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Rtc is very keen to use the word important. In context his preferred text is:
The actual authors' conclusions from the first cited source:
And the second:
I would say that Rtc's wording is a clear misrepresentation of the overall tone of these sources, noting that while Hróbjartsson and Gøtzsche do speak and write excellent English, their language is very formal, and they are not native speakers. Hence the somewhat clumsy "We did not find that placebo interventions have important clinical effects in general" rather than "We found that placebos have no clinically important effect in general", which is almost certainly what a native English speaker would have written.
I think the correct form of words, based on these sources would be:
That seems to me to be the closes to the sources. Both find no clinically relevant effect on objective measures, both play down the relevance of the nonspecific effects. What do others think? Guy ( Help!) 21:09, 17 June 2018 (UTC)
Wait..what? the Placebo effect doesn't exist?[ Citation Need ed -- Guy Macon ( talk) 18:53, 18 June 2018 (UTC)
Related: Wikipedia talk:WikiProject Medicine#Placebo effect.
Like most things related to medicine, I stay away from editing articles or suggesting changes (I have this mental picture of a non-engineer M.D. trying to "fix" our Cockcroft–Walton generator or Hall effect articles...) but I am really good at asking possibly-stupid-possibly-insightful questions. -- Guy Macon ( talk) 22:11, 18 June 2018 (UTC)
From the very first sentence, this current definition of a placebo is very wrong on several points.
"A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient" - placebos are seldom, if ever, prescribed or administered to deceive the recipient. Even in clinical studies, the recipient must be advised that some patient will receive a placebo. - placebos are often medically effective. Placebo effects are real improvements in the condition of the patient. Placebos are 'believed to be medically ineffectual', but in reality, they can be very effective. - placebos are treatments for an illness, a specific case of an illness. They are not treatments for a 'disease', a class of illnesses. The patient presents an illness. The physician diagnoses a disease, but treats the illness. This is an important, non-trivial distinction.
How to understand placebos 101
==============================
There are two fundamental types of placebos, although this is seldom explicitly stated in any literature. The two types of placebos are prescribed with two different intentions, neither of which is 'to deceive the recipient'.
Placebos (real placebos) are medications or treatments prescribed by a physician with the intent to help the patient, when the physician does not know how to help the patient. The physician might believe that the prescription has no 'physical benefit' to the illness - but prescribes because he does believe it will benefit the patient in some small way. The physician's beliefs might be right, or wrong.
Note: The benefits resulting AFTER the placebo prescription has real causes. However, in many cases assigning them to the placebo causes much confusion and in many cases avoids actual investigation Calling them "placebo effect" is navel gazing, when the challenge is to understand what is going on outside of the medical system, outside of the medicine prescribed.
Clinical Placebos (fake placebos) are false medicines or treatments. They are not prescribed by a physician and there is no intention to provide any benefit to the patient. There is no intent to deceive the patient. Clinical placebos are used in scientific experiments to provide a statistical measure of the so called 'placebo effect'.
Note: The benefits resulting AFTER a clinical placebo is administered also have real causes. Ignoring these causes, naming them "placebo effects" assigning them to 'the mind of the patient' is simplistic nonsense, avoiding true investigation of the facts.
There are many fundamental difference between a real placebo and a clinical placebo. Unfortunately most references do not notice, much less attend to this distinction resulting in total nonsense and confusion. It's as if we used the same name for bears and teddy bears. Here's a comparative list of some differences:
Placebos - prescribed by a doctor - doctor doesn't know what is best - doctor intends to improve the health of the patient - prescribed to sooth the patient - can be active or passive. Active are more effective - works, statistically, but we don't understand (and seldom study) why or how - patient believes they are getting a medicine (in normal cases)
Clinical Placebos
- administered by a scientist physician
- researcher believes that the placebo is useless
- researcher has no intention to improve the health of patients who receive a placebo
- administered to measure statistically, the effects of medicine, by subtraction of 'clinical placebo effect'.
- often specifically designed to simulate the activity of the drug or treatment being tested
- when the placebo works, the research has failed
- patient hopes they are NOT getting the placebo
When we assume that clinical placebos are the same as real placebos, we create nonsense because the assumption is nonsensical.
Because of this fundamental difference between real placebos and clinical placebos, it is very difficult to measure the effects of real placebos in a clinical study - and as far as I am aware this has never been accomplished. To create the real life placebo, it would require the doctor to be allowed to decide when to prescribe a placebo, and to choose the placebo being prescribed.
Thus, we can also see that 'real placebo effects' are quite different from 'clinical placebo effects', but that's another story....
Until this reality about, and distinction between a real placebo and clinical placebo is recognized, we will continue to publish nonsense about placebos, because we simply don't understand.
There seem to be enough sources on open-label placebos to establish notability for an independent article; could we include some mention of them in this main article, please? HLHJ ( talk) 16:56, 19 August 2018 (UTC)
The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
Should the fourth paragraph in the lede of Placebo:--
but a 1997 review of the study found "no evidence [...] of any placebo effect in any of the studies cited".
but a 1997 review of the study found a wide range of "conceptual and methodological mistakes" in the study as well as "a total of 800 articles on placebo". It noted that the reported outcomes could be "fully ... explained without presuming any therapeutic placebo effect" and concluded that "the existence of therapeutic effects of placebo administration seems questionable".
Actually, I beg your pardon as the paper does gloss this particular mention of bias as "response bias" ("as polite patients may tend to report what they think socially most acceptable"). However, this does not bear on the question of "actual healing" as this merely means that the responses may be biased to over-state the effect the subject feels: e.g. they may say their headache feels better even when they don't really think it does! Alexbrn ( talk) 13:39, 17 June 2018 (UTC)
Hi everyone. I relay like this article, it is very well written and documented. But I think it can be even improved. The lead paragraph gives the impression than in modern science the general consensus is that there is no such thing as "placebo effect" or that its effect is irrelevant. Such a description is completeley false. Many contemporary studies (if not most) do defend that the placebo effect does have substantial effects on clinical outcomes (at least for some diseases). Remember, the point is not to discuss here whether there is or not a placebo effect, but to reflect ALL the modern views ont he issue. And there are many papers on genetics, neuroscience, medicine or psychology defending the reality and relevance of the placebo effect. The placebo effect can be difficult to understand in medicine (even though it is also present in medicine) but in psychology is obviously a relevant variable. For example, Blease (2015) defends that psychoanalysis is non-scientific and that patients do not improve because of the psychoanalytic therapy per se: it is the placebo effect the responsible of the patients' improvement. Again, the point is not whether these authors and publications are or not right. The point is to represent ALL the modern views: those who dismiss the relevance of the placebo effect, and those (probably the majority) who defend the relevance of the place effect. It would be a really biased article if it were to avoid mentioning all the current research which defends the importance and reality of the placebo effect.
The article's lead paragraph cites a 2010 meta-analysis of (reportedly) all medical conditions, which showed no substancial placebo effect. However, in science no study is absolutely definitive or conclusive. The meta-analysis was made in 2010 and all the sources I give are from 2014-2018, so of course that relatively "old" meta-analysis did not analyze the studies that I include in the references. Also, why would a single study be more reliable than ALL the other studies made on the topic?
