A new hypothesis in medicine: give patients drugs they know don’t work(vox.com)
vox.com
A new hypothesis in medicine: give patients drugs they know don’t work
https://www.vox.com/science-and-health/2017/6/1/15711814/open-label-placebo-kaptchuk
75 comments
Auto immune diseases are all untreatable and severely reduce quality of life in some cases. One thing proven to slow their progress is stress reduction.
As you can imagine, being less stressed is really hard when you have a chronic illness. This is exacerbated by doctors ignoring you. Having anyone spend an hour to help you in any way is such a relief. I wouldn't be surprised if this played a large role.
As another example, my wife and I have had six miscarriages. We're 25 and both healthy and the many doctors we've seen agree. Well if the doctors don't have a diagnosis, they don't wanna see you.
When it comes to recurrent miscarriage, there is no treatment. They suspect there are likely auto immune diseases we don't know about. Indeed, this seems likely. Most studies on potential treatments cannot be reliably replicated. The only thing that has been shown to reduce miscarriage risk in future pregnancies is tender loving care-- having a doctor who will talk with you for hours whenever you want, and being taken care of.
So now we see a new matronly obstetrician. She's a bit quirky but we feel like she won't abandon us like the other doctors did. Her appointments are multiple hours long, and she's happy being paged in the middle of the night when we've found out we're pregnant again. At 5 am when you find out you're pregnant after five miscarriages, nothing is more calming than a soothing voice on the telephone
This doctor has also encouraged us to seek out alternate practitioners, like acupuncturists and massage. She doesn't believe in their treatments working per se (she's an md and is happy providing real treatments), but I think she understands they these practitioners will at least make you feel calm and taken care of. Whereas I used to laugh at people who would see them before, I get it now.
When you have a medical condition that is chronic and there's no end in sight and no cure available, you need a friend more than a doctor, and unfortunately, there's not much overlap between the two
As you can imagine, being less stressed is really hard when you have a chronic illness. This is exacerbated by doctors ignoring you. Having anyone spend an hour to help you in any way is such a relief. I wouldn't be surprised if this played a large role.
As another example, my wife and I have had six miscarriages. We're 25 and both healthy and the many doctors we've seen agree. Well if the doctors don't have a diagnosis, they don't wanna see you.
When it comes to recurrent miscarriage, there is no treatment. They suspect there are likely auto immune diseases we don't know about. Indeed, this seems likely. Most studies on potential treatments cannot be reliably replicated. The only thing that has been shown to reduce miscarriage risk in future pregnancies is tender loving care-- having a doctor who will talk with you for hours whenever you want, and being taken care of.
So now we see a new matronly obstetrician. She's a bit quirky but we feel like she won't abandon us like the other doctors did. Her appointments are multiple hours long, and she's happy being paged in the middle of the night when we've found out we're pregnant again. At 5 am when you find out you're pregnant after five miscarriages, nothing is more calming than a soothing voice on the telephone
This doctor has also encouraged us to seek out alternate practitioners, like acupuncturists and massage. She doesn't believe in their treatments working per se (she's an md and is happy providing real treatments), but I think she understands they these practitioners will at least make you feel calm and taken care of. Whereas I used to laugh at people who would see them before, I get it now.
When you have a medical condition that is chronic and there's no end in sight and no cure available, you need a friend more than a doctor, and unfortunately, there's not much overlap between the two
> Auto immune diseases are all untreatable
I think you mean "incurable." Not untreatable.
Otherwise, I sure wasted a lot of time memorizing immune modulators and autoimmune disease treatment protocols for my board exams.
And yes, doctors' job is diagnosis and treatment. If for whatever reason you're not a candidate for those two things, they have nothing to do for you. This is like complaining your IT guy isn't there to support you when your PC gets stolen by a house invasion. That's not what that relationship is.
I think you mean "incurable." Not untreatable.
Otherwise, I sure wasted a lot of time memorizing immune modulators and autoimmune disease treatment protocols for my board exams.
And yes, doctors' job is diagnosis and treatment. If for whatever reason you're not a candidate for those two things, they have nothing to do for you. This is like complaining your IT guy isn't there to support you when your PC gets stolen by a house invasion. That's not what that relationship is.
You've really captured the essence of the pretentious doctor with this comment. Bravo.
Honestly, I'd prefer a doctor that could look at me and say "Sorry, but you shouldn't buy any more of my time." Being able to say when you can't do any more is probably the antithesis of arrogant doctors - what you really have to watch out for is a pseudo-quack that will send you off on increasingly strong medications with zero-approaching success rates without telling you!
He has half a point: my first comment was more glib than it needed to be.
But, yes, docs who take your money to pat you on the head rather than admit they can't help you aren't doing you any favors. Most docs are more ethical than that (and then get lambasted for "not wanting anything to do with you if they can't treat or diagnose you.")
But, yes, docs who take your money to pat you on the head rather than admit they can't help you aren't doing you any favors. Most docs are more ethical than that (and then get lambasted for "not wanting anything to do with you if they can't treat or diagnose you.")
[deleted]
A doctor's job is to restore health, using whatever mechanisms they can. In the case of miscarriage, tender loving care is literally the best treatment available, as confirmed by numerous studies.
