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== Another possible historical account ==
__TOC__

== This article completely omits the primary part of the place effect ==

Which is the 'error in reporting' by the patient. How do you separate when a patient feels better versus he wrongly *thinks' he feels better, convinced by the doctor and the apparent treatment? You state in the article yourself that physical diseases such as wound healing are not improved by placebo when using objective test criteria. Isn't that a little suspicious? I strongly suspect that error in reporting makes up 90% or more of what we perceive as the placebo effect. ] (])
:How would you ever be able to objectively say that a patient who claims to "feel better" is in error? ] (]) 15:38, 28 September 2009 (UTC)

:: By examining him using objective criteria. Say, he reports that the placebo made his arthritis better but X-ray show it hasn't. Or improved his depression but the objective signs have in fact gotten worse, such as insomnia, weight loss and so on. Maybe the placebo put him in an optimistic mood and he now rates his disease differently, even though nothing has changed objectively. Note also that they usually don't ask him if he feels better(which is subjective) but if his disease is getting better(which is objective). Look at all the miraculous healings at christian TV shows. They proclaim to be instantly cured or that they improved but the week after they realise they feel the same as before and it was just suggestion. That is the placebo effect IMHO. ] (]) <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added 15:36, 3 October 2009 (UTC).</span><!--Template:Undated--> <!--Autosigned by SineBot-->
:::I believe Looie496 was addressing the presumption that "feel" is subjective. Of course in this era of ] that presumption is no longer ''necessarily'' accurate, but for most purposes we still assume that meaning unless further qualified. ] <small>]</small> 18:00, 30 March 2010 (UTC)

== Additional information ==

There's a recent article from ''Wired'' that has a lot of information that could be added to the article:

*{{cite news |title=Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why |work=Wired magazine |date=August 24, 2009 |author= Steve Silberman |url=http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all }}

-- <font style="font-family:Monotype Corsiva; font-size:15px;">] </font> ] 16:09, 12 November 2009 (UTC)

== Placebo Effect? ==

I kind of think this article should be called The Placebo Effect, not placebo, and the placebo disambiguation page should be called placebo or the band's article should be called placebo. ] (]) 00:52, 13 January 2010 (UTC)
:Please see ] and ] both of which pertain. An obscure band's name, and one which is derivative from the effect, is not cause for renaming the article on the effect.] <small>]</small> 17:49, 30 March 2010 (UTC)

== Homeopathy in lead ==

Two editors are apparently trying to use this article about a key concept of mainstream medicine as a ] for discussing homeopathy, a fringe topic. Homeopathy, as a system of therapy that relies mainly on placebos, is of course relevant to this article, as are many other fields of CAM, and as is the widespread abuse of aspirine and other relatively harmless medications as placebos described by GPs. But this fringe topic does not belong in the second sentence, per ] and ]: When people hear of homeopathy, the think of placebos, but not usually the other way round. (Except for people who are obsessed with homeopathy or have another rare, specific reason to make the connection.)

I can see no valid reason for the change from
{{quotation|Common placebos are inert tablets, sham surgery, and other procedures based on false information.}}
to
{{quotation|Things that are known to produce a placebo effect are inert tablets, homeopathic preparations, sham surgery, and other procedures based on false and deceptive information.}}

* There is no need to avoid the word "placebo" for a medical intervention in the sentence right after its definition, and to circumscribe it awkwardly as "things that are known to produce a placebo effect. Especially not ''before'' the definition of the placebo effect.
* The list contains ] and mentions other ''procedures''. It is extremely jarring to refer to these as ], as they are obviously not physical things.
* There is no need for the loaded word "deceptive". We already have the equally loaded word "sham" in "sham surgery", which is justified because it is a technical term. That it is effective in getting the message across that placebos ''can'' be regarded as deception is evident from the number of complaints about this word on this talk page.
* There is no general agreement that deception that relieves a patient's symptoms is morally wrong. Therefore the pushing of "deceptive" into the second sentence, which already contains "sham", combined with a complete lack of even hinting at the opposite POV, is a severe POV problem. Since this is the lead and supposed to be brief, the solution is not to push one POV in the first place, rather than balance it with the opposing POV.
* ] has no business being mentioned in the first paragraph, per ] as discussed above.

