Studying the Placebo Effect.

There’s a good read up over at Wired News: Why Sugar Pills Cure Some Ills on how scientists are starting to try and figure out how the placebo effect works and why it only seems to work for some people. Part of the problem in studying placebos is in deciding what you use for a controlled experiment seeing as placebos are what’s usually given to the control group when testing other drugs.

“There really hasn’t been a whole lot of research on the placebo,” said epidemiologist Dr. John Bailar, professor emeritus at the University of Chicago. “There’s a lot of description and a lot of chatter, but we don’t know a whole lot about it.”

One thing seems to be clear, however. The brain is a “crucial player,” said Leitner during a workshop on placebos at a February meeting of the American Association for the Advancement of Science.

“What we need to learn is how taking a placebo affects the brain’s processing of symptoms and other sensations related to illness, how it affects output and the activity of your immune system,” said Dr. David Spiegel, a Stanford University psychiatrist who studies placebos.

Research has shown that people who unknowingly take placebos—sometimes pills, sometimes injections—often feel relief from pain, cardiovascular disease, gastrointestinal disorders and high blood pressure. But placebos don’t help people recover from diseases like cancer. “They’re more likely to be effective when there’s a perceptive component to the illness,” Spiegel said.

Anyone skeptical of alternative medicines, such as I am, is probably already pretty familiar with the placebo effect as it’s generally regarded as one of the main reasons people actually believe homeopathic remedies and healing magnets actually do something. The book Voodoo Science I listed over on the left under my “Currently Reading” heading talks about the power of belief in the form of the placebo effect quite a bit and gives an overview of how it’s thought to work, but more studies are clearly warranted and will provide some useful insight into how the brain works.

Providing they can figure out how to study it.

27 thoughts on “Studying the Placebo Effect.

  1. Les, I read a provocative argument somewhere that says that the placebo effect doesn’t exist—in that there is nothing that causes our brains to effect a lessening of symptoms.  It’s ALL perception, and has a lot to do with a certain series of events:  most illnesses increase and decrease in severity over their course, and people tend to seek a new treatment when it’s in its worst phase, so their swing into feeling slightly better happens to coincide with the treatment.  So they believe the treatment is responsible for making them feel better, when actually it’s just a matter of timing.

    This would explain why the “placebo” effect doesn’t work for everybody, and why it doesn’t work for diseases that have a definite linear progression.

  2. With regard to your statement “one of the main reasons people actually believe homeopathic remedies actually do something”:

    If someone does something that effectively triggers the “placebo effect” and reduces their pain, then it was an effective remedy. I’m perfectly happy with the thought that that is a legitimate solution since it can have real, beneficial results (like a reduction in the intake of another medicine with real side effects).

    Unfortunately, the placebo effect is usually exploited to make money (enter homeopathy, chiropractic, etc). Unfortunately, the fact that something is “expensive” often improve the effect for some people making it ripe for exploitation.

    If someone puts a potato in their pocket, or $12 magnets in their shoes and gains, in their eyes, some benefit then more power to them. There is a gain without harm. If they put $399 magnets in their shoes, that’s just criminal exploitation.

    I’m ranting.

    I guess my point is that I think placebos are valid science, so I’m glad they’re trying to research it at last.

  3. Well not all alternative remedies are useless. For example acupuncture seems to be the most reliable for alternative remedies.

    For example in UK they are training vets with acupuncture. Dogs which was suffering from pain for a long time and had trouble moving was cured by acupuncture and I would think that there is no placebo effect on animals.

  4. Emphasis on “seems.”  I’d feel a lot better about acupuncture if they’d stop explaining its use in terms of invisible, fictional “energy lines” and actually talk about the real anatomy that’s already there. 

    And just because a lot of people are using it doesn’t mean it actually works.  It just means they THINK it does.  See my previous posting about coincidences.

    (And you know, if I were a dog and were being poked with needles, I’d get motivated enough to start moving again, pain or no pain.)

