http://www.amazon.com/Placebo-Effects-Understanding-mechanisms-disease/dp/0199559120 I hope it helps!

Thank you Charikleia! I will order this book.

The famous cancer statistician John C. Bailar (2001) wrote the following in the introduction to his article "The powerful placebo and the Wizard of Oz" (http://tinyurl.com/cbnlexm): "Some myths really ought to be true. We react with surprise and pleasure when we encounter them and then believe them when they neatly and comfortably help to explain some confusing aspect of our world. Thereafter, evidence against them is unwelcome and not to be trusted. But some such myths are flawed and misleading."

Until the 1900s, acted almost all drug treatment on placebo, as there were very few effective drugs. Many things, which the established medicine will not accept, have been rejected with the phrase "just placebo".

I do agree with the need to increase and improve studies on this topic. Some good papers have been published by Benedetti and co-workers (you can find lots of references in Medline).

Hi Geir,

Although there were a lot of "snake oil" remedies on the market prior to the early 20thC, it's not strictly true to say that MOST medicines prior to the 1900s were placebos- the most common OTC and prescribed medications in the 1800s contained ingredients like camphor, ethanol, opium, morphine, heroin, caffeine, nicotine, cocaine, ephedra, cannabis tinctures and a host of other active herbal and mineral ingredients. (Whether the benefit people reported from these medicines was because the active ingredients "cured" the disorder, or simply masked or repressed the symptoms, is another matter).

There is a "real" placebo effect, although in many studies a percentage of the effect attributed to placebo is probably just "return to the mean".

There is quite a good discussion here;

http://www.skeptic.com/eskeptic/09-05-20/#feature

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Paul.

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I wouldn’t describe it as “simply” a matter of anything.

I’m not convinced there is one single simple explanation for all placebo phenomenon, but I think there are sufficient (but several and different) explanations for most or all effects observed/reported.

The paper Sandra linked to shows that you can condition at rat to associate an unrelated stimulus with pain relief, such that the stimulus alone will induce the rat to tolerate pain better. The same sort of operant conditioning is happening in humans as well. Conditioning is just hardwiring an association into your nervous system.

Whenever you learn something new, you are physically forging new connections between brain cells.

(And if you didn’t already know that, then you have subtly altered the shape of your brain, just by reading that sentence).

Mental state affects brain chemistry. Brain chemistry affects mental state. Now loop these two sentences recursively, and you are starting to affect brain structure.

Placebo responses are strongest to pain, which is a highly subjective symptom. The endogenous opioid system is involved in this, as evidenced by studies that demonstrate that naloxone (Narcan) blocks placebo pain relief.

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From Sandra’s first post: http://placeboforschung.de/wiki/index.php?title=General_Information

You write;

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You are quite correct to point out that placebos work on very small children, BUT they only do so when an adult gives them the placebo and tells them it is medicine. Social conditioning begins at birth, (and quite possibly in utero). There is an expectation on a child’s part of feeling better whenever a care-giver offers care. If you slip a tasteless odourless placebo into their drink without their knowledge nothing happens.

Note that placebo pain killers don’t work on newborn infants, but cuddling, stroking or swaddling them; (or even their mother’s soothing voice); will make them feel better, and does so by activating the neurotransmitter release of oxytocin and endogenous opiates.

Note also that placebos don’t work on unconscious people, or on people who do not know that they have been given anything; however strong pain killers like morphine and buprenorphine have a greater analgesic effect when administered with the patient’s knowledge than when administered secretly. If the patient is told it is a new, more effective drug they will typically report even more pain relief.

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I don’t know where the “missing” pharmacological explanation for non-pharmacological, neurochemical events might be hiding… …I usually start by looking behind the couch.



If it’s not there, try reading the excellent article Sandra linked to.

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So, is it all “simple” conditioning?

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From Sandra’s first post: http://placeboforschung.de/wiki/index.php?title=General_Information

Paul.

Thanks for all the posts on this issue; for interesting views on placebo, and links to relevant material for those who want to read more.

there´s another dimension to that: in my opinion, views on and attitudes toward placebos and placebo use are subject to changes in society, culture and medical sciences resepectively. Now, there´s an interesting topic for further research isn´t it?

Is it cheating to take advantage of the placebo effect in medical treatment?

Is it "cheating?"

Rationalwiki says;

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http://rationalwiki.org/wiki/Placebo_effect#Ethical_considerations

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However these effects are part of a lot of medical practice. Every winter many people contract colds or influenza, and go to see their general practitioner, who almost always prescribes antibiotics.

If someone's immune systemn is weakened by fighting the flu, antibiotics may be a useful prophylactic, to prevent opportunistic bacterial infections, but obviously the antibiotics don't cure viruses like influenza.

Typically, a few days into the course of antibiotics, the patient starts to feel better and attributes their recovery to the medicine, when in actual fact they are just "regressing to the mean" and probably would have recovered at the same time without medication.

http://scholar.google.com.au/scholar?q=ethical+issues+placebo+effect&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ei=JGlSUbLGGu6ZiQeKk4GwAw&ved=0CCwQgQMwAA

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Paul.

Hi Geir, To begin to answer this question, we have to go back to the origin of the word - I will please [God]- as well as to the brain. I would suggest to read the research :Fabrizio Benedetti, Helen S. Mayberg, Tor D. Wager, Christian S. Stohler, and Jon-Kar Zubieta, “Neurobiological Mechanisms of the Placebo Effect,” Journal of Neuroscience 25, no. 45 (November 9, 2005):10390-10402, doi:10.1523/JNEUROSCI.3458-05.2005 SYMPOSIA AND MINI-SYMPOSIA. New research has shown that what is named the Mammalian and Universal brains in the LIFE biosystem model react most strongly to placebos. These are namely the areas of the anterior cingulate, left nucleus accumbens, right anterior insula, as well as the left dorsolateral prefrontal cortex of the Analytical brain, which is linked to awareness and short-term memory (and receives inputs from the ventrolateral PFC). In fact I personally believe that the psychological filters we live with (middle prefrontal cortex) either allow or block the placebo effect.

We know that the placebo effect releases endorphins and is instantaneous which calls in other physical and subtle stuctures which I discuss in my book. yes the placebo effect is not only a vague term but has some strong physiological reality.

Hope that helps!

For different (additional) perspectives and explanations of placebo from the ones mentioned above I strongly recommend Daniel Moerman's Meaning, Medicine and the 'Placebo Effect' (and his other articles on the same issue). There is also an interesting chapter on placebo (and homeopathy) in Brooks's 13 Things That Don't Make Sense: The Most Intriguing Scientific Mysteries of Our Time.