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The Myth of the Placebo Response

By |February 26, 2020|Placebo|

The Myth of the Placebo Response

The Chiro.Org Blog

SOURCE:   Frontiers in Pychiatry 2019 (Aug 16); 10: 577

Wayne Jonas, MD

Department of Family Medicine,
Uniformed Services University,
Bethesda, MD, United States.

The placebo response is a myth. It does not exist in reality, and continuing to name it is hindering the optimal application of science to healing in medicine. On the surface, it is obvious that, when defined as a biological response to an inert pill (like a sugar pill), the idea of a “response” to a placebo is impossible. Inert treatments by definition do not produce responses. So why do we continue to ponder why people get better from taking inert substances and base our acceptance of legitimate treatments on demonstrating that they go beyond that response? The problem arises because we have flawed assumptions of the value that reductionistic science and the demonstration of specific effects has for healing. To support those flawed assumptions, we support the idea of “the placebo response.” This causes confusion among patients, clinicians, regulators, and even scientists.

Legitimate medical treatments have become defined as those that do more than produce a placebo response. An entire pharmaceutical industry and its regulators attempt to control and profit by proving that small molecules produce a clinical effect greater than the placebo response. Billions of dollars are made when that is proven, often even when the size of the response in the active over the placebo group is miniscule. The fact is people heal and that inherent healing capacity is both powerful and influenced by mental, social, and contextual factors that are embedded in every medical encounter since the idea of treatment began. In this chapter, I argue that our understanding of healing and ability to enhance it will be accelerated if we stop using the term “placebo response” and call it what it is – the meaning response, and its special application in medicine called the healing response.

KEYWORDS:   healing; myth; placebo; response; traditional

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The Placebo Effect in Alternative Medicine

By |May 19, 2019|Placebo|

The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?

The Chiro.Org Blog

SOURCE:   Annals of Internal Medicine 2002 (Jun 4);   136 (11):   817–825

Ted J. Kaptchuk, OMD

Harvard Medical School,
Boston, Massachusetts, USA.

In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics.

This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient-physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness.

Five components of the placebo effect — patient, practitioner, patient-practitioner interaction, nature of the illness, and treatment and setting — are examined. Therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and it seems possible that the unique drama of this realm may have “enhanced” placebo effects in particular conditions. Ultimately, only prospective trials directly comparing the placebo effects of unconventional and mainstream medicine can provide reliable evidence to support such claims.

Nonetheless, the possibility of enhanced placebo effects raises complex conundrums. Can an alternative ritual with only nonspecific psychosocial effects have more positive health outcomes than a proven, specific conventional treatment? What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?

From the FULL TEXT Article:


Efficacious therapy, in one biomedical definition, is therapy that has positive effects greater than those of an indistinguishable dummy treatment in a randomized, controlled trial (RCT). [1–3] Such specific efficacy is actually a comparative measure: intervention contrasted with placebo.

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Different Placebos, Different Mechanisms, Different Outcomes

By |May 14, 2019|Placebo|

Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials

The Chiro.Org Blog

SOURCE:   PLoS One. 2015 (Nov 4); 10 (11): e0140967

Fabrizio Benedetti, and Sara Dogue

University of Turin Medical School,
Neuroscience Department,
Turin, Italy.

I have been fascinated with placebo-controlled trials since the 90s. In those days, virtually all the placebo-controlled manipulative trials claimed that SMT was *no better than placebo*. And in those days, medicine looked down their long noses, considering placebo as worthless, a mild side-effect of trickery and quackery.

“A patient finally went to a chiropractor for her back pain after finding no relief with the orthopedist. After three adjustments and a week of no symptoms, she had a follow-up visit with her M.D.

Upon learning about the success of the D.C., the orthopedist stated, “That was just the placebo effect.”

The patient responded, “If it works so well, why didn’t you use it?”

–– Attributed to Robert Mootz, D.C.

Finally, I got around to copying several of those early SMT/placebo studies, and was pleasantly shocked to discover that, compared to pre-study findings, BOTH groups improved significantly. This did NOT mean SMT didn’t help patients, it just means that it didn’t help them MORE than the pacebo did. It also strongly suggested that the plazcebo(s) were probably NOT inert.

At any rate, now you know why I started collecrting articles on placebo, and they eventually coalesced (2002) into our topical
Problem with Placebos/Shams Page. This is how many of our other topical pages evolved from their humble beginnings.

