A Case Against the Placebo Effect
carcinisation.com
carcinisation.com
The arguments should not be summarily dismissed (a lot of thinking and research went into this essay). The arguments should be taken apart and critiqued individually.
In particular I agree with the key idea that it is important to critically evsluate the strength of evidence and the strength of experimental designs that favor long-lasting functional placebo effects.
If a design is a perfectly implemented triple-blinded study (https://www.scribbr.com/methodology/double-blind-study/) in which a reliable outcome measure is significantly affected with a reasonably large effect size—-for example, a Cohen’s d score above 0.2) then the evidence in favor would be pretty compelling (https://www.statology.org/interpret-cohens-d/). And very compelling us independently replicated in a second case/control study.
But how many studies reach this level? I doubt that there are any in animal model research with which I am more familiar.
If “faith and prayer” are regarded as a placebo effect then how much does this reduce the incidence and impact of illness when controlling well for socioeconomic factors? Was COVID severity modulated by said factors (or ivermectin ;-) ?
The general problem is it interprets the evidence to fit the conclusion: studies showing a placebo effect are interpreted as having bad methodology while ones showing no effect are interpreted as having correct methodology.
Of course, study design can exaggerate the effect. Does that mean it's doesn't exist, though?
Probably the more general problem is that contrarian views get clicks (and all that goes with that) which creates an unfortunate incentive.
We clearly double blind instead of single blind because we are all as concerned about researcher bias as the writer of the article. Their beliefs about our beliefs on where the errors are introduced in single blind studies seem at best presumptuous.
She was in a study to see if a vitamin supplement would have a beneficial effect to a condition she suffered. She didn’t know if she was getting placebo or the supplement so after two weeks of not feeling any positive effect, she decided to start taking additional supplements of the vitamin in question on her own next to the study tablets to “be sure”. I remember choking on my coffee when she casually told me this later. I’m a scientist and it never occurred to me that anyone would act like this in a study.
If unrecorded, that would be fatal to the study's design and intent. I think you know what people are going to ask:
* Did she report this change to the research program?
* Was she dropped from the study?
* Did the study's authors consider writing/enforcing better, clearer subject instructions after this action was (hypothetically) brought to light?
* Does she understand how science works?nothing will change as long as researchers get to keep publishing as they are
source: did some of this myself
[1] https://www.nytimes.com/2024/07/30/well/eat/ultraprocessed-f...
Is that largely impossible as well?
I wonder if there are good resources which would help lay scientists to write good articles (maybe an opportunity for an LLM proofreader?)
I have no idea what the rest of the article says because this single sentence is so bat shit insane on so many levels.
The placebo effect is not “real healing”, it’s “our study is unable to show a statistically relevant result from our treatment”.
I’m not big on LLMs personally, so I won’t make any specific claims on what they can do. But from what I’ve read, I’d doubt they’d correct that mistake.
On the flip side, I would trust an LLM to tell me whether it should have been “batshit”, “bat-shit”, or “bat shit”.
I thought placebo proponents were usually advocating it for things like pain relief, tinnitus, fatigue, etc. Things where what you are consciously thinking can make a difference to your experience even if it doesn't actually fix the underlying issue.
I think that's quite a bit different from thinking that placebos actually heal wounds.
A completely separate issue is whether placebos should be used clinically.
It's hard to tell if the author is using either of those definitions.
https://movementdisorders.onlinelibrary.wiley.com/doi/10.100...
However, others advocate it for cancer, and run studies where people imagine they don’t have cancer and then measure their tumours to see if they shrink.
Thus, in some kinds of infectious disease, the body is entirely capable of clearing the infection on its own in most cases as long as the subject isn't suffering some kind of immunodeficiency (e.g. all the strange diseases that HIV patients succumbed to before antiviral therapy was introduced). Studies like this led to the movement to reduce antibiotic treatment for minor infections that are very unlikely to lead to issues like sepsis etc, given the deleterious side effects on the human microbiome and so on. A placebo study might also reveal significant problems with toxicity, such as liver-kidney damage to the subject caused by a problem with the antibiotic under study.
Likewise with vaccines, careful study with placebos could demonstrate that the vaccine under study didn't prevent transmissibility of the infectious virus any better than the placebo did. Notably this was a problem with all the Sars-Cov2 vaccines, none seem to have prevented transmision from an infected person to a vaccinated person. Why wasn't this seen in the clincal trials, one wonders?
As far as depression/mental health studies, placebos are often readily detectable by the patient, which is a big problem in today's research into the 5-HT2a receptor drug research (eg psilocybin, LSD, DMT, mescaline). They've tried to get around this by giving subjects drugs like methyphenidate and methamphetamine as the 'placebo' (because the subject clearly can tell when they've been given a powerful psychoactive substance), but this is not a usual placebo, it's an alternative treatment.