In addition, in the lead paragraph of the article it is said that "Placebos have no impact on disease itself; at most they affect peoples' assessment of their own condition." and it is cited a webpage of the American Cancer Society. Such a claim is problematic for three reasons: 1) it is too general (they are obviously talking about cancer, not psychological diseases like depression or social anxiety dissorder, so that source can't exclude avery kind of disease), 2) it is a webpage, not an academic article or book and 3) it is disputed, since many academic articles say that placebos do affect some diseases. Because of these three reasons I did delete that problematic claim. Some articles/chapters which defend that the placebo effect does affect some kind of diseases:
Placebos "can have substantial effects on clinical outcomes" according to this Annual Review in Clinical Psychology. https://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-021815-093015
"Women receiving placebo improved 3.62 (95% CI 3.29–3.94) on the Female Sexual Function Index." "This meta-analysis of Level I evidence demonstrates that 67.7% of the treatment effect for female sexual dysfunction is accounted for by placebo." Article in Obstetrics in Ginecology. https://cdn.journals.lww.com/greenjournal/Abstract/2018/08000/Female_Sexual_Dysfunction_and_the_Placebo_Effect_.24.aspx
"Expensive placebo significantly improved motor function in Parkinson disease" Published in Journal Neurology http://n.neurology.org/content/84/8/794.short
"more detailed attention needs to be given to understanding how psychotherapy works, including whether psychoterapy just is placebo". (Blease also talks about the clinial importance of the placebo effect). Published in the chapter "Informed consent, the placebo effect and psychodynamic psychotherapy" from the Springer Book New Perspectives on Paternalism and Health Care https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false
Some of the other references I added to support the relevance of the placebo effect in modern research:
Ashar, Y. K., Chang, L. J., and Wager T. D. (2017). Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account. Annual Review of Clinical Psychology DOI:
https://doi.org/10.1146/annurev-clinpsy-021815-093015
Wager, T. D. and Atlas L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience DOI: https://doi.org/10.1038/nrn3976
Blease, C. R. (2015). Informed consent, placebo effect and psychodynamic psychotherapy. In New Perspectives on Paternalism and Health Care (pp. 163-182). Springer. URL= https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false
Colloca, L., Jonas, W. B., Killen Jr., J., Miller, F. G., Shurtleff, D. (2014). Reevaluating the Placebo Effect in Medical Practice. Zeitschrift für Psychologie DOI: = https://doi.org/10.1027/2151-2604/a000177
Weinberger, J. et al. (2018). Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis. Obstetrics and Ginecology DOI: https://doi.org/10.1097/AOG.0000000000002733
Espay, A. J. et al. (2015). Placebo effect of medication cost in Parkinson disease: a randomized double-blind study. Neurology DOI: https://doi.org/10.1212/WNL.0000000000001282
Flick, C. E. et al. (2017). Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World Journal of Gastroenterology DOI: https://doi.org/10.3748/wjg.v23.i12.2223
Kathryn, T. H., Loscalzo, J., and Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine DOI: https://doi.org/10.1016/j.molmed.2015.02.009}}
Thanks for your time. Best, User:James343e ( talk). 3:03, 3 October 2018 (UTC)
a report from the American Medical Association which disagrees with the notion that placebos have no effect on the clinical condition.That is not accurate. "Therapeutic benefit" and "[beneficial] effect on clinical conditions" are not synonymous terms. Laughter has a well-documented therapeutic benefit, as does sex, backrubs, spending time with friends & family and anything else that contributes to emotional well-being. Feeling good is therapeutically beneficial, but has no clinical impact on any condition except clinical depression (and even then, it's only temporary). ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 14:37, 3 October 2018 (UTC)
Calling someone biased is an argumentum ad hominem ONLY if it is not accompanied by arguments to discuss the topic.That's a very weird thing to say, considering that it's not true and doesn't make any sense: fallacious arguments don't become sound just because they are adjacent to others. A sound ad hominem argument consists of an accurate claim that the other party is possessed of some quality that undermines claims of fact that they make. Nothing you said did that.
Also, you say that the publications in Nature Reviews Neuroscience, Annual Review of Clinical Psychology, Neurology or Springer are pseudoscientific, without analyzing their articles per seYou can assume that I haven't reviewed them all you want, but you know what they say about assuming.
You just made the general claim "they are pseudoscientific"No, I did not, I said something different. If you're not going to copy and paste from my comment, you should avoid putting quotes around it.
AGAIN, THE SCIENTIFIC CONSENSUS IS NOT THAT THE PLACEBO EFFECT IS NOT REAL OR RELEVANT.citation needed
Your claim that it is "pseudoscience" is just an "argumentum ad hominem" applied to the articles.Soup cackles purple jumps in the fall peacoat with a seamless chili pepper. See? I'd say my nonsense statements are much better than yours. Because they're lyrical, you know? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 16:07, 3 October 2018 (UTC)
James343e, get out of here quickly. There is a strong cabal of editors here that try to keep this and other articles free from anything that contradicts their overly skeptic world view, and be it even only the presentation of what a source actually says rather than what they would like it to say (you might notice that "useful means" occurs nowhere in the one source that is cited in the lede to support their view, and that the other source contains a lot more of a nuanced view than what "no evidence [...] of any placebo effect in any of the studies cited" might suggest). If you continue voicing your opinion here, they will continue to harass until they succeed tricking you into violations of the rules and use that as leverage to get you blocked. They have a lot of experience with this and resistance is completely futile. Many other editors agree with you but do not have the experience and energy that the tight-knit gang has to game the system that successfully. -- rtc ( talk) 19:05, 3 October 2018 (UTC)
There is a strong cabal of editors here that try to keep this and other articles free from anything that contradicts their overly skeptic world viewAnd that cabal goes all the way to the top, MUAH HA HA HA HA!!!. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 19:48, 3 October 2018 (UTC)
I started this section, because the other one was too long and difficult to follow. Guy ( Help!)), ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. I apologize for being disrespectful with you guys, I won’t use any personal attack anymore and will focus on the topic. I would love to reach consensus with you!! Let us see if with good forms and good manners from my part we can reach some consensus.
Hi Snow let's rap, I consider you one of the greatest Wikipedia editors. You make contributions to Wikipedia articles about medicine, neuroscience and psychology and you are always very respectful. That is why I wanted you to enjoy this conversation. I would really appreciate your opinion on the issue.
First of all, by no means I am doing this because I want to support a pseudotherapy. I consider homeopathy, acupuncture or psychodynamic (psychoanalytic) therapy to be pseudosciences. I only want to reflect the current scientific view on the placebo effect.
I was a bit skeptical on the neutrality of this article, since I do not think it reflects all the current views on the placebo effect. This Wikipedia article explicitly defends that the placebo effect has no impact on any disease and is considered not relevant in contemporary science. However, the scientific consensus is NOT that the placebo effect is not real or relevant.
