Here’s something I slopped together recently. I’m not really familiar with the literature on any of this, so maybe it’s all pretty well known (or well known to be confused). Anyhow, comments are welcome, and I apologize in advance for my usual pile of typos, grammatical errors, and other miscellaneous blunders.
W
Johnny Woulda, 45, has had chronic tendonitis in both of his elbows since he was about 30. He’s always been told that there’s no help for it except rest and steroid injections, but the rest hasn’t worked, and he’s afraid the injections will be worse for him than the elbow pain. He takes a bus to work every day and one day he sees a poster that says “Do you have tendonitis? We are testing a new non-steroidal oral drug, and if you are an otherwise healthy male between the ages of 18 and 48 you could earn $100 by taking part in our clinical trial.” The drug company, Montrezl, is interested in testing the effectiveness of their experimental product, Elbowftra©. Based on their tests on chimpanzees, which have no belief one way or the other whether they are being given a real drug, they believe that Elbowftra© drug would have at least a 50% effectiveness rate on humans people—higher if the person is credulous (the sort of person now spending a ton of money on herbal remedies). The FDA has assured Montrezl that if they can confirm that at least 30% more human volunteers are cured by Elbowftra© than are cured by a sugar pill placebo, as determined by blind reviewers, they should have no problem getting their drug approved. On the other hand, if there’s not much difference between Ebowftra’s effectiveness and that of a placebo, there isn’t much hope.
Let us suppose now, that there is something a little unusual about chronic tendinitis sufferers like Johnny Woulda. They happen to not only be extremely desirous of getting relief from their pain, but more credulous than a randomly chosen subject. If you even suggest to one of this group that you’ve got a pill that MAY work, a couple of doses is quite likely (about 70%) to provide them long-term relief from both their inflammation and their pain symptoms. The problem for Montrezl is that for this cohort there is no significant difference between the effects of Elbowftra© and the placebo: they both have around a 70% effectiveness rate. This means that a double-blind experiement will likely result in a determination by the FDA that Elbowftra is garbage and may not be sold.
This produces a paradox which may be put as follows:
Let S= people in the trial; X = any pill; E = Elbowftra©; and P = a sugar pill of no medicinal value. Assume too that the FDA is very careful and strict, only allowing curative drugs to be sold.
1. (X) (if X is safe and helps at least 50% of those taking it in double-blind clinical trials, then X should be allowed to be sold). [premise]
2. E is safe and at cures elbow tendinitis in 70% of those taking it in double-blind clinical trials. [premise]
3. Therefore, E should be allowed to be sold. [2 & 3]
4. (S) (X) (X is allowed to be sold, then it is rational for S to believe that X is curative of something). [FDA accuracy and stringency assumption]
5. It is rational to believe that E is curative of elbow tendinitis. [3 & 4]
6. (P) ~(P has the power to cure any medical ailment). [medical valuelessness of placebos]
7 E is no more effective than P in clinical trials. [premise]
8. (S) (X) (P) (if X is no more effective than P in clinical trials, it is irrational for S to believe in the power of X to cure anything. [What is no better than something useless must itself be useless]
9. It is irrational to believe that E is curative of elbow tendinitis effective on at least 50% more individuals than no drug at all.
We have thus proven that it is both rational and irrational to believe in the effectiveness of Elbowftra©.
It is easy to see the similarities between this paradox and Newcomb’s paradox of the money boxes. It is argued there that since it is irrational to believe that there could ever be less in both boxes than there is in one box, it must always make sense to take both boxes. This is in the face of the obviously rational approach of predicting that the future will be like the past.
The logical, apparently scientific sort—the type that believes that sugar pills cannot cure tendonitis—can always be expected to take both boxes: “How can it ever make sense not to? The money is either in the second box or it isn’t—my choice can’t affect the outcome!” But the credulous pragmatist, like Johnny Woulda, is more interested in the cure than the scientific truisms. He doesn’t care if it is his belief that is causing the success-creating effect or not: he just wants his elbow to stop hurting (or to become a millionaire if he’s playing the Newcomb game). The concern of how these apparently crazy results might happen, being purely academic, holds little or no interest for him.
