Placebos

famous placebos examples:
unicorns horn
theriac
mandrake

sold for 10x its weight in gold
made from vipers flesh

what causes a person to get better?

1. natural history: the ailment runs its course
2. Active treatment: surgery, physical helps a person
3. placebo: non specific aspect of treatment(context, delivery method, thoughts/beliefs)

placebo

any medical procedure that procedures an effect in a patients because of its therapeutic intent and not because of its active qualities
so common that every drug test has to have a placebo
-shows whether the real drug works cause it has to better than a placebo to be considered effective

To test a placebp effect

group 1 : placebo
Groups 2: no treatment
shows where it works cause it only competes against no treatment
TOO REALLY TEST, RUN STUDY WITH: ACTIVE DRUG, PLACEBO, NOTHING GROUPS
objectively and double blindly measure your outcome

placebo rogaine

balding drug
placebo would grow hair
30% in placebo grew new hair

placebo acupuncture for irritable bowel syndrome

sham acupuncture v wait-list controlled group
2/week x3
28% reported pain relief for wait list (no treatment)
44% for sham acupuncture (placebo)
with sham acupuncture and doctor speaking nciely- 68% got better

placebo knee surgery

real surger
placebo surgery(sedation + incision)
both groups regained ability to walk at same time, 2 year follow up:40% of both groups were completely recovered

morphine after dental surgery placebo

either saline or morphine
both groups has high levels of pain relief

Proof of placebo

placebos work for pain, work when outcomes is measured subjectively and continuously, work for some objectively
concalusion: PLACEBOS WORK FOR CERTAIN PROBLEMS UNDER CERTAIN CONDITION

asthma study

inhaler, w and w drug, sham acupuncture, no treatment groups
measures: objective(force expiratory volume)
subjective(self-reported improvement)
outcome: only actual drug showed improvements for subjective
placebos both worked as well as drug for subjective

some things that placebos help
dont help

allergies, colds,
cancer, HIV, COVID, blindness/deaf
PLACEBOS DO HELP WITH SIDE EFFECTS THO

what determine sif they work

1. how doctor behaves: confidence, doubt
2. characteristics of the patients (NOT TUE)
3.Aspects of situation
4. social norms

situational factors

pill color matters, expensive pill>pill on scale
MORE FANCY AND MEDICAL, THE BETTER THEY WORK
cool colors: sedating
hot colors: stimulating
surgery>injections>capsules>tabletsh

how do placebos work?
decreases anxiety

reduce physical symptoms of stress
upset stomach, diarrhea, trouble sleeping
not all placebo effects have to do with these things

how do placebos work?
endorphin release

endogenous opiods naturally produced by body
their body releases endorphins which relive pain
not all placebo effects have to do with pain

how do placebos work?
classical conditioning

before: needle -> no pain
morphine-> pain reduction
during: Needle+ morphine -> pain reduction
after: needle-> pain reduction
conditioned pain relief is more effective if that placebo has been paired several timespr

problems with conditioning

1. placebo effects can get stronger over time but conditioned effects show extinction
2. placebos can do the opposite of what they are supposed to do
3. placebos behave in culturally determined wayshow do placebos work?

prior experience with the drug is not necessary
the more believable the placebo the more likely to work
a placebo can do the opposite of the active drug
you don't typically see palcebo effects in the absence of an expectation

skin rash study

subjects with non posionous leaves, told it was poison ivy, all developed a rash
subjects rubbed w/ real poison ivy, told it was non poisonous, non developed a rash

conditions and epectancies together
pain endurance

natural hisotry - no change
placebo + expectation of less pain- less pain
placebo + expectation of more pain- more pain
conditioned less pain + expectation of less pain - lot less pain
conditioned less pain + expectation of more pain- more pain
EXPECTATION OF LESS PAIN BEATS OUT CONDITIONING

nocebo effect

unpleasent effect
-pain, hair loss, nausea
pills might cause nausea could still make you feel it

asthma nocebo effect

Nocebo: patients given saline and told it would impair breathing and it did
placebo: same patients gshiven saline and told it would help and it did

should doctors avoid inducing nocebo effects

need to be honest about side effects
how can you do this w/o inducing the nocebo effect
maybe only mention those most likely
great question for ethicistsh

should doctors perscribe placebos?

cheaper safer drug, patients want the attention and confidence as much as the drug
might work