Unfortunately, most doctors are basically giant hash tables mapping conditions to prescription drugs, sorted on the kickbacks you get from pharma companies.
My dad was in pharmaceutical sales for two plus decades -- I know all the tricks.
Unfortunately, most doctors are basically giant hash tables mapping conditions to prescription drugs, sorted on the kickbacks you get from pharma companies.
My dad was in pharmaceutical sales for two plus decades -- I know all the tricks.
I'm sorry you and your wife are going through this. I can't even imagine the toll it takes. Know that some random guy in Seattle is wishing for the best for both of you.
Thank you! We appreciate it
I am Reiki Level 1 attuned. In my opinion the Reiki qualifications are mostly nonsense. What makes a difference is the other things you've mentioned: the sympathetic ear of someone who we have faith and trust in. Reiki is instutionalised caring.
Something else I believe is extraordinarily powerful is touch, and Reiki is one method formalising touch with professional intention. I think this is a good thing.
Doctors here in Australia are the same. 10 minute back to back appoints all week long. Back of the envelope calculation: my mechanic has spent more time with my car this year alone than I have spend with doctors my life to date. Fairly sure the mammalian bodies vastly more complicated than cars.
On a side note, my partner and I recently raised a dog, she's now 16 months old. I've currently got a mild respiratory tract infection which is worse for cold air and at night so I'm sleeping in the lounge room with the heat pump turned up so as not to disturb my partner with my coughing fits. The dog has been laying right up against me the whole night with her head resting on my arm or chest and has not made one complaint. When I get up, for whatever reason, she sits and watches me till I get back. She's warm, tolerant to a fault, never complains, misses us, always happy to see us. Dogs are the ultimate touch-healers. Just having some by your side whenever you need it, someone to play with whenever you want, is, in my experience, very powerful.
Something else I believe is extraordinarily powerful is touch, and Reiki is one method formalising touch with professional intention. I think this is a good thing.
Doctors here in Australia are the same. 10 minute back to back appoints all week long. Back of the envelope calculation: my mechanic has spent more time with my car this year alone than I have spend with doctors my life to date. Fairly sure the mammalian bodies vastly more complicated than cars.
On a side note, my partner and I recently raised a dog, she's now 16 months old. I've currently got a mild respiratory tract infection which is worse for cold air and at night so I'm sleeping in the lounge room with the heat pump turned up so as not to disturb my partner with my coughing fits. The dog has been laying right up against me the whole night with her head resting on my arm or chest and has not made one complaint. When I get up, for whatever reason, she sits and watches me till I get back. She's warm, tolerant to a fault, never complains, misses us, always happy to see us. Dogs are the ultimate touch-healers. Just having some by your side whenever you need it, someone to play with whenever you want, is, in my experience, very powerful.
Drug trials for mood disorders (etc) often show a really strong placebo effect, and I've heard some speculation that this happens for a similar reason.
People running the trial really want you to complete the study. The payments are structured to encourage this, but the staff also try to be warm and friendly to encourage you to come back, and this (along with getting out of the house and checking something off a to-do list), helps lift people's mood.
People running the trial really want you to complete the study. The payments are structured to encourage this, but the staff also try to be warm and friendly to encourage you to come back, and this (along with getting out of the house and checking something off a to-do list), helps lift people's mood.
The huge problem with this is that patients might choose it over medicine that does work. See Steve Jobs.
From the actual trial: "Patients were randomized to either open-label placebo pills presented as “placebo pills 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” or no-treatment controls with the same quality of interaction with providers."
Sounds like they didn't give them pills that the patients "know don't work" as the Vox title states, but instead told the patients that trials showed that these pills did work just not through a chemically induced action.
Sounds like they didn't give them pills that the patients "know don't work" as the Vox title states, but instead told the patients that trials showed that these pills did work just not through a chemically induced action.
But that's the truth, isn't it? From a scientific perspective, it might be interesting to see how well the placebo effect holds up if patients literally think it won't work, e.g. by selecting participants who haven't heard of the placebo effect, and not informing them. But from the perspective of helping people, if the placebo effect is to some extent caused by knowledge of the placebo effect, so much the better; there's no deception in that.
A data point from my personal experience: 15 years ago I started developing acute dysphagia (difficulty swallowing) which eventually got so severe I went to see a doctor about it. It was diagnosed as acid reflux, and I was prescribed proton pump inhibitors. That seemed to help for a long time, but a few years ago the symptoms started to return. They got so bad that I went back to the doctor, and this time was diagnosed with a newly discovered malady called eosinophilic esophagitis (EOE -- http://www.aaaai.org/conditions-and-treatments/related-condi...). EOE is an allergic reaction in the esophagus, which made sense because the initial symptoms appeared shortly after we got pets -- a dog and a cat -- for the first time, and I'm allergic to both. Case closed, or so I thought.
A few months ago, despite the fact that both or dog and cat had long since died, my symptoms started to come back worse than ever. Things got so bad that at one point I was actually heading to the emergency room (I never made it because before we got there I threw up, which fixed the immediate problem). But that episode scared me enough that I made another doctors appointment.