I am sick and tired of editors who make no positive contributions to certain articles trying to push their eccentric POVs into them or reverting blindly based on ]. In the entire history of this article, one of the editors in question has reverted several times, fixed a trivial grammar error (once), and tried to push the word "sham" into the first sentence. That's it. And now . "Sourced, relevant and informative" is hardly a reasonable justification for adding the words "homeopathic preparations" and "deceptive" to the second lead sentence. And neither is confusion about the meaning of one of the most common English words. ] ] 12:52, 20 March 2010 (UTC)

: (aside): I would really love to avoid yet another pseudoscience ArbCom. I also changed the section header to make it easier to search the archives.
: I think Hans Adler's final bullet point says it best - people clicking on ] are expecting to learn about placebos. The sourcing is almost certainly there to ] using ] as a notable historical example in the body of the article, but there is really no need to burden the lead with unfamiliar terms and qualifying that "low potency" homeopathic preparations can have biological effects. If we are considering only homeopathic preparations like ], then ''homeopathic preparation'' is entirely redundant with ''inert tablet'', and should be cut out since the lead is already a bit on the long side.
: On a semi-related note, we could change ''inert tablet'' to ''sugar pill'', as the latter is both more accessible and redirects here. - ] <small>(])</small> 14:34, 20 March 2010 (UTC)

::We once had ''sugar pill'', but BullRangifer changed that, claiming that sugar is not inert. He does have a point: Sugar pills are usually made of ], which I guess can cause trouble with ]. <s>And it is not uncommon for people to develop ] (an unrelated condition) while on an anti-fungus diet (which avoids other sugars).</s> Once they have it, I guess even the small amounts of lactose in a sugar pill become a problem. ] ] 14:47, 20 March 2010 (UTC)

::Regarding another pseudoscience Arbcom case: Carcharoth has proposed addressing the obvious problems at ], which have somehow managed to spill over all the way to this page, via an amendment to one of the earlier cases. I am currently preparing a related RfC/U. Let's wait if such an amendment is still necessary afterwards. ] ] 14:51, 20 March 2010 (UTC)

:I don't really care either way on this, but I do want to note that Hans mistakenly marked an edit as minor which was not. Please do not do that. Per ], minor edits do not make content changes. ] | (] - ]) 18:52, 20 March 2010 (UTC)
::Oh, sorry for that. I often use rollback + Javascript edit summaries for simple reverts for convenience, but I completely forgot that it marks edits as minor. I will try not to do this again. ] ] 19:44, 20 March 2010 (UTC)

:::Maybe you can tweak the program so it doesn't? I know we can tweak the monobook so Twinkle doesn't do that. ] | (] - ]) 20:03, 20 March 2010 (UTC)
::::<small>It looks as if the API can't do that. I tried the "notminor" parameter, which is not documented for rollbacks, and it doesn't seem to work. (I don't know how it usually works, so I used "notminor=true".) Too bad. ] ] 20:43, 20 March 2010 (UTC)</small>

== Depression section: Placebo effect is NOT MEASURED in Double Blind trials but discounted ==

Am I the only one who is confused by the text and the reference in the depression section? Surely if there is a double blind trial the placebo effect should be discounted. If there is a large rate of recovery in both the placebo group and the active drug group the reason could be that a very large number of patients with depression get better over time regardless of whether they are on active medication or not. The placebo effect will be the same for both groups.

Here is my reasoning and understanding....

People taking placebo often report better recovery than people taking no medicine. The difference between the two groups is the PLACEBO EFFECT.

The PLACEBO RESPONSE is what is measured in the referenced meta-analysis study along with not the ACTIVE DRUG RESPONSE. The PLACEBO RESPONSE is not the same as the PLACEBO EFFECT because the placebo response will include those who spontaneously recover (or decline) and this factor is discounted when determining a PLACEBO EFFECT

:PLACEBO EFFECT = PLACEBO TREATMENT RESPONSE + NO TREATMENT RESPONSE

The "No treatment response" is not the same as the pre-treatment state because Before and after measurements of wellness nust be taken in the No treatment group as well as the placebo group.