The thing is, being just a thought experiment, there is no actual empirical basis for the Newcomb results, only a discussion of pragmatic versus academic dispositions. But there is plenty of empirical support for the existence of the placebo effect. One really can improve one’s elbows if one believes. This is not like Pascal’s wager, where there’s no basis for supposing that anybody has ever benefitted from what seems like a completely wacky supposition of the existence of some kind of diety. On the contrary, it’s a well-known fact that the credulous are more likely to do better in clinical trials. We even have a name for it—“the placebo effect.” We may say that the person who takes ginko biloba based on anecdotes of a couple of friends is just deluding herself, but—again assuming it’s completely safe—only good would seem to come from these kinds of “delusions.” And if a belief is really (not just in-pretend) success-producing, why is it more delusional to have it than not to have it?
I think the problem with assessing the Newcomb paradox is that those who insist on taking both boxes don’t REALLY BELIEVE that the past empirical results could have been as they are described by the one who sets up the story for them. As it seems impossible to this type that the single box taker has always (or almost always) gotten away with the big money and the two-box taker gotten screwed, they feel that their choice of both boxes is more rational than that of the (credulous, not to say stupid) pragmatist. But it is the pragmatist who is actually relying on the empirical results rather than the insisted upon theorems (“There just has to be at least as much money there for you if you take both boxes!” “There’s no way glucosamine can help tendons!”). These “musts” and “no ways” are not really science, however; they are simply denials of the accuracy of the actual empirical results based on a supposed knowledge of what must be the case—given the logical principles or scientific laws. So who is really the religious thinker here after all?
this, IMO, is one of the most common misperceptions of what the palcebo (and/or nocebo) effect ‘is’. Placebos do not, and cannot, cure anything. They don’t work on tumors, virus, or bacteria but they do show efficacy on very subjected endpoints, e.g., pain perception.
Here is a new article on placebo/nocebo effects in clinical trials:
http://harvardmagazine.com/2013/01/the-placebo-phenomenon
Obviously, Montrezl should market their product as a diet supplement instead of as a therapeutic drug. That way, it escapes FDA review.
I rather fond of Newcomb’s paradox. It does illustrate problems with conventional ways of thinking.
As for rationality — it’s a myth. I sometimes toy with the idea of a post titled “Rationality is irrational; logic is illogical”.
BK,
Interesting article, BK. Seems very convincing evidence that the placebo effect is real. But how can we exploit the effect without mass deception? What would happen if the cat were let out of the bag?
Alan, yes, the placebo/nocebo effect is real but the extent of it’s capabilities are often over-stated. Here in the US the effect is exploited via mass deception by allowing the supplement/alternative medicine marketers free reign to market their products via dubious and questionable methods, i.e., use of testimonials and general mistrust of anything resembling ‘real’ science-based methodologies. What has happened is that despite funding into these alternative modalities, via US congresssional support< is that nothing has changed. Despite a nearly 100/% track record of debunking the alleged efficacy the market remains. Look at the recent (and past) research into taking vitamins. They don't prevent disease manifestation/progression and present a real threat to an individuals health.
some, if not all, of these type of beliefs can be viewed at sites like:
http://www.curezone.org
the idea that Hulda clark's zapper can kill the parasites that cause cancer remains strong (even though Hulda died of cancer and her record of bilking patients is long) and that the organs of the human body can be viewed as waste-bins which need, and can be, emptying periodically (liver flushes etc).
BK,
I was sort of musing on whether being less of a sceptic regarding alternative health treatment would result in them actually working for me! Though I do take glucosamine for my joint pain and manage to convince myself that sporadic high doses do make me feel better. (This is not a claim and should not be read as an endorsement for glucosamine as a treatment for chronic joint pain. 😉 )
Like many issues of fact, the best course seems checking information from multiple sources and verifying and exchanging evidence.
ETA spelling better not batter. Thanks for letting me spot that myself, guys!