It would be really desirable to reach a consensus. As of now, 2 of us agree that some changes are necessary rtc ( talk) and I, but ideally I want to reach universal consensus with all of you. I think that some of the numerous papers which defend the reality and clinical relevance of the placebo effect should be cited in this article to reach neutrality.
I listed below 16 scientific articles (I could have included more) which defend the reality and clinical relevance of the placebo effect. 8 of them have a high Impact Factor (over 10.000). The remaining ones have an average Impact Factor (2.000-9.000). To my knowledge, no meta-analysis excludes articles from journals with an average Impact Factor. Thus, papers published in journals with an average Impact Factor are also part of science and should not be ignored here. In any case, half of the papers I cited are from journals with a High Impact Factor:
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1. Ashar, Y. K., Chang, L. J., and Wager T. D. (2017). Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account. Annual Review of Clinical Psychology DOI: https://doi.org/10.1146/annurev-clinpsy-021815-093015 (It claims the placebo effect is relevant for the clinical development of many patients. Direct quote: "they can have substantial effects on clinical outcomes."). High Impact Factor for the Annual Review of Clinical Psychology: 13.278 the second highest Impact Factor among journals of Psychology: http://www.bioxbio.com/if/html/ANNU-REV-CLIN-PSYCHO.html http://psychology.wikia.com/wiki/Impact_factors_of_psychology_journals 2. Wager, T. D. and Atlas L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience DOI: https://doi.org/10.1038/nrn3976 (Article which claims that the placebo effect is both real and relevant for pseudoscience). High Impact Factor for Nature Reviews Neuroscience: 32. 635. https://www.nature.com/nrn/about/journal-metrics 3. Blease, C. R. (2015). Informed consent, placebo effect and psychodynamic psychotherapy. In New Perspectives on Paternalism and Health Care (pp. 163-182). Springer. URL= https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false (It claims that the pseudoscientific psychodynamic (or psychoanalytic) therapy works by means of placebo effect, not the therapy per se. It is a book, so of course it lacks Impact Factor. But it is from the Editorial Springer, which is prestigious enough to be reliable. 4. Elsenbrunch, S. and Enck P. Placebo effects and their determinants in gastrointestinal disorders. Nature Reviews Gastroenterology & Hepatology. DOI: https://doi.org/10.1038/nrgastro.2015.117 (It defends the reality of the placebo effect, Direct quotes: “rain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias.”, “Brain imaging studies have demonstrated that the placebo response is not merely a response bias, but exhibits neurobiological and psychobiological properties along the gut–brain axis”). High Impact Factor for Nature Reviews Gastroenterology and Hepatology: 16.990 https://www.nature.com/nrgastro/about/journal-metrics 5. Weinberger, J. et al. (2018). Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis. Obstetrics and Ginecology DOI: https://doi.org/10.1097/AOG.0000000000002733 (2/3 of the Female Sexual Dysfunction recovery is due to the placebo effect rather than any specific therapy. according to the article): Average Impact factor for Obstetrics and Ginecology: Obstetrics & Gynecology's 2017 impact factor is 4.982. The journal's ranking is the fifth highest impact factor out of all 82 obstetrics and gynecology journals. https://journals.lww.com/greenjournal/Pages/citationsandimpactfactor.aspx 6. Espay, A. J. et al. (2015). Placebo effect of medication cost in Parkinson disease: a randomized double-blind study. Neurology DOI: https://doi.org/10.1212/WNL.0000000000001282 (It defends that the Placebo effect is real in the Parkinson disease, since the placebo condition's patients showed improvement). Average Impact Factor for Neurology: 8.320. Neurology is the most widely read and cited journal about neurology. http://www.neurology.org/about/about_the_journal http://n.neurology.org/ 7. Flick, C. E. et al. (2017). Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World Journal of Gastroenterology DOI: https://doi.org/10.3748/wjg.v23.i12.2223 (It defends patients do exhibit some improvement because of the placebo effect, rather than the therapist's action): Average Impact Factor for the World Journal of Gastroenterology: 3.300 ranking WJG as 35 among 80 journals in gastroenterology https://www.google.es/search?ei=igm1W_bHIdDSkgWo27cg&q=%27World+Journal+of+Gastroenterology+impact+factor&oq=%27World+Journal+of+Gastroenterology+impact+factor&gs_l=psy-ab.3..0i67k1j0i30k1l5j0i8i30k1l4.1639.1639.0.1850.1.1.0.0.0.0.119.119.0j1.1.0....0...1.1.64.psy-ab..0.1.119....0.U6XUwL-ZlD0 8. Kathryn, T. H., Loscalzo, J., and Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine DOI: https://doi.org/10.1016/j.molmed.2015.02.009}} (It claims that the placebo effec is relevant for the study of genetics, and could be to some degree inheritable). High Impact Factor for Trends in Molecular Medicine: 11.021 https://www.journals.elsevier.com/trends-in-molecular-medicine 9. Finnish, D. F. Kaptchuk, J., Miller, F., Benedetti, F. (2010). Biological, clinical, and ethical advances of placebo effects. The Lancet. DOI: https://doi.org/10.1016/S0140-6736(09)61706-2 (The article emphasizes the well-stablished fact that the placebo effect is real). High Impact Factor for The Lancet: 53.254. The most cited journal of general medicine. https://www.journals.elsevier.com/the-lancet 10. Colagiouri et al. (2015). The placebo effect: from concept to genes. Neuroscience. DOI: http://dx.doi.org/10.1016/j.neuroscience.2015.08.017 (The article emphasizes the clinical relevance of the placebo effect. Direct quote: "which demonstrate the broad range of effects that placebo interventions caninduce and their clinical relevance." Page 172). Average Impact factor: 3.382. https://www.journals.elsevier.com/neuroscience 11. Fraguas et al. (2009). A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: The relevance of the placebo effect and psychological symptoms. Contemporary Clinical Trials. DOI: https://doi.org/10.1016/j.cct.2009.01.007 (It defends the importance of placebo effect for depression). Average Impact Factor: 2. 658 https://www.journals.elsevier.com/contemporary-clinical-trials 12. Peciña et al. (2015). Association Between Placebo-Activated Neural Systems and Antidepressant Responses Neurochemistry of Placebo Effects in Major Depression. Journal of the American Medical Association. DOI: https://doi.org/10.1001/jamapsychiatry.2015.1335 (This article clearly emphasizes both the reality and relevance of the placebo effect. Some direct quotes: "High placebo responses have been observed across a wide range of pathologies" (abstract), "These data demonstrate that placebo-induced activation of the µ-opioid system is implicated in the formation of placebo antidepressant effects in patients with MDD and also participate in antidepressant responses" (Conclusions)). High Impact Factor for JAMA: 47.000 The Journal for American Medical Association is the second journal with higher Impact Factor in Medicine. https://jamanetwork.com/journals/jama/pages/for-authors 13. Rutherford et al. (2016). Patient Expectancy as a Mediator of Placebo Effects in Antidepressant Clinical Trials. The American Journal of Psychiatry. DOI: https://doi.org/10.1176/appi.ajp.2016.16020225 (It defends the importance and reality of the placebo effect by means of patient expectancy in antidepressant clinical trials. Direct quote: "Expectancy-related interventions should be investigated as a means of controlling placebo responses in antidepressant clinical trials and improving patient outcome in clinical treatment." (Conclusions). They want to control