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| 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, ], and ] have strong responses that can be explained by changes in brain chemistry. It may help calibrate what conditions should be mentioned in this article.}}
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from: http://www.gutenberg.org/files/10800/10800-h/ampart1.html from: http://www.gutenberg.org/files/10800/10800-h/ampart1.html


== Is it a chimera? == == Needs clarification ==


There is research suggesting that the placebo effect does not exist, is over-blown, or is merely psychological. 2012/02/05 BY THE ORIGINAL SKEPTICAL RAPTORHow the placebo effect proves nothing and means nothing at skeptical raptor;Placebo effects are weak: regression to the mean is the main reason ineffective treatments appear to work Published December 11, 2015 at dcscience.net;Perspect Biol Med. Author manuscript; available in PMC 2010 Oct 1.
Published in final edited form as:Perspect Biol Med. 2009 Autumn; 52(4): 518. doi: 10.1353/pbm.0.0115 PMCID: PMC2814126NIHMSID: NIHMS168943PMID: 19855122
The placebo effect: illness and interpersonal healing; and more in any Internet search using 'fallacy of the placebo effect' as a search term. ] (]) 00:29, 12 August 2019 (UTC)

== "Placebo studies" ==

Note there's a discussion at ] about our ] article. In particular it has been suggested that some of it might be merged here. Eyes from placebo-savvy editors welcome ... ] (]) 00:46, 17 August 2019 (UTC)

==Real or not==

There seems to be consensus at this page that the placebo effect is not "real" in the sense that it can only improve self-reported outcomes and does not result in healing. This viewpoint is based on a few rather old reviews, and is contradicted by numerous more recent reviews such as these.<ref>{{Cite journal|last=Benedetti|first=Fabrizio|last2=Carlino|first2=Elisa|last3=Pollo|first3=Antonella|date=2011-1|title=How placebos change the patient's brain|url=https://www.ncbi.nlm.nih.gov/pubmed/20592717|journal=Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology|volume=36|issue=1|pages=339–354|doi=10.1038/npp.2010.81|issn=1740-634X|pmc=3055515|pmid=20592717}}</ref><ref>{{Cite journal|last=Pacheco-López|first=Gustavo|last2=Engler|first2=Harald|last3=Niemi|first3=Maj-Britt|last4=Schedlowski|first4=Manfred|date=2006-9|title=Expectations and associations that heal: Immunomodulatory placebo effects and its neurobiology|url=https://www.ncbi.nlm.nih.gov/pubmed/16887325|journal=Brain, Behavior, and Immunity|volume=20|issue=5|pages=430–446|doi=10.1016/j.bbi.2006.05.003|issn=0889-1591|pmid=16887325}}</ref><ref>{{Cite journal|last=Sheldon|first=Robert|last2=Opie-Moran|first2=Morwenna|date=12 2017|title=The Placebo Effect in Cardiology: Understanding and Using It|url=https://www.ncbi.nlm.nih.gov/pubmed/29173596|journal=The Canadian Journal of Cardiology|volume=33|issue=12|pages=1535–1542|doi=10.1016/j.cjca.2017.09.017|issn=1916-7075|pmid=29173596}}</ref><ref>{{Cite journal|last=Quattrone|first=Aldo|last2=Barbagallo|first2=Gaetano|last3=Cerasa|first3=Antonio|last4=Stoessl|first4=A. Jon|date=08 2018|title=Neurobiology of placebo effect in Parkinson's disease: What we have learned and where we are going|url=https://www.ncbi.nlm.nih.gov/pubmed/30230624|journal=Movement Disorders: Official Journal of the Movement Disorder Society|volume=33|issue=8|pages=1213–1227|doi=10.1002/mds.27438|issn=1531-8257|pmid=30230624}}</ref><ref>{{Cite journal|last=Colagiuri|first=B.|last2=Schenk|first2=L. A.|last3=Kessler|first3=M. D.|last4=Dorsey|first4=S. G.|last5=Colloca|first5=L.|date=2015-10-29|title=The placebo effect: From concepts to genes|url=https://www.ncbi.nlm.nih.gov/pubmed/26272535|journal=Neuroscience|volume=307|pages=171–190|doi=10.1016/j.neuroscience.2015.08.017|issn=1873-7544|pmc=5367890|pmid=26272535}}</ref><ref>{{Cite journal|last=Peciña|first=M.|last2=Zubieta|first2=J.-K.|date=2015-4|title=Molecular mechanisms of placebo responses in humans|url=https://www.ncbi.nlm.nih.gov/pubmed/25510510|journal=Molecular Psychiatry|volume=20|issue=4|pages=416–423|doi=10.1038/mp.2014.164|issn=1476-5578|pmc=4372496|pmid=25510510}}</ref> This list of references is by no means comprehensive and represents just a small part of the recent research that has been conducted on the subject. This article's view on placebos needs to be updated. --] (]) 20:48, 18 August 2019 (UTC)
{{reftalk}}
: Medicine is littered with studies of imaginary things. Homeopathy, for example. The issue here is that those arguing for the existence of a placebo effect are primarioly either quacks trying to use it to validate inert treatments (usully acupuncture) or are ctually studying something else - the effect of perception on physical symptoms. What you're offering is primary studies into a thing, predicated on the belief that it exsts, as rebuttal to review studies that say the thing does not exist. <b>]</b> <small>(])</small> 07:50, 19 August 2019 (UTC)
:: I'm offering up six reviews saying that it exists, all published in Medline indexed journals. And this was just what I found on my first pass of pubmed. You are offering up one review saying that it doesn't. --] (]) 12:37, 19 August 2019 (UTC)
::: No, they ''assume'' it exists and try to quntify it. <b>]</b> <small>(])</small> 16:12, 19 August 2019 (UTC)
:::: 1) That is not so. These reviews show a lot of empirical evidence. 2) Wikipedians should not try to peer review studies. If the bulk of the literature finds that it exists (even if it doesn't) than Misplaced Pages should too. See ]. --] (]) 13:23, 20 August 2019 (UTC)
{{re|JzG}} I see that you reverted by addition of these two books to the further reading section, saying that it makes no sence to have a book on the neurobiology of something that doesn't exist. I would like to add these two books to the pile of evidence that the placebo effect does exist. It should be noted that the amount that we know about the neurobiology of the placebo effect is too large to fit into one book. --] (])
* {{Cite book|url=https://www.worldcat.org/oclc/1032303151|title=Neurobiology of the placebo effect. Part I|others=Colloca, Luana,|isbn=9780128143261|location=Cambridge, MA|oclc=1032303151}}
* {{Cite book|url=https://www.worldcat.org/oclc/1049800273|title=Neurobiology of the placebo effect. Part II|others=Colloca, Luana,|isbn=9780128154175|edition=First edition|location=Cambridge, MA, United States|oclc=1049800273}}
:: Actually one book. Show me the evidence that this is considered to be a worthwhile contribution to reality-bsed treatment? You seem very keen to refactor this article to show the belief that placebos are real. That's problematic. I note also that virtually everything the (single) author has ever done, is promoting the idea that the placebo effect is a thing. She seems very vested in this notion. You'll forgive me for being suspicious: this field of research looks incredily like acupucture studies or homeoapthy studies - endless discussion of "how X works" while studiously ignoring anything that shows it doesn't. <b>]</b> <small>(])</small> 14:15, 19 August 2019 (UTC)