<I was sort of musing on whether being less of a sceptic regarding alternative health treatment would result in them actually working for me!
Oh…..nevermind then!
more seriously, yes, I agree that checking multiple sources to verify the underlying evidence that support various claims to not making expensive urine. It is one of the reasons I previously posted Peter Moran’s site on how to read a ‘cancer cure testimonial’ in an attempt to provide a format for vetting those and other efficacy related claims.
I note that you quote this line: “Sham treatments won’t shrink tumors or cure viruses.” But not this one: “But researchers have found that placebo treatments–inteventions with no active drug ingredients–can stimulate real physiological responses, from changes in heart rate and blood pressure to chemical activity in the brain, in cases involving pain, depression, anxiety, fatigue, and even some symptoms of Parkinsons.”
The following is a sound argument:
High blood pressure is considered a disease by the modern medical world.
Placebos lower blood pressure.
To lower high blood pressure is to cure high blood pressure.
Therefore, placebos can cure at least one syndrome considered a disease by the modern medical world.
What do you want, egg in your beer?
Nobody said placebos can cure EVERYTHING. The question is whether they can cure SOME things, maybe like glucosamine, reduce elbow swelling and pain. I think they probably can. They work for Johnny Woulda anyhow.
In any case, I heartily agree with the subject of that article, where it seems you do not. “Disregarding the knowledge that placebo treatments can affect certain ailments, Kaptchuk says, ‘is like ignoring a huge chunk of healthcare.’ As caregivers, ‘we should be using every tool in the box.'”
You are correct, walto, that I did not quote everything in the article. Instead I posted the link soi everyone could read it at their pleasure.
Placebos have not been noted to cure high blood pressure and the article makes no claims to the contrary. The placebo effects noted have not been tested for durability and longevity such as a comparison between placebos and ACE inhibitors might reveal. That short-term manifestations of the physiological effects of the placebos (or nocebos) is directly related to their effects on subjective endpoints. That placebos can elicit a reduction in anxiety and consequently a reduction in blood pressure does not equal cure.
I don’t find that to be a particularly sound argument. Rather I find it to be so generalized as to be quite meaningless. High blood pressure can have many causative factors associated with its etiology. You have not come anywhere the burden of proof required for claims of curing anything, let alone high blood pressure. You also seem to forget that the placebo does nothing chemically/biochemically in the body. They are inert in this regard. What does happen is that the patient’s expectations influence their subjective experience, such as reducing anxiety and noting a reduction in blood pressure. So placebos cure nothing in the endgame.
I don’t know what I stated that makes you think I disagree with the article I linked to. Quite the contrary, I do recognize the effects placebos can elicit and why they are necessary for clinical trial comparisons of new drug applications. I also recognize the limitations of the placebo effect. You do realize that doctors do prescribe placebos to patients? However, it is a tricky and slippery slope when it is done.
Apparently, you aren’t that familiar with the realm of so-called alternative medicine and the supplement industry and its claims of curative powers. Heck, colloidal silver is alleged to cure over 650 ailments all on its own! Of course the reality is that it can’t cure anything but it might turn you blue.
another example is acupuncture. Acupuncture demonstrates a placebo effect if you use needles, or If you use sham needles, and it doesn’t even matter where you stick the needles (or sham needles, to have an alleged effect on Qi and a persons ailment.
Is it the acupuncture treatment triggering the response or is it more representative of patient expectation and their response to the ‘show’ being presented by the practitioner?
You’re absolutely right that I shouldn’t have said that nobody says that placebos cure EVERYTHING. There are substances which are such that some people will say of them that they cure everything.
OTOH, I don’t think placebos cure everything, and those people don’t think that the substance that they think will cure everything are placebos.
I do believe in the placebo effect, though, and agree with the subject of the article you linked (for which, thanks), that stuff that in one sense can’t do anything, actually does more than make people just THINK that they’re better. The physiological effects are real and shouldn’t be scorned. But they’re a result of a paradoxical process. How can something that can’t help help?
It’s not clear what’s being argued here.