There followed a truly bizarre confluence of circumstances: first, my wife fell down and broke her arm. Then my doctors office called to confirm my appointment, but my wife picked up the phone and thought it was her doctors office calling about her arm. She thought the appointment was for her, but she hadn't made an appointment, so she told them the appointment was a mistake an they should cancel it, which they did. I called to reschedule, and that delayed it for another few weeks. The day of my new appointment, my doctors office called and said they were running hours behind because of computer problems and needed to reschedule again. Bottom line: it has been several months now and I still haven't been able to see a doctor.
But here's the punch line: in the intervening time, my symptoms have completely disappeared. If I had been able to see a doctor, I would almost certainly have ascribed this positive outcome to any intervention she would have done. And yet there has been no intervention, but only because of these weird twists of fate that kept me from seeing my doctor. Moreover, I know there has been no intervention. And yet I suddenly feel better than I have in 15 years. It's really weird.
A few months ago, despite the fact that both or dog and cat had long since died, my symptoms started to come back worse than ever. Things got so bad that at one point I was actually heading to the emergency room (I never made it because before we got there I threw up, which fixed the immediate problem). But that episode scared me enough that I made another doctors appointment.
There followed a truly bizarre confluence of circumstances: first, my wife fell down and broke her arm. Then my doctors office called to confirm my appointment, but my wife picked up the phone and thought it was her doctors office calling about her arm. She thought the appointment was for her, but she hadn't made an appointment, so she told them the appointment was a mistake an they should cancel it, which they did. I called to reschedule, and that delayed it for another few weeks. The day of my new appointment, my doctors office called and said they were running hours behind because of computer problems and needed to reschedule again. Bottom line: it has been several months now and I still haven't been able to see a doctor.
But here's the punch line: in the intervening time, my symptoms have completely disappeared. If I had been able to see a doctor, I would almost certainly have ascribed this positive outcome to any intervention she would have done. And yet there has been no intervention, but only because of these weird twists of fate that kept me from seeing my doctor. Moreover, I know there has been no intervention. And yet I suddenly feel better than I have in 15 years. It's really weird.
"The great secret, known to internists and learned early in marriage by internists wives, but still hidden from the general public, is that most things get better by themselves. Most things, in fact, are better by morning."
- Lewis Thomas, The Lives of a Cell (Among other achievements, he was dean of Yale Medical School and president of Sloan-Kettering. This collection of essays was published in 1974 and is absolutely prescient and fascinating - he offers profound thoughts on the nature of science, computing, and medicine that have stood the test of time astonishingly well.)
- Lewis Thomas, The Lives of a Cell (Among other achievements, he was dean of Yale Medical School and president of Sloan-Kettering. This collection of essays was published in 1974 and is absolutely prescient and fascinating - he offers profound thoughts on the nature of science, computing, and medicine that have stood the test of time astonishingly well.)
But that't the whole point: for fifteen years it didn't get better on its own. In fact, it got progressively worse over a period of months and years. When things got really bad (like on-the-floor-writhing-in-pain-wishing-I-were-dead bad) I went to see a doctor. The doctor did something (meds, endoscopies) and then things got better, and they'd stay better for a few years before they slowly, steadily, and inexorably got worse again. This cycle repeated itself three times in fifteen years. This most recent episode was the fourth cycle.
What makes this last episode interesting was that fate intervened to force me to do a control experiment, and the outcome has been dramatic: I feel as good (if not better) than immediately after all the prior interventions. In 15 years I have never had that happen if I just did nothing.
What makes this last episode interesting was that fate intervened to force me to do a control experiment, and the outcome has been dramatic: I feel as good (if not better) than immediately after all the prior interventions. In 15 years I have never had that happen if I just did nothing.
Wow! I did somehow miss the 15 years aspect. Mysterious.
I'm glad you're feeling better.
Thanks! Me too! :-)
Also, any doctor will tell you that.
In the late 70's there were a couple of guys who tried to bring placebo pills to market. They had a bottle of sugar pills and a little booklet that listed all the various things placebos had worked for along with the percentage effectiveness. If you had something that the placebos weren't that effective for, well, you just took more...
The FDA wouldn't go for it.
The FDA wouldn't go for it.
> People on no treatment got about 30 percent better. And people who were given an open-label placebo got 60 percent improvement in the adequate relief of their irritable bowel syndrome.
There's a few differences between these groups:
- People on the placebo pill were reminded about their illness at least once a day (when they took the pill), and can be expected to have special attention for their illness.
- People on the placebo pill were seeing a doctor, and had the prospect of going back to the doctor to evaluate their progress.
- For people NOT on the placebo pill, all hope was basically lost.
So perhaps "hope" (however small) is the underlying psychological effect causing this, or perhaps it's the attention from self.
There's a few differences between these groups:
- People on the placebo pill were reminded about their illness at least once a day (when they took the pill), and can be expected to have special attention for their illness.
- People on the placebo pill were seeing a doctor, and had the prospect of going back to the doctor to evaluate their progress.
- For people NOT on the placebo pill, all hope was basically lost.
So perhaps "hope" (however small) is the underlying psychological effect causing this, or perhaps it's the attention from self.
