All Placebos are not created equal (2021) | Hacker News Reader

All Placebos are not created equal (2021)

samstack.io

73 pointssebg34 comments

Something I never see discussed (though if you have resources on the subject, please share them with me) are the very real and important difference between believing and wanting to believe and feeling better about something without the something itself being better.

When I feel like my symptoms have improved, that is factually distinct from my symptoms having improved. Ok, so far so obvious. But it is also factually distinct from me really feeling like my symptoms have improved. It may very well be that I'm just not sure and that I subconsciously lean toward giving the benefit of the doubt as a tie-breaker for my own uncertainty. And then I can feel better about that without the underlying symptom improving, and that is definitely factually distinct from the symptom improving.

The impact would obviously be age-related, since age equals exposure to factors like social influence, introspective knowledge of the limits of self evaluation, and so on.

And it is not the same thing as a placebo effect improving the symptom itself. I can be experiencing the exact same amount of pain but wishy-washy on the evaluation, but people report on the placebo effect as though it means I experience less pain. But maybe I'm just less frustrated by the pain, or less inclined to admit the pain to myself or to others, or less inclined to trust myself. Maybe believing feels good, so I want to do it.

Also discounting that the mind and body themselves are self regulating technology. For instance I have the conscious ability to push pain off into the distance and be unaffected by it, for others they can “take their mind off it” in various ways. Reminds me of Lawrence of Arabia, “the trick is to not care.”

There is more, much more, regarding our humanity and the mind body link which science does not have qualitative ways of exploring.

I find this very true of minor burns (e.g. touching a hot or dish). I can tell myself it doesn’t hurt and mostly it doesn’t from that point forward. I can’t do that for any other type of pain, though.

I don't want to expose the actual placebo or condition but have been self-studying this for ~7 years now. It's not within societal knowledge as of today.

The placebo is mentally administered, has a 100% success rate at provably halting the condition for a indeterminate amount of time. It also works in reverse, and is quite dangerous when used this way.

It's one of my LLM tests to have the LLM come to the conclusion based on available data on the condition (as it was my only source). Today, no LLM has passed the test.

I hope this helps.

No, it does not help.

Feel free to submit detailed results to peer review. 100% success rates have been too rare, these days.

You're welcome to be upset at the lack of peer review or details. However, I will point out that the post includes that this is deliberate. I also pointed out that the knowledge can be dangerous, which is why it wasn't expounded on.

There's some questions in the person's post that I was providing some reflection on. The truth of my comment, or any peer reviewed study for that matter, is up to the reader.

It's funny because the idea of a mental placebo requires the user to place their trust in the very same.

Have a good day.

What condition?

It doesn't help because without any details at all from which to form an empathic bond between us there's no path for us to navigate from "obviously fabricated anecdote" to "believable anecdote".

It's also obnoxious for you to play obfuscatory gatekeeper with grown ass adults, and it makes your word less valuable not more.

> It also works in reverse, and is quite dangerous when used this way.

We're adults. We get to make our own mistakes if we want to. Thank you for the warning, but please provide the information so we can decide what to do with it for ourselves instead of patronizing your audience. Otherwise it really does make you sound like a crank, unfortunate as that may be.

The intent was to indicate that part of your problem might lie in what you believe and how that impacts the effect of any placebo.

I have no desire or need to prove anything on the internet. I provided enough information for a motivated person to determine what was said and apply it themselves.

The human body is extremely complex, drugs have always side-effects. Placebo effect is quite efficient for simple symptoms and has no side-effect, so it's in our interest to "want to believe"

Placebos do have side effects, it's called the nocebo effect.

Would you really call that a side effect? Nocebo is more akin to the opposite effect. We wouldn't say negative is a side effect of positive

> But maybe I'm just less frustrated by the pain, or less inclined to admit the pain to myself or to others, or less inclined to trust myself. Maybe believing feels good, so I want to do it.

That wouldn’t be the placebo effect then, it would be more of a psychological phenomenon in the realm of how your mental outlook can influence how you experience pain. That is also heavily studied.

Edit: This video is good intro to the placebo effect: “Harnessing the power of placebos” Alia Crumb, 2017 (video) https://youtu.be/WcQnSW1wpGA?si=A2tzqvd45BLiMADW

Edit 2: I think what you’re describing is generally called “pain tolerance”.

> That wouldn’t be the placebo effect then

This is my point! I would argue that a lot, if not most or even all, of what gets called a placebo effect is clearly confounded by these obviously-not-placebo-effect-as-defined effects without any distinction, and to me that casts the field into myopic disrepute.

> I think what you’re describing is generally called “pain tolerance”.

No, I think that's yet another different thing.

You get that these studies aren't actually measuring pain, right? They're measuring things like "how the patient rates the pain on a scale of 1-10". The difference between a "genuine" placebo and a "psychological" placebo is not detectable in that data.

I think my favorite point to this effect is that there's plenty of medical literature (in the Lancet, and others) suggesting hypnosis is as effective as certain drugs for killing pain in certain contexts. And hypnosis is nothing more than talking someone, in a very directed way. There's caveats of course, but that's true of all drugs... Not to mention all this stuff on gut microbiota, and even the truly 'woo-woo' stuff like acupuncture. Personally, I don't think it's crazy at all to imagine that sticking a needle near the right neuron can cause some kind of occasionally helpful physiological response... in fact, it would be almost more surprising to me if this wasn't possible. Modern medicine works wonders for infectious diseases & physical issues, but I'm not entirely convinced we have a handle on the more subtle stuff.

I've been a lot more attentive to this kind of stuff lately due to some chronic health stuff that came up in the family. I think there's probably some framework in modern medicine that makes it less prone to adopting these kinds of methods. Maybe it's just historical baggage, who knows...

