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Comment by septerr | Hacker News Reader

I think it will be close to impossible to make the participants feel like it is 2003 by doing things like placing turn-of-the century magazines around etc. It sounds silly. It almost seems to be mocking their intelligence (I know that's not what they are doing). IMO, they should stick to just telling these participants to try and put themselves in the mindset they were in before they ever faced cancer.

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That's the whole point of the studies, though—they made people feel younger by doing everything possible to make it feel like they had stepped back in time.

The placebo effect is more complex than, intuitively, it should be. Otherwise, all you'd need to do was explain the placebo effect to someone, and the belief in the placebo effect itself would effect the desired results (in effect, the placebo effect would be the placebo<g>). Instead, we need to do tricks—sugar pills, simulated environments—to get it to work. It really defies reason.

I'm not sure it defies reason. If you take a child and place him in a blank room and tell him to play, they will have trouble playing and will get bored. If you take that same child and place them in a room with a bunch of complex toys they will probably use those toys in pretty normal ways. But if you take a child and put them in a place where there aren't "traditional" toys (toys they're used to, objects marketed as toys) they will use their imaginations to make a block of wood a car, or a house, or something else.

So in that same sense, if you take an adult and tell them to imagine it is 2003 in a blank room it's going to be difficult. And if you do the same in a room that is filled with things from today it will also be difficult because they will be trying to force objects from post 2003 to fit into a 2003 mindset. But finally, if you put them in a room filled with things from 2003 they will be able to use their imaginations much more effectively to enter a 2003 mindset.

For the record, these are just my thoughts on the matter.

Regarding placebos, the placebo effect is not, for the most part, "people magically get better.". People do magically get better sometimes, because we're incredible self-repairing organisms, but attributing those remissions to placebo or sham treatments is a post hoc fallacy.

The placebo effect is, the most part, a measurement error when collecting subjective measurements. When coupled with objective measurements, it is normal to see people subjectively reporting feeling better when objective measurements say they are doing awful.

There is some valid disagreement about whether a subjective improvement is good enough when it is a subjective condition being treated, eg, pain or depression or anxiety. On the one hand, if a person reports feeling better, great. On the other hand, reporting feeling better is very different from feeling better, as anyone who has ever tried to lie to themselves or others about how they feel knows.

Placebo effects include biological responses that can be measured in objective ways such as heart rate and blood pressure, observable allergic reaction, immune response in blood samples, or healing of tissue. For some drugs for psychological problems, we can measure the effects of a placebo medication/procedure/ritual causing release of dopamine in specific areas of the brain - again, an objective measurement of a real effect caused by the placebo treatment.

The effect of placebo's certainly is not limited to subjective feelings of improvement, it actually causes people to not only feel better, but be better up to a certain amount. Some medicines give significantly better results than a placebo, and some medicines, well, don't - so in that case they're probably placebos in essence.

I'm not even sure if what you describe would be called a placebo effect in medical literature - if objective measurements say they're doing awful, then we count it as a failure, period, and not an expression of the placebo.

That's a very specific claim, and I would expect it to be published in a medical journal article that we can all look up if it is true. More than that, if this claim is generally accepted, it will be found in authoritative medical textbooks used to train medical practitioners. I have resources for looking up references like that--I go to my alma mater university library just about weekly to look up facts about things I read here on Hacker News. Do you have any references for anything you have read on this topic?

Meanwhile, I am sure that if any of our friends here on Hacker News are (may it never be) injured in a car crash, they are not going to go look for placebo treatments, but for actually effective treatments. The medical researchers who look at the issue with proper study designs and statistical controls know that placebos are essentially useless, as they at most have influence just on self-reported subjective symptoms, not on any sign that affects the progression of a disease or maintenance of good health.[1] This topic keeps coming up over and over and over here on Hacker News because most participants here have heard about this issue only in popular press reports or blog posts that are mostly wrong. I encourage you and all our friends here to take some more time and effort to learn more about the actual research base before assuming that a placebo can change your heart rate over the long term, reduce allergy symptoms (I know all about those), or heal tissue. (Which tissue?)

Findings on placebo effects by researchers who have considered the issue carefully include

"Despite the spin of the authors – these results put placebo medicine into crystal clear perspective, and I think they are generalizable and consistent with other placebo studies. For objective physiological outcomes, there is no significant placebo effect. Placebos are no better than no treatment at all."[2]

"We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed."[3]

[1] http://www.sciencebasedmedicine.org/michael-specter-on-the-p...

http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-plac...

[2] http://theness.com/neurologicablog/index.php/the-rise-and-fa...

[3] http://www.ncbi.nlm.nih.gov/pubmed/20091554

Is this really true? My understanding was that most of the reason the placebo effect is so interesting is that it does result in concrete objective improvements in people's conditions.

tokenadult has a lot of nice links; the individual study that sticks in my mind as a great exemplar was an asthma study which involved a subjective measurement ("how do you feel?") and an objective measurement of lung function (eg, blowing into a tube). Subjects receiving the real treatment would report feeling better and show significantly improved lung function. Subjects receiving the placebo treatment would also report feeling better, but show no improvement in their lung function.

I'm not sure the placebo effect is really interesting so much as it has a great PR guy. It's like the Kardashians of science.

> and the belief in the placebo effect itself would effect the desired results

Are there any studies saying that this precise trick, consciously invoked by people who understand the situation, doesn't work?

I don't have the exact studies and I'm too lazy to look for them now, but I recall seeing a controlled trial on placebo effect showing that people who are (a) informed about placebo effect as such (IIRC that group was all medical professionals) and (b) informed that the pills they're taking definitely are just a placebo with no active substance, they still showed a placebo response. It was lower than for "normal people" who were told that the sugar pill is a medicine for testing, but still significant.

Huh, interesting. Because for the longest time I've been going "I can cause the placebo effect on myself by believing that it works" whenever I feel bad, but I've never been able to find any studies that'd confirm the effectiveness. I guess that if the placebo effect sticks around when you tell people they're taking sugar pills, though, it should work with just the self-referential invocation.

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