This echoes the negative effect of praying for the sick. Those who were prayed for feared their conditions were serious enough to warrant prayer and lost some hope. Perhaps if you are given a sugar pill, and are told it's only a sugar pill, you also relax about the threat of your condition -- well, it can't be that bad!
I can't find a reference for the following at the moment but there was something about the perceived health being a far better indicator for life expectancy/longevity than the actual health. The mindset of the patient seems to matter a lot!
This isn't so new, a major study lots of this is based on was published in 2010. Here's a skeptical look at that study:
https://sciencebasedmedicine.org/placebo-effects-without-dec...
https://sciencebasedmedicine.org/placebo-effects-without-dec...
>a major study lots of this is based on was published in 2010.
this is from 2016 Dec ( see "4.1 Limitations" )
"Open-label placebo treatment in chronic low back pain: a randomized controlled trial." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113234/
"Conclusions Our data suggest that harnessing placebo effects without deception is possible in the context of a plausible rationale. More research on this possibility is warranted in cLBP and other conditions defined by self-appraisal."
this is from 2016 Dec ( see "4.1 Limitations" )
"Open-label placebo treatment in chronic low back pain: a randomized controlled trial." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113234/
"Conclusions Our data suggest that harnessing placebo effects without deception is possible in the context of a plausible rationale. More research on this possibility is warranted in cLBP and other conditions defined by self-appraisal."
2 replays ( "Letter To Editor" )
"The effect of nothing? Time to abandon the concept of placebo" ( Traeger, Adrian C.; Kamper, Steven J. )
Pain: June 2017 - Volume 158 - Issue 6 - p 1179
doi: 10.1097/j.pain.0000000000000884
http://journals.lww.com/pain/Citation/2017/06000/The_effect_...
( "open image in new tab" to read )
--
"Are placebo pills presented as experimental treatment a true placebo?" ( Mestre, Tiago A.; Ferreira, Joaquim J. )
Pain: March 2017 - Volume 158 - Issue 3 - p 535
doi: 10.1097/j.pain.0000000000000793
http://journals.lww.com/pain/Citation/2017/03000/Are_placebo...
( "open image in new tab" to read )
"The effect of nothing? Time to abandon the concept of placebo" ( Traeger, Adrian C.; Kamper, Steven J. )
Pain: June 2017 - Volume 158 - Issue 6 - p 1179
doi: 10.1097/j.pain.0000000000000884
http://journals.lww.com/pain/Citation/2017/06000/The_effect_...
( "open image in new tab" to read )
--
"Are placebo pills presented as experimental treatment a true placebo?" ( Mestre, Tiago A.; Ferreira, Joaquim J. )
Pain: March 2017 - Volume 158 - Issue 3 - p 535
doi: 10.1097/j.pain.0000000000000793
http://journals.lww.com/pain/Citation/2017/03000/Are_placebo...
( "open image in new tab" to read )
Yeah, I think maybe Vox is sensationalizing a bit with that article title.
Back in 1995, Dr. Andrew Weil wrote:
It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. [Spontaneous Healing]
I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?
It seems to me Kaptchuk has varied one aspect of the experiment (eliminate double blindness, and even single blindness). Does that make it a radically new hypothesis?
Back in 1995, Dr. Andrew Weil wrote:
It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. [Spontaneous Healing]
I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?
It seems to me Kaptchuk has varied one aspect of the experiment (eliminate double blindness, and even single blindness). Does that make it a radically new hypothesis?
> I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?
Well, Kaptchuk at least tries to do science. Andrew Weil is a full-blown crank.
Well, Kaptchuk at least tries to do science. Andrew Weil is a full-blown crank.
Ah. Ok. Got it. Maybe if I rephrase it slightly it will be more useful:
Back in 1995, a full-blown crank wrote:
It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease.
I'm not saying that this full-blown crank describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?
Back in 1995, a full-blown crank wrote:
It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease.
I'm not saying that this full-blown crank describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?
I wonder how far you can go with this. I mean, there is a huge scale from homeopathy ("I know this does not work, but some believe in it"), things labeled placebo and administered by a doctor, smarties in a pill bottle and buying someone a candy bar and saying "here, that will make you feel better".
I'm pretty sure I know a few cases of self-administered placebos. When you are sick everyone has the wondercure, be it healthy food, some natural bee-wax-antibiotic, homepathy, "it's all just psychosomatic"/"there is allways a deeper reason for a sickness" or what not.
They probably all just need someone to bring camilla tea and a wet cloth for on the forehead :)
I'm pretty sure I know a few cases of self-administered placebos. When you are sick everyone has the wondercure, be it healthy food, some natural bee-wax-antibiotic, homepathy, "it's all just psychosomatic"/"there is allways a deeper reason for a sickness" or what not.
They probably all just need someone to bring camilla tea and a wet cloth for on the forehead :)
The thing is, homeopathy claims to heal all kinds of illness (cancer for instance), while the author of this study leaves it very, very clearly that it only works on the perception of illness by the mind.
He clearly states that the placebo won't work in quantifiable illnesses because those quantifiable effects don't depend on the perception from your brain.
He clearly states that the placebo won't work in quantifiable illnesses because those quantifiable effects don't depend on the perception from your brain.
