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Comment by Swizec | Hacker News Reader

Question: If it works, why not heal with a [active] placebo?

Congratulations, you just invented "alternative medicine"

I mean, why not use placebos in real medicine? They obviously work, their rate of working is measurable and we have a list of specific diseases they work on and to what extent they work.

AFAIK this is already done today. (Mostly in Hospitals.) If your doctor gives you a big red pill with some name like 'Ultracure2000 FORTE' it is most likely a placebo.

These effects are recorded when patients know they are taking part in new medical research trial, and prime their minds accordingly. The placebo is unlikely to do the same thing when they are in a different context.

Happens all the time, at least in the UK: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna...

Because it opens up a lot of very important medical ethics problems.

During trials, the doctor and the patient don't know that the patient is getting a placebo (it's called "double blind"). If people know that what they are getting is a placebo, I don't think it works as well. So the only way to get an effective placebo is to lie to the patient and tell them it's a good drug.

But there is a long history of abuses in medicine (Nuremburg, Tuskegee syphilis experiment, etc.), so "informed consent" is very very very important in medical ethics. This means you can't lie to patients. To use placebos as you suggest, you'd have to throw that out. This is a dangerous path.

"Can the recommendation for a treatment intended to promote the placebo effect be made without deception and also without undermining its therapeutic potential? Consider, for example, the case of a clinician who recommends treatment with acupuncture for a patient with chronic low back pain who has not been helped by standard medical therapy. Aware of the results of the recent acupuncture trials, described above, this clinician thinks that acupuncture may work by promoting a placebo response. The clinician might provide the following disclosure to the patient: “I recommend that you try acupuncture. Several large studies have shown that traditional acupuncture is not better than a fake acupuncture treatment, but that both of these produce considerably greater symptom improvement in patients with chronic low back pain condition as compared with those patients who receive no treatment or conventional medical therapy. Although the specific type of needling doesn't appear to make any difference, it is likely that acupuncture works by a psychological mechanism that promotes self-healing, known as the placebo effect.” On its face, this disclosure appears honest. A patient who received this disclosure and subsequently got better after undergoing acupuncture might nonetheless develop a false belief about why it worked. This does not mean, however, that the patient has been deceived by his physician."

from:

Placebo Effects: Biological, Clinical and Ethical Advances (Damien G Finniss, Ted J Kaptchuk, Franklin Miller, and Fabrizio Benedetti

PMCID: PMC2832199 / NIHMSID: NIHMS169379

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/

But does the placebo effect work as well if the patient is told that type of words?

"Placebo effect works even if patients know they're getting a sham drug Study suggests patients benefit from the placebo effect even when told explicitly that they're taking an 'inert substance'"

http://www.guardian.co.uk/science/2010/dec/22/placebo-effect...

Plenty of techniques that were once considered alternative medicine have found their way into Western medicine, so it's not all as cut and clear as you present it.

Plenty is a bit of a stretch.

Acupuncture, marijuana, diet therapy, light therapy, etc etc.

@Samuel_Michon

Acupunture isn't accepted into western medicine because it doesn't actually work. It performs as good as any other placebo (reduces pain, makes patients feel better).

It's getting more mainstream, but that doesn't mean it's an accepted medicine.

A review of reviews:

http://www.painjournalonline.com/article/S0304-3959(10)00689...

  By definition, I begin
  Alternative Medicine, I continue
  Has either not been proved to work,
  Or been proved not to work.
  You know what they call alternative medicine
  That's been proved to work?
  Medicine.

- Tim Minchin

Tim Minchin is a comedian, but sadly he's not the only one saying things like that. Apparently, it's a great way for lazy doctors to always be right.

For instance, check this guy:

“Calling ‘alternative medicine’ medicine is kind," says Dr. George Demetri, director of the Center for Sarcoma and Bone Oncology at the Dana-Farber Cancer Institute in Boston. "We need to be careful about how we use language. Show me an alternative medicine that works and I’ll show you a medicine that is no longer alternative.” http://www.prweb.com/releases/2012/11/prweb10183664.htm

Because it (mostly) doesn't actually work.

It looks like it works because it exposes bias in both patients and researchers.

This is why it's more effective with subjective and self reported symptoms like pain, nausea, etc.

A great short article about placebo: http://www.sciencebasedmedicine.org/index.php/the-placebo-ef...

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