  5. Frac, if the only goal is to relive pain then, yes, placebos can be useful. Most homeopathic remedies, however, make bigger claims than just reliving pain. And a lot of the homeopathic pills are literally sugar pills with a drop of the “remedy” on it. Magnets in your shoes isn’t homeopathic though it is still just a scam. Is it really gain without harm? Depends on the ailment I would say. With some of the more serious conditions that homeopathy claims to cure you could be risking your life by relying on a false sense of comfort.

    Pop tarts, acupuncture is most reliable? There has yet to be any proof that it does much of anything. The fact that in the UK vets are being trained in it just means there’s money to be made. Major hospitals in the U.S. have set up “alternative medicine” divisions not because there’s any proven validity, but because their patients insist on it and there’s money to be made at it.

  6. Agreed. I was trying to be careful to say that. Homeopathy in particular is bunk that might trigger placebo effects. Anyone even a little familiar with statistics will balk at the claim that homeopathic remedies gain potency with doublings.

    My main point is that a placebo is scientically valid. Exploiting it is not.

    I feel like ranting on religious “cures” now… but I won’t.

    I’ll take the oportunity to take another poke at chiropractic, though. Witch doctors that have managed to manufacture credibility.

  7. I have to disagree with your position on chiropractic Frac. I as well as my brother were skeptical but have recently changed our minds. I had a job where I sat all day and for whatever reason my hips are susceptible to leaning to one side. After two years of this my hips titled heavily to one side. This caused the muscles in my back to shorten on one side and lengthen on the other. Eventually the situation got more and more painful until they had a spasm and I couldn

  8. I think that alternative medicine, placebo effects, and homeopathy need scientific study to determine whether or not they are effective.  Just b/c something sounds crazy doesn’t automatically mean it’s b-s, although it’s more likely to be.

  9. I think the REALLY weird part about placebos is how often “side-effects” occur with people taking a placebo in a study. So it’s not always the positive result that takes place.

    Personally, I think mental attitude has a great deal of influence on healing, and so do plenty of studies. I

  10. And, oh, sorry for double-dipping. But as long as we’re on a related topic of testing things for actual effectiveness, I agree with ragman 100%. I’m tired of hearing herbal medicines claims to all kinds of wonders while the same ads talk about the harm of real pharmaceuticals.

    Most of the time real pharmaceuticals are derivatives or analogs of the herbal, and the dosages are known. The companies are required to test the snot out of them and then prove they actually do what they claim. Herbals are not proven (except anecdotally) and not held to any standards, including any idea of potency. You can kill yourself on St Johns Wort and no one is at fault. Take 20 times the recommended dosage of aspirin and get ill, take BMS to court and win millions. I

  11. Here is a CNN report on a scientific study on acupuncture:

    http://www.cnn.com/2004/HEALTH/conditions/03/15/acupuncture.headaches.reut/index.html

    Let me copy and paste the article here:

    Study: Acupuncture eases chronic headaches
    LONDON, England (Reuters)—Acupuncture is a useful, cost-effective treatment for patients who suffer from chronic headaches or migraine, researchers said on Monday.

    In one of the largest randomized studies to assess the effectiveness of the ancient Chinese treatment, scientists found it worked better than just conventional treatments alone.

    “People using acupuncture had fewer headaches, less severe headaches and they used less health resources over the course of the following year,” Dr. Andrew Vickers, of Memorial Sloan-Kettering Cancer Center in New York, said in an interview.

    The scientists compared acupuncture plus standard treatment to normal therapy alone in 401 patients in England and Wales who suffered from headaches several days each week. Their research is published online by the British Medical Journal.

    Patients who had been assigned acupuncture plus standard treatment received up to 12 treatments over three months.

    Initially there was not much difference between the two groups but at the end of the year-long trial the scientist noticed a big change.

    Patients receiving acupuncture had 22 fewer days of headaches per year, used 15 percent less medication, made 25 percent fewer visits to their family doctors and took fewer days off sick than the other group.

    There were not many side effects and Vickers and his colleagues also found that the treatment was cost effective.

    “For severely affected patients, acupuncture reduced the severity and the frequency of their headaches to make a real difference in their lives,” Vickers said.

