[HN Gopher] Even when we know they're "fake," placebos can tame ...
___________________________________________________________________
Even when we know they're "fake," placebos can tame our emotional
distress
Author : akeck
Score : 137 points
Date : 2023-04-12 12:56 UTC (10 hours ago)
(HTM) web link (nautil.us)
(TXT) w3m dump (nautil.us)
| johndhi wrote:
| Open placebo studies are super interesting to me. One of the
| difficulties of pharma is proving efficacy over placebo...
| because placebo is a very strong factor! I feel like we could, as
| a medical community, leverage placebo to improve health outcomes
| much better than we do today. Why not? It seems the only reason
| not to is some weird Victorian notion about the capital-T Truth.
| amalcon wrote:
| There was a famous study where the patients were told they were
| receiving a "pill with no medicine in it." It still resulted in
| measurable improvement.
|
| The short version is that we do use it in some cases where
| there's a lack of other options. E.g. I can walk into the major
| pharmacy down the street and buy "earache medicine", which is
| (almost literally) just water. My insurance won't pay for
| something like acupuncture right now, but if I were undergoing
| cancer treatment, suddenly things like that would be partially
| covered in the name of "pain relief".
| johndhi wrote:
| This treatment works well for irritable bowel syndrome. Not
| for everything, of course.
| otikik wrote:
| > One of the difficulties of pharma is proving efficacy over
| placebo
|
| I guess that could be true in a very specific subset of
| medicine, but I cannot imagine that is true in general. As
| others are mentioning, the placebo effect _already_ is part of
| the medicine, except in cases where the patient is medicated
| while in coma or things like that.
|
| Do you have evidence to support your claim?
| Bjartr wrote:
| I think they mean it in the sense that when developing a new
| medicine whose degree of efficacy is unknown, you can't just
| test the medicine and show benefits. You need to test the
| medicine and separately test a placebo version of the
| treatment and show that the medicine (+the inherent placebo
| effect) is more effective than the placebo effect alone.
| sublinear wrote:
| > some weird Victorian notion about the capital-T Truth.
|
| Only if neither the patient nor insurance are paying for it.
| Otherwise that's just straight up grift.
| boomboomsubban wrote:
| If a doctor gives you a placebo, you only get the placebo
| effect. If a doctor gives you medicine, you get the placebo
| effect plus whatever extra benefit the medicine provides.
|
| We already are leveraging the placebo effect, unfortunately we
| are also doing it in a negative way by highlighting side
| effects.
| munk-a wrote:
| For some medications those side effects can be severe though
| - I think there's some rationale in actually purposefully
| leveraging the placebo effect without giving the patient a
| medication that could harm them.
| notahacker wrote:
| I mean, this might have been the case when standards of
| medical practice were so bad that the homeopathic hospital
| was one of the safest places to be because whilst the
| medical care there was purely placebo, that was better than
| a doctor with unwashed hands attempting crude surgery.
|
| But modern treatments are evaluated based on having
| demonstrable net positive effects _above and beyond_
| placebo.
| boomboomsubban wrote:
| The side effects are also influenced by the placebo effect.
| Maybe they'd be less problematic, but they'd still exist.
| s1artibartfast wrote:
| We already have witchdoctors for that. I don't need my
| medical professionals trying to deceive me.
|
| It's one thing if they tell me that a cup of tea helps some
| people with migraines, and is another thing if they're
| selling me sugar pills
| LoganDark wrote:
| > the placebo effect plus whatever extra benefit the medicine
| provides.
|
| Plus, the act of noticing those extra effects can give you
| another placebo effect on top, e.g. if the medicine has some
| noticeable effect, the placebo can get stronger, or cause
| other effects to accompany it.
|
| Of course there is also consciously learning to leverage the
| effects of the medicine, which is a non-placebo~
| taeric wrote:
| Close. If a doctor gives you a placebo, you can only get the
| placebo. No guarantee you will get anything, of course. You
| could also get the negative side effects of the real
| medicine, without any cure.
| schwartzworld wrote:
| I think we already do. When you buy a bottle of decongestant
| with phenylephrine, you're just buying a bottle of placebo, and
| this is the most commonly purchased type of decongestant.
| OkayPhysicist wrote:
| Thinking about this ticks me off every time it comes up.
|
| For those unaware, phenylephrine should never have passed FDA
| trials. It was whisked through almost certainly at the behest
| of Johnson and Johnson to provide a replacement for the very
| effective psuedoephedrine, which happened to be a relatively
| easy methamphetamine precursor.
|
| Then, for J&J to have the gall to market phenylephrine as
| "Sudafed" was just the cherry on top. I wasn't aware of all
| that at the time, but the first pill out of a box of new
| Sudafed was so ineffective compared to the previous pill from
| the old stuff that I had to look it up.
| madog wrote:
| Wow. I had no idea, I've been taking that for years. It's
| in every single OTC cold and flu medication with
| painkillers.
|
| I found this to be a good read/overview:
|
| https://www.science.org/content/blog-post/uselessness-
| phenyl...