The obvious answer is because vaccines are not designed to prevent viruses from ever becoming transmissible through the air according to some impossible standard devised by vaccine sceptics, they were designed to ensure that the body on average killed the virus off more quickly with less strain to their health[1]. So they tested the thing the vaccines were intended to do (against placebo), and not the thing they were not intended to do.
[1]a corollary of this is that people who are infected with viruses for shorter periods are less likely to transmit it, which is in fact what happened....
Since this wasn't reported to the public, but many official government sources claimed it was a sterilizing vaccine (0% breakthrough), this resulted in great public distrust of the health authorities. It's a lesson for the future: be honest with people.
Then it did, despite the best efforts of people who had been sowing public distrust in the health system since long before there was a vaccine, so the last refuge of those particular scoundrels was to insist that the long series of lies they'd told about COVID were actually an honest desire to inform the public that the vaccine wasn't a sterilising one, as if that was a remotely good reason to advise people not to take it.
I see your argument has mutated too
Couldn't have been the Baric Lab, it was too busy making the frogs gay. There's a lot that remains unknown, and now the Onion is covering it all up!
And let's not forget, you started off with every antivaxxers' favourite canard that the only criteria for a successful vaccine is sterilizing immunity (which is brilliant, because it lets them declare most vaccines don't work, which is sorta true if you consider stuff like increasing chances of survival and reducing chances of transmission to be irrelevant) and an insinuation that stats on transmission efficacy from Phase III trials that drug companies were so keen to share they put them in press releases were somehow not studied or withheld from the public.
If you don't want to get compared to Alex Jones, maybe don't adopt his style of argument.
The larger issue we need to think about is that there are hundreds of mammalian viruses out in natural systems that don't infect humans but which could all be altered to become human pathogens by this kind of technological approach. That's why so many people who have detailed knowledge of these systems (but who are not affiliated with the guilty parties in the Chinese and American virology funding system) want to see global agreements to ban this kind of research and institute significant penalties for those who pursue it.
Hopefully we'll have some comprehensive public hearings into the question in the coming year, at least in the United States, which I look forward to.
Not true. The only claims by the vaccine manufacturers were that it would stop people getting sick. They made no claims about infection/transmission. So there were two possibilities: Either it did work to reduce infection/transmission, or it only suppressed the symptoms and made asymptomatic transmission more common.
Government and media claimed the first without evidence, and we actually got the second.
I think this is from a misunderstanding of what transmissibility people were talking about. People getting the vaccine did not transmit the disease to others simply by virtue of being vaccinated. What that means is, you can get the shot and not worry that, by getting the shot, you are going to transmit the disease to others.
What that does not mean is that, once vaccinated, you cannot ever transmit the disease to others. If you get sick, the vaccine will likely make you get over it faster and have it less impactful, reducing transmission as an added bonus of those two things happening (you're coughing less so less is put in the air, you are sick for less time so the period you will be heavily contagious for and also symptomatic is shorter) but it will not entirely prevent transmission.
It was seen, then ignored by the media so the average person didn't realize what was going on. Remember that 95% effective? It wasn't 100% because vaccinated people not only got infected, they actually got sick (they were only testing once symptoms showed, not everyone in the study). The study it came from also only lasted 3 months, if it had gone on the planned 6 months it would have almost certainly gone much lower. I think they did end up having a follow-up at the 6-month mark (don't remember the results), but they got the EUA on the 3-month results.
This article is built upon a questionable definition of the placebo effect. Debatably, it’s a straw man argument that sidesteps the complexities of placebo response by using an oversimplification that is easier to dismiss.
The placebo effect varies by treatment and illness. Placebo isn’t fixing broken legs or making cancer disappear. Placebo effects are strongest where measures involve perception and are related to more complex mental processes.
Pain is a common example. Pain is a sensation, but sharp pain is associated with additional fear and panic response. Placebo addresses some of the fear and panic response, thereby addressing part of the pain. I agree that some of the studies showing placebo performing as well as fentanyl and morphine are likely flawed. We have a lot of studies showing dose-response curves for pain management using OTC analgesics, so it’s laughable to see a study showing a dose-response curve that is basically flat or inverted (placebo == 0mg dose).