Clinical trials use placebos with the assumption that they are inert, thus all placebos are considered to be equal. Here we show that this assumption is wrong and that different placebo procedures are associated to different therapeutic rituals which, in turn, trigger different mechanisms and produce different therapeutic outcomes. We studied high altitude, or hypobaric hypoxia, headache, in which two different placebos were administered. The first was placebo oxygen inhaled through a mask, whereas the second was placebo aspirin swallowed with a pill.

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What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain?

By |September 30, 2017|Placebo|

What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain? A Literature Review and Survey to Develop a Taxonomy

The Chiro.Org Blog

SOURCE:   BMJ Open 2017 Jun 30); 7 (6): e015516

Felicity L Bishop, Beverly Coghlan, Adam WA Geraghty,
Hazel Everitt, Paul Little, Michelle M Holmes,
Dionysis Seretis, George Lewith

Department of Psychology,
Faculty of Social Human and Mathematical Sciences,
University of Southampton,
Southampton, UK.

OBJECTIVES:   Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice.

DESIGN:   Literature review and survey.

METHODS:   We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature.

RESULTS:   The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patient—practitioner interaction (7 procedures and 18 clinical applications).

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The Problem with Placebos/Shams Page


Imperfect Placebos Are Common In Low Back Pain Trials:

By |October 20, 2016|Placebo|

Imperfect Placebos Are Common In Low Back Pain Trials: A Systematic Review Of The Literature

The Chiro.Org Blog

SOURCE:   Eur Spine J. 2008 (Jul); 17 (7): 889–904

L. A. C. Machado, S. J. Kamper, R. D. Herbert,
G. Maher, and J. H. McAuley

Back Pain Research Group,
Musculoskeletal Division,
The George Institute for International Health,
Missenden Rd, P.O. Box M201,
Camperdown, NSW, 2050, Australia.

The placebo is an important tool to blind patients to treatment allocation and therefore minimise some sources of bias in clinical trials. However, placebos that are improperly designed or implemented may introduce bias into trials. The purpose of this systematic review was to evaluate the adequacy of placebo interventions used in low back pain trials. Electronic databases were searched systematically for randomised placebo-controlled trials of conservative interventions for low back pain. Trial selection and data extraction were performed by two reviewers independently. A total of 126 trials using over 25 different placebo interventions were included. The strategy most commonly used to enhance blinding was the provision of structurally equivalent placebos. Adequacy of blinding was assessed in only 13% of trials. In 20% of trials the placebo intervention was a potentially genuine treatment. Most trials that assessed patients’ expectations showed that the placebo generated lower expectations than the experimental intervention.

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Placebo Effects In Trials Evaluating 12 Selected Minimally Invasive Interventions

By |October 19, 2016|Placebo|

Placebo Effects In Trials Evaluating 12 Selected Minimally Invasive Interventions: A Systematic Review And Meta-Analysis

The Chiro.Org Blog

SOURCE:   BMJ Open. 2015 (Jan 30); 5 (1): e007331

Robin Holtedahl, Jens Ivar Brox, Ole Tjomsland

Department of Physical Medicine and Rehabilitation,
Oslo University Hospital,
Oslo, Norway.

OBJECTIVES:   To analyse the impact of placebo effects on outcome in trials of selected minimally invasive procedures and to assess reported adverse events in both trial arms.

DESIGN:   A systematic review and meta-analysis.

DATA SOURCES AND STUDY SELECTION:   We searched MEDLINE and Cochrane library to identify systematic reviews of musculoskeletal, neurological and cardiac conditions published between January 2009 and January 2014 comparing selected minimally invasive with placebo (sham) procedures. We searched MEDLINE for additional randomised controlled trials published between January 2000 and January 2014.

DATA SYNTHESIS:   Effect sizes (ES) in the active and placebo arms in the trials’ primary and pooled secondary end points were calculated. Linear regression was used to analyse the association between end points in the active and sham groups. Reported adverse events in both trial arms were registered.

RESULTS:   We included 21 trials involving 2,519 adult participants. For primary end points, there was a large clinical effect (ES≥0.8) after active treatment in 12 trials and after sham procedures in 11 trials. For secondary end points, 7 and 5 trials showed a large clinical effect. Three trials showed a moderate difference in ES between active treatment and sham on primary end points (ES ≥0.5) but no trials reported a large difference. No trials showed large or moderate differences in ES on pooled secondary end points. Regression analysis of end points in active treatment and sham arms estimated an R(2) of 0.78 for primary and 0.84 for secondary end points. Adverse events after sham were in most cases minor and of short duration.

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