| [deleted]
| thomastjeffery wrote:
| Emotions are an association between "fake" and "real".
|
| We can take advantage of this with objectivity: if you have an
| objective perspective on emotion itself - as a process that
| transfers data between imaginary thought and physical feeling -
| then you can alter the surrounding circumstances of emotions, and
| actively pursue specific thoughts that are connected to desirable
| feelings.
|
| But the utility doesn't end there: you can also directly hijack
| the process itself.
|
| Emotion is only truly understood from an _implicit inference_
| perspective: the explicit definition I just gave is not provable
| the way a mathematical theorem is. The only available evidence is
| from experiencing the result. It 's a soft science, but it's
| still useful enough to construct reliable tools.
|
| Here's my testing method: breathing.
|
| I know that the physical act of breathing is not functionally
| different, whether it's intentional or automatic. I know that
| physically, my lungs are filtering oxygen from my environment
| into my blood (with a breath in), and CO2 from my blood into my
| environment (with a breath out). Simply breathing does not have a
| noticeable effect on my emotional state, save for providing a
| baseline of functional cardiovascular support. I can feel
| happiness, anger, depression, pain, euphoria, or any other
| physical sensation: all the time breathing in and out with the
| same fundamental process. These elements of the breathing process
| have been _explicitly_ proven, much like a mathematical model.
|
| So how can breathing hijack emotion? Story.
|
| The associations that an emotion is made of are volatile. They
| can be changed. We all experience emotional change that is
| unintentional: based on the experience of our surrounding
| circumstances. We can also make emotional changes that are
| _intentional_ : based on the experience of our own imagination:
| by playing out a story.
|
| Here's an example: Imagine the feeling of ice on your skin. It
| feels cold to the touch, even the air nearby it. The rest of your
| body is comfortably warm: blissfully unaware of the chilling
| sensation from ice in that one place. Your lungs are not for
| filtering oxygen and CO2 anymore: now they draw in that sensation
| of cold touch, and filter out the sensation of warm comfort. Each
| breath in draws another lungful of chill into the bloodstream.
| Your heart pumps, and your blood meticulously draws out (like the
| CO2 before) the warm comfort from the body, to be replaced by the
| chilling touch of ice. Each breath out releases that warmth out
| into the air around you, to be scattered away in the wind. Do you
| _feel_ it? Now replace the cold touch with heat. Excitement.
| Peace.
|
| The Rolling Stones told us that love is, "just a kiss away"; but
| it's even closer than that: you can find it in a breath.
| segasaturn wrote:
| Yeah I've known this for a while, I suffer from anxiety and
| obsessive compulsive disorder and am well aware that my
| compulsions are total placebo and have no connection to my
| obsessions but still find they calm the anxiety almost
| completely. I think people are just drawn to ritual, be it
| religion or placebo/quack medicine or OCD.
| intalentive wrote:
| If the placebo effect comes down to the power of suggestion, then
| hypnotism is potentially a valid form of treatment.
| w_for_wumbo wrote:
| It works better if you believe in it. Feels like hardcore
| skeptics are doing themselves any favours by completely
| discounting the power of their mind to affect the environment
| (their body) which it is connected to.
| [deleted]
| cycomanic wrote:
| An interesting aspect of placebo is that supposedly the strength
| of the effect has been increasing in the last decades. So much so
| that quite a few approved medications would likely not get
| approved anymore, because their effect would not be strong enough
| compared to the placebo effect.
| bitcurious wrote:
| The placebo effect getting stronger as the population of earth
| increases is probably the most compelling evidence for us
| living in a simulation.
| boomboomsubban wrote:
| That doesn't make sense. If the approval process were happening
| now, the new trials would have the drug benefit from the higher
| placebo effect.
| agumonkey wrote:
| I think a lot of this psychological layer has been ignored
| because it wasn't phenomenologically interesting to study as a
| science, but the important of the semantic/emotional layer is
| hard to ignore. A simple thought (say someone tells you something
| regarding your child that is not true but you believe it) can
| fuck up your biology down to physiological death.
|
| Sadly, and obviously, the reverse isn't true, you can rarely cure
| infections through neurons triggering pathway cascades. But
| still.
| bell-cot wrote:
| I'd bet the same applies to both old social and religious rituals
| - but sugar pills are well-suited to and culturally accepted by
| modern scientific study. So nobody's likely to study mailing a
| paper-based note of apology (to the friend you're distressed over
| hurting), nor praying to $Deity (who you might not really believe
| in), etc.
| lazyasciiart wrote:
| What makes you think that?
| https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377...
| PaulDavisThe1st wrote:
| For years (decades, actually), I've been a believer in the idea
| that deliberately and systematically harnessing the placebo
| effect will be the biggest medical development of the first half
| of the 21st century.
|
| However, I've become aware of studies and claims that actually
| the placebo effect itself is an illusion caused by poor
| statistical understanding and poor study design (sometimes
| necessitated by the study matter).
|
| At this point I am deeply unsure what to make of things.