In most drug trials the drug is tested double blind against a placebo and the the statistical difference (if any) between the drug group and the placebo group is assumed to be totally due to the effect of the drug. In other words the placebo effect is fully discounted as well as the spontaneous recovery effect. In other words a given response in a double blind trial is assumed to be as follows

:PLACEBO GROUP. Placebo Group response = Placebo response + elapsed time response

:DRUG GROUP Observed response = Placebo response + Drug response + elaspsed time response

And therefore

: DRUG RESPONSE = Drug group response less the Placebo group response

But following reference in the article led me to this in the abstract

<blockquote>
" Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 doubleblind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect." http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1999-11094-001
</blockquote>


I found this in The Anatomy of Melancholy by Robert Burton (1621):
I cannot fathom how they can claim to measure the placebo effect because the very nature of double blind trials eliminates the placebo effect (or more accurately at least it is present in equal measures in both groups) The "i'm taking a pill of some kind but I don't know what it is" effect is present in both groups. The large rate of recovery in the placebo group could simply be spontaneous recovery. A placebo effect, properly defined and measured cannot include spontaneous recovery. That is something else entirely.


---
Or have I misunderstood something? (quite possible - I am human!)--] (]) 01:54, 25 April 2010 (UTC)
And sometimes a strong conceit or apprehension, as Valesius proves, will take away diseases: in both kinds it will produce real effects. Men, if they see but another man tremble, giddy or sick of some fearful disease, their apprehension and fear is so strong in this kind, that they will have the same disease. Or if by some soothsayer, wiseman, fortune-teller, or physician, they be told they shall have such a disease, they will so seriously apprehend it, that they will instantly labour of it. A thing familiar in China (saith Riccius the Jesuit), If it be told them they shall be sick on such a day, when that day comes they will surely be sick, and will be so terribly afflicted, that sometimes they die upon it. Dr. Cotta in his discovery of ignorant practitioners of physic, cap. 8, hath two strange stories to this purpose, what fancy is able to do...
---
from: http://www.gutenberg.org/files/10800/10800-h/ampart1.html


== Needs clarification ==
:It sounds like you're discussing the same issue that brought up in their Cochrane review. For the placebo effect to be properly measured there needs to be a no drug group. Many scientists have erroneously assumed that if there is only an active drug and a placebo drug, the placebo effect can be measured, when it really can't - it has to be compared to a no drug group. ] | (] - ]) 02:54, 25 April 2010 (UTC)


I have attempted to edit this line, but was reverted: "The use of placebos as treatment in clinical medicine raises ethical concerns, as it introduces dishonesty into the doctor–patient relationship." However, for example, if the patient were *told* that they were being given a placebo, then there would be no dishonesty. It is possible that this statement is being taken out of context from the cited work. As it stands, the statement is misleading. Perhaps more context from the cited work can be given to illustrate the way in which giving a placebo might introduce dishonesty into a doctor-patient relationship. ] (]) 15:24, 26 November 2019 (UTC)
::It seems obvious that the section needs work. I have changed the first sentence, based merely on the last sentence of the abstract (perhaps someone with access to the article can verify the change was correct), to say the placebo effect is "half", not 75%. The second sentence doesn't make much sense to me, but I guess it has a similar problem, as does the third. So I have tagged them.
::The second paragraph also needs work/removing/replacing, but since it's less explicitly misleading than the rest I have not tagged it. It would be nice if an expert could do the rest. ] ] 08:57, 25 April 2010 (UTC) :The reason is clear - bypassing informed consent. The scenario you set out does not appear in the sources we cite, does it? ] (]) 15:34, 26 November 2019 (UTC)
::I concur with Alexbrn, "bypassing informed consent" was recently added in fact to precisely clarify why placebo may introduce dishonesty. But I think I see what you mean: I need to check but I think that there are studies showing that the placebo effect can still happen even when the patient is informed, in which case there would be no bypassing of informed consent. I need to check for sources then, but this may make this statement about dishonesty a bit too strong, but then this can be easily fixed by changing "as it introduces dishonesty" -> "as it '''may''' introduce dishonesty". Let me check for sources and we'll see. --] (]) 21:14, 26 November 2019 (UTC)
:::Found that it's called "open-label placebos", but need to find a review and if multiple studies reproduced the result. Also, the lede only mentions the informed consent issue, but it should probably also mention the fact that in clinical research patients are given a placebo when there are effective medications available (as described later in the article), this is also an ethical issue. --] (]) 00:09, 27 November 2019 (UTC)
:::Found 3 reviews on open-label placebos: and 1 in french (but not focused on open-label placebos). --] (]) 00:27, 27 November 2019 (UTC)
::::What happens in research is another matter, the text in question applies to what happens in clinical medicine. ] (]) 08:07, 27 November 2019 (UTC)
:::@Signimu, "as it '''may''' introduce dishonesty" is exactly the change I attempted to make. I'm glad you concur. ] (]) 19:11, 17 December 2019 (UTC)
:I have edited the lede to clarify that placebos do not need to be disguised in order to be considered placebos or to have placebo effects. It also includes a note about the ethical issues of using a placebo as a control in a clinical trial when there is already an existing treatment. ] (]) 12:07, 27 November 2019 (UTC)