The drugs that I take reduce my blood pressure. But, if I stop taking those drugs, the pressure will go back up. So they don’t cure blood pressure, either.
the patients in the clinical trials also don’t know that they are taking a placebo but that doesn’t make the placebo into something other than a placebo. Likewise, with the vast majority of supplements and so-called alternative treatments.
Neil, yes, in many cases drugs can only have an impact on the ‘symptoms’ of the disease state in question rather than the underlying cause. With high blood pressure there are numerous causes and some are amenable to life-style changes resulting in no further need for medication but others not so much. The point is your blood pressure medicine (most common ACE inhibitors) work if you believe in them or not and have the added advantage of ahving predictability in dose and response relationship. Placebos haven’t been shown to have such efficacy in the long-term versus short-term responses. I am sure that there could be an experiment conducted that tests if large placebo pills work better than small placebo pills (or different colors, ect) it all depends on how it is sold to the patient.
From scientific american, Feb/Mar 2009:
Fixed that for you.
I’m not sure we could go that far. I guess we could say that the administering of placebos and shrinkage of a tumour were concurrent.
correlation is not often the best predictor of causation.
As with your testimonial to your wife’s cancer cure via faith healing there are many questions about Mr Wright’s case that need to be presented before any claim of a placebo shrinking a tumor has any credibility.
There have been numerous instances of supplements having good efficacy in treating disease. On the other hand this raises enough suspicion that the supplements end up being analyzed and have been found to contain pharmaceuticals…..imagine that!
And you need to consider the largely unexplored (in the Anglophone world) efficacy of suppositories.
IOW, when the evidence indicates against your view, the evidence must be wrong. Understood.
From Medscape:
In a study using inactive pacemakers, the patients that had the fake pacemaker:
No, WJM, it isn’t the case that the ‘evidence’ is necessarily wrong simply because it goes against my or anyone else’s view. We (rhetorical we that is) are not approaching these subjects in a vacuum. There is a wealth documentation/studies/experiments available that indicates the types of rational people use to believe, and propagate, extreme positions
You threw out one of the weakest types of claims possible….the unverifiable testimonial and expect everyone to accept it at face value. Your lack of consideration of the details that are missing is quite telling but then again you believe what you want because you find it attractive not because the evidence is compelling. Anyone can easily make a fairly extensive list of what data is missing and must be present in order to support the conclusion. You can set the bar as low as you wish (and it appears to be a very very low bar for you) but it doesn’t make the obviously missing data no longer a problem for the claim(s).
When I managed a drug store, I was privvy to all the trade publications that came through for the pharmacy. In those trades, any drug effectiveness would be compared to a placebo on a graph, and the placebo was always to some degree effective vs no treatment, and often nearly as effective as the drug.
One thing I find interesting in looking up information today is that the limits of placebo treatment and effectiveness is not something that appears to have been studied much in its own right. Wonder why?
I also noticed that medicine is moving away from using placebos – no wonder! Hard to sell drugs with a straight face when your drug has only been shown to be marginally better than a placebo. And, we wouldn’t want people getting the idea that their health is largely a matter of mind.
What claim do you think I made? Also, I expected no one to accept it at all. Someone asked me a question about some of my experiences – I answered by reiterating an experience of mine. You act here as if I was attempting to make a case of some sort; I was not.
I suggest you re-read that thread to find out what was actually going on, what I actually said, and in what context.
WJM, you should really include proper citations when you report results from any study or source. It is common courtesy.
I’m not sure what you find compelling here. Subjective perception of pain is one of hallmarks of the placebo realm. That debridement is not effective (apparently but can’t verify due to lack of citation) in relieving knee pain means what exactly in the placebo context. I can show you studies from asthmatics who subjectively believed their symptoms were much reduced while taking placebos but the objective measurements indicated a different story.
IN the pacemaker study (if it is the one I think you are referring to you’ve left out a large portion of the data and conclusions. Why only you can answer…perhaps they didn’t fit your view so they were wrong.
