back

by pella·12y ago·view on hn ↗
"- Administration of placebos should be considered when a patient is refractory to standard treatment, suffers from its side effects, or is in a situation where standard treatment does not exist."

from: http://jme.bmj.com/content/40/4/219.full

"The moral case for the clinical placebo"

1 comments
Thanks for the link. I note that it reports, "Nevertheless, it is important to mention that according to an influential 2001 meta-analysis comparing placebo-treatment arms with no treatment, placebos make no clinical difference." The citation at that sentence is to an article that lives online in free full text[1] that we can all download and read.

The same team's updated Cochrane review[2] still sums up the evidence by saying, "We found an effect on patient-reported outcomes, especially on pain. Several trials of low risk of bias reported large effects of placebo on pain, but other similar trials reported negligible effect of placebo, indicating the importance of background factors." They add a caution about experimental methods consistent with the article submitted here on HN: "The use of placebos in blinded randomised trials is a precaution directed against many forms of bias, and not only against effects of placebo. Unblinded patients may differ from blinded ones in their way of reporting beneficial and harmful effects of treatment, in their tendency to seek additional treatment outside the study, and in their risk of dropping out of the study. Furthermore, unblinded staff may differ in their use of alternative forms of care and in their assessment of outcomes. Thus, even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding."

[1] https://math.dartmouth.edu/~doyle/docs/40/PlaceboArticle.pdf

[2] http://summaries.cochrane.org/CD003974/COMMUN_placebo-interv...

placebo paradoxon- different teams - different conclusions :)

I agree with this:

"It is evident that placebo effects are real and that they have therapeutic potential. Laboratory evidence supports the existence of numerous placebo mechanisms and effects in both healthy volunteers and patients with a variety of medical conditions. Furthermore, clinically relevant evidence demonstrates that placebo effects can have meaningful therapeutic effects, by virtue of magnitude and duration, in different patient populations. Although substantial progress has been made in understanding placebo effects, considerable scientific work remains to be done in both laboratory experiments and translational clinical trial research, ---> with the ultimate aim of harnessing placebo effects to improve patient care."

Damien G Finniss,corresponding author Ted J Kaptchuk, Franklin Miller, and Fabrizio Benedetti

"Placebo Effects: Biological, Clinical and Ethical Advances"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/