== First sentence and Section 1 "Definitions" ==


The first sentence has a questionable reference. As it contains a definition, the definition should be absolutely solid, not in contradiction (and best: in no means different) from the definitions given in the respective section, and the definition should refer to a reference that is outmost credible. These conditions do not seem to apply here, as the currenty reference 1 stems from one national academic society and not from democratically legitimzed regulatory, refers to only one indication, namely pain, and most importantly, refers to a very unusual situation, namely "placebo in pain management". Please note that such use is likely to be illegal! Placebos cannot be prescribed or purchased. Legal use of placebos is confined to clinical trials.
::] | (] has put it very succinctly. Thanks.
However, there is a solid and extremely widely accepted reference for this topic, namely the Internationl Conference for Harmonization (ICH) with its guideline E10 "Choice of COntrol Group in Clinical Trials", issued and adopted in 2000. The sentence essential for placebo in this guideline is:
:::The new text is very well put, but I'm not sure I'd agree with the deletion of the text re clinical (mis)use of placebos. In a nutshell, this is the core issue between "mainstream" and "alternative" medicines. The former eschews the clinical use of placebos while the later forms embrace it under numerous elaborate sham methodologies, whether or not the practitioners believe the methodology matters. ] <small>]</small> 15:44, 25 April 2010 (UTC)
"In a placebo-controlled trial, subjects are randomly assigned to a test treatment or to an identical-appearing treatment that does not contain the test drug."
There are other important considerations below this sentence. Hence, it appears justified to modify the sentence to a definition:
>>Placebo is expected to be an identical-appearing treatment that does not contain the test drug.<<
You may also refer to the older US definition given in 21 CFR 314. §128, b 2 i:
"Placebo concurrent control: The test drug is compared with an inactive preparation designed to resemble the test drug as far as possible."
As the US FDA themselves contributed to and adopted finally ICH E10, they do not see a relevant difference between these definitions.
All in all, please consider
1. modifying the first sentence,
2. removing reference 1 as far as definitions are concerned,
3. inserting the definitions given by ICH E10 and 21 CFR 314,
4. providing respective references.


When having done this, you might find that the section 1 (Definitions) might require re-editing. Then you might find also other sections of the placebo article that need improvement. <!-- Template:Unsigned --><small class="autosigned">—&nbsp;Preceding ] comment added by ] (] • ]) 10:18, 10 December 2019 (UTC)</small> <!--Autosigned by SineBot-->
:{{u|Hajokrem}}, thank you for the interesting references and comment. Please feel free to update the entry, as you seem knowledgeable about it and the references you provide are sound, and it is unlikely others will not do it (at least in the near future). If you do so, I will fix any formatting issue or wording, so don't worry. ] (]) 14:18, 10 December 2019 (UTC)
:These definitions only deal with the use of placebos in clinical trials. ] (]) 11:30, 11 December 2019 (UTC)
::Hajokrem writes that from the sources it's stated placebos are regulated and only allowed for clinical trials, is that true? ] (]) 13:08, 11 December 2019 (UTC)
:::The prevailing view in medical ethics is that placebos have an important role in clinical trials. Otherwise, it is considered unethical to give fake medicine to a patient, especially if the patient is being deceived.
:::But even if it is considered unethical, it still happens in practice. ] is basically an entire industry that is built on giving out placebos. Besides alt-med, shows it is common for doctors to prescribe an unrelated medicine as a placebo. ] (]) 10:54, 12 December 2019 (UTC)
::::{{u|Anywikiuser}}, to be fair, alt med is also largely unethical... ''']''' <small>(])</small> 12:03, 12 December 2019 (UTC)
::{{u|Anywikiuser}}, correct, any other use is unethical. ''']''' <small>(])</small> 12:02, 12 December 2019 (UTC)


== Creating a redirect from ]? ==
Clinical misuse of placebos`???? Are you by any chance referring to this text which got deleted recently??.....