| hinkley wrote:
| Warts are an immune system that hasn't identified an intruder
| yet. There are plenty of folk remedies that are basically about
| tricking the brain into telling the body to get on with it. One
| involves tracing it and burning the paper.
|
| The last wart I had (when I was younger) I got mad (and
| angrier) at it one day and started trying to cut it out. I'm
| certain there were bits of it I missed, but it was gone in a
| week. I decided I had finally had enough and my body got the
| message.
| smeej wrote:
| This reminds me of the "homesickness prevention pills" my mom
| sent with me to sleep away camp.
|
| They were just unlabeled M&Ms, _and I knew that_ , but I'll be
| darned if those things didn't cure the homesickness right up!
| em-bee wrote:
| they reminded you that your mom cares about you. they are
| special because you didn't just buy them yourself, but your mom
| sent them to you as a gift.
|
| just like when my grandma made me cookies.
| misssocrates wrote:
| It could be argued this is why wearing masks can be helpful, for
| some, even though there is no evidence they protect against
| respiratory viruses.
|
| > Wearing masks in the community probably makes little or no
| difference to the outcome of influenza-like illness
| (ILI)/COVID-19 like illness compared to not wearing masks (risk
| ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9
| trials, 276,917 participants; moderate-certainty evidence.
| Wearing masks in the community probably makes little or no
| difference to the outcome of laboratory-confirmed influenza/SARS-
| CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to
| 1.42; 6 trials, 13,919 participants; moderate-certainty
| evidence).
|
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
| TurkishPoptart wrote:
| I prefer wearing my tinfoil hat :D
| PaulDavisThe1st wrote:
| From the cited paper:
|
| > The high risk of bias in the trials, variation in outcome
| measurement, and relatively low adherence with the
| interventions during the studies hampers drawing firm
| conclusions.
|
| Statement from the publishers:
| https://www.cochrane.org/news/statement-physical-interventio...
|
| > The original Plain Language Summary for this review stated
| that 'We are uncertain whether wearing masks or N95/P2
| respirators helps to slow the spread of respiratory viruses
| based on the studies we assessed.'
| [deleted]
| permo-w wrote:
| reminds me of public apologies
| luckylion wrote:
| For some definition of "we" and "know".
| LoganDark wrote:
| This argument always bothers me a bit, because words are almost
| _always_ used with "some" definition.
| luckylion wrote:
| I was trying to highlight that these words and the
| definitions you choose do a lot of lifting there. What's
| "we", or rather you or I, are you only your conscious mind
| which 'knows' something, or are you also the subconscious
| that doesn't know that at all? I'm certainly more we than I
| but I say I because it's easier and doesn't require tons of
| explanations. Recently I discovered that I've gotten a slight
| needlephobia. I'm perfectly fine with needles. I'm willing to
| give you my blood or get my shot, I don't have a problem with
| needles. But if you come close to me with a needle and I'm
| aware of it and believe that you'll stick it into me, I'll
| just shut down my conscious mind. But I obviously don't. But
| I absolutely do. Which one of those am I? Which one 'knows'
| something about placebos? Which one is affected by illnesses
| and medication the most?
|
| And what do you actually 'know' there? Do you know it doesn't
| contain any medication? Do you know that it usually still has
| a good chance of helping you? How is it fake if it has an
| effect? Do you 'know' that you don't 'know' how or why it
| works exactly? But does that make it fake, or does that make
| it surprising _that_ it works? I know how basically nothing
| about how anything works, but it still works, and that 's not
| surprising to me.
|
| But I'm lazy (all of me) and I didn't want to write all of
| that, so I apologize for having abbreviated my thoughts to
| that sentence that I agree doesn't really say much and could
| be applied to anything.
| halfjoking wrote:
| Placebos can also work in reverse - if you strongly believe a
| medication or procedure is harmful then you will be harmed by it.
|
| That's why it's entirely unethical to force a medical product on
| a population.
|
| Take for example the mRNA covid vaccine. Let's say it did what
| they claimed at the start and stopped transmission 100% without
| ever causing a side effect. Even then, the emotional distress and
| reverse placebo effect of coercing people to take a vaccine if
| they don't want it still outweighs any benefit.
|
| People who believe a vaccine is dangerous but take it to save
| their job will get harmed whether it caused a side effect or not.
| The emotional distress alone can be debilitating. If the mind is
| so powerful it can strongly affect health outcomes, how could
| anyone think it's ethical to punish someone for making their own
| medical decision?
| piotrkaminski wrote:
| > Even then, the emotional distress and reverse placebo effect
| of coercing people to take a vaccine if they don't want it
| still outweighs any benefit.
|
| That's ridiculous -- of course benefits can outweigh
| psychological side-effects. Usually you'd want those benefits
| to accrue to the person suffering the side-effects, but living
| in a civilized society means accepting that sometimes the good
| of the many outweighs the pain of the few. If a vaccine for a
| deadly, highly communicable disease can completely stop
| transmission then I think it's perfectly ethical to require
| everyone to accept it or isolate from those willing to do so.
