It is not correct that “we have to compare new cancer drugs to a placebo because a placebo might cause some shrinkage of the tumour”. (That would indeed be nonsense.)
Rather, it is warranted to compare the effect of a drug against a placebo because the improvements measured in patients taking the drug could be artifactual rather than real—they would have gotten better anyway. The placebo controlled design therefore constitues a severe test of the drug’s effectiveness.
In cancer trials, I understand placebos are rarely used (but gaining favor apparently); instead, the control group is given a different cancer drug, one which is known to work. The null hypothesis is “the new drug isn’t more beneficial than the old drug”.
It is not nonsense. Immune response is affected by a patient’s psychological state of mind.
The reason for cancer trials comparing against other cancer drugs has more to do with 1) those trials being part of costly clinical trials that aim for FDA/European approval which needs comparative data and 2) ethic board approvals being contingent on cancer patients not being treated on just placebo in any case.
Also, no such thing as objective pain. The patient may lie about the severity of the discomfort, but if he successfully convinces himself he’s feeling better, he is feeling better.
Lastly, most of your sources make no claim such as “no such thing as a placebo effect”. If you disagree with claims of strong placebo effects, you may find support for the inverse claim, but that would be “the placebo effect is not strong”, not that it doesn’t exist in the first place.
For a DIY, if you don’t have qualms about that sort of thing, give your ailing grandma a sugar pill some time, tell her it’s some leftover pain medication. See for yourself what happens. (Disclaimer: On second thought, don’t do this. There could be a significant nocebo effect involved.)
Incidentally, it is an ubiquitous occurance that patients report feeling the effects of medication long before it has even passed their liver. For relief of subjective symptoms, there is no deeper objective level. Compare Tinnitus treatment. As for cause-and-effect: If you give a pill and there is a shift in the patient’s subjective experience strictly depending on having taken that pill, that’s as much cause and effect as it gets.
Immune response is affected by a patient’s psychological state of mind.
I have come across, but have yet to investigate fully, claims that immune response can be manipulated through classical conditioning. One book claims this as a placebo response mechanism. This is a much narrower claim than “affected by a patient’s psychological state of mind”.
The patient may lie about the severity of the discomfort, but if he successfully convinces himself he’s feeling better, he is feeling better.
That was not the case in the acupuncture study mentioned earlier: patients reported feeling better, but they were still experiencing reduced grip strength. They were feeling subjectively better, but that was at odds with a functional measurement of their condition.
Conditions requiring medical treatment are not, to my knowledge, exclusively subjective. Tinnitus is very much involuntary, and responds to lidocaine (including in placebo-controlled trials conducted after it was observed that tinnitus patients also “respond” to placebo). In other words, people are not able to convince themselves that their tinnitus is gone, but lidocaine can manage that, at least temporarily.
claims that immune response can be manipulated through classical conditioning. One book claims this as a placebo response mechanism. This is a much narrower claim than “affected by a patient’s psychological state of mind”.
Hence my using the broadest category, leaving open the specific etiology of such an effect. “Can be affected by a patient’s psychological state of mind” is necessarily a less burdensome assertion than “can be manipulated through classical conditioning”, because the former is true if the latter is true, but not vice versa (not iff).
They were still experiencing reduced grip strength. They were feeling subjectively better, but that was at odds with a functional measurement of their condition.
I’m not making the claim that placebo works for objectively quantifiable symptoms that aren’t subject to the perception of the patients. Discomfort, however, is.
Conditions requiring medical treatment are not, to my knowledge, exclusively subjective.
There are indeed kinds of e.g. tinnitus that have a component that can be objectively measured. However, if placebo can effectively treat subjective components, that in itself would justify their usage. For many disease complexes, medication will only address partial symptoms. Which is fine. No need for a panacea.
Of course there in an involuntary cause to subjective symptoms, at least involuntary to a first approximation. The effectiveness of placebos does not preclude the effectiveness of other, actual medicine, such as lidocaine. Also, effectiveness implies only a reduction, not a cessation (“not able to convince themselves that their tinnitus is gone”)
Damn, after all this tinnitus talk now I’m cognizant of my own tinnitus. Better take another sip of my, um - (suspending disbelief) - “special” water.