I have seen objections to the term "placebo effect" for a couple of reasons. Some are technical, basically that it is a fuzzy term that can cover a mixture of several effects that should be considered separately: reporting bias in RCT + social ritual healing (common knowledge is that going to the doctor and following her instructions make people better, and that expectation makes it happen) + various noise in remission statistics (reversal to the mean, spontaneous remission etc.); is a possible source discussing it. Some are political: the name "placebo effect" allows cranks to say "well, there is an effect" and convince the public in a way "as efficient as sugar" does not (see the start of though I doubt that is a reliable source by WP's standards).
"In one common placebo procedure, a patient is given an inert pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief may produce a subjective perception of a ], causing the patient to feel their condition has improved. This phenomenon is known as the placebo effect."......


I would think my first source is enough to justify a redirect from ] to here and a small mention in the lead but I have no idea how well-received in the community those views are (if they are totally fringe, we probably should not). Non-expert me has found Google Scholar hits for "placebo effect" (163k) vs "contextual effect" (15k, most seem to be about medicine) that indicate the term is in use, but that is hardly convincing ("faith healing" scores 24k).
I think it got deleted because there it implies that patients are given an inert pill on the understanding that it will cure them. That is an unsubstantiated claim and if it happened it would, I believe, be totally unethical. AFAIK in clinical double blind trials, all the participants are told quite clearly that thay may be treated with the active drug or with a placebo and that neither the doctor adminstering the pill nor the patient will know which he or she gets. Patients understand this and participate in such trials voluntarily in order to advance medical knowledge. If you know otherwise then as long as you vans support the claim with a reliable source. the text could go back. As I see it, there is no evidence provided to substantiate the claim.


The political objections might be worth a discussion too somewhere but only if it is a sourceable view (not necessarily among practitioners, but also among skeptics, governmental bodies, etc.). For obvious reasons I found mostly opinion pieces to that effect. ]<sup>]</sup> 14:26, 11 February 2020 (UTC)
If I recall correctly, there was some discussion at the time about giving placebos to patients with depression given that they are "so effective" - but that was a misunderstanding and a misuse of the term "placebo effect" because there may have been no placebo effect at work at all in those patients who recover on placebo. Depression is a condition that in many people goes away in time anyway. You cannot know whether there is a placebo effect at work in depression unless there us a trial of placebo versus no treatment with measured outcomes. It may be that there isn't (or if there is, it may be clinincally insignificant). The important thing about that research is that it counters the "miracle drug" claims made for prozac and related drugs. They have some effect in the very depressed, but for the mildly depressed the results were clinically not significant for the drug versus placebo. (The outcome scores were statistically different in the meta data (say a 2 point improvement over time - I can't rememeber the actual data - but it is highly unlikely that a patient would cognitiviely detect an improvement of 2 points). The lesson of course is that doctors should be more honest with their patients before prescribing drugs that have imperceptible improvements when patients have heard wonder stories in the press no doubt fuelled by the marketing machines of the pharmaceutical companies. Getting back to the point though, I am not aware of any clinically acceptable method of prescribing a placebo though I am sure some doctors have prescribed ] tabs to their well "worrier" patients with mild aches and pains not telling them that it is something more commonly known by another name.--] (]) 22:29, 28 April 2010 (UTC)
:Note the (brackets) in "(mis)use". I fully understand that it is regarded as unethical in modern practice to use placebos except with disclosure under approved trial protocols. That has not always been the case. And given the disclosure has happened, the effect rather obviously has potentially been diminished. OTOH, practitioners of "alternative medicine" have no such ethical connundrum because they hold that they are not using placebos but "therapies". Paradoxically, the fullest potency of the placebo effect may only be available to those who are sure they are delivering real therapy, not a blinded pill that they are unsure of. Its a real connundrum, though I have no idea how suitable trials could be constructed to test it.] <small>]</small> 22:57, 28 April 2010 (UTC)


== Self contradiction ==
:Hauskalainen, please read the article closely before doing a lot of changes and making broad statements. The . It says "Among the general practitioners, 86% (95% confidence interval 81-91) reported to have used placebo interventions at least once, and 48% (41-55) to have used placebo interventions more than ten times, within the last year ...Approximately 30% (28-36) of the clinicians believed in an effect of placebo interventions on objective outcomes, and 46% (42-50) found clinical placebo interventions generally ethically acceptable". The fact that suggests that you read it, and are therefore intentionally making false statements on the talk page. I hope that isn't the case, but you should not be changing the use of a reference without reading it.
:In , Hawskalainen added a definition of placebo effect which is unsourced and redundant with the last paragraph.
:For these reasons I'm going to revert back to the April 25 version. ] | (] - ]) 23:12, 28 April 2010 (UTC)


Reading the article feels like a true rollercoaster, which is pretty troublesome when you want to get a sense of the validity of the concept.
== Inert, or Sugar? ==
What i mean is that the article contains several quotes and sources about deeming placebo insignificant, dubious or outright dismissible, while at the exact same time it provides factual data that its a very much existing, functioning and measurable concept, especially with pain, nausea, depression.