:::Most medical professionals seem to take the placebo effect as a given, assuming that the patient's expectation of something can result in a change in perception or a psychosomatic response. That may very well be incorrect, but it's far from being a fringe belief. This is what my pharmacology textbook has to say:
::::{{ex|The 'placebo response' (see review by ) is '''widely believed''' to be a powerful therapeutic effect, producing a significant beneficial effect in about one-third of patients. While many clinical trials include a placebo group that shows improvement, few have compared this group diretly with untreated controls. A survey of these trial results (Hróbjartsson & Gotzche, 2001) concluded (controversially) that the placebo effect was often insignificant, except in the case of pain relief, where it was small but significant. They concluded that the popular belief in the strenght of the placebo effect is misplaced, and probably reflects in part the tendency of many symptoms to improve spontaneously and in part the reporting bias of patients who want to please their doctors.}} (Rang & Dale's Pharmacology, 2016)
:::The paper they cite for "widely believed" is . The website of the which we cite says: {{ex|Even though they don’t act on the disease, placebos affect how some people feel. This happens in up to 1 of 3 people.}} – ''']''' ] 14:16, 19 August 2019 (UTC)

:::: {{re|JzG}} Placebos have been found to produce clinically significant improvements in some diseases, but this is not the same as asserting that they should be used in clinical settings. Some argue that they should, while others argue that this amounts to deceiving the patient and is therefore unethical. We should keep these two discussions distinct. --] (]) 14:23, 19 August 2019 (UTC)
::::{{re|Þjarkur}} I have seen no evidence that placebos shrink tumors. I'm sure that everything the American Cancer Society said is true in the context of cancer treatment. --] (]) 14:38, 19 August 2019 (UTC)
::::: No, they have not been found to produce clinical improvements in any disease. They ''have'' been shown to produce temprary changes in ''symptoms'' of diseases, but this is generally restricted to ''self-reported and subjective'' symptoms. Example: the infamous asthma study found that patients resported improvements, but measurements showed no change at all in lung function - which is pretty dangerous. Thikning your asthma meds are workign when they aren't is a realy bad outcome. <b>]</b> <small>(])</small> 14:39, 19 August 2019 (UTC)
:::: {{u|Þjarkur}}, it's not a fringe belief, what's fringe is the move from "placebos make people feel better" to "this is how placebos maake people better". That's the problem. All the objective data says people feel better, but not much, not for long, and they nly feel it, it doesn't translate into objective effects. Bear in mind that there are at least two widely-promoted forms of SCAM that claim to harness the placebo effect: acupuncture and homeopathy. Neither of these is actually shown to have any objectively measurable effect on te disease proecesses when you blind and test properly. <b>]</b> <small>(])</small> 14:44, 19 August 2019 (UTC)
:::::: On the contrary, acupuncture and homeopathy claim to be active treatments, not placebos. It's their opponents who dismiss them as placebos. ] (]) 16:06, 19 August 2019 (UTC)
::::: In some diseases placebos produce only perception of improvement (such as asthma) while in others (such as pain and Parkinson's) it can produce real improvement. This has been determined by empirically, and the biological mechanisms have been identified. For example, finds that placebos reduce symptoms in ]. In finds that placebos cause the brain to release dopamine. That means the mechanism of action for placebos in Parkinson's is the same as for active drugs: they raise dopamine levels in certain parts of the brain. Furthermore, the size of the effect depends on the patient's expectation of improvement, and larger dopamine release can be conditioned through prior exposure. It is also well-verified that placebo analgesics reduce pain, and even the 2010 review that is cited in the article finds this. Placebo analgesics cause the release of ], which are natural painkillers. Another study (that I can't seem to find right now) found that placebo analgesia is blocked by the opiate antagonist ]. --] (]) 14:51, 19 August 2019 (UTC)
::::::I would be fine with the Parkinson's disease study, as it fits the criteria for being a reliable secondary medical source. Ideological discussions about the placebo effect won't get us anywhere − it comes down to whether editors can supply information that is supported by acceptable sources. ] (]) 15:42, 19 August 2019 (UTC)
::::::: Both acupuncture and homeopathy have a history of claiming to harnes the "placebo effect", including acupuncture claiming that because sham acupuncture and real acupuncture are indistinguishable, so acupuncture harnesses the "placebo effect" ''relaly well'', give us more money please.
::::::: Meanwhile back in the real world the evidence for objective effects is sketchy at best, and the risks of claiming the placebo narrative are demosntrated by the asthma case. <b>]</b> <small>(])</small> 16:12, 19 August 2019 (UTC)
{{od}}
{{u|Wikiman2718}} I am looking for a critique of that naltrexone study. As Ir ecall it was the usual shit: based on self-reported subjective outcomes. Virtually every study of the "placebo effect" is based on patient questionnaires. <b>]</b> <small>(])</small> 16:14, 19 August 2019 (UTC)
: {{re|JzG}} Can you show the review (and the original study)? Even the American Cancer society article stated that placebo analgesics cause the release on endorphins. That makes it completely implausible that placebo analgesics would ''not'' produce clinical improvement in real outcomes. There seems to be far more evidence for than against here. --] (]) 16:27, 19 August 2019 (UTC)
::If you have reliably sourced information (see ] for guidelines), feel free to add it to the article. I'm wary that this discussion is turning into a debate on the placebo effect and I don't think that's going to get us anywhere. ] (]) 17:59, 19 August 2019 (UTC)
::: I am familiar with the analysis you just added (). It's perfectly emblematic of the problem: virtually every included study has subjective endpoints (e.g. Parent-reported ADHD Scale, SDQ). There is a profound lack of data based on objective measurements, and on the rare occasions when subjective and objective outocmes are compared (e.g. ) the result clearly shows no objective effect. <b>]</b> <small>(])</small> 09:51, 20 August 2019 (UTC)
::::A few months ago I added a meta-analysis on insomnia treatments that makes a similar point. ] (]) 10:39, 20 August 2019 (UTC)
::::: These studies have al the elemnts of "tooth fairy science". <b>]</b> <small>(])</small> 11:37, 20 August 2019 (UTC)
:::::: Do you have any studies to show this? So far it just seems to be one 2010 review and a statement from the American Cancer Society based on that review. In a field like this with lots of research, we should rely on reviews from the last five years. --] (]) 13:17, 20 August 2019 (UTC)