| mistermann wrote:
| > If a vaccine for a deadly, highly communicable disease can
| completely stop transmission then I think it's perfectly
| ethical to require everyone to accept it or isolate from
| those willing to do so.
|
| Did you consider the law of unintended consequences?
| bandofthehawk wrote:
| > That's ridiculous -- of course benefits can outweigh
| psychological side-effects.
|
| I understood the grandparent post to mean that the harm can
| sometimes outweigh the benefits when the vaccine is forced.
| Not that it's always the case.
|
| > If a vaccine for a deadly, highly communicable disease can
| completely stop transmission
|
| Are you suggesting that the COVID vaccines were able to
| completely stop transmission?
| Kokouane wrote:
| Parent comment seems completely hypothetical so this seems
| like a bit of a stretch.
| piotrkaminski wrote:
| > I understood the grandparent post to mean that the harm
| can sometimes outweigh the benefits when the vaccine is
| forced. Not that it's always the case.
|
| On careful re-reading I believe you're correct. Though if a
| hypothetical 100% effective zero side-effects vaccine
| doesn't pass their bar of outweighing psychological harm
| then it seems unlikely anything could, hence my
| interpretation of GP as an absolute statement.
|
| > Are you suggesting that the COVID vaccines were able to
| completely stop transmission?
|
| Hah, I wish! No, just going with the GP's hypothetical.
| PaulDavisThe1st wrote:
| > Let's say it did what they claimed at the start and stopped
| transmission 100%
|
| This claim was never made.
|
| No vaccine works 100%, ever.
| burkaman wrote:
| This is called the nocebo effect, and it is well-studied.
| Example: https://jamanetwork.com/journals/jamanetworkopen/fulla
| rticle.... When you think of an interesting idea like this,
| please don't assume you've discovered something new that the
| entire public health field is unaware of. A drug or treatment
| that had worse nocebo effects than medical benefits would not
| be approved.
| halfjoking wrote:
| I don't agree that the nocebo effect can be tested in a
| clinical trial which only has willing participants.
|
| If there was a person who'd rather take a bullet than the
| vaccine, don't you think the nocebo affect would be stronger?
| My feeling is anyone who requests an exemption due to their
| beliefs should be given it because you can't measure the
| resoluteness of their beliefs, religious or not.
| lifeformed wrote:
| Your fallacy is implying that the harms are equal. The nocebo
| effect from a vaccine is not more harmful than the benefits it
| gives to the person and to the society.
| lazyasciiart wrote:
| Because their emotional distress and placebo effects don't
| outweigh the benefit to everyone else of having them
| vaccinated. And requiring vaccination to keep your job is not a
| punishment, any more than we punish people with epilepsy by
| saying they can't drive. It's an attempt to reduce the risk to
| society posed by their medical state.
| em-bee wrote:
| what's more, the distress is not caused by facts but by
| misinformation and people deliberately causing a scare.
|
| car traffic is more dangerous than the vaccine yet rarely is
| anyone experiencing distress over that.
| Zigurd wrote:
| Humans evolved in a world of arbitrary danger. That we evolved an
| affinity for coping mechanisms to the extent they have undeniable
| physical manifestations seems likely.
| treeman79 wrote:
| My dad used to joke about how placebos helped my mom and older
| sisters many body ache complaints. I just thought severe pain was
| normal until I was diagnosed with autoimmune, MS and a few other
| things. Doctors told me for years it was just in my head and that
| I just needed medication for anxiety.
|
| Proper medication and diet changes resolved pain and anxiety.
|
| My mom and sisters all have same issues. Dad and doctors gaslight
| them and me for decades.
|
| The highlight when I was in the ER coughing up blood. ER doctors
| explaining how I was faking it since my blood work was normal.
| Until chest X rays came back. Then doctor also went pale.
| Night_Thastus wrote:
| The more I talk to people in my life (friends, family, mentors,
| teachers, etc) the more this story seems to repeat itself.
| People who have a somewhat uncommon issue, and are forced to go
| from doctor to doctor until one finally recognizes the problem
| and knows what to do.
|
| I think that we have a couple problems. One is that we just
| don't have enough doctors to give thorough care to each person.
| They're under too much time crunch to really investigate. The
| second is that the human body is hopelessly complex and I'm not
| sure humans will _ever_ be able to be good at diagnosing
| problems with it effectively.
|
| Until we develop real gAI and much better imaging techniques,
| I'm not sure we will ever solve this problem in a satisfactory
| way.
| Herval_freire wrote:
| This is an illustration about not just placebos but how
| delusional people are.
|
| These are doctors who were taught to be investigative and
| logical yet they were so delusional they have to say that you
| were faking the blood that you were coughing up.
|
| A lot of "logical" people like to rag on cults or religious
| groups but what they don't understand is that delusion is
| pervasive. Most humans lie to themselves extensively and you
| dear reader, are likely not an exception.
|
| Take for example the armies of people who told me AI won't ever
| take over their jobs and chatGPT is just a stochastic parrot.