In its nature the article is completely self-defeating, because if its taken at face value, one is left with a PhD level demonstration of what gossip among scientists and medical professionals looks like with everyone throwing slanted/partial data in the pool, then at the end you are exactly where you started: It exists, maybe, but we cant really figure how much, but its most certainly insignificant, except when its not.
Question: are placebos inert, or do they actually contain sugar (sucrose)?
I mean... is this supposed to be some red tape bureaucratic comedy? Whilst writing these articles, you might wish to provide a factual, on ground conclusion. An answer if you will instead of tossing in pro and contra data points left and right, creating an informational mire.
] (]) 00:21, 1 November 2021 (UTC)
:Yeah, this article does seem weird. It seems to be stating repeatedly that ''The Powerful Placebo'' was debunked and implying that there's no such thing as the placebo effect, which seems unlikely given the extent of the measures that usually seem to be taken to allow for the placebo effect in clinical trials. Possibly it just means that the particular data used in ''The Powerful Placebo'' were duds, rather than that the placebo effect doesn't exist? If so, it might make sense for it to say so. ] (]) 04:16, 16 December 2022 (UTC)


:I think the issue here is that while the idea of a Placebo Effect for quantitative health outcomes has been debunked, patients still *self-report* things like decreased pain, reduced depression, etc. I agree the article would benefit with being restructured to first cover the "history and debunking" of a "real placebo effect" (historical misunderstanding of regression to the mean) and then continue with a discussion of the "actual placebo effect" as it related to self-reported conditions. ] (]) 13:46, 23 August 2023 (UTC)
If they are inert, I think it should be noted that 'sugar pill' is misleading, as an inert pill would not contain ]. But if they contain sugar I believe it should be noted that they are not wholly inert (just mostly inert) as ] that sugar "can make you ]." <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 07:15, 6 May 2010 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->
::The placebo effect has not been debunked. It is real. I study placebos. The page needs strong changes. Placebo effect is real. That's a fact. I can give you tons of references.... ] (]) 19:34, 19 September 2024 (UTC)

Latest revision as of 19:34, 19 September 2024

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To-do list for Placebo: edit · history · watch · refresh · Updated 2018-08-21


Here are some tasks awaiting attention:
  • Cleanup : Introduction, several other sections
  • Merge : References instead of multiple citations to same reference (use <ref=name"...") If there ever were any, none now. Some first author names repeat, but to different articles.
  • Verify : Check if everything is correct
  • Other : sort "further reading" references alphabetically (and perhaps by type)? Section no longer exists. "See also" has only three listings.
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On 31 May 2010, Placebo was linked from Slashdot, a high-traffic website. (Traffic)

All prior and subsequent edits to the article are noted in its revision history.


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The following references may be useful when improving this article in the future:
  • may help lead to tertiary medical sources...of particular interest was discussion of the different strength of response across medical conditions, and how certain conditions like pain, Parkinson's disease, and Irritable bowel syndrome have strong responses that can be explained by changes in brain chemistry. It may help calibrate what conditions should be mentioned in this article.

Another possible historical account

I found this in The Anatomy of Melancholy by Robert Burton (1621):

--- And sometimes a strong conceit or apprehension, as Valesius proves, will take away diseases: in both kinds it will produce real effects. Men, if they see but another man tremble, giddy or sick of some fearful disease, their apprehension and fear is so strong in this kind, that they will have the same disease. Or if by some soothsayer, wiseman, fortune-teller, or physician, they be told they shall have such a disease, they will so seriously apprehend it, that they will instantly labour of it. A thing familiar in China (saith Riccius the Jesuit), If it be told them they shall be sick on such a day, when that day comes they will surely be sick, and will be so terribly afflicted, that sometimes they die upon it. Dr. Cotta in his discovery of ignorant practitioners of physic, cap. 8, hath two strange stories to this purpose, what fancy is able to do... --- from: http://www.gutenberg.org/files/10800/10800-h/ampart1.html