* See also: ] --] (]) 13:23, 20 August 2019 (UTC)
*: We seem to have consensus that placebos improve objective outcomes in at least two illnesses-- pain and Parkinson's. We also have consensus that placebos do not improve objective outcome is asthma or cancer. We should evaluate each claim on a case-by case basis, taking care to distinguish between objective and subjective outcomes. --] (]) 13:48, 20 August 2019 (UTC)
:::I would argue that pain is neither a fully objective nor a fully subjective experience. And I'd be careful about saying placebos can objective outcomes for Parkinson's (my hunch is that it can't improve life expectancy, for instance). But the source does provide evidence that there is a link between placebo treatment of Parkinson's and the release of hormones, which is an objective effect. And I agree about the need to evaluate each claim on a case-by-case basis. It comes down to whether the information is backed by reliable sources. ] (]) 14:43, 20 August 2019 (UTC)
:::: finds that placebos can improve motor control in Parkinson's disease by causing the brain to release dopamine. That's the same mechanism as the active drug. That's about as objective as it gets. I don't think anyone's ever studied the effect on life expectancy. --] (]) 15:20, 20 August 2019 (UTC)
:::::Indeed, and I'm fine with that studies' findings being added to the article. ] (]) 15:35, 20 August 2019 (UTC)
::::: That is indeed what it appears to show, but I think you may be missing my point. Overall, the evidence strongly shows that placebo effects are purely subjective. If, uniquely, Parkinsons can show an objective effect, then that would be a remarkable finding but it doesn't change the fact that if you look at pretty much any review of placebos, you find all the outcomes to be subjective and self-reported, and very few actually even test for any objective outcome. Where this is done, none is found. So if we cover PD it should be as an exception that's not yet understood, rather than as rebuttal to the fact that the placebo effect is not a thing. <b>]</b> <small>(])</small> 16:41, 20 August 2019 (UTC)
:::::: The reviews listed above cover Parkinson's, pain, depression, and even some immunological disorders. You keep saying that there are many reviews debunking these claims, but I have yet to see them. The reviews presently cited in the article are not from the last five years. It looks like the sources that say that placebos can effect only self-reported outcomes are outdated. If you have any ] sources that say otherwise, please show them. --] (]) 16:52, 20 August 2019 (UTC)
:::::::So, this lands us with "extraordinary claim, probably bogus, yet not debunked in the scientific literature". Do you think we play whack-a-mole? ] (]) 00:08, 26 August 2019 (UTC)
:::::::: Show sources, please. --] (]) 00:14, 26 August 2019 (UTC)
:::::::::I don't have sources, but we have ], such as ]. Do you realize that this could be the misconception of the year, next year will be another misconception about placebos which will still be not debunked, the year after that another misconception and so on. That's what I mean by whack-a-mole. You will keep edit warring to include the misconception of the current year. ] (]) 00:17, 26 August 2019 (UTC)
::::::::::: {{re|Tgeorgescu}} 1) My edits come nowhere near the threshold for an edit war. Please do not accuse me of that without evidence. 2) ] states that extraordinary claims must be justified by multiple high quality sources. I have shown seven so far, and there are a lot more available. There were only ever two studies finding the opposite: one was from 2010, and the other from the 1990s. Neither is ]. If you want your claim to stand, you will have to show some valid sources. --] (]) 00:29, 26 August 2019 (UTC)
::::::::::::The ] is upon those who want to change the status quo. Misplaced Pages isn't for bleeding-edge knowledge, it is for established, banal and boring knowledge. Also, there is no need that an edit war is fast-paced. Slowly changing an article with yet undebunked knowledge is still edit-warring. ] (]) 00:34, 26 August 2019 (UTC)
:::::::::::::{{re|Tgeorgescu}} I have shown the appropriate sources. The knowledge is well-established. If you disagree, I challenge you to find ''one'' ] source to validate your opinion. Also, ] only applied to verifiable claims, which yours isn't. --] (]) 00:36, 26 August 2019 (UTC)
::::::::::::::You're working under the misconception that ] trump ]s. ] (]) 00:40, 26 August 2019 (UTC)

::::::::::::::: ] ''is'' a guideline... Are you proposing we ignore it? --] (]) 00:56, 26 August 2019 (UTC)