the placebo effect to improve patiens's outcome in clinical treatment, as the direct quote indicates). High Impact Factor for The American Journal of Psyquiatry: 13.391, the third highest cited Psychiatry Journal. https://www.appi.org/American_Journal_of_Psychiatry 14. Role of placebo effects in pain and neuropsychiatric disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry. DOI: https://doi.org/10.1016/j.pnpbp.2017.06.003 (It emphasizes placebo's effect clinical relevance. Direct quote: "The placebo (and the nocebo) effect is a powerful determinant of health outcomes in clinical disease treatment and management."). Average Impact factor for the journal: 4.185 https://www.journals.elsevier.com/progress-in-neuro-psychopharmacology-and-biological-psychiatry 15. Using the placebo effect: how expectations and learned immune function can optimize dermatological treatments. (2016). Experimental Dermatology DOI: https://doi.org/10.1111/exd.13158 (This paper emphasizes the importance of the Placebo's effect for dermatology. Direct quote: "The role of placebo and nocebo effects—that is positive or negative treatment effects that are entirely a consequence of the patient's expectations and beliefs about a treatment outcome in terms of efficacy, safety, usability or side effects—has been shown for almost all types of diseases and physiological response systems. Evidence for the relevance of placebo and nocebo effects in dermatology is also increasing". Average impact Factor: 2.608 https://onlinelibrary.wiley.com/journal/16000625 16. Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus. (2018). Psychotherapy and Psychosomatics. URL Free access: https://www.researchgate.net/publication/325725713_Implications_of_Placebo_and_Nocebo_Effects_for_Clinical_Practice_Expert_Consensus (This paper has the EXPERT CONSENSUS THAT PLACEBO EFFECTS ARE BOTH REAL AND RELEVANT FOR THE OUTCOME OF THE DISEASE'S TREATMENT. Direct quote: "There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects." (Page 2) Placebo and nocebo studies constitute a scientifically mature field of interdisciplinary research with applications in different medical disciplines and conditions. This burgeoning research calls for evidence-based recommendations for health professionals in medical practice." (Page 6). High Impact Factor for Psychotherapy and Psychosomatics: 13.122 http://www.ovid.com/site/catalog/journals/4862.jsp |
Guy ( Help!)), ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it., Snow let's rap What do you guys think? I think to achieve neutrality we could cite some of these articles and maintain the ones which are already present. In that way, both views (the view which gives no relevance to the placebo effect, and the view acknowledging the reality and clinical relevance of the placebo effect) would be included. Can we reach consensus and include some of the recent research which points out the reality and clinical relevance of the placebo effect? Can we cite some of these 16 articles or should we ignore them all? You decide, but I would love to reach consensus. User:James343e ( talk). 3:03, 3 October 2018 (UTC)
that's what any sane reader will understand reading your biased piece of propaganda.Yeah, that was the point at which the last vestiges of any respect I had for your opinion went out the window. Go be butthurt somewhere else. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 21:49, 3 October 2018 (UTC)
If you didn't read my message then you didn't notice my argument.Hypocrisy, thy name is James343e. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 22:01, 3 October 2018 (UTC)
focus on the topic of discussion please.Hypocrisy, thy name is James343e. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 22:13, 3 October 2018 (UTC)
The whole push seems based on a false premise, that the article somehow says placebos are "not real or relevant". In fact that phrase occurs nowhere, we define what the placebo response and effect are in the article lede, and spend the article discussing placebos. A few of the new sources mentioned above are useful, but not in the way the OP seems to think. Alexbrn ( talk) 06:44, 4 October 2018 (UTC)
I restored the long standing version because Pol098's edits introduced errors such as an explicit statement that the placebo effect is real, which is unsupportable from the source in question. If a test does not prove that the inert treatment is different from classical conditioning, it has not proved it to be real. I understand that some people don't understand why the lack of effect on objective outcomes is so significant. We have discussed this before.
There are good reasons not to cite fMRI as validating savred cows. See https://blogs.scientificamerican.com/scicurious-brain/ignobel-prize-in-neuroscience-the-dead-salmon-study/ for example. Guy ( Help!) 06:58, 6 October 2018 (UTC)
Also of note: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928846/ suggests observational learning as a confounder. Guy ( Help!) 07:18, 6 October 2018 (UTC)
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From the hatted discussion: "real" has different meanings and it is not clear what "real" means in "the placebo effect is real". Tgeorgescu ( talk) 13:28, 8 October 2018 (UTC)
My thoughts: This 2010 Cochrane collaboration article is already cited in the article, including in the lede. The lede cites this article when it says that "Subsequent research has found that placebos are not a useful means of therapy." This sentence ends the lede, so would likely be the last thought it plants in the head of someone who reads the lede. But the Cochrane review does not say that. Later, on, the same article is cited in this article saying "A 2010 Cochrane review suggests that placebo effects are only apparent in subjective, continuous measures, and in the treatment of pain and related conditions." That's a much better summary.
If you look at the "Plain Language Summary" on page 2 of the Cochrane review (page 6 of the PDF) "In general, placebo treatments produced no major health benefits, although on average they had a modest effect on outcomes reported by patients, such as pain. However, the effect on pain varied from large to non-existent, even in well-conducted trials." The "Author's conclusions" paragraph right above it says the same thing.
The Cochrane review is not saying that placebos "are not useful means of therapy." It's saying they can reduce pain and other subjective outcomes. So the lede should be changed to properly represent what the Cochrane article says, though I still think it is good to treat this as the final sentence of the lede. Anywikiuser ( talk) 15:42, 9 October 2018 (UTC)
"the wording often denying that any such effect exists at all"- could you give a few examples of this wording? - I'm not seeing it. We certainly do want to give the impression that the placebo effect doesn't exist, except in the realm of perception and subjective measurements, because that is npov per reliable sources. I suspect the differences of opinion we see on this talk page boil down to differences of understaning in what terms like "real", "exists" and "actual" mean. Any reader reading the article with any care will however see the basic knowledge is here. Alexbrn ( talk) 11:41, 10 October 2018 (UTC)
No no no no no, that's not what the sources say.citation needed ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:11, 10 October 2018 (UTC)
"The patient might report a lower level of pain simply because of social expectations, not because the pain was actually reduced."Ummm.....if the person feels less pain they have less pain. Regardless of whether it has a biological or psychological basis, pain is still a feeling and a subjective experience. That experience is the personal reality for that person.
An observation.... Properly made homeopathic "medications" are the perfect placebo.