    Acupuncture was first used in China about 2,000 years ago, according to Vickers. It involves inserting very fine needles into the skin at specific points in the body. It is one of the most popular forms of alternative medicine and has been shown to relieve nausea and pain.

    German researchers have also said it could help women undergoing fertility treatment to conceive.

  12. Here is the PDF link to the article in the Britsh Medical Journal. Copy and pasting will not work since there are graphs and tables. So check it out.

    http://bmj.bmjjournals.com/cgi/reprint/bmj.38029.421863.EBv2

    Also you should know that acupuncture is not suppose to result in pain.

    Also, modern medicine no longer view them as fictional energy lines but rather that of your nerves. So it is much like the quinine bark for malaria fever, when it was first used the explanation for how it works its unbelievable but that does not mean that it does not work.

    MODERN VIEWS

    When the human body was finally described in terms of cells, biochemicals, and specific structures (most of this accomplished less than 150 years ago), the Chinese method of acupuncture and its underlying concepts were evaluated in these new terms.  As a first effort, researchers sought out physical pathways that might correspond to the meridians, and even a fluid substance that might correspond to qi.  Neither of these were found.  Nonetheless, the action of performing acupuncture was shown to have effects on the body that required some detailed explanation.

    From the modern perspective, diseases and injuries are resolved by a complex set of responses; the responses are coordinated by several signaling systems.  The signaling systems mainly involve peptides and other small biochemicals that are released at one site, travel to other sites, interact with cells, and stimulate various biologically programmed responses.  Rather than blockages of circulation described in the old Chinese dogma, diseases are understood to be caused by microorganisms, metabolic failures, changes in DNA structure or signaling, or breakdown of the immune system.  Some of these disorders are resolved by the cellular functions that are designed for healing, while others become chronic diseases because the pathological factors involved have either defeated the body

  13. Alternative medicine should be seen as complementing Western medicine rather than replacing it outright. Western medicine do not really have a good history in treating long term ailments and conditions while alternative medicine seem to be more effective. So moral of the story is when you break you arm go to a Western doctor but if several months after recovery you are still feeling pain then go to alternative medicine.

    Also another point on Chinese herbs/insects. I have a friend who is allergic (lung stopping) to the chemicals used in most fever medicine. There is this particular brand of pill will not trigger her allergy but it cost quite a bit few dollars per pill. She purchased those traditional herbs from one of those Chinese medicine stores and ever since then whenever she has fever she uses the herbs.

  14. Pop tarts, I’m all in favor of anything “complementing” Western medicine AS LONG AS IT REALLY DOES WORK.  The problem is that if you can’t describe how it works in terms of what we have already proven, I can’t really buy into it (this mystery “qi” and all that).  The long article you quoted above at first glance seems to be integrating “real words” about nerves and muscle responses along with the “magical words,” but I have a real problem with some of its conclusions.

    For example, suppose that you CAN simply stimulate the production of endorphins by sticking needles into someone.  Why does it matter where you stick them?  For that matter, why can’t you stimulate the release of endorphins a different way (have them eat a bar of chocolate or jog around the block for half an hour)?

    I’m very suspicious of anything that uses a part of the body as an analogue for the whole (where, for example, parts of the hand or foot are supposed to connect directly to the bladder, spleen, head, whatever).  This is a very common folk belief that has no basis in anatomical fact.  If there were a direct anatomical connection (not a “mystical energy meridian line”) between a point on the spine and the bladder, I’m sure someone with a scalpel would have found it by now.

    I’ve had acupuncture myself.  Just because it tingled didn’t mean it was doing anything.  I did have a nice rest on the table while it was going on, though, and I got up nice and refreshed.  So I guess it wasn’t all bad.  (Let’s not forget that as primates, we are relaxed just by being “groomed.”  Just being touched in some way by another human being, especially in a repetitive or rhythmic way, makes us feel better.  That’s why most spa treatments are so popular; it has very little to do with what’s being smeared on and wiped off again.)

