Talk:Placebo

Another possible historical account

I found this in The Anatomy of Melancholy by Robert Burton (1621):

--- And sometimes a strong conceit or apprehension, as [1617]Valesius proves, will take away diseases: in both kinds it will produce real effects. Men, if they see but another man tremble, giddy or sick of some fearful disease, their apprehension and fear is so strong in this kind, that they will have the same disease. Or if by some soothsayer, wiseman, fortune-teller, or physician, they be told they shall have such a disease, they will so seriously apprehend it, that they will instantly labour of it. A thing familiar in China (saith Riccius the Jesuit), [1618]If it be told them they shall be sick on such a day, when that day comes they will surely be sick, and will be so terribly afflicted, that sometimes they die upon it. Dr. Cotta in his discovery of ignorant practitioners of physic, cap. 8, hath two strange stories to this purpose, what fancy is able to do... --- from: http://www.gutenberg.org/files/10800/10800-h/ampart1.html

Needs clarification

I have attempted to edit this line, but was reverted: "The use of placebos as treatment in clinical medicine raises ethical concerns, as it introduces dishonesty into the doctor–patient relationship." However, for example, if the patient were *told* that they were being given a placebo, then there would be no dishonesty. It is possible that this statement is being taken out of context from the cited work. As it stands, the statement is misleading. Perhaps more context from the cited work can be given to illustrate the way in which giving a placebo might introduce dishonesty into a doctor-patient relationship. Gitpushoriginmaster (talk) 15:24, 26 November 2019 (UTC)

The reason is clear - bypassing informed consent. The scenario you set out does not appear in the sources we cite, does it? Alexbrn (talk) 15:34, 26 November 2019 (UTC)

I concur with Alexbrn, "bypassing informed consent" was recently added in fact to precisely clarify why placebo may introduce dishonesty. But I think I see what you mean: I need to check but I think that there are studies showing that the placebo effect can still happen even when the patient is informed, in which case there would be no bypassing of informed consent. I need to check for sources then, but this may make this statement about dishonesty a bit too strong, but then this can be easily fixed by changing "as it introduces dishonesty" -> "as it may introduce dishonesty". Let me check for sources and we'll see. --Signimu (talk) 21:14, 26 November 2019 (UTC)

Found that it's called "open-label placebos"[2][3][4], but need to find a review and if multiple studies reproduced the result. Also, the lede only mentions the informed consent issue, but it should probably also mention the fact that in clinical research patients are given a placebo when there are effective medications available (as described later in the article), this is also an ethical issue. --Signimu (talk) 00:09, 27 November 2019 (UTC)

Found 3 reviews on open-label placebos: [5][6] and 1 in french (but not focused on open-label placebos)[7]. --Signimu (talk) 00:27, 27 November 2019 (UTC)

What happens in research is another matter, the text in question applies to what happens in clinical medicine. Alexbrn (talk) 08:07, 27 November 2019 (UTC)

@Signimu, "as it may introduce dishonesty" is exactly the change I attempted to make. I'm glad you concur. Gitpushoriginmaster (talk) 19:11, 17 December 2019 (UTC)

I have edited the lede to clarify that placebos do not need to be disguised in order to be considered placebos or to have placebo effects. It also includes a note about the ethical issues of using a placebo as a control in a clinical trial when there is already an existing treatment. Anywikiuser (talk) 12:07, 27 November 2019 (UTC)

First sentence and Section 1 "Definitions"

The first sentence has a questionable reference. As it contains a definition, the definition should be absolutely solid, not in contradiction (and best: in no means different) from the definitions given in the respective section, and the definition should refer to a reference that is outmost credible. These conditions do not seem to apply here, as the currenty reference 1 stems from one national academic society and not from democratically legitimzed regulatory, refers to only one indication, namely pain, and most importantly, refers to a very unusual situation, namely "placebo in pain management". Please note that such use is likely to be illegal! Placebos cannot be prescribed or purchased. Legal use of placebos is confined to clinical trials. However, there is a solid and extremely widely accepted reference for this topic, namely the Internationl Conference for Harmonization (ICH) with its guideline E10 "Choice of COntrol Group in Clinical Trials", issued and adopted in 2000. The sentence essential for placebo in this guideline is: "In a placebo-controlled trial, subjects are randomly assigned to a test treatment or to an identical-appearing treatment that does not contain the test drug." There are other important considerations below this sentence. Hence, it appears justified to modify the sentence to a definition: >>Placebo is expected to be an identical-appearing treatment that does not contain the test drug.<< You may also refer to the older US definition given in 21 CFR 314. §128, b 2 i: "Placebo concurrent control: The test drug is compared with an inactive preparation designed to resemble the test drug as far as possible." As the US FDA themselves contributed to and adopted finally ICH E10, they do not see a relevant difference between these definitions. All in all, please consider 1. modifying the first sentence, 2. removing reference 1 as far as definitions are concerned, 3. inserting the definitions given by ICH E10 and 21 CFR 314, 4. providing respective references.