The placebo effect gets much more complicated in the context of mental health. Anti-depressant studies are the classic example, with placebo often performing close to (but not as well) as powerful SSRIs. This has created internet backlash that “SSRIs are almost placebo” but the truth is that placebo groups improve dramatically during the study, too. There is something about the hope of receiving treatment, the way patients are told that they’re possibly receiving a treatment, the act of self-measuring and reporting mental health scores, and the interactions with clinicians that causes many (though not all) people to turn a corner and start improving. It’s almost as if they’ve received a signal that the end of their suffering is near so they start reactivating themselves, thereby improving the depression. The SSRI groups usually perform better by a statistically significant amount, but the challenge is that the placebo group improves so much that there is little numeric resolution left in the depression inventory to see much signal!
It’s a strange phenomenon, but I don’t think this article is a good overview of the effect let alone a rebuttal to it.
> The placebo effect gets much more complicated in the context of mental health. Anti-depressant studies are the classic example, with placebo often performing close to (but not as well) as powerful SSRIs
The article correctly points to distinction between the placebo effect (psychosomatic effects of administering a placebo) and results of placebo-arm in clinical trials (which are just summary of multiple effects, including placebo effect itself, regression to the mean and reporting bias).
Many effects that happen in placebo-arm of clinical trials are unrelated to administering placebo itself and would happen even if no placebo is administered (e.g. regression to the mean). But not administering placebo would break blinding, so it is hard to distinguish these effect.
The article is also wrong about there not being a physiological mechanism. Dopamine and endorphins can be powerful mediators of pain relief, for example.
Maybe you can rule out some of this, but I'm asking the question: Is the placebo effect the only plausible explanation for this numbers? I don't think so.
Is there a placebo effect for car repair. And how does it compare to human “repair”?
You could pretend to fix peoples car issues and see if they report it improving.
Assuming the mind can’t fix cars mentally it would let you isolate what part of the placebo effect is perception.
Discuss..
I disagree, based on my understanding of the placebo affect: The placebo effect causes people to genuinely feel better - no more or less than that. The placebo effect does NOT indicate a "real healing effect" per se - just that it makes people feel better, and clearly only in situations where such a thing is possible. Meaning that nobody believes in a placebo effect for a broken arm. Only for things where people could plausibly think something HAS gotten better. Like a cold, or mild pain, etc.
Stopped reading right here because it is nonsense. Antidepressant researchers would love nothing more than the 30-50% placebo response rate to go away and yet there it is, competing with whatever tiny effect their pill does.
If the patient doubts the effect won't take at all.
So that matters but not all for the reasons OP thinks.
It matters bc you can heal yourself, ppl literally do it everyday and it is measured by science as the placebo effect but if you don't think you can, you can't.
https://www.health.harvard.edu/blog/placebo-can-work-even-kn...
Placebos are ideal drugs in some cases. Effective, no side-effects...
They are positing the psychological effects are confirmation bias and conforming to expectations, but what they don’t address is whether the psychological outcome is real. Depression is greatly impacted by our psychology and whether the effect is due to some social conformity, beliefs, or other non physiological basis, is irrelevant to the efficacy.
Ultimately the authors argument is based on the notion that psychology is not real science, because science deals with things you can directly observe, and anything that isn’t real science is false. This is obviously fallacious. Even assuming psychology isn’t a real science, and psychology researchers have done themselves no favors here, the second statement is where the fallacy lies. Well done science is generally not false. But not everything that is true has been explained by science. Something can be true without us knowing the facts of how it works. Psychology requires self reporting by its very nature and as such is subject to all sorts of bias and difficult to control aspects - some impossible to control - and it’s likely some aspects of psychology are cultural and contextual and change with time. This doesn’t make it not real and not true. It just makes it difficult.
In contrast, hearing from your doctor that "your labs are normal, you just have anxiety" is a common and horrible experience. It's likely the end of the doctor-patient relationship and if anything is being missed, maybe even a lawsuit.
I get that there are some interesting Objective Science issues here but for studies aimed at improving real world clinical practice, subjective outcomes matter.
Wait what? I’ve never heard this being the scientific consensus. It’s more like the lay person’s view. I think that many scientists agree that the placebo effect is primarily a combination of regression to the mean and participant’s desire to please the experimenter (ie the literal definition of “placebo”).
e.g. An article like https://www.health.harvard.edu/newsletter_article/the-power-... is not kooky or controversial, or the creation of a lay person. It's the accepted understanding of what's happening -- at least what is seemingly happening -- as viewed by medical experts.
As an aside, while placebo does come from Latin for "to please", you have it backwards. Placebos are to please either the patient or the participant, giving them a feeling that they're being treated/studied.
I was thinking in a wider sense, negative effect of mind on health instead of positive. It's intriguing to what extent it's speculated the mind is able to affect the physical health.
> t’s impossible to achieve a blind when comparing placebo to no treatment, since the placebo itself is the main method for blinding in the first place.
