Homeopathy and Placebo Effectiveness

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tomandlu
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Homeopathy and Placebo Effectiveness

Postby tomandlu » Mon Jul 08, 2013 8:27 am UTC

Disclaimer - I'm making the assumption here that any positive effect from homeopathy is purely related to the placebo effect.

I was wondering if any studies had been done on how to maximise the placebo effect in general - is, for instance, the placebo effect associated with homeopathic medicine more effective that, say, your doctor giving you a sugar pill?

Specifically, are users of homeopathy self-selected for susceptibility to the placebo effect. In addition, does the mythology and ritual surrounding homeopathy boost the effectiveness of the placebo effect?

I guess both these questions would come down to a few questions:

  • Do homeopathic users respond better than average to other placebo delivery mechanisms?
  • Do non-homeopathic users respond less to homeopathy than homeopathic users?
  • Do non-homeopathic users respond more to homeopathy than to a less ritualised placebo delivery?

It does strike me as a shame that more effort isn't put into understanding and utilising placebo effects, or have I missed that there's more work and activity taking place in this area than I'm aware of...
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Re: Homeopathy and Placebo Effectiveness

Postby D.B. » Mon Jul 08, 2013 10:18 am UTC

There's been at least one study which pointed towards more expensive placebos being more effective. You get what you pay for, I guess.

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Re: Homeopathy and Placebo Effectiveness

Postby tomandlu » Mon Jul 08, 2013 10:32 am UTC

D.B. wrote:There's been at least one study which pointed towards more expensive placebos being more effective. You get what you pay for, I guess.


Yes - I knew about that (and the bizarre observation that placebos can still be effective even if you're told that you're taking a placebo*). I was wondering more about attempts to maximise placebo effectiveness in a clinical purposes, rather than a vague clinical recommendation to "stay positive".

* I have anecdotal evidence of this - I was given a homeopathic cure for insect bites after a particularly nasty encounter with some mosquitoes, which I took out of politeness, and it was very effective.
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Re: Homeopathy and Placebo Effectiveness

Postby Xenomortis » Mon Jul 08, 2013 10:56 am UTC

Pick a fight with some more mosquitoes, but this time don't take anything afterwards.
Image

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Re: Homeopathy and Placebo Effectiveness

Postby idobox » Mon Jul 08, 2013 11:17 am UTC

The ritual is considered to be an important part of the placebo effect
In the treatment of pain, for example, big, dark-colored, bad-tasting placebos are more effective than small, brightly colored, good tasting ones; placebos delivered intravenously are more effective than placebos delivered intramuscularly, which in turn are more effective than placebos delivered orally (

The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface control12). And it appears that the effect of a placebo was a constant proportion of that of the active agent to which it was compared: placebo believed to be aspirin is roughly 55% as effective as real aspirin, but placebo believed to be morphine is roughly 55% as effective as real morphine (

The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface control12). More recently, we have learned that expensive placebos are more effective than cheap ones (

The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface control13).

from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582657/
So, make them taste bad, ugly, including some side effects, and requiring a complex procedure, and you'll get better results.
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Re: Homeopathy and Placebo Effectiveness

Postby ImagingGeek » Tue Jul 09, 2013 8:41 pm UTC

I don't think any studies have been done for the explicit purpose of maximizing placebo 'effectiveness', but enough work on placebos has been done for us to be able to propose methods to do just that. . .and most have been mentioned already. Basically, anything that creates the mental expectation in the patient that the placebo will do something, will increase the placebos apparent effectiveness. This can be anything from making it look/taste like 'medicine', to having the person providing the placebo look 'doctory', to telling the patient just how well its going to work (and oddly, just how nasty its going to make them feel).

But at this point its worth mentioning that the placebo effect only typically improves a patients perception of their illness - i.e. they will self-report as feeling better. In some cases this is significant - i.e. treatment of pain or nausea, where the issue is patient perception. But effects on actual disease severity and progression are minimal-to-none. I.E. if there is a objective readout of disease severity (e.g. CT scans of tumours), little-to-no effect is observed. Even in the former cases, the effects are generally small and short-lived.