Note that I don’t believe this is limited to cancer trials. Ethical considerations mean that in any situation where a treatment is known to be effective, withholding it would be wrong, so the most effective drug must be competed with. In addition, the goal of a new drug is to be better than its competitors, and comparing it to a placebo wouldn’t help with this
It is not correct that “we have to compare new cancer drugs to a placebo because a placebo might cause some shrinkage of the tumour”. (That would indeed be nonsense.)
Rather, it is warranted to compare the effect of a drug against a placebo because the improvements measured in patients taking the drug could be artifactual rather than real—they would have gotten better anyway. The placebo controlled design therefore constitues a severe test of the drug’s effectiveness.
In cancer trials, I understand placebos are rarely used (but gaining favor apparently); instead, the control group is given a different cancer drug, one which is known to work. The null hypothesis is “the new drug isn’t more beneficial than the old drug”.
It is not nonsense. Immune response is affected by a patient’s psychological state of mind.
The reason for cancer trials comparing against other cancer drugs has more to do with 1) those trials being part of costly clinical trials that aim for FDA/European approval which needs comparative data and 2) ethic board approvals being contingent on cancer patients not being treated on just placebo in any case.
Also, no such thing as objective pain. The patient may lie about the severity of the discomfort, but if he successfully convinces himself he’s feeling better, he is feeling better.
Lastly, most of your sources make no claim such as “no such thing as a placebo effect”. If you disagree with claims of strong placebo effects, you may find support for the inverse claim, but that would be “the placebo effect is not strong”, not that it doesn’t exist in the first place.
For a DIY, if you don’t have qualms about that sort of thing, give your ailing grandma a sugar pill some time, tell her it’s some leftover pain medication. See for yourself what happens. (Disclaimer: On second thought, don’t do this. There could be a significant nocebo effect involved.)
Incidentally, it is an ubiquitous occurance that patients report feeling the effects of medication long before it has even passed their liver. For relief of subjective symptoms, there is no deeper objective level. Compare Tinnitus treatment. As for cause-and-effect: If you give a pill and there is a shift in the patient’s subjective experience strictly depending on having taken that pill, that’s as much cause and effect as it gets.
I have come across, but have yet to investigate fully, claims that immune response can be manipulated through classical conditioning. One book claims this as a placebo response mechanism. This is a much narrower claim than “affected by a patient’s psychological state of mind”.
That was not the case in the acupuncture study mentioned earlier: patients reported feeling better, but they were still experiencing reduced grip strength. They were feeling subjectively better, but that was at odds with a functional measurement of their condition.
Conditions requiring medical treatment are not, to my knowledge, exclusively subjective. Tinnitus is very much involuntary, and responds to lidocaine (including in placebo-controlled trials conducted after it was observed that tinnitus patients also “respond” to placebo). In other words, people are not able to convince themselves that their tinnitus is gone, but lidocaine can manage that, at least temporarily.
Hence my using the broadest category, leaving open the specific etiology of such an effect. “Can be affected by a patient’s psychological state of mind” is necessarily a less burdensome assertion than “can be manipulated through classical conditioning”, because the former is true if the latter is true, but not vice versa (not iff).
I’m not making the claim that placebo works for objectively quantifiable symptoms that aren’t subject to the perception of the patients. Discomfort, however, is.
There are indeed kinds of e.g. tinnitus that have a component that can be objectively measured. However, if placebo can effectively treat subjective components, that in itself would justify their usage. For many disease complexes, medication will only address partial symptoms. Which is fine. No need for a panacea.
Of course there in an involuntary cause to subjective symptoms, at least involuntary to a first approximation. The effectiveness of placebos does not preclude the effectiveness of other, actual medicine, such as lidocaine. Also, effectiveness implies only a reduction, not a cessation (“not able to convince themselves that their tinnitus is gone”)
Damn, after all this tinnitus talk now I’m cognizant of my own tinnitus. Better take another sip of my, um - (suspending disbelief) - “special” water.
Note that I don’t believe this is limited to cancer trials. Ethical considerations mean that in any situation where a treatment is known to be effective, withholding it would be wrong, so the most effective drug must be competed with. In addition, the goal of a new drug is to be better than its competitors, and comparing it to a placebo wouldn’t help with this