I don't find it unprobable that a psychological bias of a patient can change the result of an medical observation, since medical problems aren't usually 100% only of physical nature either — when your kid is ill in the morning and they can avoid school they will suddenly feel very unwell, when it is the day you wanted to go to Disneyworld they will suddenly feel very well. This ofc could just be a transparent lie, but often it is not and it truly changes how people feel about their own bodies. Similar that example with the hurt kid being kissed, now the post gives some rational explaination why the pain is soothed, but that doesn't make the effect go away: the psychological presentation of a thing makes an actual difference. A sandwich in a barren break room on a Monday tastes worse than that exact sandwich on a mountain summit after four hours of hiking on a Saturday.
Psychological context won't unbreak a broken leg or anything, so there are clear limits, but I am not convinced that the placebo effect is something that only works when researchers believe in the placebo effect themselves. As a Film student I don't find it unlikely that the acting performance of active anti-placebo critics could be unconvincing, but that just means they didn't do a good study then. If you want to study the effect where people are convinced of a thing (placebo) and you half-ass the convincing-part, then you are not researching the effect. But as someone who worked with actors I can assure everybody that you don't necessarily need to believe in a thing to create a convincing performance.
Now the actual question is how far that psychological effect goes when it comes to actual measurable numbers.
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I am going to argue against that, proper rest and sleep helps your leg heal faster and you get better sleep when yoi are less stressed. You are less stressed when you believe something is taking care of you.
I had a very optimistic and upbeat neighbour who thought she could beat cancer without modern medicine into which she had zero trust — she died with age 55, having tried literally everything but modern medicine.
https://pubmed.ncbi.nlm.nih.gov/1422109/#:~:text=About%2050%....
>The picture that emerges is that a placebo pill has almost no effect when administered by researchers who do not care about the placebo effect, but the exact same pill has an enormous effect larger than all existing treatments when administered by a researcher who really wants the placebo effect to be real.
Even the most compelling and logically consistent case stands upon "mere" observation, convention and authority.
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sieabahlpark 2 minutes ago [dead] | parent | next [–]
Don't you know, the appeal to authority is the new "I'm smart enough to be credentialed, don't question me".
College really has made a whole group of people think they're elite when all they did was acquire debt and some watered down education.
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'Words and drugs have the same mechanism of action' (Fabrizio Benedetti)
The focus of current approaches to biomedicine and bioengineering are largely bottom-up – via implementation of specific functions by control of the lowest-level components (proteins, DNA sequences, etc.). However, biology uses an integrated, multiscale competency architecture in which higher levels of organization make decisions about the types of system-level outcomes we would like to control – large-scale shape and complex physiological states. The ultimate example of this is in the nervous system, where cognitive states (goals, beliefs, hopes, intentions, etc.) must connect to the functionality of the body. Recent and classic work on biofeedback, mind–body medicine (e.g., gene expression changes in the brain following meditative practices or exposure to music), psychoneuroimmunology, and placebo/nocebo effects have clearly shown that physiological and genetic states can be controlled by high-level nodes. It is crucial to note that mind–body control is not some unusual corner case relegated to exceptional circumstances such as hypnotic states. Every time one gets out of bed in the morning to begin a day of tasks, what allows this to happen is a multiscale transduction mechanism that converts executive-level metacognitive intent into depolarization of muscle cell resting potential. Thus, our embodied minds already have the capacity to control complex molecular events and harness them toward adaptive actions without each level knowing the details of the levels below and above it. The work of pioneers such as Fabrizio Benedetti [110–113], who showed that the same mechanisms are activated by drug exposure and by expectation of drug, demonstrate a crucial aspect of our evolved architecture that can be exploited therapeutically. This ability of cognitive states to implement complex downstream changes is not a unique feature of brains – instead, intelligence and distributed control are baked into all somatic cells and tissues, and are potential therapeutic targets. The native bioelectric interface linking complex goals (e.g., grow an organ of the appropriate size and shape) to the molecular implementation machinery opens a transformative possibility that artificial intelligence can serve as a powerful GPS that can guide control of living tissue to navigate transcriptional, physiological, and anatomical landscapes. New advances such as large language models offer the possibility of literally being translators between our minds (and their goals of inducing health) and the primitive intelligence of the body by helping to derive stimuli, training protocols, and experiences as therapeutics that shape the behavior of physiological and anatomical subsystems to increase healthspan. """
from:
"Future medicine: from molecular pathways to the collective intelligence of the body ( Eric Lagasse1 ; Michael Levin )"
https://www.cell.com/trends/molecular-medicine/fulltext/S147...