::::::::::::::::I know. And I find bizarre to say that Cochrane isn't MEDRS-compliant. Previously I meant: reliable sources do not trump policies and guidelines. Perhaps I was too concise. ] (]) 01:02, 26 August 2019 (UTC)

::::::::::::::::: {{re|Tgeorgescu}} It is not from the last five years. --] (]) 01:05, 26 August 2019 (UTC)

*The article currently reflects both viewpoints. I have added the self-contradictory template until such time as this is resolved. --] (]) 20:00, 25 August 2019 (UTC)
*: Template removed. Problem resolved. --] (]) 00:14, 26 August 2019 (UTC)

:::Actually, Tgeorgescu, it isn't an extraordinary claim to say that the placebo effect has objective effects. The science shows that the placebo effect influences neurotransmitters, which is clearly objective. It would be more of an extraordinary claim to say that the placebo effect has no objective effects, which seems to be what the article is saying at the moment.

:::It seems there is a bit of cherry picking in terms of the reviews used here. The sleep review that we use says there are no objective changes to sleep onset. However, as far as I can see, the review didn't actually look at any studies that measured objective sleep onset. Other reviews do find a significant difference in sleep onset. And the Cochrane review is 18 years old.

:::The problem with depression is that there are no 3-arm trials comparing antidepressants to placebo to no treatment, so we don't have any studies to definitely say there is an objective placebo effect. However, given what we know about neuroscience, it would be somewhat extraordinary if there wasn't any objective placebo effect.--] (]) 00:40, 26 August 2019 (UTC)

::::Do you realize that your argument applies to any form of quackery, e.g. faith healing? And in which way "placebo changes neurotransmitters" is different from "watching ''A Clockwork Orange'' changes neurotransmitters"? ] (]) 00:55, 26 August 2019 (UTC)
::::: We already discussed truth. Let's keep this about verifiability, please. --] (]) 01:01, 26 August 2019 (UTC)
:::::: Extraordinary claims need extraordinary evidence, that is what ] means. You cannot trump Cochrane with an ordinary review, which might as well get debunked in a couple of years. ] (]) 01:05, 26 August 2019 (UTC)
::::::: The Cochrane review is not from the last five years. I have have not shown one review, but several (as ] requires). --] (]) 01:10, 26 August 2019 (UTC)
::::::::You have to have better sources that a scientific revolution has happened. ] (]) 01:20, 26 August 2019 (UTC)
::::::::: I see no evidence that the conclusion of the Cochrane review was widely accepted in the first place. The studies I am looking at show that it wasn't. The evidence in favor of a placebo effect is absolutely overwhelming. --] (]) 01:24, 26 August 2019 (UTC)
::::::::::Why then isn't your claim big news all over the world: "Placebos finally vindicated"? ] (]) 01:28, 26 August 2019 (UTC)
::::::::::: That is a loaded question. It implies that the placebo effect was ever in genuine doubt. But regardless, you can find tons of news articles on this subject (both mainstream and scientific). —] (]) 01:34, 26 August 2019 (UTC)
::::::::::::IMHO, that smacks of ]. The reality-based community doubts that there is any solid evidence for placebo healing anything, except imaginary illnesses. You have been warned of discretionary sanctions. Your POV is: Cochrane on placebos is not good now and was never good, there wasn't ever any genuine doubt about placebos. Are you for real? Do you realize that our article tells a quite different story? Do you realize that when people wanted hard evidence of objective effects of placebos, they could not find any or they had stumped on a statistical fluke? ] (]) 03:02, 26 August 2019 (UTC)
::::::::::::: {{re|Tgeorgescu}} Refusing to acknowledge ] guidelines is disruptive. --] (]) 03:12, 26 August 2019 (UTC)
::::::::::::::I agree with you that it is disruptive. The question is, however: who does that, you or me? E.g. I'm not the one bashing Cochrane... ] (]) 03:15, 26 August 2019 (UTC)
::::::::::::::: You are. The rule says five years. That rule was created specifically for situations like these-- information becomes outdated. --] (]) 03:17, 26 August 2019 (UTC)
::::::::::::::::]. Do mind that I wasn't the only one who has reverted your edits today. See ]. You need ] for your edits, otherwise status quo wins by default. Also, daring to bash Cochrane on Misplaced Pages means that you have ''huevos'': such daring usually ends badly. ] (]) 03:28, 26 August 2019 (UTC)
::::::::::::::::: That one old review is the entire argument. We have consensus that placebos work for some conditions (e.g. Parkinsons), which means we have consensus it is outdated. Despite the massive amount of research that has been conducted in this field, there are ''literally'' no reviews from that last five years that support your viewpoint. --] (]) 03:51, 26 August 2019 (UTC)
::::::::::::::::::I did not know that there is anyone who really suggests treating Parkinsons with placebos. Otherwise, why bother with expensive, sophisticated research? As others have told you, in the research about placebos there is a lot of bunk research. Garbage in, garbage out. As the old rhyme says, "Catch Eusapia by the toe". So that five years limit is not as hard as you might think. ] (]) 03:58, 26 August 2019 (UTC)
{{OD}}
Please read the entire talk page. This is not about whether or not placebos should be used in clinical practice. That question is entirely separate from their efficacy, which most certainly exists for Parkinson's, pain, and some other conditions. And your one review is ''nine years old''.--] (]) 04:03, 26 August 2019 (UTC)
:Placebos are effective against Parkinson's.
:Therefore placebos should be used as medicines against Parkinson's.
:But that does not happen.
<br>
:Do you realize we have a logic problem here? ] (]) 04:11, 26 August 2019 (UTC)
:: Nope. There are a lot of reasons not to prescribe an effective medication. In this case, the main argument against is the ethics of deception. It's not even about biology. --] (]) 04:16, 26 August 2019 (UTC)
:::Wrong: the ethics of deception only applies to ineffective medicines. If the medicine is really effective, there is no deception involved. You cannot eat your cake and still have it. ] (]) 04:21, 26 August 2019 (UTC)
:::: Nonsense. And even if that logic were valid, it would be original research. If you're unwilling (and unable) to show sources, this will have to go to arbitration. --] (]) 04:28, 26 August 2019 (UTC)
:::::Much luck with that. You'll need it because of ] (like I were the only one who has reverted your edits today).

