Side effects of placebos

[Derek Smith]

I was talking to a friend last night who has been on a clinical trial and said that he thought initially that he'd been given the real drug as he'd had side effects: lassitude, headaches, 'upset stomach' and problems sleeping. In talking to his own doctor he was told that this proves nothing as placebos have side effects.

A little bit of research online shows that this is indeed true (unbeleivable) and that whilst the average positive response to drugs is 82%, for placebos it is over 60. This gives rise to the question as to whether a double-strength placebo might raise the success percentage, although, of course, one must be careful of overdosing.

It's sparked some interest in me. Anyone know of an online source of an in-depth introduction to the research? I've goggled but much of it is repetition or too light. I've got a decent grounding in science.

[Derek Smith]

Sorry to confuse, I was having a bit of a joke there.

But what's got me on just a little reading is that everything I knew about plcebos is wrong. It would appear that in one trial patients were told they were taking a placebo with non active ingredients yet still there was a reduction in symptoms.

There was another test which showed that homeopathy, which I thought was 100% placebo as their solutions have no active ingredients, showed a lower rate of success that placebos. How does that work?

I can understand a placebo mascerading as a sleeping tablet working as worry about whether a person would get to sleep or not would probably keep them awake. But there have been physical changes in conditions when placebos are used. There have been glib suggestions of the body's own defence systems, etc, but that has some holes in it.

There was a test of laying on of hands sort of thing prior to operations. 'Genuine' (sorry for choice of descriptor) faith healers were used as well as those who merely went through the actions (as, indeed, many feel faith healers do), toghether with those who had nothing and some who were told that a faith healer would perform some sort of ritual after they went under. Some were, some weren't.

What was surprising was that there was a significant statistical difference between each group and that the pros were beaten by the amateurs as well as, if memory serves, of those who were told they were having a post anaesthetic touching but were not.

It is, to me, remarkably confusing. One would have thought the principles could have been described by fairly basic science but it is struggling.

All I'm after is a review of the research sort of thin.

[Derek Smith]

Odie said:

Giving a double dose will be giving double nothing.

Can you say that with any degree of certainty? If there was a group of patients and one was given two placebos whilst the other just the one, and each group knew, would there be a difference? Further, there has been shown that colours of placebos has an effect on some, together with procedures. If a placebo is injected it is more powerful than if it is taken by mouth. Further still, a doctor giving the medicine is much more effective than a nurse.

My father was bemused to be given a pill for a skin rash which, the doctor said, had a side effect that was more useful than it's main purpose. A cousin of mine, his neice, was a nurse and looked it up. It was used for treatment for a tropical disease. Oddly enough, it worked despite him having the rash on and off for some 20 years after being hit in the head with a bit of an anti-aircraft shell. And he didn't get a tropical disease either.

[Derek Smith]

FunkyNige said:

I work in the data collection side of clinical trials so see the side effects of news drugs and placebos every day and some weird stuff does come out, the placebo effect is a very strange thing indeed!
I've heard of someone getting seriously ill by taking an overdose of placebo - they were on a clinical trial where they didn't know if they were taking active or placebo, took an overdose to take their own life, got rushed to hospital with really low blood pressure, etc. 5 mins after they found out they were on placebo the blood pressure was back up to normal and they were fine! You can train rats to push a button to dispense themselves cocaine and measure their brainwaves. If they push the same button and get a placebo instead, their brainwaves will be as if they took cocaine. These are both physiological responses

You have to be a bit careful with looking at placebo effects in clinical trials as the subjects do talk to each other - one drug started giving people weird dreams, by the end of the week all the subjects were reporting weird dreams if they were on the active drug or not...

If you put 'placebo' into the search of www.newscientist.com it will bring up a load of links to research into the effect.

Thanks for the link and especially the stories. Fascinating.

Cheese late at night used to give me dreams up until I was told that cheese does not give you dreams. I was very irritated to be 'taken in' by stories. It is nice to know that others are as well.

As a teenager I used to have trick of sticking pins in my arm or hand and it not hurting. It is really quite easy to do. After one got badly infected and the
doctor noted the other small puncuture wounds, I was warned off doing to. Then playing rugby I used to be able to put pain on the Sunday and Monday to the back of my mind. I still can do it with a lot of injuries but sciatica and toothache defeat me.

We had a container with a radiation warning label on it burst open at Gatwick. Everyone who was anywhere near it became affected, the nearer to the container the more immediate and serious the injury.

We contacted the relevant authority and they came back with the result of it being a brand new empty container, never having been used for radioactive material or, inded, anything. When the result was circulated and the terminal manager picked the thing up and replaced it in its box, everyone got better.

But the 'victims' were adament that they had felt ill. I was told that one went off sick due to embarrassment.

Thanks again for the help.

Derek

[Derek Smith]

Ray Luxury-Yacht said:

Interesting post Derek. I'm currently studying biology and psychology and this has come up. The ability of the human mind to combine psycho-somatic symptoms is amazing.

Here's one for you to try when you're Googling for information - we were shown this at college, I don't think it's very well-known...

Open a Google home page. Go to the tab at the top labelled 'more.' Then scroll down to the bit that says 'even more.'

Then, you'll get a page with a load of icons on it. Scroll down near the bottom, and one of the icons is labelled 'Specialised Search.'

Click on this, and it brings up a home page called 'Google Scholar.' When you now do a search, it only returns results of scientific papers and research. Helps to cut through the crap. Let us know what you find!

Thanks for that. Excellent. It is brilliant.

I found this on first perusal:

http://www.nejm.org/doi/full/10.1056/NEJM200105243...

Hrobjartsson and Gotzsche.

It's a meta-analysis, not something I believe implicitly. It often seems to me that people use it to prove what they want it to prove, and there is no double blind of course. However, it makes fascinating reading. Confusing of course, but fascinating.

And then there's Benedetti and the nocebo, that required multiple sites. It seems strange that placebos are under threat but nocebos aren not.

It's a bit like dark energy. We can prove it exists but it might not.

Placebos are fun.

[Derek Smith]

Alfanatic said:

Placebos seem to work particularly well as painkillers, apparently by convincing the patient's body to start releasing its own natural painkillers. This still works even when the patient knows it's a placebo.

When there have been tests on subjects claiming pain relief via placebos no endorphins have been found. So natural painkillers would appear to be unsupported.

Simpo Two said:

I'm not convinced. I tend to hold the view that once you've picked your way through the maze of questions and dead-ends, the genuine answers are often very simple; witness the discovery of the structure of DNA.

DNA is neither simple nor the complete answer.