What does the placebo pill have to do? | Universe weekly taster – mahrgan

This article on the placebo effect first appeared on Cosmos Weekly on October 1, 2021. More stories about this category, Subscribe to “Universe Weekly”.

The website of Zeebo Relief pills reads like any other dubious fuzzy alternative health treatment. “Help you to exert your physical and mental strength,” the site is enthusiastic. These pills have been “used in published clinical trials” (it is always “used” with these things, rather than “shown to be effective”) for “chronic pain, stress and performance.” They obviously allow you to design your own experience and “focus on concentration, clarity, calmness, and symptom relief.”

But there is a key difference between Zeebo and homeopathy, which, if not respectful, deserves at least some attention: Zeebo pre-declared that their pills have no medical effect. They are “honest placebo pills”.

“You are the active ingredient,” the website insists. The idea is that you take the pill, knowing that it will not do anything, but-through the psychology, biology, or possible magic of the placebo effect-your symptoms will be reduced. These pills are currently US$20 (approximately US$27) per bottle plus shipping; prices fluctuate.

Placebo plays a vital role in clinical trials. Without a placebo, it is difficult to distinguish the effect of the drug you are testing from the effect of just participating in the trial—whether it is positive or negative.

But clinical trials have never been the only place for placebos. We know that people who believe they are receiving treatment usually get better, and in the past few centuries, there have been some examples of trying to turn this treatment into real treatment.

This interest has intensified in the past decade. A 2010 Cochrane review found that although placebos are ineffective in most cases, they are slightly better at reducing pain and nausea. Since then, studies have sprung up, advocating the use of placebos, especially for chronic pain, but also for other diseases.

Professor Chris Maher of the University of Sydney School of Public Health pays attention to these studies, most of which are small in scale and none of them are deterministic.

Without a placebo, it is difficult to distinguish the effect of the drug you are testing from the effect of just participating in the trial—whether it is positive or negative.

“In the past two or three years, I have been reading a lot of reviews and editorials. People over-promote the research in these reviews and editorials and strongly recommend that clinicians should use placebos in clinical care. This seems true to me. It’s an unwise step,” he said.

Maher is the lead author of the most recent view Australian Medical Journal It is cautioned not to absorb any of these studies too enthusiastically. The paper argued that the placebo proved ineffective, and the trials that showed the most promising results were almost all small-scale and peculiar methods.

“Most research is characterized by poor quality,” Mach said.

“For example, it is generally believed that the color of the placebo capsule will affect the effect. People think that the red pill is better than the white pill. But when you go back to the study […] The people involved are not actually taking birth control pills. They just line up the pills on the table and ask people who have no health problems:’Which of these pills do you think is the most effective? ‘.

Other studies on open-label placebos have theoretically produced more promising results. One was about low back pain. I prescribed an open-label placebo for three weeks, and then claimed that the participants felt the benefits after five years.

“The way they achieve this goal is to discard the data from the control group. Most clinical trials just look at it and say,’This is crazy, why are you doing this?'” Maher said.

“There is no analgesic that can take you for three weeks of chronic low back pain, and after five years you will claim to be effective.”

Maher said that in placebo studies, especially in open-ended placebo studies, two things happen.

“Some people follow the usual scientific rules and sum up things fairly. There is another group of people who seem to deliberately make the placebo mysterious and powerful.”

He thinks this is particularly worrying, as placebo prescriptions may be increasing among Australian healthcare workers. A paper in 2019 Australian Journal of General Practice It was found that 39% of Australian general practitioners had given patients at least one inert placebo, and 77% had used an “active” placebo: a drug that was effective but could not treat the patient’s condition (for example, prescribe antibiotics for the patient) viral infections ).

Professor Mark Morgan both teaches students and serves as a general practitioner. He is also the chairman of the Royal Australian College of General Practitioners’ Quality Nursing Expert Committee. He is not so alarmed by this statistic. First, this is a small study: the survey used in the study has only 136 respondents. On the other hand, some terms in the survey are ambiguous.

“Some things that are described as placebos, depending on how they are used, will not be placebos. They will be mild treatments,” Morgan said.

An example is saline spray, which was described as a placebo in the study. “When you say to someone,’This is a salt water spray that makes your nose easier to clean’, I would not say that it is a placebo. It will not cure anything, but if you use it it may help relieve symptom.”

Morgan did say that prescribing really useless placebos without telling patients that they are useless is a major breach of trust.

I think the worry about prescribing or using treatments knowing that treatments have no effect on the person is that you are actually violating certain trusts.

– Professor Mark Morgan

“I think the worry about prescribing or using treatments knowing that this kind of treatment has no effect on people is that you actually violate some trust,” he said. “This person’s trust is fragile, but it is also very valuable and necessary for future treatment, the confidence that this person has, and the medical advice they may get.”

The study also touched on another major problem with GP: 40% of placebo prescribers stated that their patients expected or requested treatment.

“This is not a real placebo use. It succumbs to pressure and expectations, and I think this can be overcome with really good conversations,” he said.

“If general practitioners know that treatment is unlikely to benefit patients, to what extent should they respond to treatment requests? I think it boils down to adult-to-adult dialogue and ultimately joint decision-making. You explained the patient’s perspective from the patient’s perspective Potential harm and cost versus potential benefit. This is the topic we talk about every day with antibiotics for coughs, colds and sinus congestion.”

Both Maher and Morgan agree that the placebo effect has some advantages in certain situations, but it should not replace medical care.

“I think there is still some research needed to study the extent to which people’s expectations of treatment affect treatment outcomes. I suspect that the answer is one thing, but it’s not as dramatic as some people think,” Morgan said.

“Some aspects of the treatment ritual do affect the treatment effect, so maybe this is related to the empathy of the clinician and the comfort of the doctor,” Maher said.

“[If] We actually define all the other things in a very rich clinical environment, and then measure them to see if there are related effects, which may be a useful thing.

“But when we are still at the stage of’everything is about the red pill’, I think it’s very simple for me.”

In short-spend the $20 (plus shipping) on ​​something more practical.

This article first appeared on Cosmos Weekly on October 1, 2021.To see more similar in-depth stories, please subscribe now and access our weekly e-publication, as well as access to all past issues of Cosmos Weekly.

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