Except I’m not the one with a conclusion that requires supporting. All I’m doing here is providing information from medical studies that appear to contradict your claims about what the placebo effect can and cannot do. Observers can come to their own conclusions about how you and others react to this information.
Pacemaker placebo study
http://www.ncbi.nlm.nih.gov/pubmed/10190407
I was referring to the Mr. Wright claims you presented as well as the claim you made about faith healing being effective in curing cancer.
I’m glad to see you expected no one to believe what you posted….they have good reasons for no doing so.
Well you were trying to make a case on both counts: One that faith healing works to cure terminal cancer and two that you think placebos shrink tumors. Both are testimonials which have no evidentiary support. To test this try to find the actual case study of Mr. Wright and see what clinical data is available to support this. There are some fairly humorous claims surrounding this ‘event’, e.g., Mr Wright found out that the drug was bogus (for the second time) and his tumors regrew and killed him in two days……do you see anything wrong or missing from this type of allegation?
WJM, all you are doing is furiously googling a subject you know little about and throwing it out there to see what sticks. you are not vetting the information for quality or veracity and when questions arise as to the quality, or lack there of, in the study you just become dismissive and refuse to drill down and look at the details….you know that area of science where the devil resides.
Yes, observers ca come to their own conclusions about how you react and respond to an attempt to discuss details of vague generalities.
Shrinking tumors and detectable pacing effects are not “perceptions of pain” or “perceptions of psychological distress”; they are measurable. It is interesting that when faced with two scientific reports of placebo effects having physically measurable effects that you question the evidence or my motives.
The indication here is that you have an a priori bias against information that supports the contention that the mind can effect real physical changes in the body, such as tumor reduction or LV outflow.
Your use of the term “subjective perception of pain” seems to dismiss the idea that there is an actual physical agency triggered by the mindset of the patient that experiences a reduction in pain – that the placebo effect is psychological in nature.
http://phys.org/news105029324.html
Attacking me and characterizing me negatively doesn’t change or address the scientific evidence I’ve provided that appears to contradict your claims about placebos.
WJM, we previously discussed lowering of blood pressure which by the way is measurable, so your claim is quite empty and contrary to what has already been posted. I am not questioning your motives I am only pointing out how you are responding.
No that again is not the case. The tumor shrinkage claims are completely unverifiable so are we to take the conclusion at face value?
As I stated previously, when you cited the pacing studies you failed to report much of the results. However, that placebo/nocebos can, and do, elicit physiological effects is not in question. What is in question is the significance of the results. is it surprising to you that a reduction in anxiety (non-pacing placebo group) can result in a relaxed vasculature promoting increased blood flow?
pointing out what you are doing is not an attack it is simply the facts as anyone can see. We also have past history to work off of as well in regards to your supporting your assertions.
WJM, the placebo effect is entirely psychological in nature. That perceptions can cause measurable physiological responses is no surprise. For example someone can take baseline measurements of cortisol and epinephrine levels and then send you through a ‘haunted house’. At some point something leaps out of the darkness and surprises you. Blood is then drawn and cortisol and epinephrine again is measured. Would it surprise you that this psychological experience has caused these levels to be measurably different? how is the perception of nurturing and caring (e.g., visit to the acupuncturist or massage therapist) any different?
Can there not be another study made about the capacity the placebo effect to shrink tumors? Of course it is verifiable – the real question is, why has there been so little real research in to the healing capacity of the placebo effect? Why has no one attempted to verify that 1957 case work?
Perhaps it is a mindset that such events are coincidental? Perhaps the idea that a placebo effect can be as effective (at least for some people) as drugs undermines the standing of big pharmaceuticals and the medical industry? For something that has been known to exist for as long as the placebo effect has been known to exist, there has been startlingly little research conducted wrt how it works and what actually is responsible for the effect.
WJM, this is the basis for the psychological response. The researchers could have manipulated the patients into believing that the compound was a nocebo and patients would have, likely some at least, responded negatively to the compound treatment. Same compound different results (the article I posted earlier describes this scenario as well). Is it the placebo eliciting the response or is it a psychological response in the patients triggering the response?
