Placebo Effect

• Placebo Effect

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Alternative medicine - Placebo effect

1 Use of placebos in order to achieve a placebo effect in integrative

medicine has been criticized as “diverting research time, money, and

other resources from more fruitful lines of investigation in order to

pursue a theory that has no basis in biology”.


Alternative medicine - Placebo effect

1 Another critic has argued that academic proponents of integrative medicine

sometimes recommend misleading patients by using known placebo treatments in order

to achieve a placebo effect. However, a 2010 survey of family physicians found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-

five percent of respondents believed placebos can have both psychological and

physical benefits.https://store.theartofservice.com/the-placebo-effect-toolkit.html

Placebo - Placebo effect and the brain

1 These changes can act upon the brain's early stages of information processing: Research using Event-

related potential|evoked brain potentials upon painful laser pulses, for example, finds placebo effects

upon the N2–P2, a biphasic negative–positive complex response, the N2 peak of which is at about 230 ms, and the P2 one at about 380 ms


Placebo - Placebo effect and the brain

1 The brain is also involved in less-studied ways upon nonanalgesic placebo effects:


Placebo effect

1 Placebo effect consists of several different effects woven together, and

the methods of placebo administration may be as important

as the administration itself.


Placebo effect

1 Placebo effects are subject of recent scientific research aiming to understand

underlying neurobiological mechanisms of action in pain relief, immunosupression,

Parkinson disease and Depression (mood)|depression.Neurobiological Mechanisms of

the Placebo Effect, Fabrizio Benedetti, Helen S. Mayberg, Tor D. Wager, Christian

S. Stohler, and Jon-Kar Zubieta,


Placebo effect

1 The Journal of Neuroscience, 9 November 2005, 25(45)

[http://www.jneurosci.org/content/25/45/10390.full] Brain imaging techniques done by

Emeran Mayer, Johanna Jarco and Matt Lieberman showed that placebo can have real, measurable effect on physiological

changes in the brain.The neural correlates of placebo effects: a disruption account,

Matthew D. Lieberman, Johanna M. Jarcho, Steve Berman, Bruce D. Naliboff,


Placebo effect

1 Placebos are widely used in medical research and medicine, and the

placebo effect is a pervasive phenomenon; in fact, it is part of the

response to any active medical intervention.


Placebo effect

1 The placebo effect points to the importance of perception and Neural top down control of physiology|the

brain's role in physical health


Placebo effect

1 Most studies have attributed the difference from baseline until the end

of the trial to a placebo effect, but the reviewers examined studies

which had both placebo and untreated groups in order to

distinguish the placebo effect from the natural progression of the

disease.


Placebo effect - History

1 John Haygarth was the first to investigate the efficacy of the placebo effect in the 18th-

century



1 Émile Coué, a France|French pharmacist, working as an apothecary at Troyes

between 1882 and 1910, also discovered the potency of the Placebo Effect. He

became known for reassuring his clients by praising each remedy's efficiency and

leaving a small positive notice with each given medication. His book Self-Mastery Through Conscious Autosuggestion was published in England (1920) and in the

United States (1922).https://store.theartofservice.com/the-placebo-effect-toolkit.html


1 Beginning in the 1960s, the placebo effect became widely recognized and placebo controlled trials became the

norm in the approval of new medications.


Placebo effect - Mechanism of the effect

1 A 2001 meta-analysis of clinical trials with placebo groups and no-treatment groups found no evidence for a placebo effect on

objectively measured outcomes and possible small benefits in studies with

continuous subjective outcomes (particularly pain). A 2004 follow-up analysis

found similar results and increased evidence of bias in smaller trials that calls

into question the apparent placebo effect on subjective outcomes.


Placebo effect - Mechanism of the effect

1 Because the placebo response is simply the patient response that

cannot be attributed to an investigational intervention, there

are multiple possible components of a measured placebo effect


Placebo effect - Brain and body

1 Recent reviews have argued the placebo effect is due to top-down

control by the brain for immunity and pain


Placebo effect - Brain and body

1 A recent fMRI study has shown that a placebo can reduce pain-related neural activity in the spinal cord,

indicating that placebo effects can extend beyond the brain.


Placebo effect - Clinical significance

1 Another group of researchers noted the dramatically different conclusions

between these two sets of authors despite nearly identical meta-

analytic results, and suggested that placebo effects are indeed significant

but small in magnitude.



1 Other writers have argued that the placebo effect can be reliably

demonstrated under appropriate conditions.



1 Several clinical (physical placebos, patient-involved outcomes, falsely

informing patients there was no placebo) and methodological (small sample size, explicit aim of studying

the placebo effect) factors were associated with higher effects of

placebo



1 In 2013 Jeremy Howick et al. used Hróbjartsson Gøtzsche's data to

compare the magnitude of placebo effects with the magnitude of

treatment effects. They found a statistically significant difference between placebo and treatment effect sizes in trials with binary outcomes but not in trials with

subjective outcomes.https://store.theartofservice.com/the-placebo-effect-toolkit.html

Placebo effect - Doctor-patient relationship

1 * Roughly only 30% of the population seems susceptible to placebo effects,

and it is not possible to determine ahead of time whether a placebo will work or not. (However the placebo

effect is zero in studies of blood poisoning and up to 80% in studies of

wound on the duodenum).


Placebo effect - Genes

1 In social anxiety disorder (SAD) an inherited allele|variant of the gene for tryptophan hydroxylase 2 (enzyme that synthesizes the neurotransmitter

serotonin) is linked to reduced amygdala activity and greater susceptibility to the placebo effect.