| There is merit to both sides of the debate, but I guarantee you
| a lot of the hostility against AI comes from delusional lies
| people tell themselves to cover up a possible future
| trivializes their job skills. Not trying to start an argument
| on AI here, but I bring this topic up because it's the most
| current example of mass delusion I can think of. You have to
| bring up the current delusion to show people how strong the
| capacity to lie to oneself is.
| Maursault wrote:
| Jesus rebuked the demon, and it came out of the boy, and he was
| healed at that moment. Then the disciples came to
| Jesus in private and asked, "Why couldn't we drive it out?"
| He replied, "Because you have so little faith. Truly I tell you,
| if you have faith as small as a mustard seed, you can say to this
| mountain, 'Move from here to there,' and it will move. Nothing
| will be impossible for you."[1]
|
| [1] Matthew 17:18-20
| coding123 wrote:
| I'd like to see a placebo study where they have 2 placebos:
|
| 1. This medicine will cure your muscle pain, but it has very bad
| side effects: Insomnia, depression, back pain, knee pain - but
| don't worry only a small percentage of people see these issues
| (like 1%)
|
| 2. This medicine will cure your muscle pain, and has no side
| effects, in fact it will make you happy and help you sleep
| better.
| thenerdhead wrote:
| I've read up a bit about this topic, but is there any books or
| recommendations that really cover the idea of what is popularized
| as the "mind-body connection + placebo effect"? There's obviously
| the best sellers / self-help crap in the world and even books on
| back pain being healed from this general "placebo" effect or at
| least the new awareness of it.
|
| I've noticed this personal effect to be a constant theme in my
| life. I'm a chronic overthinker (OCD perhaps) and when I become
| aware enough of said "placebo effect", my problems go away and
| new ones take their place. Maybe that's just life, but there's
| such a strong power to placebo I'd love to learn more about.
| nabnob wrote:
| Irving Kirsch, psych professor at Harvard, wrote a book called
| "The Emperor's New Drugs" which argues that antidepressants are
| basically just placebos. I haven't read the book but I have
| seen a lot of interviews and articles on his research and it's
| pretty damning.
| thenerdhead wrote:
| Thank you. Very interesting!
| NickM wrote:
| I have read this book, and can confirm, it is extremely
| interesting and pretty damning.
|
| I'm frankly surprised it hasn't had more of an impact; it
| really does seem like SSRIs are causing a lot of harm to a
| lot of people in the form of side effects, and the scientific
| evidence seems to point strongly toward them being no better
| than any other active placebo. Yet, they continue to be
| prescribed in ever-increasing numbers.
| taeric wrote:
| Placebos are a ripe topic. Specifically of interest to me, is
| that it is clear that placebos can work even when you know they
| are placebos for "solving" things; this implies that they can
| also work for making things worse.
|
| And letting that sink in is terrifying. Just telling people that
| they are going to do worse on something can, in fact, cause them
| to do worse at said thing. Even if the reasons are completely
| wrong.
|
| That is, placebos aren't limited to cures.
| sd9 wrote:
| The nocebo effect.
|
| "This video will hurt" - CGP Grey https://youtu.be/O2hO4_UEe-4
| taeric wrote:
| Thinking of how this fits in to conspiracy theories and
| general thoughts on public policy are... less than pleasant,
| all told. I personally take it as a good reason to have even
| more patience and empathy for folks; but I don't get that
| impression from everyone else. :(
| thecrash wrote:
| It is said that a visitor once came to the home of Nobel Prize-
| winning physicist Niels Bohr and, having noticed a horseshoe hung
| above the entrance, asked incredulously if the professor believed
| horseshoes brought good luck. "No," Bohr replied, "but I am told
| that they bring luck even to those who do not believe in them."
| arkj wrote:
| I've heard Zizek repeat this a lot in his talks but has never
| been able to find a reliable source for this claim
| WallyFunk wrote:
| On the subject of luck:
|
| https://quoteinvestigator.com/2012/07/21/luck-hard-work/
| peteradio wrote:
| Anytime I find a horseshoe I throw it in the trunk of my jeep,
| never had an accident since ... _knocks on wood_.
| mito88 wrote:
| no creo en brujas, pero que las hay las hay.
| hinkley wrote:
| One of my favorite Civ VI quotes:
|
| > "I don't believe in astrology; I'm a Sagittarius and we're
| skeptical." - Arthur C Clarke
| jffhn wrote:
| Reminds me of this quote: "Do not be ashamed to speak nonsense!
| You only have to be attentive to your own nonsense."
| (Wittgenstein, Miscellaneous Remarks (Vermischte Bemerkungen))
| latexr wrote:
| Reads like the setup of a short story. In the final act the
| horseshoe would be physically important, either to help the
| protagonist1 and make their point or hurt them2 and disprove
| the claim.
|
| 1 E.g. it contains an inscription which provides a vital clue.
|
| 2 E.g. it falls on their head.