When having done this, you might find that the section 1 (Definitions) might require re-editing. Then you might find also other sections of the placebo article that need improvement. — Preceding unsigned comment added by Hajokrem (talk • contribs) 10:18, 10 December 2019 (UTC)

Hajokrem, thank you for the interesting references and comment. Please feel free to update the entry, as you seem knowledgeable about it and the references you provide are sound, and it is unlikely others will not do it (at least in the near future). If you do so, I will fix any formatting issue or wording, so don't worry. Signimu (talk) 14:18, 10 December 2019 (UTC)

These definitions only deal with the use of placebos in clinical trials. Anywikiuser (talk) 11:30, 11 December 2019 (UTC)

Hajokrem writes that from the sources it's stated placebos are regulated and only allowed for clinical trials, is that true? Signimu (talk) 13:08, 11 December 2019 (UTC)

The prevailing view in medical ethics is that placebos have an important role in clinical trials. Otherwise, it is considered unethical to give fake medicine to a patient, especially if the patient is being deceived.

But even if it is considered unethical, it still happens in practice. Alt-med is basically an entire industry that is built on giving out placebos. Besides alt-med, this UK survey shows it is common for doctors to prescribe an unrelated medicine as a placebo. Anywikiuser (talk) 10:54, 12 December 2019 (UTC)

Anywikiuser, to be fair, alt med is also largely unethical... Guy (help!) 12:03, 12 December 2019 (UTC)

Anywikiuser, correct, any other use is unethical. Guy (help!) 12:02, 12 December 2019 (UTC)

Creating a redirect from contextual effect?

I have seen objections to the term "placebo effect" for a couple of reasons. Some are technical, basically that it is a fuzzy term that can cover a mixture of several effects that should be considered separately: reporting bias in RCT + social ritual healing (common knowledge is that going to the doctor and following her instructions make people better, and that expectation makes it happen) + various noise in remission statistics (reversal to the mean, spontaneous remission etc.); here is a possible source discussing it. Some are political: the name "placebo effect" allows cranks to say "well, there is an effect" and convince the public in a way "as efficient as sugar" does not (see the start of that though I doubt that is a reliable source by WP's standards).

I would think my first source is enough to justify a redirect from contextual effect to here and a small mention in the lead but I have no idea how well-received in the community those views are (if they are totally fringe, we probably should not). Non-expert me has found Google Scholar hits for "placebo effect" (163k) vs "contextual effect" (15k, most seem to be about medicine) that indicate the term is in use, but that is hardly convincing ("faith healing" scores 24k).

The political objections might be worth a discussion too somewhere but only if it is a sourceable view (not necessarily among practitioners, but also among skeptics, governmental bodies, etc.). For obvious reasons I found mostly opinion pieces to that effect. Tigraan^{Click here to contact me} 14:26, 11 February 2020 (UTC)

Self contradiction

Reading the article feels like a true rollercoaster, which is pretty troublesome when you want to get a sense of the validity of the concept. What i mean is that the article contains several quotes and sources about deeming placebo insignificant, dubious or outright dismissible, while at the exact same time it provides factual data that its a very much existing, functioning and measurable concept, especially with pain, nausea, depression.

In its nature the article is completely self-defeating, because if its taken at face value, one is left with a PhD level demonstration of what gossip among scientists and medical professionals looks like with everyone throwing slanted/partial data in the pool, then at the end you are exactly where you started: It exists, maybe, but we cant really figure how much, but its most certainly insignificant, except when its not. I mean... is this supposed to be some red tape bureaucratic comedy? Whilst writing these articles, you might wish to provide a factual, on ground conclusion. An answer if you will instead of tossing in pro and contra data points left and right, creating an informational mire. 37.191.17.124 (talk) 00:21, 1 November 2021 (UTC)

Yeah, this article does seem weird. It seems to be stating repeatedly that The Powerful Placebo was debunked and implying that there's no such thing as the placebo effect, which seems unlikely given the extent of the measures that usually seem to be taken to allow for the placebo effect in clinical trials. Possibly it just means that the particular data used in The Powerful Placebo were duds, rather than that the placebo effect doesn't exist? If so, it might make sense for it to say so. Wombat140 (talk) 04:16, 16 December 2022 (UTC)

I think the issue here is that while the idea of a Placebo Effect for quantitative health outcomes has been debunked, patients still *self-report* things like decreased pain, reduced depression, etc. I agree the article would benefit with being restructured to first cover the "history and debunking" of a "real placebo effect" (historical misunderstanding of regression to the mean) and then continue with a discussion of the "actual placebo effect" as it related to self-reported conditions. Meekohi (talk) 13:46, 23 August 2023 (UTC)