Un-placebo effect?

[Daecon]

Has there ever been a recognised phenomenon where, when someone has taken a medication, it didn't have any effect because the patient didn't expect it to work?

 

For example, expecting an antidepressant to not work, and so it doesn't - even after having taken it for 3 months...?

[zule]

A un-placebo would be the absence of placebo, and the placebo effect is always important, as much in the case of working treatment as in the case of not working.

[Cap'n Refsmmat]

Sounds like an interesting study to do.

 

Hand them a pill that would actually cure them but say "This is a placebo. We're just using it for comparison in the study."

 

(You'd have to find subjects that wouldn't immediately attack you and demand to get real medication.)

[ecoli]

Sounds like an interesting study to do.

 

Hand them a pill that would actually cure them but say "This is a placebo. We're just using it for comparison in the study."

 

(You'd have to find subjects that wouldn't immediately attack you and demand to get real medication.)

Idk... if it's a study where their testing a side effect, I'm sure you could find plenty of people that would get paid for taking a sugar pill.

 

On the other hand, if the medication DOES cause side-effects, and the subjects think their just taking a placebo, your bound to be into some trouble.

[Daecon]

I'm not talking about side effects, I'm talking about intended effects.

 

Like if I take a Lemsip but my cold & flu symptoms don't go away, or an aspirin doesn't cure my headache, etc...

[SkepticLance]

Most of the time that placebos are given, there is no measurable effect. When clinical trials, controlled with placebo, are reported, the results usually say something like :

Treatment X - 30% improvement

Placebo - 10% improvement.

 

In other words, 90% of those given placebo showed no improvement.

 

About 30% of the popuation is regarded as being prone to the placebo effect. That means 70% are not. Perhaps, the major reason is a lack of faith in the placebo? Certainly, clinicians have found that placebos that are 'talked up' by the researchers are more likely to have a curative effect.

 

Another thing that needs remembering is that a substantial part of the placebo effect has nothing to do with actual improvements in health. Much of the time, the people reporting improvements do not actually experience such, as shown by objective testing like blood tests, but report an improvement because they expect it, and adjust their subjective impressions accordingly.

[John Cuthber]

http://en.wikipedia.org/wiki/Nocebo_effect

[iNow]

http://en.wikipedia.org/wiki/Nocebo_effect

 

Except, in that case, there's still no drug involved. The idea here being that there IS a drug, but it's effects are negated by some sort of self-fulfilling prophecy.

[dichotomy]

http://www.sciencedaily.com/releases/2008/03/080304173339.htm

 

"You Get What You Pay For? Costly Placebo Works Better Than Cheap One

 

In the full-price group, 85 percent of subjects experienced a reduction in pain after taking the placebo. In the low-price group, 61 percent said the pain was less."

 

I found this both amusing and enlightening. They should use this same set-up and include a real painkiller medication.

[antimatter]

That was quite interesting, actually.

Though I think that's actually very easy to predict.

[SkepticLance]

Just as an aside :

 

I discovered that the word 'placebo' in Latin means 'I will please', where 'nocebo' means 'I will harm'.

[antimatter]

Just as an aside :

 

I discovered that the word 'placebo' in Latin means 'I will please', where 'nocebo' means 'I will harm'.

 

That's very odd, and at the same time very illuminating.

[dichotomy]

That was quite interesting, actually.

Though I think that's actually very easy to predict.

 

Why’s that? Because people generally think that the more expensive product of two similar products is better? More effective? Even if they are really the same? Or, is it easy to predict because people are easily tricked?

[Glider]

Why’s that? Because people generally think that the more expensive product of two similar products is better? More effective? Even if they are really the same?

Yes, that is a factor. As a rule, the more a person has to work for a thing, or the greater the sacrifice a person must make to attain a thing, the more valuable that thing will be to the person. That person will (in their own mind) attribute that thing with more positive qualities than it might posess.

 

You might know somebody who has paid over the odds for something (e.g. a car, or a computer) and who will subsequently defend it, focussing on the positive and ignoring the negative, even in the face of evidence to the contrary (this effect may even be a factor in the pervasive nature of religion).

 

This is not unique to humans. Konrad Lorenz noted that even in birds that imprint (e.g. ducks), the harder a young bird had to work to keep up with its parent, the stronger and longer lasting the subseqent bond. This phenomenon can be seen in many social animals.

 

In the case of placebo, it is entirely probable that a placebo that is worked for, or paid for, would have a greater effect than one given freely. It's important to note that placebo is only effective at treating symptoms that are susceptible to psychological intervention (pain is the most common example), so any way to get a person to attribute a placebo with more positive qualities would enhance its effect.

 

Or, is it easy to predict because people are easily tricked?

That is also a factor.

[Psyber]

Has there ever been a recognised phenomenon where, when someone has taken a medication, it didn't have any effect because the patient didn't expect it to work?

 

For example, expecting an antidepressant to not work, and so it doesn't - even after having taken it for 3 months...?

Commonly, if people don't expect it to work they don't take it - compliance becomes an issue, but it always is. I remember reading an article years ago that suggested that only 54% of prescribed medication was ever taken as prescribed, for as long as prescribed.

 

That recent study by a couple of Psychologists suggesting antidepressants don't work hinged on uncritical acceptance of the DSM-IV definition of depressive illness. The classification works from symptoms, with inadequate consideration of aetiological factors in the presentation. As someone here suggested - it is like calling everyone who comes into a doctor's office struggling for breath "Asthmatic" and then giving them anti-asthmatic medication and proving it doesn't work.

[dichotomy]

http://www.newscientist.com/article/dn13375-prozac-does-not-work-in-most-depressed-patients.html

 

“The antidepressant Prozac and related drugs are no better than placebo in treating all but the most severely depressed patients, according to a damaging assessment of the latest generation of antidepressants.”

“drug companies have tended to publish studies showing positive results of the SSRIs in mildly depressed patients.”

 

 

"Mildly depressed" might mean an average man who thinks that they should be feeling ecstatic, when they are really feeling quite average and normal. Unrealistic expectations of oneself perhaps?

[talitha00cumi]

Like the man said, with statistics, you can prove anything, even the opposite.

 

Before citing the stats from various studies, study the studies. Find out what they are really saying.

 

As for the fellow above who said, "As a rule, the more a person has to work for a thing, or the greater the sacrifice a person must make to attain a thing, the more valuable that thing will be to the person," that is impression that refers to, not fact. Just because someone believes in something doesn't make it true - and doesn't make it as effective as they may report.

[Cap'n Refsmmat]

Like the man said, with statistics, you can prove anything, even the opposite.

One would expect that a peer-reviewed trial would have its statistics examined by someone who knows what he's doing.