| RheingoldRiver wrote:
| I like the 2nd ending, but when they're taken to the hospital
| for horseshoe-induced head trauma, an early-stage brain tumor
| is discovered & operated on, thus ultimately saving their
| life.
| macawfish wrote:
| Doctors in surveys around the world have admitted to prescribing
| antibiotics as placebo, yet homeopathy is off limits? Something
| unsettling about this for me. So much of illness wrapped up in
| distress. We need reassurances, however irrational the ritual
| that brings them. Why is there no space for this in conventional
| medicine?
| mannykannot wrote:
| Prescribing antibiotics where they will be nothing more than a
| placebo is undesirable, but prescribing homeopathy where it
| will be nothing more than a placebo (i.e. in every case except
| dehydration) would have a number of undesirable consequences,
| including a predictable increase in the number of people who
| will turn to homeopathy when antibiotics are needed for
| themselves and, more importantly, for their children.
|
| This reminds me of a cartoon (in the New Yorker?) where a
| patient is demanding a better placebo as the current one is not
| working.
| otikik wrote:
| > Doctors in surveys around the world have admitted to
| prescribing antibiotics as placebo, yet homeopathy is off
| limits?
|
| You are comparing something that has cured many of humanity's
| illnesses (in fact, there's a good chance that you are alive
| thanks to antibiotics) with something that has the curative
| properties of rubbing quartz crystals or drinking blessed
| water.
|
| Of course there is something unsettling about that comparison.
| jcutrell wrote:
| I'm not sure what the bias is here - maybe halo effect? - but
| the issue at hand is that the antibiotics are being used in a
| scenario where they cannot be effective. They are, in that
| way, a placebo to the same degree that homeopathy is, despite
| any other properties outside of the acute situation.
|
| Say I have some really great tasting distilled water.
| Perfectly pure, exactly what I need if I wanted to quench my
| thirst. Now, I also have an empty gas tank.
|
| Should I put water or flat Coca Cola in the gas tank? They
| are both bad, despite the separately superior qualities of
| the water. Or, maybe a better comparison is putting diesel in
| vs coke. They are equivalently bad for the engine despite one
| of them being used for a similar but separate situation.
| otikik wrote:
| Your metaphor is does not work well because water and coke
| are both pernicious to a car. A better one would be
| quelching thirst with water versus coke. Both will calm
| thirst, and are reasonably "neutral". The second has
| pernicious effects, especially in some people (diabetes for
| example)
|
| Distilled water has other uses besides drinking. It can be
| used in chemistry for example. You would not get good
| results in chemistry if you replaced distilled water with
| coke. "I can drink water, surely I can use coke instead of
| water on this chemistry experiment, because I can also
| drink coke" is clearly faulty logic.
|
| And yet, that's exactly what people do with homeopathy.
|
| While it should always be presented as a "complement" to
| medicine(because it can have some mental/placebo effect in
| some people, in some cases), very often people take it as a
| substitute (the marketing word is "alternative") to
| medicine. This is something that the homeopathic industry
| can't help but "allow happening". In fact they are
| motivated to promote that way of thinking. First it
| increases direct sales. Secondly, the more mixed up their
| product is with medicine, the stronger the placebo effect
| will be, and that will increase sales further.
|
| Unfortunately the placebo effect is very limited. You can't
| mend a broken arm with placebo alone. You can't cure cancer
| with placebo alone. And yet people replace chemotherapy
| with homeopathic "remedies". And then they die.
|
| In short: doctors should never give homeopathic remedies,
| because that puts them on the same level as medicine. That
| will ultimately make some homeopathic makers richer, but it
| will also get some people killed.
| somenameforme wrote:
| Antidepressant/SSRIs are a much bigger one. The actual
| experimental evidence for these drugs, contrasted against
| placebo, is shockingly weak. Moreso, SSRIs come with tremendous
| side effects. At the very least we should be making an effort
| to gradually phase these out of society. In reality, we've gone
| the other direction and floored it - with SSRI prescriptions
| growing exponentially.
| mannykannot wrote:
| I have seen the argument that the weak evidence for their
| effectiveness is _entirely_ due to them being better
| placebos. What makes them a better placebo? Ironically, it is
| (according to this theory) that their side-effects are
| obvious to the patient, so those who are actually on them are
| more sure than the controls are that they are taking the drug
| under test, as opposed to the placebo being used in the
| trial.
| LoganDark wrote:
| SSRIs do have a studied and recorded physical effect of
| inhibiting serotonin reuptake, but _what that actually does
| to someone_ is still not entirely understood, past "it can
| help with depression and/or maybe ADHD".
|
| It's unfortunate that SSRIs have harmful long-term effects
| --I know some people who have been dependent on SSRIs for
| around a decade, and probably will be forever because of
| the neurotoxicity.
| Herval_freire wrote:
| There is space for placebos in conventional medicine. Doctors
| CAN and are allowed to prescribe placebos.
|
| However medicine strives to maintain a separation between an
| actual body of scientific knowledge and placebo treatments. So,
| yes, while a placebo can be effective nobody is going to
| transcribe that placebo onto actual scientific knowledge as if
| it wasn't a placebo.