"Homeopathy is bullshit. Only very, very diluted. It's completely safe to drink." - Peter Dorn
--
BullRangifer (
talk) PingMe
02:30, 11 October 2018 (UTC)
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Rtc is very keen to use the word important. In context his preferred text is:
The actual authors' conclusions from the first cited source:
And the second:
I would say that Rtc's wording is a clear misrepresentation of the overall tone of these sources, noting that while Hróbjartsson and Gøtzsche do speak and write excellent English, their language is very formal, and they are not native speakers. Hence the somewhat clumsy "We did not find that placebo interventions have important clinical effects in general" rather than "We found that placebos have no clinically important effect in general", which is almost certainly what a native English speaker would have written.
I think the correct form of words, based on these sources would be:
That seems to me to be the closes to the sources. Both find no clinically relevant effect on objective measures, both play down the relevance of the nonspecific effects. What do others think? Guy ( Help!) 21:09, 17 June 2018 (UTC)
Wait..what? the Placebo effect doesn't exist?[ Citation Need ed -- Guy Macon ( talk) 18:53, 18 June 2018 (UTC)
Related: Wikipedia talk:WikiProject Medicine#Placebo effect.
Like most things related to medicine, I stay away from editing articles or suggesting changes (I have this mental picture of a non-engineer M.D. trying to "fix" our Cockcroft–Walton generator or Hall effect articles...) but I am really good at asking possibly-stupid-possibly-insightful questions. -- Guy Macon ( talk) 22:11, 18 June 2018 (UTC)
From the very first sentence, this current definition of a placebo is very wrong on several points.
"A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient" - placebos are seldom, if ever, prescribed or administered to deceive the recipient. Even in clinical studies, the recipient must be advised that some patient will receive a placebo. - placebos are often medically effective. Placebo effects are real improvements in the condition of the patient. Placebos are 'believed to be medically ineffectual', but in reality, they can be very effective. - placebos are treatments for an illness, a specific case of an illness. They are not treatments for a 'disease', a class of illnesses. The patient presents an illness. The physician diagnoses a disease, but treats the illness. This is an important, non-trivial distinction.
How to understand placebos 101
==============================
There are two fundamental types of placebos, although this is seldom explicitly stated in any literature. The two types of placebos are prescribed with two different intentions, neither of which is 'to deceive the recipient'.
Placebos (real placebos) are medications or treatments prescribed by a physician with the intent to help the patient, when the physician does not know how to help the patient. The physician might believe that the prescription has no 'physical benefit' to the illness - but prescribes because he does believe it will benefit the patient in some small way. The physician's beliefs might be right, or wrong.
Note: The benefits resulting AFTER the placebo prescription has real causes. However, in many cases assigning them to the placebo causes much confusion and in many cases avoids actual investigation Calling them "placebo effect" is navel gazing, when the challenge is to understand what is going on outside of the medical system, outside of the medicine prescribed.
Clinical Placebos (fake placebos) are false medicines or treatments. They are not prescribed by a physician and there is no intention to provide any benefit to the patient. There is no intent to deceive the patient. Clinical placebos are used in scientific experiments to provide a statistical measure of the so called 'placebo effect'.
Note: The benefits resulting AFTER a clinical placebo is administered also have real causes. Ignoring these causes, naming them "placebo effects" assigning them to 'the mind of the patient' is simplistic nonsense, avoiding true investigation of the facts.
There are many fundamental difference between a real placebo and a clinical placebo. Unfortunately most references do not notice, much less attend to this distinction resulting in total nonsense and confusion. It's as if we used the same name for bears and teddy bears. Here's a comparative list of some differences:
Placebos - prescribed by a doctor - doctor doesn't know what is best - doctor intends to improve the health of the patient - prescribed to sooth the patient - can be active or passive. Active are more effective - works, statistically, but we don't understand (and seldom study) why or how - patient believes they are getting a medicine (in normal cases)
Clinical Placebos
- administered by a scientist physician
- researcher believes that the placebo is useless
- researcher has no intention to improve the health of patients who receive a placebo
- administered to measure statistically, the effects of medicine, by subtraction of 'clinical placebo effect'.
- often specifically designed to simulate the activity of the drug or treatment being tested
- when the placebo works, the research has failed
- patient hopes they are NOT getting the placebo
When we assume that clinical placebos are the same as real placebos, we create nonsense because the assumption is nonsensical.
Because of this fundamental difference between real placebos and clinical placebos, it is very difficult to measure the effects of real placebos in a clinical study - and as far as I am aware this has never been accomplished. To create the real life placebo, it would require the doctor to be allowed to decide when to prescribe a placebo, and to choose the placebo being prescribed.
Thus, we can also see that 'real placebo effects' are quite different from 'clinical placebo effects', but that's another story....
Until this reality about, and distinction between a real placebo and clinical placebo is recognized, we will continue to publish nonsense about placebos, because we simply don't understand.
There seem to be enough sources on open-label placebos to establish notability for an independent article; could we include some mention of them in this main article, please? HLHJ ( talk) 16:56, 19 August 2018 (UTC)
The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
Should the fourth paragraph in the lede of Placebo:--
but a 1997 review of the study found "no evidence [...] of any placebo effect in any of the studies cited".
but a 1997 review of the study found a wide range of "conceptual and methodological mistakes" in the study as well as "a total of 800 articles on placebo". It noted that the reported outcomes could be "fully ... explained without presuming any therapeutic placebo effect" and concluded that "the existence of therapeutic effects of placebo administration seems questionable".
Actually, I beg your pardon as the paper does gloss this particular mention of bias as "response bias" ("as polite patients may tend to report what they think socially most acceptable"). However, this does not bear on the question of "actual healing" as this merely means that the responses may be biased to over-state the effect the subject feels: e.g. they may say their headache feels better even when they don't really think it does! Alexbrn ( talk) 13:39, 17 June 2018 (UTC)
Hi everyone. I relay like this article, it is very well written and documented. But I think it can be even improved. The lead paragraph gives the impression than in modern science the general consensus is that there is no such thing as "placebo effect" or that its effect is irrelevant. Such a description is completeley false. Many contemporary studies (if not most) do defend that the placebo effect does have substantial effects on clinical outcomes (at least for some diseases). Remember, the point is not to discuss here whether there is or not a placebo effect, but to reflect ALL the modern views ont he issue. And there are many papers on genetics, neuroscience, medicine or psychology defending the reality and relevance of the placebo effect. The placebo effect can be difficult to understand in medicine (even though it is also present in medicine) but in psychology is obviously a relevant variable. For example, Blease (2015) defends that psychoanalysis is non-scientific and that patients do not improve because of the psychoanalytic therapy per se: it is the placebo effect the responsible of the patients' improvement. Again, the point is not whether these authors and publications are or not right. The point is to represent ALL the modern views: those who dismiss the relevance of the placebo effect, and those (probably the majority) who defend the relevance of the place effect. It would be a really biased article if it were to avoid mentioning all the current research which defends the importance and reality of the placebo effect.
The article's lead paragraph cites a 2010 meta-analysis of (reportedly) all medical conditions, which showed no substancial placebo effect. However, in science no study is absolutely definitive or conclusive. The meta-analysis was made in 2010 and all the sources I give are from 2014-2018, so of course that relatively "old" meta-analysis did not analyze the studies that I include in the references. Also, why would a single study be more reliable than ALL the other studies made on the topic?