    I’d like to see some real, peer-reviewed, double-blind studies on Chinese medicine before I started believing their efficacy was anything but coincidence.

  15. Oh, and PT, did your friend actually get demonstrable fever relief from these herbs?  Or did she just take them until her fever went away on its own?  There’s a difference, you know.  That’s why anecdotal evidence is so unreliable.

  16. One problem I have with the study reported by CNN is that it lacks a proper control group.

    There should have been at least a third group of patients that received placebos in addition to conventional treatment. How this kind of research can be conducted as a double-blind study is a bit of a puzzle, though.

  17. Yes, but if I pull a hair out of your butt crack, your eyes will water!
    I stand corrected.  Behold the POWER of QI!!

    Yeah, it would be hard to do a double-blind study of acupuncture, unless you had people stick needles in at random, or something.  And if you had too many combos going at once, it would be hard to control for all the factors.  But I would still like to see more research AND a more understandable explanation on how these things are supposed to work.

    Oh, and this isn’t to mean that I think “Western medicine = GOOD” and “everything else = BAD.”  There are a lot of Western practices that have never been placed under the loupe either.  We keep changing our minds all the time about whether something works.  Estrogen replacement therapy is good, then it’s bad, soy works, then it doesn’t, your body needs 64 ounces of water a day, no, it doesn’t.  A lot of Western doctors prescribe things just because they’re told they work, or their patients believe they work and demand them.

    I’m all for rigorous testing standards—the SAME ones—for all medical claims, regardless of origin or length of tenure.

  18. Well I am pretty sure my friend got relief from the fever. Or at least as certain as me getting relief from fever when I take Western medicine when I get fever.

    So GeekMom, did the acupuncture work? Never tried it myself.

    Here is the article from the British Medical Journal in case folks do not have PDF. Could not get the tables and graphs in:

    [Article removed due to copyright]

  19. You know, Pop Tarts, I’m not too keen on your argument, I’m actually leaning towards Geekmom on this one (which has left ME pretty much speechless).  But I’m lovin’ your name. I’m just a bit confused as to why you chose the plural…

  20. Wow, seems these threads grow faster than I can keep up with them these days. Just the same there are a few points I’d like to touch on (if you’ll pardon the pun).

    Chiropractic: As a means of dealing with lower-back pain and various neck injuries there’s a quite a bit of evidence that supports the idea that chiropractic therapy is an effective means of treating these ailments. Indeed, I visit a chiropractor regularly specifically due to lower-back problems and have had fewer problems as a result. Though in all honesty I could probably do more to alleviate my problems if I lost some weight. There is growing evidence in support of chiropractic for treatment of headaches and other pains as well.

    That said, the school of thought that claims chiropractic therapy is a means of treating whatever ails you (cancer, liver problems, the common cold, etc.) through the unblocking of nerves or “bio-energetic synchronization” is pretty much bunk. One of the more ridiculous claims some chiropractic practitioners make is that germ theory is wrong and all diseases are the result of nerve blockages.

    There are plenty of Chiropractors out there who don’t make ridiculous claims of being able to cure every problem you might have by twisting your spine around and if you do a little looking they’re not hard to find. I made it clear when I first visited my current Chiropractor that I was looking for someone who wasn’t of the cure-anything camp and he not only understood my concerns, but agreed with them. You may not even need question a Chiropractor directly, though. Many of the cure-anything camp will have plenty of posters and signs in their office windows making the claims boldly before you ever walk in the front door. The office I visit is absent of such materials.

    Acupuncture: More than likely this concept is largely bunk. Traditional Chinese medicine isn’t based on any understanding of biology or any known healing process and is almost entirely mystical in its explanation on how it achieves its supposed cures. The National Council Against Health Fraud (NCAHF) put out a position paper back in 1990 that said “Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease” and that “the perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms.”

    That said, the number of Empirical studies is still on the small side and there does seem to be some evidence that acupuncture may be a useful method of pain control. Probably the best summary out there for the claims and realities of acupuncture can be found in the Skeptic’s Dictionary entry on acupuncture, which is where I got some of the information in this summary. GeekMom may be interested in it particularly as it discusses the potential reason behind why the location of a needle on the body would make a difference in pain control. In short, there may be some benefits, but nothing on the scale of the claims often made in regards to it. Just the same, there is motivation for some more studies.