The problem with acupuncture is that the relative effectiveness compared to placebos has gotten worse and worse as better placebos have been developed for trials.

I.e. you mentioned "sticking a needle next to the right nerve" - that's a valid research question...and it was studied. Turns out sticking needles where an acupuncture specialist thinks they should go, versus just randomly has the same reported effect in trials.

Can you expound on "better placebos" are you speaking in the context of acupuncture exclusively?

That is what this article is about.

Oh huh. Just quickly glancing, it seems that indeed you may be right, at least for a lot of the standard things it's used to treat. The exception seems to be allergies?

I'm not sure that invalidates my broader point in any case, but good to know!

There's a common misconception about placebos that they are merely a "reporting/statistical effect", but this is inaccurate. The placebo effect can have measurable effects on things that are not subjective. Wiki cites (in response to a controversial study claiming to have found the placebo effect is not "real") : "...the existence of placebo effects seems undeniable. For example, recent research has linked placebo interventions to improved motor functions in patients with Parkinson's disease. Other objective outcomes affected by placebos include immune and endocrine parameters, end-organ functions regulated by the autonomic nervous system, and sport performance." [1] And that should not be taken as an exhaustive list of examples - placebos can show objectively measurable improvements in a vast array of domains. It's certainly real.

The evil twin of the placebo, the nocebo, has even more dramatic proof of its realness: "there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')". [2] This could also largely explain why elderly married couples tend to follow each other into the grave in short order - dying of heartbreak, perhaps not being an entirely rhetorical expression.

[1] - https://en.wikipedia.org/wiki/Placebo#Effects

[2] - https://en.wikipedia.org/wiki/Nocebo#Ambiguity_of_anthropolo...

> The implications of this are pretty serious - the placebo effect in the United States has actually become quite a lot stronger over time, meaning that drugs that once would have been approved may not be now - because their performance relative to that of placebo is less convincing.

> Weirdly, it seems like this is only happening in the United States, whereas other countries haven’t seen particularly large increases in the effect size of placebos.

Any theories for this?

I mean, I only read the abstract of the study but the implication is clear:

> This trend has been driven by studies conducted in the United States. Consideration of participant and study characteristics revealed that in the United States but not elsewhere, RCTs have increased in study size and length. These changes are associated with larger placebo response. Analysis of individual RCT time courses showed different kinetics for the treatment vs placebo responses, with the former evolving more quickly than the latter and plateauing, such that maximum treatment advantage was achieved within 4 weeks.

I have a theory why placebo works: It may be caused by the "Selfish Gene".

When my sub-conscious believes the body is dying it decides it's for the best of the whole gene-population that the individual in question stops fighting for resources and for reproductive opportunities in the world. It would be wasteful to use scarce resources for me, not from the viewpoint of me the individual, but from the viewpoint of the gene-population.

But if I do believe the doctor's pill will cure me soon, then the sub-conscious "thinks" that it must be more true than not, because who can we believe more than the experts? So it's time for it to NOT give up my fight for the survival of the fittest, but to help me do it.

In other words if my subconscious believes I am dying soon, it would not make sense (from the viewpoint of the gene-population) to take away scarce resources from other individuals who are NOT dying soon.

The "Selfish Gene" is in fact the most unselfish thing there is, it is guided by what is best for all of us.

Some flu strains have an early symptom of making the person more social, leading up to the incapacitation part (in bed with a fever, etc.)

Interesting didn't know that can be an early symptom

not the study i read, but a study that claims this: https://www.sciencedirect.com/science/article/abs/pii/S10472...

i should note if one lives with someone with BPD or manic depressive disorder it can be impossible to tease out a manic breakthrough from pre-bedridden viral infection. Fun!

also the most famous example of this "feature" of infections (not viral though) is Toxoplasmosis Gondii, where infected rodents will just go wander around in the open against their instinct when there are cats around.

Would anybody more knowledgeable in the topic help me understand the results of the first graph? Paper is here: https://sci-hub.se/https://psycnet.apa.org/doi/10.1037/hea00... (I haven't finished reading it) Seems the authors claim it's statistically significant, but does it matter if it's clinically significant? 1mm difference seems pretty small, and they conclude that it suggests that it 'can harnessed to improve treatment outcomes'. I'd have understood if the conclusion were that effects exist at all, but not if the claim is that it's useful for something else.

If you want to create a genuinely effective treatment, you want to maximize the placebo effect so much as possible - so that anything above that is 100% driven by the medicine.

Though in practice I expect it is probably already exploited in the opposite direction. By minimizing the effect of the placebo (or even pushing it into nocebo territory) pharmaceutical companies can construct studies that are much more likely to show statistically significant effects that do not exist. There's some seriously perverse incentives in play when a few percent this way or that is the difference between losing millions, and earning billions.

This comment contributes nothing, but I find the title jarring. To make it more obvious, "All doctors are not men" vs "Not all doctors are men".

I also do not like that the first (and wrong) form is seen by many as equivalent to the second form.

There are so many misconceptions in this article.

Placebo effect is not getting stronger over time. We are getting better at controlling for all other factors: regression to the mean, self reporting related biases, the effect that people change their behaviour when they are being observed, etc.

Placebo effect is not "mind over matter" it just all the peoples behaviours, biases and life that is happening while they are getting treatment.

> Placebo effect is not getting stronger over time

Isn't that what the study says that is linked from the article? I'm curious why the off-hand dismissing of a study. Direct link for reference: https://journals.lww.com/pain/Abstract/2015/12000/Increasing... (I can only see the abstract of course)

A reminder: The Placebo Effect is a reporting/statistical effect, not a physical effect. It's not saying that there is an effect on your body from believing that some intervention is working, but that in a trial where people believe an intervention is working there is an effect on the data.

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