If a licensed professional gives you a placebo for your illness, they're also effectively saying it's not that important to worry about, which changes the psychology of the patient.
... this is like walking through a minefield, but here it goes.
A lot of the illnesses they're talking about in the article, like IBS, lower back pain, and CFS have a strong psychosomatic component to it for a lot of people. They essentially say this in the article--something like "this won't work for malaria, but it will work for pain."
This can be a really controversial position, and it gets really twisted by a lot of people. No I'm not advocating mind-body dualism. What I'm saying is that there's top-down influences on physical symptom perception and that probably influences bottom-up processes, leading to some sort of vicious circle.
I think a lot of these psychosomatic conditions are really explained by the same processes involved in the nocebo effect. There have been studies to support this, showing that psychosomatic patients report more nocebo effects in control conditions than other patients and controls.
The idea you're discussing--reassurance effects--is interesting and actually really understudied I think. However, I think there's an equally plausible hypothesis, that you're kind of fighting negative psychosomatic effects with positive psychosomatic effects in certain situations.
I don't think that's all of the placebo effect, but I do think there's some broader causal system involved that encompasses placebo effects, nocebo effects, and psychosomatic illnesses and effects, including more psychosomatic psychiatric conditions (e.g., conversion disorder, psychogenic seizures, etc.), as well as psychological effects on disease process (e.g., stress effects on inflammation).
I kind of wish this area of research didn't get so bogged down with political infighting, which invariably happens. Patients start insisting that we're being dismissive by discussing psychosomatic processes, some researchers will spuriously start criticizing other researchers for advocating Cartesian dualism, as political smear tactic, when the real issues pertain to emergent processes and top-down mutual influences. It's a very interesting area of research with lots of potential, but tends to get oversimplified really quickly to score political points.
A lot of the illnesses they're talking about in the article, like IBS, lower back pain, and CFS have a strong psychosomatic component to it for a lot of people. They essentially say this in the article--something like "this won't work for malaria, but it will work for pain."
This can be a really controversial position, and it gets really twisted by a lot of people. No I'm not advocating mind-body dualism. What I'm saying is that there's top-down influences on physical symptom perception and that probably influences bottom-up processes, leading to some sort of vicious circle.
I think a lot of these psychosomatic conditions are really explained by the same processes involved in the nocebo effect. There have been studies to support this, showing that psychosomatic patients report more nocebo effects in control conditions than other patients and controls.
The idea you're discussing--reassurance effects--is interesting and actually really understudied I think. However, I think there's an equally plausible hypothesis, that you're kind of fighting negative psychosomatic effects with positive psychosomatic effects in certain situations.
I don't think that's all of the placebo effect, but I do think there's some broader causal system involved that encompasses placebo effects, nocebo effects, and psychosomatic illnesses and effects, including more psychosomatic psychiatric conditions (e.g., conversion disorder, psychogenic seizures, etc.), as well as psychological effects on disease process (e.g., stress effects on inflammation).
I kind of wish this area of research didn't get so bogged down with political infighting, which invariably happens. Patients start insisting that we're being dismissive by discussing psychosomatic processes, some researchers will spuriously start criticizing other researchers for advocating Cartesian dualism, as political smear tactic, when the real issues pertain to emergent processes and top-down mutual influences. It's a very interesting area of research with lots of potential, but tends to get oversimplified really quickly to score political points.
Maybe that's what I need, I have residual headaches after a stroke (CVT). It seems to be a common issue and it doesn't come from the head pressure.
What sorts of treatment do doctors suggest for that?
Just pain-killer or nothing if the pain is low enough. It looks like it is a source of pain-killer overuse, and psychiatric issues. In my case the pain responds very well, so I just treat it with paracetamol, but I have used just 8 doses in 3 weeks.
To put it in context, tho, it is an extremely rare kind of stroke (5/1,000,000 per year), so the select people having had this stroke might have pain medicine issues, but it is not a contributor of anything in the grand scheme of things.
To put it in context, tho, it is an extremely rare kind of stroke (5/1,000,000 per year), so the select people having had this stroke might have pain medicine issues, but it is not a contributor of anything in the grand scheme of things.
I don't have the resources right now to condense the arguments or cite the evidence, but the Skeptics with a K podcast [1] has recently done a whole series on why the article and pretty much every other study mentioned in the comments so far is not any evidence of "the mysterious power of the placebo" but actually misuse of analysis on experimental biases. Well worth a listen.
[1] http://www.merseysideskeptics.org.uk/category/podcast/skepti...
[1] http://www.merseysideskeptics.org.uk/category/podcast/skepti...
Also, more expensive sugar pills work better than cheaper sugar pills. (And bigger ones, colourful ones, etc). Presumably this means something like homeopathy could work better than sugar pills.
It's easy to ridicule homeopathy, and it certainly shouldn't be used for illnesses that are easy to treat. But, perhaps it could be a valid treatment for chronic, hard to treat conditions. It's certainly very elaborate and expensive.
It's easy to ridicule homeopathy, and it certainly shouldn't be used for illnesses that are easy to treat. But, perhaps it could be a valid treatment for chronic, hard to treat conditions. It's certainly very elaborate and expensive.