|
| Right, so antibiotics work as a placebo, but am I going to put
| that knowledge down into textbooks that antibiotics can cure
| the common cold just because such knowledge effectively works
| as a placebo? No.
| flavius29663 wrote:
| > antibiotics can cure the common cold
|
| Antibiotics are not pure placebo. They are also given to make
| sure there isn't a bacteria ready to take advantage of the
| weakened immune system. The regular treatment for COVID also
| included antibiotics, for the reason I mentioned.
| kube-system wrote:
| Because it isn't quite that simple. Overprescription of
| antibiotics isn't usually done _only_ for the placebo effects,
| but other social reasons as well. A significant subset of
| patients react poorly to "it's probably viral and so we
| probably can't do anything". As bad as antibiotic overuse is,
| lying to patients and fraudulently prescribing a treatment is
| still much worse than giving someone antibiotics in the 5%
| chance that something is bacterial.
|
| I don't think that lying to patients to falsely reinforce their
| untrue beliefs is a solution to the problem -- it'll probably
| create an additional problem by reinforcing beliefs of the
| legitimacy of pseudoscience.
| jcutrell wrote:
| I think there's a chance here to actually tell them the
| truth.
|
| "This stuff is not studied to work. It is a placebo." OP
| study says this can still be effective.
| kube-system wrote:
| Although not as effective as deceptive placebos. I
| personally suspect that the subset of people for which
| honest placebos work well overlaps significantly with the
| same subset of people who already believe "pill = good"
| above the expert advise of their doctors.
| treeman79 wrote:
| On a 4 page list of my notes on issues and treatments I
| mentioned that my symptoms always got better on doxycycline
| for a couple of months. My ancient neuro-ophtomogist oh, you
| have Sjogrens. I'm like what's that? Apparently he had seen
| that many times before.
|
| Turned out he was right.
| vonnik wrote:
| The key thing we should update on, as a society, is that placebo
| effects are huge (often as large as the treatment effects
| established for drugs in RCTs), and through specific actions, the
| placebo effect can be maximized.
|
| In fact, it used to be part of a medical doctor's training to
| take on the mantle of an authority capable of producing placebo
| effects, back when they had little else to give.
|
| The thing you really want to do, and every doctor should aim for,
| is to stack the placebo effect on top of a well-established
| treatment effect.
|
| It's hard for people to do this to themselves, deliberately --
| like turning the knob on a pressure cooker while you're inside
| the cooker... But obviously being credulous helps a lot!!
|
| There is actually a literature on this, but it's adjacent to the
| medical journals:
|
| Daniel Moerman describes himself as a medical anthropologist. He
| wrote a book called "Meaning, medicine and the 'placebo effect'
| ".
|
| https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-An...
| hdjjhhvvhga wrote:
| > The thing you really want to do, and every doctor should aim
| for, is to stack the placebo effect on top of a well-
| established treatment effect.
|
| Isn't it risky? Saying "everything will be fine" or "this will
| definitely help" with authority when you know the probability
| can have consequences, and in the end patients will stop
| believing you.
| retrac wrote:
| It's perhaps less "everything will be fine" and more
| "whatever happens, you're in good hands". A certain confident
| assertiveness, even when there's nothing to be confident
| about. I've not had the experience some have, with physicians
| pretending to be mini-gods. So far, the ones I've met have
| been quite willing to admit they have no idea what's going on
| when that's the case.
|
| That can be done in a way that leaves you feeling like you
| have support and practical things to do in the meantime, or
| it can leave you feeling lost. A friend who is a nurse who
| works in hospice has some critical things to say about the
| bedside manner of some of her peers. When there is nothing to
| be done, but how nothing is done can still matter a lot.
| Sometimes it's simple as despair leading to self-neglect that
| leads to more rapid worsening of illness. That effect seems
| to be related to the placebo effect.
| taeric wrote:
| I'd actually assume it should be more "everything will be
| fine." You specifically broadcast the reaction you want to
| get from folks. Someone down thread posted the video to the
| nocebo effect. It really is far more effective than makes
| sense.
|
| Problems are legion, of course. Is it something inherent to
| the people that are impacted by this? Would make some
| psychotic disorders interesting evolutionary defenses.
|
| And, of course, there is no reason this has to be limited
| to medical behaviors. Teaching and coaching can be more
| effective for some people, if you tell them what you are
| doing is going to be effective. This actually tracks
| remarkably well with how so many advocates for different
| techniques all lead with usually over the top assertions on
| how what they are doing will work. Often more so than on
| why it would work.
| em-bee wrote:
| that's because "everything will be fine" or "this will
| definitely help" sound unrealistic. the message needs to be
| more subtle and believable.
|
| but what is the risk? the only situation where the
| believability of a doctor suffers is when the patient doesn't
| heal at all. we do read about cases where people go from
| doctor to doctor because nothing works, until they meet that
| one doctor who has the right insights and finds a treatment
| that actually does work.