<blockquote>''Our house, our rules'' is a blunt way of saying that the Misplaced Pages community has a set of norms that govern how the encyclopedia is built: norms about what kind of sources we use, about how we handle conflict, and so on. Those norms include not using self-published internet sources, not making blanket statements about ethnic groups (Jews, in this case) without support, not editing against the consensus of editors, and so on. You may consider discussion of those norms as "off-topic," but the Misplaced Pages community tends to think they are important. Misplaced Pages articles aren't "owned" by individuals, but they are "owned," in a sense, by the Wikimedia community and the consensus of editors. When an editor, like yourself, decides they want an article to go in a direction other than what the majority of editors want to do, the majority of editors typically preserve their preferred version. Adding material to an article, and then having other editors take that material out, is part of the normal editing process. It's not "force" and it's not "vandalism." It happens to all of us. I'm pretty sure that none of us have our edits here accepted by the community 100% of the time. Learning to abide by Misplaced Pages's communal decisions is an important part of getting along here as an editor. And if you don't want your editing to be limited by the Misplaced Pages community's particular goals and methods and decisions, the good news is that there's plenty of other outlets for your work, like perhaps Conservapedia, or getting a personal blog. At the end of the day, Misplaced Pages really is the private project of the Wikimedia Foundation. It is, roughly, a service that provides summaries of the contents of mainstream scholarship, in the specific sense that "mainstream scholarship" has here at Misplaced Pages. It's really not an experiment in treating all views equally, and if you think it is, you're likely to wind up frustrated. ] (]) 12:16, 24 January 2018 (UTC)</blockquote>

:::::Quoted by ] (]) 05:10, 26 August 2019 (UTC)
::::::{{re|Tgeorgescu}} How many ] reviews would it take to make you change your mind? --] (]) 14:43, 26 August 2019 (UTC)

:Well, I think this is what Tgeorgescu's argument boils down to: " The reality-based community doubts that there is any solid evidence for placebo healing anything, except imaginary illnesses." So are you saying that depression is imaginary? What about Parkinson's? And no, wikipedia isn't about the "majority" of editors holding an article hostage. It is based on evidence, reviews, and logical discussion. Calling depression imaginary isn't based on any kind of logic or science, never mind basic humanity. If you have anything useful to add, go ahead. Otherwise I'm not sure how useful further discussion is. Misplaced Pages uses high quality reviews. End of story. If you want to discuss the reviews then we're all ears, but this discussion is getting silly and useless. --] (]) 17:04, 26 August 2019 (UTC)