In addition, in the lead paragraph of the article it is said that "Placebos have no impact on disease itself; at most they affect peoples' assessment of their own condition." and it is cited a webpage of the American Cancer Society. Such a claim is problematic for three reasons: 1) it is too general (they are obviously talking about cancer, not psychological diseases like depression or social anxiety dissorder, so that source can't exclude avery kind of disease), 2) it is a webpage, not an academic article or book and 3) it is disputed, since many academic articles say that placebos do affect some diseases. Because of these three reasons I did delete that problematic claim. Some articles/chapters which defend that the placebo effect does affect some kind of diseases:
Placebos "can have substantial effects on clinical outcomes" according to this Annual Review in Clinical Psychology. https://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-021815-093015
"Women receiving placebo improved 3.62 (95% CI 3.29–3.94) on the Female Sexual Function Index." "This meta-analysis of Level I evidence demonstrates that 67.7% of the treatment effect for female sexual dysfunction is accounted for by placebo." Article in Obstetrics in Ginecology. https://cdn.journals.lww.com/greenjournal/Abstract/2018/08000/Female_Sexual_Dysfunction_and_the_Placebo_Effect_.24.aspx
"Expensive placebo significantly improved motor function in Parkinson disease" Published in Journal Neurology http://n.neurology.org/content/84/8/794.short
"more detailed attention needs to be given to understanding how psychotherapy works, including whether psychoterapy just is placebo". (Blease also talks about the clinial importance of the placebo effect). Published in the chapter "Informed consent, the placebo effect and psychodynamic psychotherapy" from the Springer Book New Perspectives on Paternalism and Health Care https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false
Some of the other references I added to support the relevance of the placebo effect in modern research:
Ashar, Y. K., Chang, L. J., and Wager T. D. (2017). Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account. Annual Review of Clinical Psychology DOI:
https://doi.org/10.1146/annurev-clinpsy-021815-093015
Wager, T. D. and Atlas L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience DOI: https://doi.org/10.1038/nrn3976
Blease, C. R. (2015). Informed consent, placebo effect and psychodynamic psychotherapy. In New Perspectives on Paternalism and Health Care (pp. 163-182). Springer. URL= https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false
Colloca, L., Jonas, W. B., Killen Jr., J., Miller, F. G., Shurtleff, D. (2014). Reevaluating the Placebo Effect in Medical Practice. Zeitschrift für Psychologie DOI: = https://doi.org/10.1027/2151-2604/a000177
Weinberger, J. et al. (2018). Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis. Obstetrics and Ginecology DOI: https://doi.org/10.1097/AOG.0000000000002733
Espay, A. J. et al. (2015). Placebo effect of medication cost in Parkinson disease: a randomized double-blind study. Neurology DOI: https://doi.org/10.1212/WNL.0000000000001282
Flick, C. E. et al. (2017). Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World Journal of Gastroenterology DOI: https://doi.org/10.3748/wjg.v23.i12.2223
Kathryn, T. H., Loscalzo, J., and Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine DOI: https://doi.org/10.1016/j.molmed.2015.02.009}}
Thanks for your time. Best, User:James343e ( talk). 3:03, 3 October 2018 (UTC)
a report from the American Medical Association which disagrees with the notion that placebos have no effect on the clinical condition.That is not accurate. "Therapeutic benefit" and "[beneficial] effect on clinical conditions" are not synonymous terms. Laughter has a well-documented therapeutic benefit, as does sex, backrubs, spending time with friends & family and anything else that contributes to emotional well-being. Feeling good is therapeutically beneficial, but has no clinical impact on any condition except clinical depression (and even then, it's only temporary). ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 14:37, 3 October 2018 (UTC)
Calling someone biased is an argumentum ad hominem ONLY if it is not accompanied by arguments to discuss the topic.That's a very weird thing to say, considering that it's not true and doesn't make any sense: fallacious arguments don't become sound just because they are adjacent to others. A sound ad hominem argument consists of an accurate claim that the other party is possessed of some quality that undermines claims of fact that they make. Nothing you said did that.
Also, you say that the publications in Nature Reviews Neuroscience, Annual Review of Clinical Psychology, Neurology or Springer are pseudoscientific, without analyzing their articles per seYou can assume that I haven't reviewed them all you want, but you know what they say about assuming.
You just made the general claim "they are pseudoscientific"No, I did not, I said something different. If you're not going to copy and paste from my comment, you should avoid putting quotes around it.
AGAIN, THE SCIENTIFIC CONSENSUS IS NOT THAT THE PLACEBO EFFECT IS NOT REAL OR RELEVANT.citation needed
Your claim that it is "pseudoscience" is just an "argumentum ad hominem" applied to the articles.Soup cackles purple jumps in the fall peacoat with a seamless chili pepper. See? I'd say my nonsense statements are much better than yours. Because they're lyrical, you know? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 16:07, 3 October 2018 (UTC)
James343e, get out of here quickly. There is a strong cabal of editors here that try to keep this and other articles free from anything that contradicts their overly skeptic world view, and be it even only the presentation of what a source actually says rather than what they would like it to say (you might notice that "useful means" occurs nowhere in the one source that is cited in the lede to support their view, and that the other source contains a lot more of a nuanced view than what "no evidence [...] of any placebo effect in any of the studies cited" might suggest). If you continue voicing your opinion here, they will continue to harass until they succeed tricking you into violations of the rules and use that as leverage to get you blocked. They have a lot of experience with this and resistance is completely futile. Many other editors agree with you but do not have the experience and energy that the tight-knit gang has to game the system that successfully. -- rtc ( talk) 19:05, 3 October 2018 (UTC)
There is a strong cabal of editors here that try to keep this and other articles free from anything that contradicts their overly skeptic world viewAnd that cabal goes all the way to the top, MUAH HA HA HA HA!!!. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 19:48, 3 October 2018 (UTC)
I started this section, because the other one was too long and difficult to follow. Guy ( Help!)), ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. I apologize for being disrespectful with you guys, I won’t use any personal attack anymore and will focus on the topic. I would love to reach consensus with you!! Let us see if with good forms and good manners from my part we can reach some consensus.
Hi Snow let's rap, I consider you one of the greatest Wikipedia editors. You make contributions to Wikipedia articles about medicine, neuroscience and psychology and you are always very respectful. That is why I wanted you to enjoy this conversation. I would really appreciate your opinion on the issue.
First of all, by no means I am doing this because I want to support a pseudotherapy. I consider homeopathy, acupuncture or psychodynamic (psychoanalytic) therapy to be pseudosciences. I only want to reflect the current scientific view on the placebo effect.
I was a bit skeptical on the neutrality of this article, since I do not think it reflects all the current views on the placebo effect. This Wikipedia article explicitly defends that the placebo effect has no impact on any disease and is considered not relevant in contemporary science. However, the scientific consensus is NOT that the placebo effect is not real or relevant.