Please support this assertion.
<Can there not be another study made about the capacity the placebo effect to shrink tumors? Of course it is verifiable – the real question is, why has there been so little real research in to the healing capacity of the placebo effect? Why has no one attempted to verify that 1957 case work?
Because real world oncologist see the opposite. WJM, we aren’t operating in a vacuum here there is much in support for not investigating such dubious claims. it also be quite unethical to conduct a placebo treatment as a cancer curative.
Previously, I linked to a cite operated by Peter Moran. Dr. Moran is/was a cancer specialist. He felt obliged to his patients to track down and verify such curative claims if they might be of help to his patients. He outlines his work in this regard on his website. You should take the time to read his or other sciencebased medicine sites. As Dr. Moran states repeatedly he regularly saw patients who choose alternative treatments of science-based medicine and once they realize the their choice was poor they present to the oncologist with advanced disease with poor prognosis….can anyone say Steve Jobs?
Dr. Gorski is another cancer specialist who has extensively commented on this topic. His work is also worth reading.
WJM, I already have using the citation you provided also see the article I posted previously.
WJM, the placebo/nocebo effect is entirely based on the perception of the patient for the likelihood of a ‘good’ or ‘bad’ outcome/response in taking the inert formulation. you can give the same inert compund and depending what story you tell the patient you will get opposite responses. If it isn’t the perception of the patient driving the response what is it? It certainly isn’t the inert chemical compound or sham needling that is proving the response. That narrows the field of possibilities quite quickly to a single conclusion.
Your own paper and your own responses above contradict your assertion that “WJM, the placebo effect is entirely psychological in nature.”
You do know the difference between “psychological” and “physiological”, do you not? When a placebo effect entails measurable physical effects in the body like a change in electrical and metabolic activity and the release of pain or depression-fighting chemical agents, the placebo effect is no longer “psychological” – it is physiological.
A genetic disposition to placebo effects is physiological, not psychological.
Your own paper contains a great deal of scientific evidence that contradicts your claim that the placebo effect is entirely psychological. You yourself directly contradicted this assertion when you said:
These two statements of yours are contradictory:
WJM, here is a follow up study to your pacing citation:
As you can clearly see the placebo effect was not durable and required early intervention to return to active pacing to reduce obstruction and improve blood flow. this is a typical response with placebo treatments.
Where did I challenge or offer any evidence challenging your view of the durability of the placebo effect?
I know the difference but do you?
When you can give the same inert chemical compound to two groups of patients and tell them differing stories of efficacy or adverse side effects and elicit two opposite response in physiology are the changes due to the placebo/nocebo itself (remember these are inert) or to the psychological perception of the patient for benefit or harm. The root cause of the effect(s) is not in the inert chemical compound but is in how the patients are primed for expectation, i.e., a psychological response.
The physiological measurements are the endpoint(s) but what we are concerned is with what generated those responses and it clearly is psychological in nature. If you don’t buy this explanation provide your alternative.
Do you think you can give a unconscious person a placebo/nocebo and see the same response(s) that are noted in the patients who have been psychologically primed for expectation of what the inert pill will do?
WJM, it isn’t my view of the durability of the placebo effect it is the data that demonstrates if it is or if it isn’t…….and it isn’t. Durability is a prime concern when treating patients with placebos. Which , of course, is why it is unethical to do placebo trials with cancer patients.
BK,
You asserted that the placebo effect is “entirely psychological in nature”. Trying to fix attention on the inert quality of the medication doesn’t change the fact that a lowering of the blood pressure or the release of natural opiates in the body that reduce pain are physiological aspects of the placebo effect.
While the placebo effect may sometimes be strictly psychological (such as the perception of reduced symptoms in the asthma experiment), you’ve admitted and the science clearly demonstrates that in other cases, the effect is not “entirely psychological in nature”, because there are measurable physiological elements and effects involved.
Psychology may cause those physiological elements and effects, but it is all part of “the placebo effect”, and thus not “entirely psychological in nature”.