* Here are some reviews that find evidence of a placebo effect.<ref>{{Cite journal|last=Quinn|first=Veronica F.|last2=Colagiuri|first2=Ben|date=2015-6|title=Placebo interventions for nausea: a systematic review|url=https://www.ncbi.nlm.nih.gov/pubmed/25515086|journal=Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine|volume=49|issue=3|pages=449–462|doi=10.1007/s12160-014-9670-3|issn=1532-4796|pmid=25515086}}</ref><ref>{{Cite journal|last=Colloca|first=Luana|last2=Howick|first2=Jeremy|date=2018|title=Placebos Without Deception: Outcomes, Mechanisms, and Ethics|url=https://www.ncbi.nlm.nih.gov/pubmed/29681327|journal=International Review of Neurobiology|volume=138|pages=219–240|doi=10.1016/bs.irn.2018.01.005|issn=2162-5514|pmc=5918690|pmid=29681327}}</ref><ref>{{Cite journal|last=Pecina|first=Marta|last2=Zubieta|first2=Jon-Kar|date=2018|title=Expectancy Modulation of Opioid Neurotransmission|url=https://www.ncbi.nlm.nih.gov/pubmed/29681324|journal=International Review of Neurobiology|volume=138|pages=17–37|doi=10.1016/bs.irn.2018.02.003|issn=2162-5514|pmc=6314670|pmid=29681324}}</ref><ref>{{Cite journal|last=Belcher|first=Annabelle M.|last2=Ferré|first2=Sergi|last3=Martinez|first3=Pedro E.|last4=Colloca|first4=Luana|date=12 20, 2018|title=Role of placebo effects in pain and neuropsychiatric disorders|url=https://www.ncbi.nlm.nih.gov/pubmed/28595945|journal=Progress in Neuro-Psychopharmacology & Biological Psychiatry|volume=87|issue=Pt B|pages=298–306|doi=10.1016/j.pnpbp.2017.06.003|issn=1878-4216|pmc=5722709|pmid=28595945}}</ref><ref>{{Cite journal|last=Coste|first=Joël|last2=Montel|first2=Sébastien|date=03 01, 2017|title=Placebo-related effects: a meta-narrative review of conceptualization, mechanisms and their relevance in rheumatology|url=https://www.ncbi.nlm.nih.gov/pubmed/27477808|journal=Rheumatology (Oxford, England)|volume=56|issue=3|pages=334–343|doi=10.1093/rheumatology/kew274|issn=1462-0332|pmid=27477808}}</ref><ref>{{Cite journal|last=Frisaldi|first=Elisa|last2=Piedimonte|first2=Alessandro|last3=Benedetti|first3=Fabrizio|date=2015-1|title=Placebo and nocebo effects: a complex interplay between psychological factors and neurochemical networks|url=https://www.ncbi.nlm.nih.gov/pubmed/25928679|journal=The American Journal of Clinical Hypnosis|volume=57|issue=3|pages=267–284|doi=10.1080/00029157.2014.976785|issn=0002-9157|pmid=25928679}}</ref><ref>{{Cite journal|last=Holmes|first=R. D.|last2=Tiwari|first2=A. K.|last3=Kennedy|first3=J. L.|date=11 2016|title=Mechanisms of the placebo effect in pain and psychiatric disorders|url=https://www.ncbi.nlm.nih.gov/pubmed/27001122|journal=The Pharmacogenomics Journal|volume=16|issue=6|pages=491–500|doi=10.1038/tpj.2016.15|issn=1473-1150|pmid=27001122}}</ref><ref>{{Cite journal|last=Hansen|first=E.|last2=Zech|first2=N.|last3=Meissner|first3=K.|date=2017-10|title=|url=https://www.ncbi.nlm.nih.gov/pubmed/28702702|journal=Der Internist|volume=58|issue=10|pages=1102–1110|doi=10.1007/s00108-017-0294-0|issn=1432-1289|pmid=28702702}}</ref><ref>{{Cite journal|last=Sheldon|first=Robert|last2=Opie-Moran|first2=Morwenna|date=12 2017|title=The Placebo Effect in Cardiology: Understanding and Using It|url=https://www.ncbi.nlm.nih.gov/pubmed/29173596|journal=The Canadian Journal of Cardiology|volume=33|issue=12|pages=1535–1542|doi=10.1016/j.cjca.2017.09.017|issn=1916-7075|pmid=29173596}}</ref><ref>{{Cite journal|last=Gross|first=Liza|date=02 2017|title=Putting placebos to the test|url=https://www.ncbi.nlm.nih.gov/pubmed/28222121|journal=PLoS biology|volume=15|issue=2|pages=e2001998|doi=10.1371/journal.pbio.2001998|issn=1545-7885|pmc=5319646|pmid=28222121}}</ref><ref>{{Cite journal|last=Benedetti|first=Fabrizio|date=2014-11-05|title=Placebo effects: from the neurobiological paradigm to translational implications|url=https://www.ncbi.nlm.nih.gov/pubmed/25442940|journal=Neuron|volume=84|issue=3|pages=623–637|doi=10.1016/j.neuron.2014.10.023|issn=1097-4199|pmid=25442940}}</ref><ref>{{Cite journal|last=Quattrone|first=Aldo|last2=Barbagallo|first2=Gaetano|last3=Cerasa|first3=Antonio|last4=Stoessl|first4=A. Jon|date=08 2018|title=Neurobiology of placebo effect in Parkinson's disease: What we have learned and where we are going|url=https://www.ncbi.nlm.nih.gov/pubmed/30230624|journal=Movement Disorders: Official Journal of the Movement Disorder Society|volume=33|issue=8|pages=1213–1227|doi=10.1002/mds.27438|issn=1531-8257|pmid=30230624}}</ref><ref>{{Cite journal|last=Pacheco-López|first=Gustavo|last2=Engler|first2=Harald|last3=Niemi|first3=Maj-Britt|last4=Schedlowski|first4=Manfred|date=2006-9|title=Expectations and associations that heal: Immunomodulatory placebo effects and its neurobiology|url=https://www.ncbi.nlm.nih.gov/pubmed/16887325|journal=Brain, Behavior, and Immunity|volume=20|issue=5|pages=430–446|doi=10.1016/j.bbi.2006.05.003|issn=0889-1591|pmid=16887325}}</ref><ref>{{Cite journal|last=Morral|first=Antoni|last2=Urrutia|first2=Gerard|last3=Bonfill|first3=Xavier|date=2017-07-07|title=Placebo effect and therapeutic context: A challenge in clinical research|url=https://www.ncbi.nlm.nih.gov/pubmed/28521961|journal=Medicina Clinica|volume=149|issue=1|pages=26–31|doi=10.1016/j.medcli.2017.03.034|issn=1578-8989|pmid=28521961}}</ref> They are all medline indexed and from the last five years. If this goes to dispute resolution, I will submit these as evidence. If not, these reviews will be useful to editors wishing to improve the article. {{re|Tgeorgescu}} You have stated that you . Just to make it clear, the ''only'' evidence for your case is ? If you want to continue this dipute, tell me now and I will submit the form. Otherwise I am ready to declare consensus and begin improving the article. --] (]) 17:15, 26 August 2019 (UTC)
{{reftalk}}
::::I much prefer the wording "which is not designed to have a therapeutic value" (which is very similar to the current wording, so that's fine). Because it paraphrases a professional medical organisation's definition, that means it wasn't simply made up on the spot by a Wikipedian. Likewise I prefer the wording that "In general, placebos...have no impact on the ] itself" because it avoids stating this is particularly common while leaving open the possibility of exceptions. Even when they actually do have objective effects, such as with Parkinsons, this may be more to do with helping the brain produce hormones that relieve symptoms, rather than fighting the disease. We can do more to cover conditions where an objective effect has been noted. There is also some later wording on the Cochrane article that could be tweaked, but I would be careful, as these are usually the best evidence you can get for medical evidence. ] (]) 18:45, 26 August 2019 (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)
:::Well, then show me the evidence that placebos are healing any real illness, instead of some transient effects of feeling better. There is a catch-22 involved here: if the placebo is effective, it should be marketed as a cure for that illness. So, what does it even mean to say that the placebo is effective? It leads to logical paradoxes, so of course saying that is nonsense. And ]: don't put your words in my mouth. ] (]) 18:44, 26 August 2019 (UTC)
:::: {{re|Tgeorgescu}} The above studies answer your first challenge. And the argument that placebos are not prescribed is invalid. Discuss sources or ].--] (]) 18:47, 26 August 2019 (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)
:::::I've taken the matter to ]. ] (]) 18:50, 26 August 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)
:::::: Are you honestly suggesting that my viewpoint is fringe? I showed thirteen high quality reviews. This is forum shopping, and your editing is becoming tendentious. --] (]) 18:53, 26 August 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)
:::::::]. I've done it according to ]. Since there is only one forum, there is no forum shopping involved. ] (]) 18:55, 26 August 2019 (UTC)
