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Comment by jimmyswimmy | Hacker News Reader

Indeed.

>With SAINT, study participants underwent 10 sessions per day of 10-minute treatments, with 50-minute breaks in between. After a day of therapy, Lehman’s mood score indicated she was no longer depressed; it took up to five days for other participants. On average, three days of the therapy were enough for participants to have relief from depression.

One imagines that three to five 10 hour (!) days of a presumably highly-trained professional spending time and attention and focus on a patient serves as no less than an incredibly strong placebo. It would be interesting to see a blinded study where the transducer functionality was replaced by a small heater (or whatever is needed to make the system act, feel and sound the same for all involved).

It would be lovely if this held up. Depression and other psychological issues are insidious.

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OTOH, getting that much attention for depression seems quite rare, and given that there are strong learned behavioral issues with depression that require a lot of retraining, that means high frequency intervention is needed.

Talking to a therapist 1 hour a week doesn't help you manage those waves of depression you feel 20x a day 6 other days of the week. If you are going to change any subconscious or neurological patterns, you need to intervene in those moments of symptoms.

How scalable could this possibly be to widespread depression? Critical depression already can lead to intensive hospitalization with frequent daily intervention, so something seems off.

Either that preexisting intervention also would have a big success rate, in which case this isn’t news and just isn’t applicable widely due to scale, or else this effect is not due to frequent attention / intervention.

They are doing said study. From the second sentence:

> The researchers are conducting a larger, double-blinded trial in which half the participants are receiving fake treatment.

Once they have results from the study, then is the right time for a press release.

How does fake treatment work in a clinical therapy test setting?

I'd think I'd either figure out that the person giving me therapy was talking nonsense pretty quickly, or their 'placebo' therapy is indistinguishable from actual therapy, in which case am I still a control?

This is magnetic stimulation. You could have a control group where you don't turn on the magnet.

Yeah but there was an article posted a few days ago about how Reiki can't possibly work but it still does.

IMO the only way to blind this is to put people in an automated machine that either turns the magnet on or it doesn't (and it makes some noises either way). You can't have highly trained professionals in the loop making people feel valuable by giving them all this attention, as that could be a confounding effect in both the alleged-treatment and the alleged-placebo.

https://news.ycombinator.com/item?id=22764824

> IMO the only way to blind this is to put people in an automated machine that either turns the magnet on or it doesn't (and it makes some noises either way). You can't have highly trained professionals in the loop making people feel valuable by giving them all this attention, as that could be a confounding effect in both the alleged-treatment and the alleged-placebo.

It's fine as long as both the experimental group and the control group get the same amount of attention, right? If both groups show the same amount of improvement, that means it was caused entirely by the attention, not by the magnetic treatment.

@jefft that's what "double-blind" means.

This probably only works if the professionals are blinded to whether the machine is enabled

That's what the "double" in double-blind means

msandford is saying that you can only run an experiment like this and get good results if the treatment is administered entirely by a machine. PhasmaFelis is saying that as long as both groups get similar amounts of professional attention then you can still get good results. I'm saying that to make sure you get equal levels of professional attention you need to blind the professionals to whether the machine is enabled.

(I agree that this is what the "double" in "double blind" means, but that's not what we were talking about.)

In that case, let's just call it triple-blind... /s

That is captured in the double-blind design.

Note that with Reiki, it's a little more complicated to properly blind (this is an issue for pretty much every physical therapy, and surgery).

You do everything the same except don't turn on the machine. This isn't talk therapy, they're just sitting there in a chair with the device held to their heads.

TMS is really loud, and causes a tapping sensation, so the are likely using a fake machine.

To contest one point only: A strong placebo effect that lasts is quite valuable, and should not be undervalued when it comes to depression. If this ends up being a way to consciously strengthen the placebo effect to successfully treat patients, there's a lot of people who'd benefit.

It should still be distinguished from non-placebo effects where possible and I agree with all of the concerns and worry expressed in this thread.

A "strong placebo effect that lasts" is not a placebo effect.

This is not true at all. If you have three groups, an experimental, placebo group, and control group and you find strong durable lasting effects in the placebo group that's still a placebo effect.

"What if the placebo effect isn't just a trick?" (1 year ago, 278 comments): https://news.ycombinator.com/item?id=18398342

> Those with the high-COMT variant had the weakest placebo responses, and those with the opposite variant had the strongest. These effects were compounded by the amount of interaction each patient got: For instance, low-COMT, high-interaction patients fared best of all, but the low-COMT subjects who were placed in the no-treatment group did worse than the other genotypes in that group

> Analyzing the data amassed during the first 10 years of the study, Hall found that the women with the low-COMT gene variant had significantly higher rates of heart disease than women with the high-COMT variant, and that the risk was reduced for those low-COMT women who received the active treatments but not in those given placebos. Among high-COMT people, the results were the inverse: Women taking placebos had the lowest rates of disease; people in the treatment arms had an increased risk.

Re:placebo, these were people with treatment-resistant depression. They've had depression for many years, have undergone many rounds of medication and talk therapy (I've been through 7 drugs including ketamine, and 3 therapists). This is not a group that is prone to placebo improvements, they're cynical and hopeless, though of course a double-blind study is still needed.

If it's a placebo effect that's even better!

It means you don't have to buy the expensive magnet. You just get people to hang out with a patient for a couple of days and they'll respond better than 10x the average response of an SSRI.

To get a feel for the impact, an SSRI makes you an inch taller, the placebo effect makes you another inch taller. And this intervention would make you 10 inches taller.

This roughly lines up with how long it takes to form a new habit.

Yup, TCMS is actually pretty good at inducing a placebo (complex technology, high attention) so this is unsurprising.

Very very annoying that the press release over-hypes this.

Maybe she was lonely and all that time with technician was enough to help her perk up :)

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