It would be really desirable to reach a consensus. As of now, 2 of us agree that some changes are necessary rtc ( talk) and I, but ideally I want to reach universal consensus with all of you. I think that some of the numerous papers which defend the reality and clinical relevance of the placebo effect should be cited in this article to reach neutrality.
I listed below 16 scientific articles (I could have included more) which defend the reality and clinical relevance of the placebo effect. 8 of them have a high Impact Factor (over 10.000). The remaining ones have an average Impact Factor (2.000-9.000). To my knowledge, no meta-analysis excludes articles from journals with an average Impact Factor. Thus, papers published in journals with an average Impact Factor are also part of science and should not be ignored here. In any case, half of the papers I cited are from journals with a High Impact Factor:
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1. Ashar, Y. K., Chang, L. J., and Wager T. D. (2017). Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account. Annual Review of Clinical Psychology DOI: https://doi.org/10.1146/annurev-clinpsy-021815-093015 (It claims the placebo effect is relevant for the clinical development of many patients. Direct quote: "they can have substantial effects on clinical outcomes."). High Impact Factor for the Annual Review of Clinical Psychology: 13.278 the second highest Impact Factor among journals of Psychology: http://www.bioxbio.com/if/html/ANNU-REV-CLIN-PSYCHO.html http://psychology.wikia.com/wiki/Impact_factors_of_psychology_journals 2. Wager, T. D. and Atlas L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience DOI: https://doi.org/10.1038/nrn3976 (Article which claims that the placebo effect is both real and relevant for pseudoscience). High Impact Factor for Nature Reviews Neuroscience: 32. 635. https://www.nature.com/nrn/about/journal-metrics 3. Blease, C. R. (2015). Informed consent, placebo effect and psychodynamic psychotherapy. In New Perspectives on Paternalism and Health Care (pp. 163-182). Springer. URL= https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false (It claims that the pseudoscientific psychodynamic (or psychoanalytic) therapy works by means of placebo effect, not the therapy per se. It is a book, so of course it lacks Impact Factor. But it is from the Editorial Springer, which is prestigious enough to be reliable. 4. Elsenbrunch, S. and Enck P. Placebo effects and their determinants in gastrointestinal disorders. Nature Reviews Gastroenterology & Hepatology. DOI: https://doi.org/10.1038/nrgastro.2015.117 (It defends the reality of the placebo effect, Direct quotes: “rain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias.”, “Brain imaging studies have demonstrated that the placebo response is not merely a response bias, but exhibits neurobiological and psychobiological properties along the gut–brain axis”). High Impact Factor for Nature Reviews Gastroenterology and Hepatology: 16.990 https://www.nature.com/nrgastro/about/journal-metrics 5. Weinberger, J. et al. (2018). Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis. Obstetrics and Ginecology DOI: https://doi.org/10.1097/AOG.0000000000002733 (2/3 of the Female Sexual Dysfunction recovery is due to the placebo effect rather than any specific therapy. according to the article): Average Impact factor for Obstetrics and Ginecology: Obstetrics & Gynecology's 2017 impact factor is 4.982. The journal's ranking is the fifth highest impact factor out of all 82 obstetrics and gynecology journals. https://journals.lww.com/greenjournal/Pages/citationsandimpactfactor.aspx 6. Espay, A. J. et al. (2015). Placebo effect of medication cost in Parkinson disease: a randomized double-blind study. Neurology DOI: https://doi.org/10.1212/WNL.0000000000001282 (It defends that the Placebo effect is real in the Parkinson disease, since the placebo condition's patients showed improvement). Average Impact Factor for Neurology: 8.320. Neurology is the most widely read and cited journal about neurology. http://www.neurology.org/about/about_the_journal http://n.neurology.org/ 7. Flick, C. E. et al. (2017). Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World Journal of Gastroenterology DOI: https://doi.org/10.3748/wjg.v23.i12.2223 (It defends patients do exhibit some improvement because of the placebo effect, rather than the therapist's action): Average Impact Factor for the World Journal of Gastroenterology: 3.300 ranking WJG as 35 among 80 journals in gastroenterology https://www.google.es/search?ei=igm1W_bHIdDSkgWo27cg&q=%27World+Journal+of+Gastroenterology+impact+factor&oq=%27World+Journal+of+Gastroenterology+impact+factor&gs_l=psy-ab.3..0i67k1j0i30k1l5j0i8i30k1l4.1639.1639.0.1850.1.1.0.0.0.0.119.119.0j1.1.0....0...1.1.64.psy-ab..0.1.119....0.U6XUwL-ZlD0 8. Kathryn, T. H., Loscalzo, J., and Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine DOI: https://doi.org/10.1016/j.molmed.2015.02.009}} (It claims that the placebo effec is relevant for the study of genetics, and could be to some degree inheritable). High Impact Factor for Trends in Molecular Medicine: 11.021 https://www.journals.elsevier.com/trends-in-molecular-medicine 9. Finnish, D. F. Kaptchuk, J., Miller, F., Benedetti, F. (2010). Biological, clinical, and ethical advances of placebo effects. The Lancet. DOI: https://doi.org/10.1016/S0140-6736(09)61706-2 (The article emphasizes the well-stablished fact that the placebo effect is real). High Impact Factor for The Lancet: 53.254. The most cited journal of general medicine. https://www.journals.elsevier.com/the-lancet 10. Colagiouri et al. (2015). The placebo effect: from concept to genes. Neuroscience. DOI: http://dx.doi.org/10.1016/j.neuroscience.2015.08.017 (The article emphasizes the clinical relevance of the placebo effect. Direct quote: "which demonstrate the broad range of effects that placebo interventions caninduce and their clinical relevance." Page 172). Average Impact factor: 3.382. https://www.journals.elsevier.com/neuroscience 11. Fraguas et al. (2009). A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: The relevance of the placebo effect and psychological symptoms. Contemporary Clinical Trials. DOI: https://doi.org/10.1016/j.cct.2009.01.007 (It defends the importance of placebo effect for depression). Average Impact Factor: 2. 658 https://www.journals.elsevier.com/contemporary-clinical-trials 12. Peciña et al. (2015). Association Between Placebo-Activated Neural Systems and Antidepressant Responses Neurochemistry of Placebo Effects in Major Depression. Journal of the American Medical Association. DOI: https://doi.org/10.1001/jamapsychiatry.2015.1335 (This article clearly emphasizes both the reality and relevance of the placebo effect. Some direct quotes: "High placebo responses have been observed across a wide range of pathologies" (abstract), "These data demonstrate that placebo-induced activation of the µ-opioid system is implicated in the formation of placebo antidepressant effects in patients with MDD and also participate in antidepressant responses" (Conclusions)). High Impact Factor for JAMA: 47.000 The Journal for American Medical Association is the second journal with higher Impact Factor in Medicine. https://jamanetwork.com/journals/jama/pages/for-authors 13. Rutherford et al. (2016). Patient Expectancy as a Mediator of Placebo Effects in Antidepressant Clinical Trials. The American Journal of Psychiatry. DOI: https://doi.org/10.1176/appi.ajp.2016.16020225 (It defends the importance and reality of the placebo effect by means of patient expectancy in antidepressant clinical trials. Direct quote: "Expectancy-related interventions should be investigated as a means of controlling placebo responses in antidepressant clinical trials and improving patient outcome in clinical treatment." (Conclusions). They want to control the placebo effect to improve patiens's outcome in clinical treatment, as the direct quote indicates). High Impact Factor for The American Journal of Psyquiatry: 13.391, the third highest