In other words, optimizing placebo effects is likely possible - but ultimately, not very useful.

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Re: Homeopathy and Placebo Effectiveness

Postby tomandlu » Wed Jul 10, 2013 7:39 am UTC

ImagingGeek wrote:In other words, optimizing placebo effects is likely possible - but ultimately, not very useful.

Bryan


Hmm... a very scientific response (and interesting) but somewhat dismissive... almost all illnesses - particularly chronic ones - have a pain or other component that could well benefit from effective placebos (nausea, fatigue, etc.). I work in healthcare IT, and I also have a family member with serious medical issues, and it seems a shame that, even amongst medical professionals, that the area is considered only vaguely.

To put it another way, the word 'placebo' has a lot of negative connotations - it's seen as a trick or as way of explaining fraudulent treatments, rather than as a phenomenon that, properly understood, could be a useful clinical tool for managing patient well-being, but, at best, it seems to receive a nodding and rather condescending acknowledgement and a rather vague suggestion to 'think positively'.

As an comparison - we all know the experience of being in the zone when playing a game or similar activity, and professional athletes presumably spend a lot of time learning to make the experience governable. In other words, they are trying to isolate the process and refine it, much like a method actor is trying to isolate the creative, but uncontrolled, spark that can occur on stage. (there's an anecdote in Stanislavsky's books where an actress gives an astounding cry of "help me" in a particular scene that sets everyone's hair on edge, but is then unable to reproduce it, because the inspiration that triggered it was instinctive - Stanislavsky wanted to find a way to make these moments more controllable).

Anyway, enough rambling...
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Re: Homeopathy and Placebo Effectiveness

Postby idobox » Wed Jul 10, 2013 11:09 am UTC

What ImagingGeek tried to say, I think, is that placebos can't cure you. And many people focus on curing people, and see pain relief as a less important goal. That being said, there are a number of diseases that are mostly characterized by subjective symptoms (mental illness, chronic fatigue, phantom members, etc)

I'm pretty sure the marketing department of pharma companies pay a lot of attention to the placebo effect, but, unlike with drugs, there is nothing to patent, and anybody can copy your results with little to no cost. It is a big disincentive for research.
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Re: Homeopathy and Placebo Effectiveness

Postby dukederek » Wed Jul 10, 2013 12:33 pm UTC

this video seems hugely relevant.

http://www.youtube.com/watch?v=O1Q3jZw4FGs

Ben Goldacre basically talking about all of this stuff, injected placebos working better than pills and really excitingly people feeling side effects they expect from placebos.

He's also awesome at talking enthusiastically!

EDIT: should probably say it's sort of NSFW, he starts talking by referring to "skullf***ing with his data c**k". Fine for headphones but probably not on massive speakers at your desk!

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Re: Homeopathy and Placebo Effectiveness

Postby tomandlu » Wed Jul 10, 2013 1:20 pm UTC

dukederek wrote:this video seems hugely relevant.

http://www.youtube.com/watch?v=O1Q3jZw4FGs

Ben Goldacre basically talking about all of this stuff, injected placebos working better than pills and really excitingly people feeling side effects they expect from placebos.

He's also awesome at talking enthusiastically!

EDIT: should probably say it's sort of NSFW, he starts talking by referring to "skullf***ing with his data c**k". Fine for headphones but probably not on massive speakers at your desk!


Ooo, thanks - love Goldacre (his book, Bad Science, is a nice mixture of mirth provoking and wrath provoking, as it should be).
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Re: Homeopathy and Placebo Effectiveness

Postby ImagingGeek » Thu Jul 11, 2013 1:40 pm UTC

tomandlu wrote:Hmm... a very scientific response (and interesting) but somewhat dismissive... almost all illnesses - particularly chronic ones - have a pain or other component that could well benefit from effective placebos (nausea, fatigue, etc.). I work in healthcare IT, and I also have a family member with serious medical issues, and it seems a shame that, even amongst medical professionals, that the area is considered only vaguely.

