"I'm addicted to placebos. I'd give them up, but it wouldn't make any difference." ~ Steven Wright
August 2, 2007 1:46 AM   Subscribe

The Placebo Effect In Action. "When patients believe a drug will help them, they sometimes heal themselves" (a report on a new study from Columbia University and the University of Michigan). And, an additional take on the Placebo Effect from the Skeptic's Dictionary.
posted by amyms (19 comments total) 4 users marked this as a favorite
For those of you who don't care about the article, and were just drawn here by the word "placebo"... Here are some videos from the band Placebo.
posted by amyms at 1:55 AM on August 2, 2007 [2 favorites]

And for those of you who were drawn here by the Steven Wright quote in the title, here are some video clips of his performances.
posted by amyms at 1:57 AM on August 2, 2007 [2 favorites]

My personal opinion is that people often need faith (or optimism, or the positive idea that they can be healed) more than drugs. People are overdrugged anyway, especially Americans. Whenever I go back to the states and see the insane amount of drug commercials on TV I'm always a little saddened.

Otherwise, I'd just like to add that when I was rather young I read the word "placebo" for at least a few years before I ever heard it pronounced, and I always thought it was place-bo, as in "nice place you got here".
posted by flapjax at midnite at 3:05 AM on August 2, 2007 [1 favorite]

What's a placebo?
posted by mattoxic at 4:04 AM on August 2, 2007

Interesting aqrticle, but its worth clarifying a few things here.

(1) This is just an abcnews gloss on a scientific study, but (at least as far as I can determine) the actual published study is still under embargo as isn't yet available at the .Proceedings of the National Academy of Sciences website. News reports of scientific studies are notoriously hyperbolic, oversimplified, or even downright inaccurate. Its tough to comment on the significance of the study based solely on one brief abcnews article.

(2) If the story is reporting correctly, the study administered a placebo cream to patients and then exposed them to painful stimuli. This is not the same thing as giving patients with pre-existing symptoms a placebo. That does not mean this study is worthless, just that it is demonstrating something different from what we normally think of as the placebo effect. In particular, it has nothing to do with quotation provided in the FPP ("When patients believe a drug will help them, they sometimes heal themselves"). There is no healing going on in this study, only pre-emptive release of opiods.

(3) This article hardly provides revolutionary new information. The placebo effect has long been known to be particularly strong for pain remedies, but weak or nonexistent for most other symptoms. One recent meta-analysis found there to be few clinical effects for conditions with objective or binary outcomes, and small benefits for conditions with subjective outcomes and the treatment of pain. Others have shown the placebo effect to be more effective, and to vary with the type and intensity of the treatment (e.g., a bigger pill results in a stronger placebo effect than a smaller one). [Other studies linked here]. So the article subtitle ("First To Show Placebo-Induced Pain Relief in Humans") is misleading; this may be the first to use PET scans to study the placebo effect, but it is hardly the first to "show placebo-induced pain relief."
posted by googly at 4:50 AM on August 2, 2007 [4 favorites]

Interestingly people have actually been able to block the placebo effect in some cases by giving people chemicals that prevent endorphins from being released.
posted by delmoi at 5:42 AM on August 2, 2007

I find an important point in the above comment by googly - that placebo effect is weak for symptoms other than pain.

Pain is a symptom, but in my laymen's understanding, not the cause of a condition.

Ancedotally speaking, I can attest to this. My husband became critically ill and we never considered any outcome other than positive as he was receiving treatment. (Well, maybe just a brief flash of doubt when he was first diagnosed; but the only outcome we could see/accept was positive.) We were still working towards and planning his next treatment until a few hours before he lapsed into semi-consciousness ... Even if all of the medications, etc. were simply placeboo, they didn't work just because we knew without a shadow of a doubt that they would. The feeling that it would get better didn't work on the root cause of the symptoms.

Of course, my case is just one cite. Not random, nor blind tested, etc. Perhap placeboo/postive thinking isn't as much about healing yourself as it is about believing there is a good reason to feel better. Sorry to inject a personal cite, but I think it's important to define the difference between symptom and cause of a condition - and how we react to those stimuli.
posted by mightshould at 6:01 AM on August 2, 2007 [1 favorite]

I think there's also a need for a link to the nocebo effect.
posted by ObscureReferenceMan at 7:58 AM on August 2, 2007

This is a fascinating finding -- the ability of the central nervous system to control pain has been a major part of pain theories for quite a while. This link describes the gate control theory in which one of the major mechanisms for pain control involves a central nervous system 'gate' that essentially 'turns' off pain sensation.
posted by bluesky43 at 9:06 AM on August 2, 2007

When I was young and had a loose tooth that was about to come out, I was frightened and wouldn't let my parents pull the tooth out. My dad went and got some of his special numbing cream that he rubbed on the gum and tooth before he effortlessly pulled the tooth from the single flap of skin that was still holding it in my mouth.

