Can we have the Placebo Effect without falsehood?

Great Debates
21

[QUOTE=Musicat]
Got a list of those names? I’d like to check my medicine cabinet. :slight_smile:

[/QUOTE]

Just the two I posted above, easily Googleable. My dad the pharmacist (hospital based Pharm D, actually - we have neato medical ethics conversations over dinner; the rest of the family would like us to stop talking at the dinner table about babies born without brains) tells me there are others, but he won’t tell me what they are, in case I find myself in possession of them one day! :smiley: I hereby extend the same consideration to you.

In the hospital, as was mentioned in the first article I linked, saline can be given through an IV as a placebo. Then again, almost everyone on a real IV gets saline, so next time you see saline on your pole, don’t freak out, they’re probably not trying to pull one over on you!

22

Musicat up there is right. Whenever people attribute lessening of symptoms to placebos they are committing a post hoc ergo propter hoc fallacy. People get better for all kinds of reasons, or none. The placebo has nothing to do with it. If you give half the people the placebo, and the other half the people you say to , “We’ll just keep an eye on it and see what happens”, are there different recovery rates?

23

[QUOTE=Musicat]
The one thing we can be pretty certain about is that the placebo didn’t cause the beneficial effect thru known chemical or physical actions.

Maybe the patient’s mind cured him. Maybe a supernatural being {insert god of choice here} intervened. But more likely than not, the cause and effect were simply not connected. There is such a thing as spontaneous remission and there are other, possibly unforseen and as yet undiscovered, factors at work.

So anytime you say, “The placebo cured him,” you should be saying, “The result wasn’t caused by the applied treatment.”
[/QUOTE]
[My bolding] I thought this was the whole point of placebo - that belief in a promising (but actually inert) drug leads to positive psychosomatic effects? I didn’t think that anyone (except perhaps homeopathy fans) think that sugar pills or glasses of water with especially good memories actually help people directly.

24

[QUOTE=Staggerlee]
Why ‘spiritual’? Isn’t placebo an illustration of a psychological process?

I think if the placebo effect could be shown to cure cancer, then the medical authorities would quickly weigh this up against their ethical concerns and roll out the sugar tablets across hospices worldwide. Cancers do go into remission all the time - obviously at least once in conjunction with a placebo.

So faith healing, prayer and sugar pills are all comparable? That potentially says a lot about the power of ‘mind over matter’, but also suggests that it doesn’t much matter exactly *what * you believe in as long as you believe in something. And this was my intended debate - how can we avoid throwing the baby (positive benefits of belief) out with the bathwater (objectively ineffective objects of belief).
[/QUOTE]

I use the word spiritual because placebo effect is part of the spiritual realm. We humans are not machines that respond to pills, words, or anything in the same way. While our bodies are similar, our emotional/spiritual makeup is very different.

There are very few scientists that are interested in the placebo effect. But I did find a study on patients that had terminal cancer, and that cancer went into remission. It happened years ago, by one doctor, who interviewed less than 10 patients. He found the only common thing between the patients was a change in perspective on life. They all, in some way, looked at life differently than before the remission. I can’t tell you where to find this study, it happened before the Internet. The doctor said he tried to get other doctors interested in studying the placebo effect but to no avail. He said after all, patients who get well on their own don’t need doctors so why should doctors be interested in them.

It is true that we humans are spiritual people who lived in spirit form before we came into the physical and will go back to living in spirit form after the death of our bodies. I can’t prove this, but I know it to be true. What is does is make our thoughts very important to us. We used thoughts only in the spirit world to communicate, create, and maneuver. So it is true we can control and sharpen and focus our thoughts in the physical to help us here. Not many scientists will even consider what I said so I don’t believe there is any danger of them rushing in to use the placebo in new and different ways.

Also one has to consider the nature of the physical, the being born, growing up, then dying cycle. The “Cancer Treatment Center of America” do work with the mind/body relationship. They will provide the patient almost anything the patient wants to try. At the one in my town they provided an Indian Medicine man to treat a patient because he asked for it. No, don’t know the outcome.

One more final thought. Mind, psyche, soul, spirit, and many other words all point to the same phenomenon. But I will not argue the seemed differences. The brain really has nothing to do with it, only an interface between mind and body.