  21. Absence of evidence is not evidence of absence as they say, hehe.

    Actually I do not really hold any opinion on alternative medicine. My point is that based on what I have read acupuncture seems to show the greatest promise. Either that their effects outweigh placebo or that it equals placebo (meaning it most probably does not work). Or at least I have yet to hear much negative news concerning acupuncture.

    But the thing is while acupuncture may become more popular I do not think that there would be much research in the area. The problem is that phamaceutical giants are not going to invest their cash into researching something they cannot patent. Unless of course the patent law changes and one can patent surgical methods but that is not likely. So I guess acupuncture will remain an “alternative” medicine for sometime until public funds or university research shows whether it positively works or not.

    As an aside, the plural removes the idea that I am a “tart” in the negative connotation.

  22. Absence of evidence is not evidence of absence as they say, hehe.

    Indeed, but it also does nothing to support the claims being made. After all, extraordinary claims require extraordinary proof. We can sit here and play the maxim game all day.

    Actually I do not really hold any opinion on alternative medicine. My point is that based on what I have read acupuncture seems to show the greatest promise. Either that their effects outweigh placebo or that it equals placebo (meaning it most probably does not work). Or at least I have yet to hear much negative news concerning acupuncture.

    Shows the greatest promise of what? To cure AIDS? To end hunger in our lifetime? To answer the question of why we are here? Greatest promise of what… exactly?

    But the thing is while acupuncture may become more popular I do not think that there would be much research in the area. The problem is that phamaceutical giants are not going to invest their cash into researching something they cannot patent. Unless of course the patent law changes and one can patent surgical methods but that is not likely. So I guess acupuncture will remain an

  23. Greatest promise of doing what it claimed to do. Solving chronic pains.

    Research: As I pointed out money may come from university research or public funding. While there is lots of money to be made by hospitals and doctor, the problem is who is going to take the first dip for those profit driven organisation. You need to capture the market to get returns on one’s investment. Having monopoly profits for 20 years is very different from inventing something then competiting with the rest of the market in selling it. In fact all else being equal the company that discover it without monopoly protection will be worse off. They would have spent the additional cost on research the other hospitals would not need to.

  24. Well, Les’s question was legitimate:  advocates of acupuncture have claimed all sorts of benefits outside of simple pain relief (such as curing infertility, which I think is an especially cruel promise to extend to hurting, desperate people).

    I think it’s most likely that research will come from the universities, or POSSIBLY from public funding, if it becomes provocative enough a concept that the FDA decides it has a vested interest in settling the question.  I hope so, at any rate.

  25. Placebo effects
    One case I recall seeing may or may not involve the placebo effect.
    In a case of missing limb “syndrome”?A man who had severe pain (real or imagined I’m not going there)
    in his hand which he described as being clenched incredibly tightly so as to cause him pain.He was unable to unclench this unreal hand.
    The treatment,during one of the painful episodes, his unaffected real hand was placed inside a box with a mirror that created the illusion of both hands being inside,he then clenched and unclenched his real hand.
    This perceptual trickery worked problem solved.
    I can only remember the name of the neurophsychologist vaguely as Dr Ramproshand.
    The programme covered other interesting brain anomalues such as the god spot and a remarkable weird affliction called blindsight,an ability to move and interact normally with your environment,
    but an inability to consciously access the visual input.
    apologies if this comment is not as organised (links etc.)as you are used to
    Slaps wrist, will try harder.

  26. I am attempting to study placebo effect as an historical fact. What I have learned to date is that the first man to use “an unmedicinal substance”, that is placebo, on puerpose was dr Hahneman - the grounder of homeopathy. I am suprised to see how many people belive what they think they understand and don’t belive what they do not understand and call it science. The cornerstone of science is pure observation of a pure experiment; stastistics came later and on puerpose.
    Greetings to all.

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