::::::::{{re|Tgeorgescu}} I'm not making a personal attack. I'm warning you that I'm going to report you to ANI if you don't change your editing pattern. --] (]) 19:06, 26 August 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)
:::::::::As {{u|Anywikiuser}} told you above {{tq|There is also some later wording on the Cochrane article that could be tweaked, but I would be careful, as these are usually the best evidence you can get for medical evidence.}} In case you did not get it: you are the Cochrane basher at this talk page. ] (]) 19:12, 26 August 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)
:::::::::: I’m sure it was great evidence... ten years ago. —] (]) 19:25, 26 August 2019 (UTC)
:::::::::::Your exception to Cochrane's finding is already integrated in our article. What we (me and several other editors) don't allow you to do is claim all-out victory, namely claim that placebos do heal real illnesses, which is a fringe view according to Cochrane. ] (]) 19:28, 26 August 2019 (UTC)
:::::::::::: The claim is that the evidence has changed in the last decade. In fact, we have consensus for this in the cases of pain and Parkinson’s. Therefor, if you want to call my 13 studies fringe, you will have to do it with an up-to-date source. And read the studies again. This goes a lot further than Parkinson’s.
::::::::::::—] (]) 19:40, 26 August 2019 (UTC)
:::::::::::::There has to be extraordinary evidence that a world-shattering revolution took place in medicine. We have already integrated your POV, what we don't claim is that it would be "], the whole truth, nothing but the truth". ] (]) 19:44, 26 August 2019 (UTC)
:::::::::::::: You’re repeating yourself. —] (]) 19:48, 26 August 2019 (UTC)
:::::::::::::::I do see some evidence for your POV, what I don't see is extraordinary evidence for trashing Chochrane's findings. ] (]) 19:50, 26 August 2019 (UTC)
:::::::::::::::: You don’t see thirteen studies contradicting a decade-old finding as evidence that the decade-old finding is out of date? I can find more, if you demand it. —] (]) 19:54, 26 August 2019 (UTC)
:::::::::::::::::Again: you exception was noted. What you did not show is that placebos (speaking in general) heal any real illness. What you did not show is patients who have permanently switched from medicines to placebos without compromising their health. We all agree that placebos could change neurotransmitters (as does watching ''A Clockwork Orange''), what we don't agree is that placebos heal real diseases. For if all evidence is confined to experimental conditions for a short period, you don't have much. Even the ring of a bell could make dogs salivate, we knew that much. ] (]) 20:00, 26 August 2019 (UTC)
{{OD}}
Why should anyone have to show those things? —] (]) 20:03, 26 August 2019 (UTC)
:Because you have been trashing Cochrane's conclusion that placebos do not heal any real disease. ] (]) 20:12, 26 August 2019 (UTC)
:: That conclusion is false. The last decade of research has shown that placebos can produce objective improvements in various diseases. —] (]) 21:01, 26 August 2019 (UTC)
:::So, your evidence that placebos may safely replace medicines for healing/managing certain real diseases is... ? ] (]) 21:57, 26 August 2019 (UTC)
::::I should note that the recent findings on pain and Parkinson's don't contradict the 2010 Cochrane review. The Cochrane review did suggest that placebos can help relieve pain. It did not examine Parkinson's specifically, as only one study on Parkinson's fitted the criteria. It suggests that "in general" placebos don't have significant effects (other than improving patient-reported outcomes), however there may be exceptions to that trend. ] (]) 21:19, 26 August 2019 (UTC)
:::::{{tq|Well, "Placebo does heal real illnesses" is very vague, and isn't what anyone is saying on the talk page.}} {{u|Sciencewatcher}} quoted by ] (]) 21:24, 26 August 2019 (UTC)
:::::Till now {{u|Wikiman2718}} is the only editor who thinks that there is a silver bullet against {{tq|Thefore, placebo prescription seems to lack both ethical and empirical justification. ... Therfore, we suggest that placebo interventions are not used outside clinical trials.}} ] (]) 21:31, 26 August 2019 (UTC)
::::::I suspect that as frustrating as you find this, he's acting in good faith, and isn't trying to promote alternative medicine or anything. Some find it counter-intuitive that placebos can't affect the underlying disease, because they can have strong surface-level effects. I found it counter-intuitive, because I used to cure kids' nettle stings with a fake dock leaf. ] (]) 21:59, 26 August 2019 (UTC)
:::::::That isn't the problem. Till now I have seen only one editor and zero peer-reviewed evidence that the conclusion {{tq|placebo interventions are not used outside clinical trials}} has been overturned. Of course MDs are free to choose any treatment they wish. So, what I want from him is to let Cochrane be. ] (]) 22:03, 26 August 2019 (UTC)
:::::::: The use of placebos is entirely different from the question of efficacy. This discussion is about efficacy, which is undeniable in some cases. —] (]) 22:59, 26 August 2019 (UTC)
:::::::::Ok, enough of quarreling: what we (me and other editors) want from you is letting Cochrane be in the article. This is a simple solution to comprehend and abide by. The text can be tweaked to express reservations/exceptions to Cochrane. ] (]) 23:06, 26 August 2019 (UTC)
:::::::::: Won’t work. Cochrane was wrong. That study’s conclusion is contradicted by more than a dozen high quality reviews, and supported by none. While the conclusion may have made sense at the time, the research of the last decade has fallen unilaterally in the other direction. —] (]) 23:20, 26 August 2019 (UTC)
:::::::::::Your fault is that you are not ready to agree to a compromise solution. For a therapy that never left the experimental setting, it is flat-out wrong that its evidence is world-shattering. So, "placebo does not heal any real disease" has not been overturned. Your evidence is simply not strong enough to leave the experimental setting and become a real therapy. ] (]) 23:25, 26 August 2019 (UTC)
{{OD}}
Did you even look at the evidence? This has been a massive waste of my time. —] (]) 23:37, 26 August 2019 (UTC)
:It's the "placebo has healed this real disease in 40% of the patients" part which I'm missing. Also, saying that placebo is effective but not effective enough to be marketed as a cure is self-defeating. ] (]) 23:44, 26 August 2019 (UTC)
:: We would need to show that if we were arguing that it was true. —] (]) 23:54, 26 August 2019 (UTC)
:::You are ''the only one'' at this talk page who thinks that {{tq|Therfore, we suggest that placebo interventions are not used outside clinical trials}} is bunk. You are the only one who wants to get rid of Cochrane from our article, which is a typical case of ] (see what people wrote above and what they wrote at the ] topic I have opened). ] (]) 23:57, 26 August 2019 (UTC)
:::: I’m not entirely sure what you mean. And you could stand to read ] yourself. There were other editors on your side, but they seem to have dropped the stick. You should consider doing the same. —] (]) 00:26, 27 August 2019 (UTC)
:::::We are referencing two Cochrane reviews: a 2001 one, and another from 2010. I would agree that the 2010 one should stay even though it is more than 5 years old. Interestingly, it seems as if the authors of the 2010 review made at least one serious error with regard to pain, in that the acupuncture trials (other than the German ones) did not compare against no treatment. If there are other high quality reviews with different conclusions, we should include those as well. --] (]) 00:31, 27 August 2019 (UTC)
::::::{{re|Wikiman2718}} Oh, boy! You're using the expression {{tq|dropped the stick}} rather wantonly. ] (]) 00:37, 27 August 2019 (UTC)