[http://sciencenow.sciencemag.org/cgi/content/full/2008/1202/1 The Placebo Effect: Not All in Your Head], ScienceNOW Daily News, 2 December

2008[http://www.newscientist.com/article/mg20026854.900-first-placebo-gene-discovered.html?

DCMP=OTC-rssnsref=online-news First 'placebo gene' discovered], New Scientist, 03 December

2008


Placebo effect - Genes

1 In a 2012 study, variations on the COMT (catechol-O-

methyltransferase) gene related to dopamine release are found to be

critical in the placebo effect among the patients with irritable bowel

syndrome participating in the trial, a research group in Harvard Medical

School reported


Placebo effect - Symptoms and conditions

1 The placebo effect occurs more strongly in some conditions than

others. Dylan Evans has suggested that placebos work most strongly

upon conditions such as pain, swelling, stomach ulcers, depression,

and anxiety that have been linked with activation of the Acute-phase

reaction|acute-phase response.


Placebo effect - Pain

1 The placebo effect is believed to reduce pain in two different ways. One way is by the placebo initiating the release of endorphins, which are natural pain killers produced by the brain. The

other way is the placebo changing the patient's perception of pain. A person might reinterpret a

sharp pain as uncomfortable tingling.[http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/placebo-effect Placebo Effect]. Cancer.org. Retrieved on

2013-08-25.


Placebo effect - Depression

1 In 1998, a meta-analysis of published antidepressant trials found that 75%

of the effectiveness of anti-depressant medication is due to the placebo effect and other non-specific

effects, rather than the treatment itself.Kirsch, I


Placebo effect - Gastric and duodenal ulcers

1 Moreover, in many of these trials the gap between the active drugs and

the placebo controls was not because [the trials' constituents] had high

drug effectiveness, but because they had low placebo effectiveness.


Placebo effect - List of medical conditions

1 The effect of placebo treatments (an inert pill unless otherwise noted) has

been studied for the following medical conditions. Many of these citations concern research showing that active treatments are effective, but that placebo effects exist as well.


Placebo effect - Placebo-controlled studies

1 The placebo effect makes it more difficult to evaluate new treatments.

The placebo effect in such clinical trials is weaker than in normal

therapy since the subjects are not sure whether the treatment they are

receiving is active.



1 This is particularly likely, given that new therapies seem to have greater placebo

effects



1 Clinical trials are often double-blinded so that the researchers also do not know which test subjects are

receiving the active or placebo treatment. The placebo effect in such

clinical trials is weaker than in normal therapy since the subjects

are not sure whether the treatment they are receiving is active.


Placebo effect - Nocebo

1 The recipients of the inert substance may nullify the placebo effect

intended by simply having a negative attitude towards the effectiveness of

the substance prescribed, which often leads to a nocebo effect, which is not caused by the substance, but

due to other factors, such as the patient's mentality towards his or her

ability to get well, or even purely coincidental worsening of symptoms.


Placebo in history - Placebo effect

1 The first to recognize and demonstrate the placebo effect was English physician John Haygarth in

1799



1 The wooden pointers were just as useful as the expensive metal ones,

showing to a degree which has never been suspected, what powerful

influence upon diseases is produced by mere imagination.Wootton, David. Bad medicine: Doctors doing harm

since Hippocrates. Oxford University Press, 2006. While the word placebo had been used since 1772, this is the

first real demonstration of the placebo effect.



1 In modern times the first to define and discuss the placebo effect was T.C Graves, in a published paper in

The Lancet in 1920. He spoke of the placebo effects of drugs being

manifested in those cases where a real psychotherapeutic effect

appears to have been produced.



1 In 1946, the Yale biostatistician and physiologist E. Morton Jellinek

described the placebo reaction or response. He probably used the

terms placebo response and placebo reaction as interchangeable.Jellinek, E. M. Clinical Tests on Comparative Effectiveness of Analgesic Drugs, Biometrics Bulletin, Vol.2, No.5,

(October 1946), pp. 87–91. Henry K. Beecher's 1955 paper The Powerful

Placebo was the first to use the term placebo effect, which he contrasts

with drug effects.



1 It has been suggested that a distinction exists between the

placebo effect (which applies to a group) and the placebo response

(which is individual).


Alternative health - Placebo effect

1 Use of placebos in order to achieve a placebo effect in integrative

medicine has been criticized as diverting research time, money, and other resources from more fruitful lines of investigation in order to

pursue a theory that has no basis in biology.


Placebo effect (disambiguation)

1 * Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit

results simply because the recipient believes that it will work



1 * Placebo Effect (Doctor Who)|Placebo Effect (Doctor Who), an

original novel written by Gary Russell and based on the long-running British science fiction television

series Doctor Who



1 * Placebo Effect, a song by English post-punk band Siouxsie and the Banshees on the 1979 album Join

Hands


Henry K. Beecher - Beecher and the Placebo effect

1 His 1955 paper constantly and correctly speaks of placebo reactors and placebo

non-reactors; furthermore, Beecher (1952), Beecher, Keats, Mosteller, and Lasagna

(1953), Beecher (1959), consistently and correctly speak of placebo reactors and

placebo non-reactors; they never speak of any placebo effect; and, finally, in his

Research and the Individual: Human Studies (1970), Beecher simply speaks of placebos.


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Placebo Effect