The bad thing with homeopathy is not that they're fooling people to take substances that have no effect on their own and only work via the placebo-effect. It's the "making a lot of money from sick people by selling expensive placebos"-part that's despicable.
> Thinking you’re going to get better is not what makes you better. That’s the mind-cure idea: It doesn’t happen. It’s not the way it is ... I’m a little bit of a standard deviation or two out from consensus.
This surprised me. I've been under the impression that the body's immune system could be modulated by the brain. The science has changed underneath my feet, I guess.
This surprised me. I've been under the impression that the body's immune system could be modulated by the brain. The science has changed underneath my feet, I guess.
>We have great drugs, but they don’t often treat symptoms that well. What really bothers people are the symptoms. The symptoms are things they can perceive that are modulated by the brain.
so, Kaptchuk's open-label placebo therapy appears to be centered on and limited to a person's subjective experience of their illness. that's all this is?
so, Kaptchuk's open-label placebo therapy appears to be centered on and limited to a person's subjective experience of their illness. that's all this is?
> that's all this is?
But those things can be debilitating, so anything that helps without causing harm is pretty important.
But those things can be debilitating, so anything that helps without causing harm is pretty important.
[deleted]
That's exactly why I take homeopathy medicine. I know that the science behind it is pseudo; but I also know that placebo effect works regardless. At least, on my particular sample size of one it definitely does.
Placebo effect is stronger when you break the skin, so you'd be better off, given your purpose, sticking yourself with (sterile!) needles than using homeopathic meds. (To the extent that paying for it is relevant to the placebo effect, which I've seen speculated on but not studied, you could find an acupuncturist.)
Also, real products claiming to be homeopathic medicines are very often provably not the homeopathic dilutions that they claim to be, which increases the risk factor of that approach.
Also, real products claiming to be homeopathic medicines are very often provably not the homeopathic dilutions that they claim to be, which increases the risk factor of that approach.
This is truly terrible advice and you ought to feel bad for promoting it here.
http://whatstheharm.net/homeopathy.html
http://whatstheharm.net/homeopathy.html
But he's not offering advice. He's offering a data point. There's nothing wrong with that.
I could swear I have already seen this link somewhere /s
Plus this article is a fraud. The people it lists were killed by ignorance, neglect or their own informed choice, not by homeopathy. I don't think anybody has yet died of drinking a small amount of water and the guy you are harassing said nothing about giving up other treatments, just using homeopathy as placebo.
Plus this article is a fraud. The people it lists were killed by ignorance, neglect or their own informed choice, not by homeopathy. I don't think anybody has yet died of drinking a small amount of water and the guy you are harassing said nothing about giving up other treatments, just using homeopathy as placebo.
As controls are not as tight as you know real medicine several have in fact died of homeopathic meds that contained far too much of the active ingredients
But then those homeopathic meds were defective. Being harmed by a defective product is hardly unique to homeopathy.
Why are you defending a sham industry designed to separate fools from their money that discourages people from seeking real medical attention.
Dude, it's HN, barely anyone here seriously supports homeopathy.
The problem is that you are trying too hard to convince everyone. For me, if I knew nothing about the topic, this in itself would be a huge red flag to distrust you. Slow down and make sure to attack the right people for the right reasons.
It's not true that all of this shit is low quality, I presume mainstream stuff advertised on TV like Oscillococcinum might be safe. It's not obvious that all of that is cynically designed to separate fools from their money, some of the vendors may be cranky enough to believe it or at the very least they may see it helping in some cases due to the placebo effect and conclude it must be good then. And every time you say something others know for sure to be false, you are undermining you own credibility.
The problem is that you are trying too hard to convince everyone. For me, if I knew nothing about the topic, this in itself would be a huge red flag to distrust you. Slow down and make sure to attack the right people for the right reasons.
It's not true that all of this shit is low quality, I presume mainstream stuff advertised on TV like Oscillococcinum might be safe. It's not obvious that all of that is cynically designed to separate fools from their money, some of the vendors may be cranky enough to believe it or at the very least they may see it helping in some cases due to the placebo effect and conclude it must be good then. And every time you say something others know for sure to be false, you are undermining you own credibility.
The thing I am attacking is an entire industry of con artists. Presuming medical advice is good because you heard it on tv is amazingly poorly thought out. Its as badly thought out for example as believing that the power of positive thinking provided by a fake cure is enough to balance out literally not knowing how to get good functional medial advice. In modern life where everyone who doesn't crash their car into a wall will need competent advice to reach their potential age this is a necessary survival skill long term.
Homeopathy is without exception useless nonsense. for example Oscillococcinum is duck offal diluted. The logic behind its operation doesn't even make sense in homeopathy land. Its the approximate equivalent of bad sci fi wherein having made up some imaginary laws of physics the author can't even stick to them properly.
I honestly don't know what algorithm you use to assess credibility. You suggest that you are put off by strong opinions but reassured by hearing about things on TV. You try to ascribe positive motives to modern day patent medicine scammers but distrust the motives of people angered such deceit.
Consider refining your judgment.
P.S. What did I say that you "know not to be true"?