|
| how often does that happen though and how does that affect
| the doctors or the patients?
| carlmr wrote:
| >the only situation where the believability of a doctor
| suffers is when the patient doesn't heal at all
|
| If you investigate the medicine they prescribe you and find
| out it's a placebo, you might stop believing the doctor
| about the other cures they sell you.
|
| When a doctor gives me homeopathy I will not return.
| gretch wrote:
| It's an interesting gray area because the effects of
| placebos are empirical and reproducible in rigorous
| trials.
|
| If your doctor tells you "this pill helps many people
| with your condition ", they'll be telling the truth.
| carlmr wrote:
| >If your doctor tells you "this pill helps many people
| with your condition ", they'll be telling the truth.
|
| That's actually a really good wording.
| jjeaff wrote:
| I was talking to a psychiatrist friend of mine about
| placebo effect and he told me that it definitely can make
| a big difference. But I asked him if he ever just gave
| placebo pills to patients and he said no because he felt
| that would be unethical. I didn't really think to ask
| whether it would really be unethical if it might help.
| jt2190 wrote:
| > The thing you really want to do, and every doctor should aim
| for, is to stack the placebo effect on top of a well-
| established treatment effect.
|
| Psychologist Alia Crum does research into this area.
|
| "Harnessing the Power of Placebos" by Alia Crum (Video, 2016)
| https://youtu.be/WcQnSW1wpGA
| furyofantares wrote:
| I've tried to internalize an understanding that placebo effects
| are real and can be large, with the expectation that this
| understanding should increase placebo efficacy without
| sacrificing my commitment to truth (that is, I don't seek out
| woo, but I do expect some woo is actually a real, strong placebo
| effect and I'd like to be able to replicate it myself sans-woo.)
| hinkley wrote:
| Part of the "mind over matter" aspect of the human body is that
| a deliberate act is sometimes enough to get things moving. That
| act in increasing the number of times of day you think about
| your predicament and the depth of attention you apply to it.
|
| While there's a lot of promise in harnessing that, it's also
| the source of a lot of superstition.
| gnatman wrote:
| There's a great episode of NPR's Hidden Brain about the placebo
| effect called "All The World's A Stage--Including The Doctor's
| Office".
|
| https://www.npr.org/transcripts/718227789
| assbuttbuttass wrote:
| > research published this year from Gaab and his colleagues
| showed even taking imaginary pills could reduce test anxiety
|
| I'd be curious how effective it is versus deep breathing, or any
| other anxiety-calming practice. The mind is extremely susceptible
| to the power of suggestion, but I'm not convinced there's
| anything special about a "placebo" versus ordinary mindfulness.
| j45 wrote:
| I wonder if the placebo effect can extend to learning, where you
| imagine taking a placebo that helps relieve your stress about
| having to learn something new after a long time.
|
| If anyone is familiar with research and reading at the
| intersection of placebos/psychology/learning, it would be great
| to read!
| RheingoldRiver wrote:
| Well, not quite what you are asking but, it has been shown that
| asking some demographic questions prior to testing can alter
| some outcomes (specifically Black students' math scores) [0]
| although other papers find no difference when looking at other
| factors such as asking about gender prior to physics tests [1],
| this is known collectively as "Stereotype Threat."
|
| So given that "Stereotype Threat" is a thing, I would
| absolutely believe that you can apply the placebo effect to
| learning as well.
|
| [0] https://onlinelibrary.wiley.com/doi/full/10.1002/ets2.12046
|
| [1] https://arxiv.org/ftp/arxiv/papers/1602/1602.07648.pdf
| pbourke wrote:
| > In one placebo group, people were told by a friendly,
| trustworthy, and empathetic researcher that the videos had a
| physiological impact that activated "early conditioned emotional
| schemata through the color green."
|
| > "It was a fake idea, a fake rationale behind it," Gaab said.
| "And it worked, people loved it." It worked as well as a group
| psychotherapy treatment Gaab and his colleagues used with study
| subjects a few years earlier.
|
| Were people explicitly told that it was a fake idea at the
| outset, and went along with the ruse?
|
| Can I buy sugar pills and tell myself "these pills will help with
| problem X" and have an expectation that they will work? Or do I
| need to receive "Problem X pills" from some authority in order to
| see a placebo effect?
|
| I had always assumed that a key component of the placebo effect
| is not knowing whether you're receiving the treatment or the
| control.
| kayodelycaon wrote:
| Being completely serious here. Go to any store selling
| homeopathic medicine and pick something off the shelf. Maybe
| it's placebo or maybe it works.
|
| Just make sure to do your own research first, some things are
| actually toxic or interact with medications. :)
| groby_b wrote:
| Nope. you'll still get a benefit when you know.
| (https://www.apa.org/monitor/2011/03/placebos - sorry, don't
| have a real link handy)
| kilbuz wrote:
| The book "Bad Science" has wonderful discussions and examples of
| the placebo effect as it relates to medical research. Highly
| recommended.
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