25

[QUOTE=Staggerlee]
[My bolding] I thought this was the whole point of placebo - that belief in a promising (but actually inert) drug leads to positive psychosomatic effects? I didn’t think that anyone (except perhaps homeopathy fans) think that sugar pills or glasses of water with especially good memories actually help people directly.
[/QUOTE]
Kirsch developed a theoretical model of “response expectancy”, of which the placebo effect is an example. Essentially, one’s expectations for a given outcome influence the degree to which they perceive that outcome. This not only applies to expectations associated with placebos, but also with the degree to which you are affected by spicy foods, tickling, experience of physical pain, performance on tasks such as shooting free throws, and so forth.

26

[QUOTE=Hentor the Barbarian]
Kirsch developed a theoretical model of “response expectancy”, of which the placebo effect is an example. Essentially, one’s expectations for a given outcome influence the degree to which they perceive that outcome. This not only applies to expectations associated with placebos, but also with the degree to which you are affected by spicy foods, tickling, experience of physical pain, performance on tasks such as shooting free throws, and so forth.
[/QUOTE]

Yes, the mind does influence the body. Those that believe they can, do.

Mark Twain wrote: “Some people believe they can and some believe they can’t, both are correct.”

27

I think I know of a case where a placebo-like mechanism is in effect. Someone I know is on a weight-loss program, supervised by a doctor, that consists of an amphetamine-based appetite suppressant, a diuretic, and (of course) a prescribed regimen of diet and exercise. Obviously the amphetamine is going to help with things like occasional binge-eating. I think the diuretic action of dropping water now and then serves only to keep the scale weight visibly decreasing as encouragement for those who are motivated mainly by changes in weight. It has worked, after 1 year they lost 60 pounds. Aside from still being somewhat overweight, they look good, they are not dried-up and desiccated from lack of water.

I don’t know if it counts necessarily as deception or falsehood. Technically a diuretic makes you “lose weight” though the dr. never told them it removes fat. I think they’re just sort of accepting the whole story without asking too many questions, as long as it keeps working.

28

[QUOTE=Brain Wreck]
I think I know of a case where a placebo-like mechanism is in effect. Someone I know is on a weight-loss program, supervised by a doctor, that consists of an amphetamine-based appetite suppressant, a diuretic, and (of course) a prescribed regimen of diet and exercise. Obviously the amphetamine is going to help with things like occasional binge-eating. I think the diuretic action of dropping water now and then serves only to keep the scale weight visibly decreasing as encouragement for those who are motivated mainly by changes in weight. It has worked, after 1 year they lost 60 pounds. Aside from still being somewhat overweight, they look good, they are not dried-up and desiccated from lack of water.

I don’t know if it counts necessarily as deception or falsehood. Technically a diuretic makes you “lose weight” though the dr. never told them it removes fat. I think they’re just sort of accepting the whole story without asking too many questions, as long as it keeps working.
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A very good example of using the placebo. I believe nearly all diet pills are little more than placebos. I don’t see any moral problem with this as long as it actually benefits the patient. People need to believe in “things” when they lack belief in themselves. But the placebo can be used to cause harm as when a fortune teller sells a magic candle to ward off evil spirits for a large amount of money. Rather than explaining there are no evil spirits.

29

Yes, there are different recovery rates. That’s the whole point of the “effect”. In fact, one way to make a quick and dirty determination about the worth of a study is to look at the placebo rate - if the rate of success of the control group is much higher or lower than other placebo rates in similar studies, then there’s a flaw there somewhere. We now know that X% of people with migraines will get better taking a sugar pill, and Y% of both groups will experience spontaneous healing unrelated to the method of treatment. If your study shows that X-5% or X+5% got better with your placebo, then something was wrong with your study - set-up, control, methods, or size. The Y% (the amount who get better in both the control and the experimental groups with no relation to the treatment), can be dismissed as statistical background noise. It’s only results above the Y% mark that interest us.