Homeopathy is without exception useless nonsense. for example Oscillococcinum is duck offal diluted. The logic behind its operation doesn't even make sense in homeopathy land. Its the approximate equivalent of bad sci fi wherein having made up some imaginary laws of physics the author can't even stick to them properly.
I honestly don't know what algorithm you use to assess credibility. You suggest that you are put off by strong opinions but reassured by hearing about things on TV. You try to ascribe positive motives to modern day patent medicine scammers but distrust the motives of people angered such deceit.
Consider refining your judgment.
P.S. What did I say that you "know not to be true"?
> Presuming medical advice is good because you heard it on tv is amazingly poorly thought out.
Never said that, only that mass-manufactured stuff widely used for decades probably is safe or it should have been banned long ago.
> Its the approximate equivalent of bad sci fi wherein having made up some imaginary laws of physics the author can't even stick to them properly.
No argument here.
> You suggest that you are put off by strong opinions but reassured by hearing about things on TV.
Not really strong opinions but nagging and repeating things you've already posted without a word of explanation. Also, you stated as a fact that homeopathic drugs are of low quality without any sources or examples, it's the first time I'm hearing about this, why should I believe it if this kind of incidents aren't commonly reported afaik? At least dragonwriter was able to provide some example.
> P.S. What did I say that you "know not to be true"?
Nothing, but others may. You say it's a sham industry designed to part fools from their money, I know that there are people who religiously believe in this stuff, therefore there may be vendors who believe it too, somebody may know such vendors and then how does it make you look to them? And it's these people you need to convince, I have never used, produced, distributed or recommended homeopathic drugs and very likely never will.
Never said that, only that mass-manufactured stuff widely used for decades probably is safe or it should have been banned long ago.
> Its the approximate equivalent of bad sci fi wherein having made up some imaginary laws of physics the author can't even stick to them properly.
No argument here.
> You suggest that you are put off by strong opinions but reassured by hearing about things on TV.
Not really strong opinions but nagging and repeating things you've already posted without a word of explanation. Also, you stated as a fact that homeopathic drugs are of low quality without any sources or examples, it's the first time I'm hearing about this, why should I believe it if this kind of incidents aren't commonly reported afaik? At least dragonwriter was able to provide some example.
> P.S. What did I say that you "know not to be true"?
Nothing, but others may. You say it's a sham industry designed to part fools from their money, I know that there are people who religiously believe in this stuff, therefore there may be vendors who believe it too, somebody may know such vendors and then how does it make you look to them? And it's these people you need to convince, I have never used, produced, distributed or recommended homeopathic drugs and very likely never will.
Cigarettes are mass manufactured and widely used for quite some time. Its recently been found that some fake sugars may give you a massive boost to your chance to have your brain rot via Alzheimer's. Asbestos was widely used previously as was leaded gas was everywhere decades after it was widely known how bad it was. Not being banned his historically been a really bad predictor of safety.
I linked to a whole list of people that died or suffered via trusting alternative medicine. Anyone wanting further info can check out https://en.wikipedia.org/wiki/Homeopathy
Honestly though one shouldn't need to fully explain that homeopathy isn't real in the same fashion as its usually not required to explain why witchcraft, literal magic, young earth creationism, or voodoo isn't real.
I'm not trying to convince anyone silly enough to believe, I'm trying to discourage people from promoting it as benign.
I linked to a whole list of people that died or suffered via trusting alternative medicine. Anyone wanting further info can check out https://en.wikipedia.org/wiki/Homeopathy
Honestly though one shouldn't need to fully explain that homeopathy isn't real in the same fashion as its usually not required to explain why witchcraft, literal magic, young earth creationism, or voodoo isn't real.
I'm not trying to convince anyone silly enough to believe, I'm trying to discourage people from promoting it as benign.
> It's not true that all of this shit is low quality
Not all of it is low quality, but you don't find out which one is low quality until someone dies, because of the lack of serious controls.
> I presume mainstream stuff advertised on TV like Oscillococcinum might be safe.
It might be. OTOH, there have been fairly mainstream homeopathic products that weren't, such as one of the more popular homeopathic teething remedies.
Not all of it is low quality, but you don't find out which one is low quality until someone dies, because of the lack of serious controls.
> I presume mainstream stuff advertised on TV like Oscillococcinum might be safe.
It might be. OTOH, there have been fairly mainstream homeopathic products that weren't, such as one of the more popular homeopathic teething remedies.
I'm not defending the industry. I think the industry is shameful. But the industry is distinct from the practice, and I think the practice can be beneficial to some people because placebos can be beneficial.
Not even being aware of how to determine what constitutes valid medical advice is detrmimental to people's long term health.
[deleted]
I am skeptical of the headlines touting medical mistakes as the No. 3 cause of death in the US. But to be fair, someone could put up a similar site listing thousands of people who have been harmed under conventional medical care.
Your site doesn't provide enough info to compare the rate of harm. For mild ailments, which is what I assumed OP was speaking of, homeopathic treatments might have a lower rate of harm.
Iatrogenesis is a possibility with any health care. And, to give your link credit, homeopathy certainly sounds like a dangerous route for serious conditions.
