work on The HIV=AIDS Industry for years, just published online today (May 12, 2010):
    “Does AIDS Cause HIV?”
    http://www.omsj.org/blogs/does-aids-cause-hiv
    Written simply enough that maybe even Il Duce Fauci and his corps of tens of thousands of taxpayer-funded HIV-AIDS “researchers” can understand it. Latest estimate of the total spent on HIV=AIDS over the past 25 years: someplace between $200 and $300 billion. Latest estimate of the annual sales of the toxic chemotherapy labeled with the benign-sounding euphemistic acronymn, “HAART”: over $10 billion. Does that give you a clue why we call it “The HIV=AIDS Industry”?

  27. This definitely raises some interesting legal and ethical issues. But in the end, if a person (especially, say, a hypochondriac) can see a marked improvement in their quality of life through the use of a placebo, why not use them?

  28. This is definitely an interesting topic and raises some serious legal and ethical questions (fraud and malpractice come to mind).

    But if some people can see a marked improvement in their quality of life through the use of placebos, why not use them? I’m thinking primarily of hypochondriacs, and people with similar disorders.

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