30

[QUOTE=WhyNot]
Yes, there are different recovery rates. That’s the whole point of the “effect”. In fact, one way to make a quick and dirty determination about the worth of a study is to look at the placebo rate - if the rate of success of the control group is much higher or lower than other placebo rates in similar studies, then there’s a flaw there somewhere. We now know that X% of people with migraines will get better taking a sugar pill, and Y% of both groups will experience spontaneous healing unrelated to the method of treatment. If your study shows that X-5% or X+5% got better with your placebo, then something was wrong with your study - set-up, control, methods, or size. The Y% (the amount who get better in both the control and the experimental groups with no relation to the treatment), can be dismissed as statistical background noise. It’s only results above the Y% mark that interest us.
[/QUOTE]

Interesting post, I was not aware the placebo effect was used in this manner.

31

Richard Dawkins was investigating alternative therapies last night in his mini-series ‘Enemies of Reason’. As expected, having looked over various treatments - Crystal Therapy, Ayurvedic medicine, Homeopathy, etc. - he concluded that their positive health effects could be explained through two factors.

  1. One-on-one dialogue with the therapist - having a kindly soul listen to the patient would make the patient feel better in themselves, aiding recovery.

  2. Placebo effect.

  3. High-frequency Opal Therapy*

Dawkins was willing to admit the efficacy of placebo in both alternative and orthodox medical treatments, but still saw the alternative therapies as ‘enemies of reason’ and worthy of eradication.

But what he didn’t suggest is what one could rationally replace these therapies with. Would the one-on-one dialogue work as well without the mythology to support it? It was even said that some subjects responded more positively to the placebo-based treatments than orthodox medical counterparts - do we deny irrational people treatment in the name of truth?

*No.

32

[QUOTE=Staggerlee]
Richard Dawkins was investigating alternative therapies last night in his mini-series ‘Enemies of Reason’. As expected, having looked over various treatments - Crystal Therapy, Ayurvedic medicine, Homeopathy, etc. - he concluded that their positive health effects could be explained through two factors.

  1. One-on-one dialogue with the therapist - having a kindly soul listen to the patient would make the patient feel better in themselves, aiding recovery.

  2. Placebo effect.

  3. High-frequency Opal Therapy*

Dawkins was willing to admit the efficacy of placebo in both alternative and orthodox medical treatments, but still saw the alternative therapies as ‘enemies of reason’ and worthy of eradication.

But what he didn’t suggest is what one could rationally replace these therapies with. Would the one-on-one dialogue work as well without the mythology to support it? It was even said that some subjects responded more positively to the placebo-based treatments than orthodox medical counterparts - do we deny irrational people treatment in the name of truth?

*No.
[/QUOTE]

Not sure what High-frequency Opal Therapy is, frankly, I never heard of it.

If I am reading your post correctly, Dawkins is for eradication of alternative treatment even after acknowledging that they work. He calls this reason. I do not, I call it being irrational. People will go with what works regardless of what Dawkins may say, and they should. The placebo effect firmly establishes the mind over matter argument. So does bio-feedback, and other alternative methods such as Reiki which is a laying-on-of-hands treatment used in some hospitals. Then there is accu-puncture, spiritual counseling, even psychics that help many to cope with problems in their life.

Dawkins, like any other evangelist, is highly prejudiced in favor of the doctrine he preaches and just as false. No one can prove God doesn’t exist, no one can prove mankind is not spiritual. I am sure he says there is no evidence of God or the spiritual world which is false. One has only to look around himself to see the evidence of God and for the spiritual world we have the near death experiencers evidence. Man could do better by relying on his own personal resources to answer these questions.

Before I am asked:

33

[QUOTE=lekatt]
If I am reading your post correctly, Dawkins is for eradication of alternative treatment even after acknowledging that they work. He calls this reason. I do not, I call it being irrational.
[/QUOTE]
He is against irrational behaviour of all sorts generally, from what I can tell. And in this programme he was concentrating on health treatments with no basis for their efficacy beyond the two points I outlined in my post. As he pointed out also, a review of controlled experiments (controlled to remove the confounding effects of pastoral care and placebo) showing no significant health benefits from the treatments themselves. I agree with you though that it does seem irrational in itself to reject treatments which work for the greater good. My question, yet again, is can we have the benefits of placebo-based therapy, but cut out the mumbo-jumbo?

[QUOTE=lekatt]
Dawkins, like any other evangelist, is highly prejudiced in favor of the doctrine he preaches and just as false. No one can prove God doesn’t exist, no one can prove mankind is not spiritual. I am sure he says there is no evidence of God or the spiritual world which is false. One has only to look around himself to see the evidence of God and for the spiritual world we have the near death experiencers evidence. Man could do better by relying on his own personal resources to answer these questions.
[/QUOTE]
That line of reasoning is absurd. Dawkins has his flaws, but if you read The God Delusion for instance, it is quite apparent that his grasp of philosophy and science is good enough that he would never claim to ‘disprove’ God. Comparing scientific method to religious doctrine is just the sort of tit-for-tat, eye-for-eye childishness I’ve come to expect from some fanatics. Science is just a way to describe the most likely scenario.

34

[QUOTE=lekatt]
Dawkins, like any other evangelist, is highly prejudiced in favor of the doctrine he preaches and just as false.
[/QUOTE]

said the evangelist brazenly, missing the irony…

35

[QUOTE=Staggerlee]
My question, yet again, is can we have the benefits of placebo-based therapy, but cut out the mumbo-jumbo?
[/QUOTE]

Answer 1: I don’t think so - but I’m also one of those “irrational religiousists”…or maybe I’m just pragmatic enough to not really care as long as patients are getting better.

Answer 2: Why? What’s harmful about mumbo-jumbo? What are you going to replace it with?

'Cause no, I don’t think “Mr. Jones, I can find nothing wrong with you, so here, take this placebo twice a day - you know what a placebo is, right? It’s garbage, it’s a sugar pill, it does absolutely nothing in your body that a Twinkie won’t; it’s what we give people to shut them up and make them go away. And sometimes, for reasons completely unfathomable to medical science - probably because you’ve been lying all along or it’s all in your head - sometimes it makes the problem go away,” is going to be a very effective treatment.

My trouble with this line of thinking is that it seems to be putting abstract TRUTH above relieving actual pain and suffering. If the view of a white labcoat and stethescope and 20 minutes of being listened to is what it takes to make people feel better, I don’t see the need to tear it down. I’m all for TRUTH, but it’s absolutely secondary to me - the person in pain comes first, and whatever works for them is fine by me.

Honesty is a good thing, and I think, like the examples in previous posts, we shouldn’t outright lie and tell them the placebo pill is the newest best most effective treatment out there and it works by decreasing the liver enzyme responsible for converting dietary fats into cholesterol. But it’s entirely possible to be both honest and utilize the Placebo Effect for healing, which is what the OP asked.

36

[QUOTE=Staggerlee]
He is against irrational behaviour of all sorts generally, from what I can tell. And in this programme he was concentrating on health treatments with no basis for their efficacy beyond the two points I outlined in my post. As he pointed out also, a review of controlled experiments (controlled to remove the confounding effects of pastoral care and placebo) showing no significant health benefits from the treatments themselves. I agree with you though that it does seem irrational in itself to reject treatments which work for the greater good. My question, yet again, is can we have the benefits of placebo-based therapy, but cut out the mumbo-jumbo?

That line of reasoning is absurd. Dawkins has his flaws, but if you read The God Delusion for instance, it is quite apparent that his grasp of philosophy and science is good enough that he would never claim to ‘disprove’ God. Comparing scientific method to religious doctrine is just the sort of tit-for-tat, eye-for-eye childishness I’ve come to expect from some fanatics. Science is just a way to describe the most likely scenario.
[/QUOTE]

Is Dawkins the only one that can say what is irrational behaviour. He is talking about health treatments people have been using for thousands of years with good results. Is he going to dictate what people may and may not use to improve their health, I don’t think the people will let him do that, I know I won’t. He wants his way and his way only. I don’t think he is right, nor is he qualified to tell the people of the world what their health care will or will not be. Sounds like the beginning of the dark ages again. If this isn’t a religion, what is it?

You know if you take out the pills and shots from a medical treatment they probably won’t show any health benefits either. What an illogical thing to say.

I am in good company, there is a lot of talk now that science has become just another religion, I agree with them. People will respect and follow those that produce the results, not them that just talk about it. I don’t know who started this science is better than religion movement, but they sure didn’t do science any favor. If some wiser minds don’t intervene it will be science that gets hurt. There have been whole countries trying to rid themselves of religion and failed. Religion, at least some form of it is here to stay, because we are spiritual in nature.

37

[QUOTE=WhyNot]
Answer 1: I don’t think so - but I’m also one of those “irrational religiousists”…or maybe I’m just pragmatic enough to not really care as long as patients are getting better.

Answer 2: Why? What’s harmful about mumbo-jumbo? What are you going to replace it with?

'Cause no, I don’t think “Mr. Jones, I can find nothing wrong with you, so here, take this placebo twice a day - you know what a placebo is, right? It’s garbage, it’s a sugar pill, it does absolutely nothing in your body that a Twinkie won’t; it’s what we give people to shut them up and make them go away. And sometimes, for reasons completely unfathomable to medical science - probably because you’ve been lying all along or it’s all in your head - sometimes it makes the problem go away,” is going to be a very effective treatment.

My trouble with this line of thinking is that it seems to be putting abstract TRUTH above relieving actual pain and suffering. If the view of a white labcoat and stethescope and 20 minutes of being listened to is what it takes to make people feel better, I don’t see the need to tear it down. I’m all for TRUTH, but it’s absolutely secondary to me - the person in pain comes first, and whatever works for them is fine by me.

Honesty is a good thing, and I think, like the examples in previous posts, we shouldn’t outright lie and tell them the placebo pill is the newest best most effective treatment out there and it works by decreasing the liver enzyme responsible for converting dietary fats into cholesterol. But it’s entirely possible to be both honest and utilize the Placebo Effect for healing, which is what the OP asked.
[/QUOTE]
Thank you, WhyNot - exactly the sort of view I was hoping to hear. And I am compelled to agree that if I have to choose one or the other, helping people in pain will always have to beat the ideal of Truth. Pesky humanity…

38

[QUOTE=lekatt]
Is Dawkins the only one that can say what is irrational behaviour.
[/QUOTE]
I was only using points from Dawkins’ programme to illustrate what I was trying to talk about in this thread, and partly because I didn’t fully agree with him - he frankly seemed a tad confused at what would replace ‘placebo therapies’ in his ideal rational world. But insofar as Dawkins speaks from a learned scientific perspective, I would say he is pretty well qualified to speak about rationality versus irrationality. Whether he is ‘right’ or not in other respects is a different question.
[QUOTE=lekatt]
He is talking about health treatments people have been using for thousands of years with good results. Is he going to dictate what people may and may not use to improve their health, I don’t think the people will let him do that, I know I won’t. He wants his way and his way only. I don’t think he is right, nor is he qualified to tell the people of the world what their health care will or will not be. Sounds like the beginning of the dark ages again. If this isn’t a religion, what is it?.
[/QUOTE]
He acknowledged that ‘alternative’ treatments achieved results, just that the results come from the belief itself rather than the object of belief; placebo.

[QUOTE=lekatt]
You know if you take out the pills and shots from a medical treatment they probably won’t show any health benefits either. What an illogical thing to say.
[/QUOTE]
So medicine can be shown as ineffective if in the controlled trial none of the subjects are given anything at all? My brain’s hurting now. Has anyone got the memory of an aspirin I could dissolve in this glass of water?

39

[QUOTE=lekatt]
Not sure what High-frequency Opal Therapy is, frankly, I never heard of it.
[/QUOTE]

OPAL therapy.
You had no idea, did you, Staggerlee?

40

I side with those in favor of rejecting treatments that are no better than placebo. For one, what should you charge someone for giving them a placebo, whatever form it is in? A hundred dollars to pull on your leg and fix your subluxations? How much for a pair of healing magnets? How much for a jar of snake oil?

For another, I don’t like the idea of fostering mysticism and ignorance. Telling someone that water has memory? No, not okay. I think that’s harmful.

Third, if we are going to accept a “treatment” as a “treatment” simply because it capitalizes on the placebo effect, it lessens our ability to assess what a good treatment is.

We need to work harder to understand what is happening with the placebo effect - what ability that process is tapping into it and incorporate that into our therapeutic regimens, but I think it’s unethical to sell people a bullshit story and a phony treatment.