Your site doesn't provide enough info to compare the rate of harm. For mild ailments, which is what I assumed OP was speaking of, homeopathic treatments might have a lower rate of harm.
Iatrogenesis is a possibility with any health care. And, to give your link credit, homeopathy certainly sounds like a dangerous route for serious conditions.
Even if all you care about is placebo effect homeopathy is still a bad choice: Skittles are cheaper than most of the homeopathic drugs and they taste better.
It's possible that the fact that you have to pay more for it is actually what produces the beneficial effect.
Price is a part of the ritual.
Wait, are you serious about this working for you while you are aware of price being a part of the deal or are you fucking trolling us? I was under impression that people to whom price matters as such usually are in denial of it.
100% serious. I know that it's as good as an expensive placebo chemically, but I also know that this knowledge doesn't stop placebo effect from working. And the fact that I'm paying for it and going through all the motions does help.
other interesting articles:
Changing Mindsets to Enhance Treatment Effectiveness
JAMA. 2017 May 23;317(20):2063-2064. doi: 10.1001/jama.2017.4545.
https://mbl.stanford.edu/sites/default/files/crum_zuckerman_...
==
You can train your body into thinking it’s had medicine ( 09 February 2016 )
Jo Marchant asks if we can harness the mind to reduce side-effects and slash drug costs.
https://mosaicscience.com/story/medicine-without-the-medicin...
==
The Vodka-Red-Bull Placebo Effect
People take more risks when downing caffeine-and-alcohol cocktails—but only if they know what they’re drinking.
https://www.theatlantic.com/science/archive/2017/06/caffeine...
==
Howe, L. Goyer, P., & Crum, A. (2017). Harnessing the Placebo Effect: Exploring the Influence of Physician Characteristics on Placebo Response. Health Psychology.
https://mbl.stanford.edu/sites/default/files/howegoyercrum_h...
==
Crum, A., Phillips, D., Higgins, T. (2016). Transforming Water: Social Influence Moderates Psychological, Physiological, and Functional Response to a Placebo Product. PLOS One, 11(11).
https://mbl.stanford.edu/sites/default/files/crumetal_transf...
==
Crum, A. & Phillips, D. (2015). Self-Fulfilling Prophesies, Placebo Effects, and the Social-Psychological Creation of Reality. In R. Scott and S. Kosslyn (Eds.), Emerging Trends in the Social and Behavioral Sciences. Hoboken, NJ: John Wiley and Sons.
https://mbl.stanford.edu/sites/default/files/crumphillips_em...
Changing Mindsets to Enhance Treatment Effectiveness
JAMA. 2017 May 23;317(20):2063-2064. doi: 10.1001/jama.2017.4545.
https://mbl.stanford.edu/sites/default/files/crum_zuckerman_...
==
You can train your body into thinking it’s had medicine ( 09 February 2016 )
Jo Marchant asks if we can harness the mind to reduce side-effects and slash drug costs.
https://mosaicscience.com/story/medicine-without-the-medicin...
==
The Vodka-Red-Bull Placebo Effect
People take more risks when downing caffeine-and-alcohol cocktails—but only if they know what they’re drinking.
https://www.theatlantic.com/science/archive/2017/06/caffeine...
==
Howe, L. Goyer, P., & Crum, A. (2017). Harnessing the Placebo Effect: Exploring the Influence of Physician Characteristics on Placebo Response. Health Psychology.
https://mbl.stanford.edu/sites/default/files/howegoyercrum_h...
==
Crum, A., Phillips, D., Higgins, T. (2016). Transforming Water: Social Influence Moderates Psychological, Physiological, and Functional Response to a Placebo Product. PLOS One, 11(11).
https://mbl.stanford.edu/sites/default/files/crumetal_transf...
==
Crum, A. & Phillips, D. (2015). Self-Fulfilling Prophesies, Placebo Effects, and the Social-Psychological Creation of Reality. In R. Scott and S. Kosslyn (Eds.), Emerging Trends in the Social and Behavioral Sciences. Hoboken, NJ: John Wiley and Sons.
https://mbl.stanford.edu/sites/default/files/crumphillips_em...
Those seem to back up this quote by the doctor from the article: "What’s going on in the patient’s [mind] is that the rituals of medicine... activates specific quantifiable and relevant brain regions that release these neurotransmitters. And they modulate symptoms."
For minor ailments for which there are no real cure (and are probably entirely psychological) building a new habit covers up the old one and subsequently cures the patient's pain.
For minor ailments for which there are no real cure (and are probably entirely psychological) building a new habit covers up the old one and subsequently cures the patient's pain.
In my mind what people who paid her were getting was something that they almost universally can't get inside the traditional medicine system here in the US at least, someone who cares.
Most encounters with doctors here in the US are 10 minutes or less at least for an office visit. If you have a lot of symptoms or back-story or whatever the doc might cut you off and ask questions and keep directing the conversation rather than hear you out. That might be an efficient use of their time, but it's not good for the placebo effect to work because part of that seems to be caring, wanting the patient to get better, doing things (even things we know won't work) to help.
This lady has I think only hour long appointments which are totally unheard of in the traditional system. It's not surprising that if the placebo effect is real that seeing someone who can really only care (or at least pretend to) could be effective.