I never meant to imply that control of symptoms was valueless; however, even placebos for that purpose are of minimal use - their effects tend to be short-lived and weak. Control of nausea in a cancer patient, as an example, can be the difference between remission and death. But why would you use a tool that has only a modest effect for a short period of time, when there are 'real' drugs (real, as in have a specific biochemical effect that ameliorates the symptom) that have stronger and more persistent effects?

tomandlu wrote:To put it another way, the word 'placebo' has a lot of negative connotations - it's seen as a trick or as way of explaining fraudulent treatments, rather than as a phenomenon that, properly understood, could be a useful clinical tool for managing patient well-being

In some countries they are used for that very purpose - sort-of. Some countries allow MDs to prescribe placebo pills when patients are demanding treatment for something that is otherwise untreatable or doesn't require treatment (i.e. a parent demanding antibiotics for their child's cold). Its not overly honest, but it does serve the dual-purpose of providing a patient with what they perceive they need (a treatment), while simultaneously protecting public heath from mis-use of antibiotics.

But again, I would ask why you think optimizing placebo effectiveness is valuable? Substantial improvements in the strength of the effect and its duration would still make it sub-par to existing therapeutic modalities. A placebo can make you think you feel better - medical interventions can make you feel better (and sometimes, even cure what ails you).

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Re: Homeopathy and Placebo Effectiveness

Postby The Geoff » Thu Jul 11, 2013 10:18 pm UTC

A placebo doesn't have to be inert - cause a few side effects and the patient will be even more convinced it's "working". This was pretty much how medicine has worked through human history, many medications were purgatives of some description, and just about the only thing that Hahnermann was right about when he invented homeopathy was that it was a less harmful version of what already existed - he was generally quite correct, a sugar pill is usually better for you than some mercury laced tincture.

Derren Brown did a whole program on the Placebo effect, "Faith & Fear" which showed some interesting effects - there's a brilliant scene where he has a guy who was petrified of heights sitting on the edge of a bridge...then he told the guy he'd been taking a placebo.

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Re: Homeopathy and Placebo Effectiveness

Postby webgiant » Mon Jul 29, 2013 12:34 am UTC

tomandlu wrote:
D.B. wrote:There's been at least one study which pointed towards more expensive placebos being more effective. You get what you pay for, I guess.


Yes - I knew about that (and the bizarre observation that placebos can still be effective even if you're told that you're taking a placebo*). I was wondering more about attempts to maximise placebo effectiveness in a clinical purposes, rather than a vague clinical recommendation to "stay positive".

* I have anecdotal evidence of this - I was given a homeopathic cure for insect bites after a particularly nasty encounter with some mosquitoes, which I took out of politeness, and it was very effective.


The thing to remember about "homeopathy" is that sometimes, in addition to the milk sugar and the plain water, a "homeopathic remedy" sometimes contains actual herbal and/or chemical ingredients which have an actual pharmacological effect, such as easing the pain of an insect bite with something like aloe, in alongside the "50X" milk sugar and the "100X" plain water. Naturally, when such non-homeopathic ingredients perform their intended function, the homeopathic people claim the real reason you're feeling better is the milk sugar and the plain water.

By the same reasoning, 90% pure alcohol doesn't get you drunk, its actually the 10% water content "remembering" all the human excrement that has passed through it.

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Re: Homeopathy and Placebo Effectiveness

Postby The Geoff » Mon Jul 29, 2013 1:21 am UTC

Really? I can't think of any form in the UK that does that, it wouldn't be profitable (which is what it's all about) as it would have to go through far stricter controls as a herbal medicine. It relies on not having any effect to get it past medical red tape, but oh so quietly.

One company has been prosecuted after the product was filmed running down the outside of the bottles as it was being prepared, they got done for broken glass in bottles though, they entirely rely on not being taken seriously enough to be regulated properly.,

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Re: Homeopathy and Placebo Effectiveness

Postby Copper Bezel » Mon Jul 29, 2013 2:10 am UTC

The US is weird about this - the product doesn't have to go through those checks if it's being labeled as homeopathic, leading to exactly the screwed up incentive system you'd expect.
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