Needs clarification

I have attempted to edit this line, but was reverted: "The use of placebos as treatment in clinical medicine raises ethical concerns, as it introduces dishonesty into the doctor–patient relationship." However, for example, if the patient were *told* that they were being given a placebo, then there would be no dishonesty. It is possible that this statement is being taken out of context from the cited work. As it stands, the statement is misleading. Perhaps more context from the cited work can be given to illustrate the way in which giving a placebo might introduce dishonesty into a doctor-patient relationship. Gitpushoriginmaster (talk) 15:24, 26 November 2019 (UTC)

The reason is clear - bypassing informed consent. The scenario you set out does not appear in the sources we cite, does it? Alexbrn (talk) 15:34, 26 November 2019 (UTC)
I concur with Alexbrn, "bypassing informed consent" was recently added in fact to precisely clarify why placebo may introduce dishonesty. But I think I see what you mean: I need to check but I think that there are studies showing that the placebo effect can still happen even when the patient is informed, in which case there would be no bypassing of informed consent. I need to check for sources then, but this may make this statement about dishonesty a bit too strong, but then this can be easily fixed by changing "as it introduces dishonesty" -> "as it may introduce dishonesty". Let me check for sources and we'll see. --Signimu (talk) 21:14, 26 November 2019 (UTC)
Found that it's called "open-label placebos", but need to find a review and if multiple studies reproduced the result. Also, the lede only mentions the informed consent issue, but it should probably also mention the fact that in clinical research patients are given a placebo when there are effective medications available (as described later in the article), this is also an ethical issue. --Signimu (talk) 00:09, 27 November 2019 (UTC)
Found 3 reviews on open-label placebos: and 1 in french (but not focused on open-label placebos). --Signimu (talk) 00:27, 27 November 2019 (UTC)
What happens in research is another matter, the text in question applies to what happens in clinical medicine. Alexbrn (talk) 08:07, 27 November 2019 (UTC)
@Signimu, "as it may introduce dishonesty" is exactly the change I attempted to make. I'm glad you concur. Gitpushoriginmaster (talk) 19:11, 17 December 2019 (UTC)
I have edited the lede to clarify that placebos do not need to be disguised in order to be considered placebos or to have placebo effects. It also includes a note about the ethical issues of using a placebo as a control in a clinical trial when there is already an existing treatment. Anywikiuser (talk) 12:07, 27 November 2019 (UTC)

First sentence and Section 1 "Definitions"

The first sentence has a questionable reference. As it contains a definition, the definition should be absolutely solid, not in contradiction (and best: in no means different) from the definitions given in the respective section, and the definition should refer to a reference that is outmost credible. These conditions do not seem to apply here, as the currenty reference 1 stems from one national academic society and not from democratically legitimzed regulatory, refers to only one indication, namely pain, and most importantly, refers to a very unusual situation, namely "placebo in pain management". Please note that such use is likely to be illegal! Placebos cannot be prescribed or purchased. Legal use of placebos is confined to clinical trials. However, there is a solid and extremely widely accepted reference for this topic, namely the Internationl Conference for Harmonization (ICH) with its guideline E10 "Choice of COntrol Group in Clinical Trials", issued and adopted in 2000. The sentence essential for placebo in this guideline is: "In a placebo-controlled trial, subjects are randomly assigned to a test treatment or to an identical-appearing treatment that does not contain the test drug." There are other important considerations below this sentence. Hence, it appears justified to modify the sentence to a definition: >>Placebo is expected to be an identical-appearing treatment that does not contain the test drug.<< You may also refer to the older US definition given in 21 CFR 314. §128, b 2 i: "Placebo concurrent control: The test drug is compared with an inactive preparation designed to resemble the test drug as far as possible." As the US FDA themselves contributed to and adopted finally ICH E10, they do not see a relevant difference between these definitions. All in all, please consider 1. modifying the first sentence, 2. removing reference 1 as far as definitions are concerned, 3. inserting the definitions given by ICH E10 and 21 CFR 314, 4. providing respective references.

