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Placebo, Are You There?

PeterPositive

Senior Member
Messages
1,426
Thanks, it's an interesting article.
I might need to re-read it another time but in general I didn't find anything particularly surprising.

It's interesting to discriminate between the natural course of the health problem and the other non-specific effects, but studies targeted at quantifying the placebo-effect have already taken this in consideration.

I've found the comments about placebo in Parkinson's contradictory:

De la Fuente-Fernandez et al. (2001) used labeled raclopride, a molecule binding to dopamine receptors, to detect dopamine receptors in the brain with PET scan (positron emission tomography). The patients received either an injection of levodopa[3] or placebo. They found that the placebo produced the same effect on dopamine receptors, triggering substantial release of endogenous dopamine in the brain. They concluded: “Our findings indicate that the placebo effect in Parkinson’s Disease is powerful and is mediated through activation of the damaged nigrostriatal dopamine system.”

But In the next paragraph:
It still remains to be seen whether these imaging findings translate into clinical results. A more recent study (Fregni et al., 2006) has modified the findings of the preceding study. It studied not just the patient’s subjective response, but also objective tests.
How is a PET scan not an objective test?

In general the article seems to be playing a lot with definitions and subtle semantics. Maybe this is important in the medical field in order to establish clear definitions for the observed phenomena but for general understanding I don't find this to be particularly relevant.

If you check Wikipedia's definition, you'll find a similar definition:

The placebo effect consists of several different effects woven together, and the methods of placebo administration may be as important as the administration itself.

Meaning that placebo is an umbrella term that includes the whole healing ritual: the setting, the consultation, the relationship with the healer, the "placebo object" etc...

Given this definition I find it particularly difficult to study the difference between placebo and "doing nothing" (i.e. natural course of the disease), because even the act of participating in a study with no treatment, being examined and having to report subjective parameters could alter the results.
 

barbc56

Senior Member
Messages
3,657
How is a PET scan not an objective test

I would think it's because a PET scan is not diagnostic for certain conditions. In other words, if one were to look at a PET scan would you be able to say definitively that a certain condition caused what you see? What you see may be indicative of several conditions.

Barb
 

PeterPositive

Senior Member
Messages
1,426

PeterPositive

Senior Member
Messages
1,426
i havent read the article yet, but the amount of crap that we all try we should be cured if placebo was high amongst all as mecfsers.
LOL :D I thought the same.
It's my understanding that placebo effect can vary dramatically from subject to subject and it is not applicable to many health issues. Similar to hypnosis which has a range of efficacy and works best on some people, while it has minimal or no effect on others.

Generalizing is probably not going to give us the full picture.
 
Messages
7
Lucid dreaming gives you a good intuitive understanding of the placebo effect. If I take drugs in non lucid dreams, I get high. If I take them in lucid dreams, nothing. In dreams you theoretically know you should be able to do anything, but try walking through a wall if you haven't done it before. Its not so simple cuz your subconscious is programmed to make phasing through walls impossible. You have to KNOW 100% that you can do something to overide this self imposed limitation. I usually accidentally overide them when I become lucid in the middle of a non lucid dream where I'm doing something impossible. Pretty hard to doubt you can do something when you're doing it. Its like teaching a kid to cycle a bicycle, the easiest way is to hold them up then let them go without them realising it, by the time they turn around and find out theres nobody holding them, they've overridden their self imposed limitation.

How do we consciously utilise this principle, thats what I'm trying to figure out.
 
Messages
7
LOL :D I thought the same.
It's my understanding that placebo effect can vary dramatically from subject to subject and it is not applicable to many health issues. Similar to hypnosis which has a range of efficacy and works best on some people, while it has minimal or no effect on others.

Generalizing is probably not going to give us the full picture.
I hadn't had any success with hypnosis until I tried being hypnotised while on NMDA antagonists (a strong one, similar to PCP). Alcohol is well known to enhance peoples hypnotisability, my theory is that its dissociative properties are to thank for that. Didn't surprise me that real dissociatives enhance hypnotisability for me. I only tried that experiment once so I can't make any real conclusions from it.
 

Dolphin

Senior Member
Messages
17,567
Suggestion
The power of suggestion has been known for a long time. One can cite its utilization by Mesmer under the fallacious pretext of an alleged animal magnetism or, closer to our day, by the famous Coué method.

More recent studies provide evidence of its role in the implementation of the contextual effect. Thomas (1997) followed 200 patients with functional illnesses. He divided them into four groups receiving either a placebo or nothing and either a positive or negative consultation. The first group received a placebo and a positive consultation (assurance of correct diagnosis, certainty of healing), the second, a placebo and a negative consultation (hesitation about the diagnosis, lack of confidence about the course of the disease), and the other two groups got a positive or negative consultation without a placebo. After two weeks, 64% of the patients who got a positive consultation had improved compared to 39% of those who got a negative consultation. But there was no significant difference between those who got or didn’t get a placebo. The improvement they found was therefore due to the suggestion created by the doctor and had nothing to do with taking or not taking a placebo object.

This clearly confirms that, as Bourreau and Coichard (2003) wrote, “It is useless to resort to a placebo to induce a placebo effect.” Which could be written more clearly today by saying that the placebo object is not necessary for the contextual effect.
It seems to me this could be a reporting bias rather than necessarily a true improvement.
 

Dolphin

Senior Member
Messages
17,567
We have just seen that the contextual effect is an essential element in terms of pain and probably also the various functional diseases.
To the extent that the “placebo effect” is only a contextual effect that doesn’t depend on the use of an inactive object, it can and should be used in healthcare practice. It can probably be used instead of a prescription in certain functional diseases, and it certainly can potentiate the effect of prescribed drugs in many cases (analgesics, antidepressants…)

I'm not convinced they've proved anything about functional diseases specifically. What they are probably referring to are symptoms which can occur in all sorts of conditions.

They haven't shown that for example overall level of activity can be improved in functional conditions in this way.