A new hypothesis in medicine: give patients drugs they know don’t work

As you can imagine, being less stressed is really hard when you have a chronic illness. This is exacerbated by doctors ignoring you. Having anyone spend an hour to help you in any way is such a relief. I wouldn't be surprised if this played a large role.

As another example, my wife and I have had six miscarriages. We're 25 and both healthy and the many doctors we've seen agree. Well if the doctors don't have a diagnosis, they don't wanna see you.

When it comes to recurrent miscarriage, there is no treatment. They suspect there are likely auto immune diseases we don't know about. Indeed, this seems likely. Most studies on potential treatments cannot be reliably replicated. The only thing that has been shown to reduce miscarriage risk in future pregnancies is tender loving care-- having a doctor who will talk with you for hours whenever you want, and being taken care of.

So now we see a new matronly obstetrician. She's a bit quirky but we feel like she won't abandon us like the other doctors did. Her appointments are multiple hours long, and she's happy being paged in the middle of the night when we've found out we're pregnant again. At 5 am when you find out you're pregnant after five miscarriages, nothing is more calming than a soothing voice on the telephone

This doctor has also encouraged us to seek out alternate practitioners, like acupuncturists and massage. She doesn't believe in their treatments working per se (she's an md and is happy providing real treatments), but I think she understands they these practitioners will at least make you feel calm and taken care of. Whereas I used to laugh at people who would see them before, I get it now.

When you have a medical condition that is chronic and there's no end in sight and no cure available, you need a friend more than a doctor, and unfortunately, there's not much overlap between the two

People running the trial really want you to complete the study. The payments are structured to encourage this, but the staff also try to be warm and friendly to encourage you to come back, and this (along with getting out of the house and checking something off a to-do list), helps lift people's mood.

Something else I believe is extraordinarily powerful is touch, and Reiki is one method formalising touch with professional intention. I think this is a good thing.

Doctors here in Australia are the same. 10 minute back to back appoints all week long. Back of the envelope calculation: my mechanic has spent more time with my car this year alone than I have spend with doctors my life to date. Fairly sure the mammalian bodies vastly more complicated than cars.

On a side note, my partner and I recently raised a dog, she's now 16 months old. I've currently got a mild respiratory tract infection which is worse for cold air and at night so I'm sleeping in the lounge room with the heat pump turned up so as not to disturb my partner with my coughing fits. The dog has been laying right up against me the whole night with her head resting on my arm or chest and has not made one complaint. When I get up, for whatever reason, she sits and watches me till I get back. She's warm, tolerant to a fault, never complains, misses us, always happy to see us. Dogs are the ultimate touch-healers. Just having some by your side whenever you need it, someone to play with whenever you want, is, in my experience, very powerful.

- Lewis Thomas, The Lives of a Cell (Among other achievements, he was dean of Yale Medical School and president of Sloan-Kettering. This collection of essays was published in 1974 and is absolutely prescient and fascinating - he offers profound thoughts on the nature of science, computing, and medicine that have stood the test of time astonishingly well.)

Back in 1995, Dr. Andrew Weil wrote:

It is well known that belief in medicines can cause favorable outcomes even if the medicines are ineffective. This is the placebo response, which most doctors dislike because it muddies their experiments and seems inherently unscientific from the point of view of the biomedical model ... far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease. [Spontaneous Healing]

I'm not saying that Weil describes exactly the same idea as Kaptchuk, but ideas in the same space were out there knocking around. Is Kaptchuk's idea truly radically different from what came before?

It seems to me Kaptchuk has varied one aspect of the experiment (eliminate double blindness, and even single blindness). Does that make it a radically new hypothesis?

this is from 2016 Dec ( see "4.1 Limitations" )

"Open-label placebo treatment in chronic low back pain: a randomized controlled trial." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113234/

"Conclusions Our data suggest that harnessing placebo effects without deception is possible in the context of a plausible rationale. More research on this possibility is warranted in cLBP and other conditions defined by self-appraisal."

He clearly states that the placebo won't work in quantifiable illnesses because those quantifiable effects don't depend on the perception from your brain.

A lot of the illnesses they're talking about in the article, like IBS, lower back pain, and CFS have a strong psychosomatic component to it for a lot of people. They essentially say this in the article--something like "this won't work for malaria, but it will work for pain."

This can be a really controversial position, and it gets really twisted by a lot of people. No I'm not advocating mind-body dualism. What I'm saying is that there's top-down influences on physical symptom perception and that probably influences bottom-up processes, leading to some sort of vicious circle.

I think a lot of these psychosomatic conditions are really explained by the same processes involved in the nocebo effect. There have been studies to support this, showing that psychosomatic patients report more nocebo effects in control conditions than other patients and controls.

The idea you're discussing--reassurance effects--is interesting and actually really understudied I think. However, I think there's an equally plausible hypothesis, that you're kind of fighting negative psychosomatic effects with positive psychosomatic effects in certain situations.

I don't think that's all of the placebo effect, but I do think there's some broader causal system involved that encompasses placebo effects, nocebo effects, and psychosomatic illnesses and effects, including more psychosomatic psychiatric conditions (e.g., conversion disorder, psychogenic seizures, etc.), as well as psychological effects on disease process (e.g., stress effects on inflammation).

I kind of wish this area of research didn't get so bogged down with political infighting, which invariably happens. Patients start insisting that we're being dismissive by discussing psychosomatic processes, some researchers will spuriously start criticizing other researchers for advocating Cartesian dualism, as political smear tactic, when the real issues pertain to emergent processes and top-down mutual influences. It's a very interesting area of research with lots of potential, but tends to get oversimplified really quickly to score political points.

But those things can be debilitating, so anything that helps without causing harm is pretty important.

http://whatstheharm.net/homeopathy.html

Also, real products claiming to be homeopathic medicines are very often provably not the homeopathic dilutions that they claim to be, which increases the risk factor of that approach.

For minor ailments for which there are no real cure (and are probably entirely psychological) building a new habit covers up the old one and subsequently cures the patient's pain.