== First sentence and Section 1 "Definitions" ==
{| class="wikitable"
|-
! User
! Statement
|-
|{{u|Wikiman2718}}
|The main conclusion of the Cochran review is that placebos cannot alter objective outcomes. This conclusion is contradicted by more than a dozen ] sources and corroborated by exactly zero. There is evidence that placebos alter objective outcomes in a number of neurological disorders including depression. We have already established consensus that placebos alter objective outcomes in pain and Parkinson's. Most of this research was conducted in the last decade, but the Cochran review has not been updated since 2010.


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.
Cochran reviews are generally immune to the five year rule ''because they are regularly updated''. It is Cochrane’s policy to require authors to update reviews every two years or to include a commentary explaining why the review has not been updated.<ref>{{Cite journal|last=Green-Hennessy|first=Sharon|date=2013-01-01|title=Cochrane Systematic Reviews for the Mental Health Field: Is the Gold Standard Tarnished?|url=https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.001682012|journal=Psychiatric Services|volume=64|issue=1|pages=65–70|doi=10.1176/appi.ps.001682012|issn=1075-2730}}</ref> However, since Cochran has not kept this study up to date, it should be treated the same as non-Cochran reviews and thrown out after five years. If anyone could find out Cochrane ''why'' has neglected to update this study or to leave a commentary, that would be quite helpful. --] (]) 02:37, 27 August 2019 (UTC)
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."
|{{u|Þjarkur}}
There are other important considerations below this sentence. Hence, it appears justified to modify the sentence to a definition:
|statement needed
>>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:
|{{u|Anywikiuser}}
"Placebo concurrent control: The test drug is compared with an inactive preparation designed to resemble the test drug as far as possible."
|A Cochrane source is the strongest evidence and so it needs to retain its prominent role in the article. The evidence is that in general, placebos can cause subjective improvements but not objective ones, other than with pain relief. But there will be "exceptions that prove the rule". ] (]) 09:34, 29 August 2019 (UTC)
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
|{{u|Sciencewatcher}}
1. modifying the first sentence,
|statement needed
2. removing reference 1 as far as definitions are concerned,
|-
3. inserting the definitions given by ICH E10 and 21 CFR 314,
|{{u|Alexbrn}}
4. providing respective references.
|statement needed
|-
|{{u|Tgeorgescu}}
|Ok, enough of quarreling: what we (me and other editors) want from you is letting Cochrane be in the article. This is a simple solution to comprehend and abide by. The text can be tweaked to express reservations/exceptions to Cochrane.
|}


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|Wikiman2718}} Your claim is exactly this: {{diff2|912624579}}, i.e. that it would be false that placebos cannot heal any real disease. You are '''the only editor''' expressing such POV at this talk page and at ]. We are willing to compromise and we have already integrated your claim about Parkinson's in the article. Your position is "my way or the highway", which is completely unreasonable. You're unwilling to make allowance for our doubt, although we allowed for yours. There is no ] of '''only one editor''' against the rest of the community. Misplaced Pages doesn't work like that! '''You may not''' unilaterally declare consensus. There are five editors who think that Cochrane is to be respected and one of them finds that "Placebo does heal real illnesses" is a meaningless statement. 5 against 1. Yup, you even claimed that there is a consensus for removing Cochrane when '''nobody else supported its removal'''. You are still the only one who does. And you do seem to imply that these placebo studies have left the lab in order to become real, evidence-based therapies. What's your evidence for such claim? ] (]) 05:55, 27 August 2019 (UTC)
:{{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)
:{{u|Tgeorgescu}}, {{u|Þjarkur}}, {{u|Anywikiuser}}, {{u|Alexbrn}}, {{u|Sciencewatcher}}: Let's let every user write their own statement. --] (]) 13:39, 28 August 2019 (UTC)
* Just so that everyone knows: though {{u|Tgeorgescu}} has repeatedly characterized me as holding the position that placebos should be prescribed in clinical settings, this is not my position. My positions is that placebos can produce objective improvements in outcome in at least several conditions. --] (]) 13:57, 28 August 2019 (UTC) :These definitions only deal with the use of placebos in clinical trials. ] (]) 11:30, 11 December 2019 (UTC)
::I did not write their POV instead them. I just copy/pasted their statements. So, unless they had a radical change of mind, they are all in favor of retaining Cochrane. ] (]) 21:37, 28 August 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.
::: You didn’t write the statements, but you did a lot of interpreting. The positions were not clear in every case, and some statements were made early in the debate when less evidence was available. There is no need to assert what other people believe when we could just ask. —] (]) 22:03, 28 August 2019 (UTC)
:::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)
::::Ok, maybe I wasn't too explicit why we want it to stay: there is a joke with an economist having an exam, {{tq|How has French revolution affected world economic growth? