I understand the concept but I was wondering if it applies to every kind of medicine.
Here’s what I mean I can see if you are testing a new pain medicine. Since pain is a relative thing, I could see where the “placebo effect” would matter. After all one person’s ache is another person’s massive pain. I remember I once had a bad toothache that hurt constantly till I tripped over something. I twisted my ankle a bit and for a few minutes while the ankle was hurting I didn’t notice my tooth pain. So I can see how pain can be relative and a “placebo effect” would apply.
If someone gives you a pill you THINK will stop pain, it just might.
But does the “placebo effect” also work for things like bacteria diseases. After all if I have bacterial pneumonia and I take an antibiotic, it should get better whether I believe it or not. And if I’m not getting better I don’t see how a sugar pill could destroy the bacteria, even if I believe it to do so.
Often, the bacterial infection will just run its course. The sugar pill doesn’t kill it, but the body’s defenses do. Those people would show they got better.
There also seems to be something to* thinking * you’re getting better. Those mechanisms are obscure, but there is a correlation between stress and illness; if you believe a pill will help you, then it may reduce stress and help you that way.
One of the biggest confounding factors is that stress and depression supress the mammalian immune system. If by giving someone a tablet you make them more positive in their outlook and less worried about their illness then that alone will have a positive influence on outcome.
For longer term trials depression and anxiety also have effects on htings like exercise, appetite and nutrition, with anxious and stressed people either eating less or eating more empty calries and egttihg less exercise. Once again, if you give someone a tablet that makes them think they are going to be healed it will often help simply because they start eating better and exercising more.
The Wiki article on this is quite interesting. I know I know, but its worth it as a starting point, it looks pretty good.
Basically it says that theres no evidence to support the idea that it works to help with anything other than pain relief, ie the idea that it reduces stress so we get better doesnt have empirical support. Cites are given, the studies found that placebo vs non treatment have no differences in outcome other than pain relief.
The nocebo effect thats also in that reference is a related problem, its a common issue for those suspicious of western medicine in general and can be a sod to deal with for any individual. This is where you believe the pill or therapy is likely to have a negative effect, and so it does, in the form of anxiety related symptoms or the like.
And while you might know statistically its likely to be a nocebo effect, it can be quite difficult to prove it definitively for that particular individual.
The original meaning of the word Placebo is “I Will Please,” and in 18th-19th Century medicine involved the use of medically inert treatments as patient management tools … see, for example, the sugar pill.
The placebo effect is a positive effect attributed to the perception of treatment. A rather dramatic example involves the first US medical patent: The Perkins Tractor, which was debunked by Haygarth.
Placebo effect can also be conflated with spontaneous recovery, wherein symptoms of certain diseases either come or go on their own.
In the modern Random Controlled Trial(RCT), placebo is a design tool used to equalize treatment groups in support of blinded studies, so that no bias is due to perceived differences in treatment.
The most recent and troublesome use of a therapeutic placebo is the (ab)use of antibiotics by assorted and sundry GP/FP/Peds medical offices, where any and all cases of fever and/or infection are “treated” with antibiotics, even when the cases are either likely to self-resolve without harm, or are virally-mediated, and hence not treatable by antibiotic.
Nevertheless it does. The placebo effect is quite powerful and accounts for IIRC around 30% of the effect of modern medicine (and almost all the effect of non-modern medicine, IMO). Not only does it make you believe you are feeling less pain (for instance) it does actually measurably help in your body’s fight against infections.
How are placebos prescribed? Do they count on the vast majority of people not read labels, or what? I can’t imagine ever being prescribed a placebo and not knowing it.
A friend of mine had mild epilepsy following a fall at school many years ago.
At first he had one attack a week, then one a month until it was rare that he had an attack at all.
However he was afraid to stop taking the medication he had been prescribed and continued taking it up to age 40+.
One day his doctor told him he had been taking a placebo for all those years. It seems that because my friend thought the medication was a “real” one then this served in some way to stop the attacks.
If it’s a placebo in a clinical trial of a new drug (as opposed to someone being given a placebo because they are insistent that they be given something for their sniffles) you can’t distinguish which is placebo and which is The Good Stuff from the label - they will both be labelled identically (except possibly for some arbitrary numbering to allow for tracking). Double-blind studies (the most common) are set up to prevent even the doctor administering the drug or placebo from knowing which is which, to prevent the doctor from either influencing the patient or imagining he is seeing effects if he knows the patient is getting The Good Stuff.
Well, antibiotics are commonly prescribed as placebos. Someone comes in weak and dizzy all over with the flue and demands the doctor do something. So the doc gives them an antibiotic to shut them up, even though the antibiotic will do nothing for their cold/flu.
As for placebos in clinical trials, the patients who volunteer for the trial are informed they could get a placebo, or they could get the trial medication, but they don’t know which they will get, and neither does the doctor administering the medication and evaluating the patient. The reason of course is that no one knows whether the trial medication is actually “the good stuff” or not until it has actually been tested on real human beings. This is the difference between scientific medicine and snake oil.
But that’s not really, really a placebo. Of course antibiotics have no effects on viruses, but it’s more than a sugar pill and you’ll see a bona fide medicine on the label. Is it just that doctors don’t prescribe “sugar pills,” then, but only something harmless that doesn’t do you a bit of good?
I’m referring of course to prescribed medicines meant to address complaints, not the study of medicines for clinical trials.
It is unethical and possibly illegal in some jurisdictions to prescribe a placebo without the patient knowing and attempting to pass it off as a legitimate treatment for their complaint.
I can see the point of the analytic placebo used in RCT designs, but even there, informed consent explicitly informs the subjects that they might be assigned a placebo of some sort. But the use of a therapeutic placebo(TP) seems at best an unethical practice from earlier medicine, where the doctors were gods, and the patients stupid little sheep.
The original placebo represented a Big Lie, and the patient was none the wiser. Of course, the use of the therapeutic placebo is founded rather perversely on the bridge of Doctor-Patient trust, and is contingent on the doctor credibly lying, the patient credulously believing the lie, and the underlying complaint being either self-resolving or being psychosomatic.
There are arguments pro-TP that claim that the TP, properly used, can somehow enhance the patient’s ability to either self-resolve a condition, or to more effectively use an existing treatment. One suspects that this approach has limits, and the approach inarguably violates the cornerstone of scientific and ethical medicine: informed consent.
TP is a relic of the old days, where doctors lied to their patients “for their own good.” It belongs on the trash-heap of medicine, next to the Perkin’s Tractors and Phrenology kits.
There’s another thing going for the Placebo effect- someone who cares for you wants you to get better. This is why crap like Homeopathy have a fair track record- Homeopaths generally have a very good bedside manner.