Comments on: Evidence that placebos could work even if you tell people they’re taking placebos

By: Adam

Adam — Fri, 24 Dec 2010 08:56:51 +0000

I’m with Richard Coe (comment #3) on this one. The description of placebo is clearly a description of a placebo to someone who understands the concept, but I’m sure there must be many patients who don’t really understand fully, and believe that they are actually being given something active.

The phrase “mind-body self healing processes” is straight out of woo-land, and the sort of thing that any alt-med fan would recognise as implying some genuine healing effect.

It will be fascinating when they report the results of what the patients really thought.

One other thing, but the use of open placebos is not as novel as they claim it to be, as I’ve pointed out in the responses on the PLoS One website.

By: Kimball Atwood

Kimball Atwood — Thu, 23 Dec 2010 15:27:25 +0000

“I actually thought the same at first blush but after a bit of consideration, I do think it’s a fair description of what a placebo is. You do, after all, get beneficial effects even though there’s no active ingredient. ”

Well, no. As the authors acknowledged, previous placebo studies have themselves involved deception. Thus to tell subjects that “placebo pills…have been shown in rigorous clinical testing to produce significant mind-body self-healing processes” and “the placebo effect is powerful; the body can automatically respond to taking placebo pills like Pavlov’s dogs who salivated when they heard a bell; a positive attitude helps but is not necessary; and taking the pills faithfully is critical” merely begs the question(s).

They shoulda stopped at “inert or inactive pills.”

By: Ed Yong

Ed Yong — Thu, 23 Dec 2010 14:39:26 +0000

Update: Matt Hodgkinson from PLoS says on Twitter: “PLoS ONE has no length restrictions, and we are happy for manuscripts to report qualitative results.” http://twitter.com/mattjhodgkinson/statuses/17951387644071936

By: Heather Etchevers

Heather Etchevers — Thu, 23 Dec 2010 13:01:16 +0000

This quote (“Scientific reports make it clear, even if strange and counterintuitive, that receiving – rather than the actual content of – medical treatment can trigger and propel a healing process.”) reminded me of a study I had seen, and had been interested in, about ten years ago.

http://www.ncbi.nlm.nih.gov/pubmed/11167967 in which, without reading the study, it’s impossible to get at what was interesting from the abstract: kids with these congenital malformations, having undergone nearly any kind of plastic surgery or medical intervention (dermabrasion, laser treatment, curettage), where most of the latter give fairly unsatisfactory results from an objective point of view, were better adjusted than those who were told to adjust and live with their visible difference.

The same group followed up with the slightly different: http://www.ncbi.nlm.nih.gov/sites/entrez/11786785

So, the patient-provider relationship is more beneficial to the psyche than the absence thereof. Somehow, feeling like a professional takes your problem seriously and, qualified to do so, is working with you, intervening, to effect a change, translates into a beneficial physical effect.

I would conjecture that the same effect would not have been obtained if those same sugar pills were prescribed to these particular patients by a person dressed as a traditional sangoma from Zululand.

By: Dorothy Bishop

Dorothy Bishop — Thu, 23 Dec 2010 12:37:33 +0000

Ah sorry – had misread what you’d said about the study. Thought comparison was placebo vs regular treatment. Doh!

By: Ed Yong

Ed Yong — Thu, 23 Dec 2010 12:30:27 +0000

@Dorothy – to an extent, the authors address the issue of consultation in the paper:

Both treatment arms were given in a context of a warm patient-provider relationship. It is possible that this relationship had a positive benefit for the patients, and indeed, the no-treatment arm showed improvement. Given that patients in both treatment arms experienced the same frequency and duration of contact time and the content of the interaction was very similar, we believe that the incremental improvement in our open-label arm was due to the addition of open-label placebo treatment.

By: Dorothy Bishop

Dorothy Bishop — Thu, 23 Dec 2010 12:21:10 +0000

One thing that would be common to all people in the trial would be that they would presumably first see a doctor who would confirm they had IBD. Because IBD is associated with nasty abdominal pain, many affected people worry that they may have something far more serious that has gone undetected. So I wonder whether the critical thing here was not the placebo, but the initial consultation which would have provided some reassurance that the pain was not indicative of a malignant disease. Patients seen for a research trial often do get a more thorough evaluation than they’d get from their GP, and they may also have more confidence in the study team, as they have expertise in the disorder. So I think this is a case where the study really needs a ‘wait list’ or no treatment control before you can conclude that it’s the placebo that is having an effect.

By: Ed Yong

Ed Yong — Thu, 23 Dec 2010 11:18:15 +0000

I actually thought the same at first blush but after a bit of consideration, I do think it’s a fair description of what a placebo is. You do, after all, get beneficial effects even though there’s no active ingredient. However, as to Richard’s last question, I think this is exactly why the post-trial survey is so important, and why it’s so frustrating that the results haven’t been analysed yet!

By: Yogzotot

Yogzotot — Thu, 23 Dec 2010 09:52:17 +0000

I had the same thoughts as Richard Coe: If you tell a patient that “a placebo can produce significant mind-body self-healing processes”, this is essentially the same as “homeopathy/crystals/acupuncture can produce significant mind-body self-healing processes” – they believe they get a treatment that can heal them. Not much deception removed in my book.

By: Richard Coe

Richard Coe — Thu, 23 Dec 2010 09:26:49 +0000

I’m not sure how much the deception has been removed. Saying this -> “sugar pills, have been shown in rigorous clinical testing to produce significant mind-body self-healing processes” or this -> “try a sugar pill that could help them” is still instilling the idea of efficacy in the patient who may not be able to unpick the subtlety. I’m not criticising the study or saying it’s unethical, just that I’m not sure it’s as materially different from deception as first appears.

If it’s the ritual of taking medicine that is important then will a more sceptical generation growing up with a better understanding of the concept of the active substance in a remedy be less susceptible to a placebo effect?