No ‘may’ about it, WJM. It is why you can give the same inert (and yes I am emphasizing this for a reason) chemical compound and elicit opposite effects in a patient groups is entirely dependent on how the patients are primed. The response is entirely psychological in nature since the entire manifestation of measurable endpoints is dependent on how, and what, the patients are told about the anticipated effects they might have after ingestion of the inert chemical compound.
the key component of the placebo effect is based in patient priming and anticipation. It has nothing at all to do with what is given to the patient(s) it is all in the story and expectation of the patient. You are confusing the map with the territory.
WJM, when you conduct an experiment it will involve collecting some form of data. The data are not part of the treatment they represent what may be a result of the treatment. With placebo/nocebo treatments a principle part of the treatment is the psychological conditioning of the patient with an intent to treat and what effects, adverse and/or beneficial, they might expect. That is the treatment. The measured physiological parameters are the data and are related to, but do not constitute, any part of the treatment.
I want to comment on the OP. It took me a while to understand your point and now realize how salient that point is wrt my entire operational worldview. Very interesting stuff. Never heard of Newcomb’s money boxes before and it was fun to read about, and the way you set it all up in the O.P. was really clever!
BK,
You are confusing the placebo item and the priming of the patients before the effect with the effect that follows. The effect that follows, which is called “the placebo effect”, has physiological, objectively measurable components. It is not “entirely psychological in nature”.
The placebo may be entirely psychological in nature; the effect of that placebo is certainly not.
The treatment is not the effect of the treatment. Placebo is the treatment. Placebo effect is the effect of that treatment.
From Merriam-Webster, the Medical definition of Placebo Effect:
The placebo effect is the improvement in the condition of the patient, not the treatment. The improvement is often physiological and objectively measurable, not psychological.
You’re wrong. Just admit it.
WJM, you still don’t get . The placebo effect is entirely elicited and caused by the psychological priming of the patient. The endpoints are only a measure of the efficacy of the treatment.. One effect with one story and another effect with another story. The data is predicated on how the patient is primed/conditioned and this priming of the psyche is the ‘placebo effect’. You’ve created, in the patient, a belief that with the placebo treatment things will get better. you could just as easily have done the opposite. This is where the ‘effect’ lies in the changing of expectations and the measured endpoints represent the data that are used to evaluate how effective the psychologically priming of the patient was in influencing the data.
William J. Murray,
Ethics. Comparison of no treatment at all vs pretend treatment tends to be frowned upon.
Funding. There is less money than there are research proposals, so more unusual ideas tend to lose out.
Economics. The cold hard fact is that much research is driven by having something saleable at the end of it. I don’t think this is a huge secret.
I’d recommend Ben Goldacre’s Big Pharma. For other reasons, I’d also recommend his earlier Bad Science.
WJM, Your claim might have more merit were you to actually engage. Answer the question!
What the placebo effect is cause by is irrelevant to whether or not the placebo effect itself is “entirely psychological in nature” or if there are also physiological aspects of the effect. You are mistaking treatment (the placebo) for the effect (the change in conditions).
Since there has been so little research in this area, this can only be your assumption based on an a priori metaphysical commitment about what is possible in terms of generating what we call the placebo effect.
This goes back to the OP’s Newcomb money box example. People like BK, due to a priori metaphysical commitments about the nature of reality, “know for certain” that their choice cannot change the current allocation of money in the boxes, so despite empirical evidence that suggests otherwise, they take both boxes.
The a priori commitment is demonstrated in this case by the certainty that only one of two things can possibly be responsible for the effectiveness of the treatment; the physical item (pill, pacemaker, surgery) or the psychology of the patient. Notice how this a priori assumption is the basis for the question assumed to be rhetorical in nature:
My answer is: I don’t know. Has it ever been tried? I assume you and Omagain believe there would be no placebo effect if administered to unconscious patients; if there is no empirical evidence gathered from such a test, what is your belief (and this challenge) based on if not an a priori commitment about what the placebo effect is generated by?