cited Psychiatry Journal. https://www.appi.org/American_Journal_of_Psychiatry 14. Role of placebo effects in pain and neuropsychiatric disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry. DOI: https://doi.org/10.1016/j.pnpbp.2017.06.003 (It emphasizes placebo's effect clinical relevance. Direct quote: "The placebo (and the nocebo) effect is a powerful determinant of health outcomes in clinical disease treatment and management."). Average Impact factor for the journal: 4.185 https://www.journals.elsevier.com/progress-in-neuro-psychopharmacology-and-biological-psychiatry 15. Using the placebo effect: how expectations and learned immune function can optimize dermatological treatments. (2016). Experimental Dermatology DOI: https://doi.org/10.1111/exd.13158 (This paper emphasizes the importance of the Placebo's effect for dermatology. Direct quote: "The role of placebo and nocebo effects—that is positive or negative treatment effects that are entirely a consequence of the patient's expectations and beliefs about a treatment outcome in terms of efficacy, safety, usability or side effects—has been shown for almost all types of diseases and physiological response systems. Evidence for the relevance of placebo and nocebo effects in dermatology is also increasing". Average impact Factor: 2.608 https://onlinelibrary.wiley.com/journal/16000625 16. Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus. (2018). Psychotherapy and Psychosomatics. URL Free access: https://www.researchgate.net/publication/325725713_Implications_of_Placebo_and_Nocebo_Effects_for_Clinical_Practice_Expert_Consensus (This paper has the EXPERT CONSENSUS THAT PLACEBO EFFECTS ARE BOTH REAL AND RELEVANT FOR THE OUTCOME OF THE DISEASE'S TREATMENT. Direct quote: "There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects." (Page 2) Placebo and nocebo studies constitute a scientifically mature field of interdisciplinary research with applications in different medical disciplines and conditions. This burgeoning research calls for evidence-based recommendations for health professionals in medical practice." (Page 6). High Impact Factor for Psychotherapy and Psychosomatics: 13.122 http://www.ovid.com/site/catalog/journals/4862.jsp |
Guy ( Help!)), ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it., Snow let's rap What do you guys think? I think to achieve neutrality we could cite some of these articles and maintain the ones which are already present. In that way, both views (the view which gives no relevance to the placebo effect, and the view acknowledging the reality and clinical relevance of the placebo effect) would be included. Can we reach consensus and include some of the recent research which points out the reality and clinical relevance of the placebo effect? Can we cite some of these 16 articles or should we ignore them all? You decide, but I would love to reach consensus. User:James343e ( talk). 3:03, 3 October 2018 (UTC)
that's what any sane reader will understand reading your biased piece of propaganda.Yeah, that was the point at which the last vestiges of any respect I had for your opinion went out the window. Go be butthurt somewhere else. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 21:49, 3 October 2018 (UTC)
If you didn't read my message then you didn't notice my argument.Hypocrisy, thy name is James343e. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 22:01, 3 October 2018 (UTC)
focus on the topic of discussion please.Hypocrisy, thy name is James343e. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 22:13, 3 October 2018 (UTC)
The whole push seems based on a false premise, that the article somehow says placebos are "not real or relevant". In fact that phrase occurs nowhere, we define what the placebo response and effect are in the article lede, and spend the article discussing placebos. A few of the new sources mentioned above are useful, but not in the way the OP seems to think. Alexbrn ( talk) 06:44, 4 October 2018 (UTC)
I restored the long standing version because Pol098's edits introduced errors such as an explicit statement that the placebo effect is real, which is unsupportable from the source in question. If a test does not prove that the inert treatment is different from classical conditioning, it has not proved it to be real. I understand that some people don't understand why the lack of effect on objective outcomes is so significant. We have discussed this before.
There are good reasons not to cite fMRI as validating savred cows. See https://blogs.scientificamerican.com/scicurious-brain/ignobel-prize-in-neuroscience-the-dead-salmon-study/ for example. Guy ( Help!) 06:58, 6 October 2018 (UTC)
Also of note: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928846/ suggests observational learning as a confounder. Guy ( Help!) 07:18, 6 October 2018 (UTC)
WP:RD1 applied as requested, discussion now moot |
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The following discussion has been closed. Please do not modify it. |
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From the hatted discussion: "real" has different meanings and it is not clear what "real" means in "the placebo effect is real". Tgeorgescu ( talk) 13:28, 8 October 2018 (UTC)
My thoughts: This 2010 Cochrane collaboration article is already cited in the article, including in the lede. The lede cites this article when it says that "Subsequent research has found that placebos are not a useful means of therapy." This sentence ends the lede, so would likely be the last thought it plants in the head of someone who reads the lede. But the Cochrane review does not say that. Later, on, the same article is cited in this article saying "A 2010 Cochrane review suggests that placebo effects are only apparent in subjective, continuous measures, and in the treatment of pain and related conditions." That's a much better summary.
If you look at the "Plain Language Summary" on page 2 of the Cochrane review (page 6 of the PDF) "In general, placebo treatments produced no major health benefits, although on average they had a modest effect on outcomes reported by patients, such as pain. However, the effect on pain varied from large to non-existent, even in well-conducted trials." The "Author's conclusions" paragraph right above it says the same thing.
The Cochrane review is not saying that placebos "are not useful means of therapy." It's saying they can reduce pain and other subjective outcomes. So the lede should be changed to properly represent what the Cochrane article says, though I still think it is good to treat this as the final sentence of the lede. Anywikiuser ( talk) 15:42, 9 October 2018 (UTC)
"the wording often denying that any such effect exists at all"- could you give a few examples of this wording? - I'm not seeing it. We certainly do want to give the impression that the placebo effect doesn't exist, except in the realm of perception and subjective measurements, because that is npov per reliable sources. I suspect the differences of opinion we see on this talk page boil down to differences of understaning in what terms like "real", "exists" and "actual" mean. Any reader reading the article with any care will however see the basic knowledge is here. Alexbrn ( talk) 11:41, 10 October 2018 (UTC)
No no no no no, that's not what the sources say.citation needed ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:11, 10 October 2018 (UTC)
"The patient might report a lower level of pain simply because of social expectations, not because the pain was actually reduced."Ummm.....if the person feels less pain they have less pain. Regardless of whether it has a biological or psychological basis, pain is still a feeling and a subjective experience. That experience is the personal reality for that person.
An observation.... Properly made homeopathic "medications" are the perfect placebo.
"Homeopathy is bullshit. Only very, very diluted. It's completely safe to drink." - Peter Dorn
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BullRangifer (
talk) PingMe
02:30, 11 October 2018 (UTC)