In reality the numbing cream was nothing more than an Army issue tube of toothpaste, but I was young and had never had a tooth come out before and was scared to death.

I really have to hand it to my dad, that was one of the better tricks he pulled on me, unlike the time he made me think my room was haunted or saying there was a squirrel on the tree past the kitchen window behind me and then stealing the last pork chop off my plate while I was turned around.
posted by daHIFI at 9:10 AM on August 2, 2007 [1 favorite]

Here's my own placebo story. Couple years ago I broke my wrist pretty badly & was hospitalized. They put me on a patient-assisted morphine drip for the pain, which was severe. When the bag emptied the machine would beep & the nurse on duty would replace it. One time a new nurse came in & fiddle with the machine & it stopped beeping, so I assumed she'd refilled it & started it back up. It certainly felt like the morphine was flowing as what little pain I felt went away when I hit the button. It was around this time I started to get mild hallucinations, hearing voices & music that others around me couldn't hear. When my regular nurse came back she noticed that the drip was empty, which confused me because "the other nurse came just an hour ago & refilled it". She checked my chart & assured me it hadn't been filled in hours. When I added that this non-existent morphine was also giving me hallucinations, they took me off it for good & switched me to Percocet. Which it turns out I'm extremely allergic to, but that's another story.

All in all it was a curious experience. I tricked myself into thinking the morphine was there, so my brain started manufacturing it for me.
posted by scalefree at 9:16 AM on August 2, 2007 [1 favorite]

Let me change the discussion slightly to "do medications give efficacy by a placebo response?"

Here's an example from psychiatry: shrinks love polypharmacy. They start with drug A, no effect, and then supplement with drug B, and get effect. Was it a) Drug A finally kicking in, and B did nothing? b) the combination of Drug A and Drug B finally working? c) Drug B doing all work, and you could just as efficaciously switched to Drug B, as opposed to supplementing with Drug B?

And it depends on your paradigm. If you believe that drug A failed because, for example, "bipolar is a difficult illness to treat" then your bias is that two drugs are necessary. Or, you could believe that your patient is not a responder to Drug A, and so should switch to drug B.

Right now, psychiatry is in the former camp-- "if one doesn't work, you should add two." But, importantly, none of the studies actually show this. Psychiatry simply chooses to believe that, likely, polypharmacy is necessary.

So, too, the placebo effect. The interesting question isn't whether or not the placebo effect is real-- it is real, and it generates real brain responses when it does work-- the question is whether or not many of the medications we use are not, in fact, placebos--with bad side effects.
posted by TheLastPsychiatrist at 2:06 PM on August 2, 2007 [2 favorites]

I find an important point in the above comment by googly - that placebo effect is weak for symptoms other than pain.

It's also strikingly effective in Parkinson's patients, but doesn't last very long. There's some preliminary evidence that it's dopamine mediated.
posted by porpoise at 2:06 PM on August 2, 2007

"...but weak or nonexistent for most other symptoms..."

I was under the impression it is also quite strong for both depression and chronic disgestive issues like colonic inflammation, IBS, etc.
posted by lastobelus at 3:43 PM on August 2, 2007

Homeopathics work by placebo effect, IMO. Wonderful how powerful the mind is!
posted by five fresh fish at 8:05 PM on August 2, 2007

Homeopathics work by placebo effect, IMO. Wonderful how powerful the mind is!

Maybe, but I always keep some Arnica on hand. It's certainly worked for me in the past, placebo or not. I personally think it should be on hand in ambulances. At the very least they could do a trial where one hospital used it consistently and see what the recovery rates looked like.
posted by Deathalicious at 8:14 PM on August 2, 2007

And in much the same spirit, I always choose the worst-tasting cough medicines, on the theory they encourage my body to get healthier, faster.

That not one double-blind clinical trial has shown proof of homeopathic efficacy is, I think, the nail in the coffin of any arguments you may wish to have about it. If that doesn't suit you, I can only recommend you try some homeopathic oxygen.
posted by five fresh fish at 8:17 PM on August 2, 2007

The mind is a terrible thing.
posted by homunculus at 9:06 PM on August 2, 2007

Slim in a thirteeth bed-rig?
posted by five fresh fish at 10:08 PM on August 2, 2007

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