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SBM says there's no 'true' placebo affect.

Discussion in 'Other Health News and Research' started by Esther12, Mar 25, 2010.

  1. Esther12

    Esther12 Senior Member

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    This article reminded me of the recent CBT papers which showed significant improvement in self-reported symptoms, but no improvement in actual activity levels. It's very hard to double-blind CBT and GET, so some of the problems mentioned here would be affecting this research.

    http://www.sciencebasedmedicine.org/?p=4304#more-4304

    ps: I remember SBM being a bit poor on CFS generally.
     
  2. Wonko

    Wonko Senior Member

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    hmmm...

    I use the placebo effect all the time in pain management - just as worry about the cause or fear about the potential damage the pain represents can make pain worse blocking these thoughts (distraction methods) can effectively (but temporaily) reduce subjective pain - tbh I'm fairly sure I've seen studies that indicate a similar thing with branded painkillers vs the generic version of the same drug - people believe the branded version is more effective coz adverts tell them so and so they are

    whilst I've experienced examples of the placebo effect having a temporary effect on other aspects of M.E. this can be dangerous to exploit - thinking your energy levels higher or using similar methods to reduce PEM effects will only result in a crash at some point as you've stopped listening to your body - you can subjectively fool it short term but at a cost which is too high for general use - again I'm fairly sure a lot of PWME use it for things like social events they 'have' to go to - deliberately raising energy levels higher than is safe knowing they will pay the price afterwards

    so I'd have to agree - biologically the placebo effect has no lasting effect so anythign which exploits it couldnt be used as a treatement - but that doesnt mean it doesnt have a value in some specific cases
     
  3. Robin

    Robin Guest

    SBM is a stable of physician and scientists wrtiers of various disciplines. There's no peer review or consensus -- they just write about whatever they want to and sometimes disagree. The views on CFS vary from suspecting its a manifestation of somatic illness, to admitting they don't know what the cause is, to having patients in clinical practice and suspecting some type of biological issue. There's been two posts on CFS recently and one suggested it was somatic (and was very poorly researched and written, to boot) while another pointed out the negative XMRV studies and issued caution to patients. None of them are very well versed or particularly interested in CFS.

    Generally though, they're pretty good within their areas of expertise. Elsewhere on this forum I had been discussing with Koan placebo in psychatric medicine so I thought this particular blog was very interesting.

    The CBT/GET is measured against people who don't participate in the study (the cochrane review says this -- sorry I don't have the citation right now!) as the control. I imagine, as you pointed out, it is near impossible to attempt a placebo!
     
  4. Jerry S

    Jerry S Senior Member

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    Perhaps this is relevant.

    From The New York Times:

    For Chronic Fatigue, Placebos Fail the Test

    By NICHOLAS BAKALAR

    Published: March 29, 2005

    Any doctors believe that sugar pills are likely to be effective for patients with chronic fatigue syndrome, trusting that a placebo will help relieve the mental and physical exhaustion that characterize the illness.

    But a new study has found that people who have the syndrome respond at a lower rate to placebos than patients with other diseases. The paper was published in the March-April issue of Psychosomatic Medicine.

    Studies suggest that placebos relieve the symptoms for about 30 percent of patients suffering from a wide variety of illnesses. Migraine headaches, for example, respond at a rate of about 29 percent to placebo treatment, major depression at about 30 percent and reflux esophagitis at about 26 percent.

    In some diseases, placebo treatments are even more effective - 36 to 44 percent of patients with duodenal ulcers improve on placebos, depending on how many of the treatments are offered each day.

    But by pooling results from more than two dozen studies, the researchers, led by Dr. Hyong Jin Cho, a professor of psychiatry at King's College London, found that, among people with chronic fatigue syndrome, only 19.6 percent responded to placebos, not the 50 percent found by previous, less systematic studies.

    To Dr. Cho, the results were both unexpected and disappointing: he says he believes placebos can be a legitimate and useful form of medical treatment. He concluded not that placebos were unhelpful in treating chronic fatigue but that their use should be perfected.

    "At the clinical practice level," he wrote, "the overall low placebo response emphasizes the need to enhance" the placebo effect in treating the illness.

    To many doctors, chronic fatigue syndrome seems like a perfect candidate for placebo treatment, Dr. Cho and his colleagues write. Its symptoms are often indistinct: in addition to general fatigue, patients complain of muscle and joint pain, headaches, memory impairment and mood disturbances. Moreover, the symptoms frequently fluctuate over time, and they are more acute when the patients are paying close attention to them.

    The illness has no cure, and the Centers for Disease Control and Prevention estimates that as many as 500,000 Americans suffer from it.

    Dr. Cho and his colleagues speculate that the skepticism about the illness on the part of health care professionals may damage the trust between doctor and patient - a factor that may influence the effect of a placebo.

    According to the study, placebos presented as medical or alternative-complementary treatments have a greater effect with chronic fatigue patients than do those offered as psychiatric interventions. The researchers suggest that this may be because most patients have a firm prior belief that the illness is physical. They make no judgment about the accuracy of that belief.

    But Dr. Brian Fallon, an associate professor of psychiatry at Columbia University, offers a different interpretation. The fact that chronic fatigue syndrome responds so poorly to placebo treatment, he said, provides evidence that the syndrome has a physiological basis, though one that is still poorly understood.

    "The finding by Dr. Cho and colleagues will come as no surprise to patients with C.F.S. who experience debilitating fatigue despite numerous treatment interventions," Dr. Fallon said. "That the placebo response in C.F.S. was far lower that in primary psychiatric disorders such as depression highlights the distinct nature of C.F.S. and how little we know."

    Whatever conclusions may be drawn from the study's results, Dr. Cho says he sees placebo treatments as important.

    "Many alternative therapies may provide a cure that depends on this powerful placebo effect," he said in an e-mail message. "I'm not using the term pejoratively, since empathy and time spent with the patient by the professionals in this area are indeed of important therapeutic value."
     
  5. Esther12

    Esther12 Senior Member

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    Thanks. I've only heard about that second hand (well - I guess NYT is still second hand, but still a bit more authorative sounding).
     
  6. biophile

    biophile Places I'd rather be.

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  7. Gerwyn

    Gerwyn Guest

    This is the key part for me

    What the authors found is also most compatible with the hypothesis that placebo effects, as measured in clinical trials, are mostly due to bias. Specifically, significant placebo effects were found only for subjectively reported symptoms. Further, the size of this effect varied widely among trials.

    Bias in self reported symptoms see CBT studies
     
  8. Jerry S

    Jerry S Senior Member

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  9. Mithriel

    Mithriel Senior Member

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    I totally agree. I have read things about the placebo effect but I can't remember where. probably the New Scientist. They said that someone looked again at the original studies which discovered the placebo effect and found it had been overstated.

    It is most apparent for pain, but fact that reduction in pain with distraction and other techniques occurs makes me think it is not the placebo effect as stated that is at work.

    It also happens in drug trials, but again it is more subjective things where it is most apparent. Did the drug bring down levels of thyroid hormone has less placebo than "Do you feel less depressed"

    My own opinion, based on reading, nothing else, is that the placebo effect doesn't exist at all. Something happens, but think it is more a factor of the physiology of processes rather than the psychological slant of placebo.

    I wish I was well and could have run experiments. :Retro smile:
     
  10. biophile

    biophile Places I'd rather be.

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    Sounds like the researchers Hrbjartsson & Gtzsche. This is their latest systematic review on the placebo effect: http://www.ncbi.nlm.nih.gov/pubmed/20091554 (but no mention of "fatigue" in the abstract).

    "AUTHORS' CONCLUSIONS: We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed."
     

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