When having done this, you might find that the section 1 (Definitions) might require re-editing. Then you might find also other sections of the placebo article that need improvement. — Preceding unsigned comment added by Hajokrem (talk • contribs) 10:18, 10 December 2019 (UTC)

Hajokrem, thank you for the interesting references and comment. Please feel free to update the entry, as you seem knowledgeable about it and the references you provide are sound, and it is unlikely others will not do it (at least in the near future). If you do so, I will fix any formatting issue or wording, so don't worry. Signimu (talk) 14:18, 10 December 2019 (UTC)
These definitions only deal with the use of placebos in clinical trials. Anywikiuser (talk) 11:30, 11 December 2019 (UTC)
Hajokrem writes that from the sources it's stated placebos are regulated and only allowed for clinical trials, is that true? Signimu (talk) 13:08, 11 December 2019 (UTC)
The prevailing view in medical ethics is that placebos have an important role in clinical trials. Otherwise, it is considered unethical to give fake medicine to a patient, especially if the patient is being deceived.
But even if it is considered unethical, it still happens in practice. Alt-med is basically an entire industry that is built on giving out placebos. Besides alt-med, this UK survey shows it is common for doctors to prescribe an unrelated medicine as a placebo. Anywikiuser (talk) 10:54, 12 December 2019 (UTC)
Anywikiuser, to be fair, alt med is also largely unethical... Guy (help!) 12:03, 12 December 2019 (UTC)
Anywikiuser, correct, any other use is unethical. Guy (help!) 12:02, 12 December 2019 (UTC)

Creating a redirect from contextual effect?

I have seen objections to the term "placebo effect" for a couple of reasons. Some are technical, basically that it is a fuzzy term that can cover a mixture of several effects that should be considered separately: reporting bias in RCT + social ritual healing (common knowledge is that going to the doctor and following her instructions make people better, and that expectation makes it happen) + various noise in remission statistics (reversal to the mean, spontaneous remission etc.); here is a possible source discussing it. Some are political: the name "placebo effect" allows cranks to say "well, there is an effect" and convince the public in a way "as efficient as sugar" does not (see the start of that though I doubt that is a reliable source by WP's standards).

I would think my first source is enough to justify a redirect from contextual effect to here and a small mention in the lead but I have no idea how well-received in the community those views are (if they are totally fringe, we probably should not). Non-expert me has found Google Scholar hits for "placebo effect" (163k) vs "contextual effect" (15k, most seem to be about medicine) that indicate the term is in use, but that is hardly convincing ("faith healing" scores 24k).

The political objections might be worth a discussion too somewhere but only if it is a sourceable view (not necessarily among practitioners, but also among skeptics, governmental bodies, etc.). For obvious reasons I found mostly opinion pieces to that effect. Tigraan 14:26, 11 February 2020 (UTC)

Self contradiction

Reading the article feels like a true rollercoaster, which is pretty troublesome when you want to get a sense of the validity of the concept. What i mean is that the article contains several quotes and sources about deeming placebo insignificant, dubious or outright dismissible, while at the exact same time it provides factual data that its a very much existing, functioning and measurable concept, especially with pain, nausea, depression.

In its nature the article is completely self-defeating, because if its taken at face value, one is left with a PhD level demonstration of what gossip among scientists and medical professionals looks like with everyone throwing slanted/partial data in the pool, then at the end you are exactly where you started: It exists, maybe, but we cant really figure how much, but its most certainly insignificant, except when its not. I mean... is this supposed to be some red tape bureaucratic comedy? Whilst writing these articles, you might wish to provide a factual, on ground conclusion. An answer if you will instead of tossing in pro and contra data points left and right, creating an informational mire. 37.191.17.124 (talk) 00:21, 1 November 2021 (UTC)

Yeah, this article does seem weird. It seems to be stating repeatedly that The Powerful Placebo was debunked and implying that there's no such thing as the placebo effect, which seems unlikely given the extent of the measures that usually seem to be taken to allow for the placebo effect in clinical trials. Possibly it just means that the particular data used in The Powerful Placebo were duds, rather than that the placebo effect doesn't exist? If so, it might make sense for it to say so. Wombat140 (talk) 04:16, 16 December 2022 (UTC)
I think the issue here is that while the idea of a Placebo Effect for quantitative health outcomes has been debunked, patients still *self-report* things like decreased pain, reduced depression, etc. I agree the article would benefit with being restructured to first cover the "history and debunking" of a "real placebo effect" (historical misunderstanding of regression to the mean) and then continue with a discussion of the "actual placebo effect" as it related to self-reported conditions. Meekohi (talk) 13:46, 23 August 2023 (UTC)
The placebo effect has not been debunked. It is real. I study placebos. The page needs strong changes. Placebo effect is real. That's a fact. I can give you tons of references.... Placebo18 (talk) 19:34, 19 September 2024 (UTC)
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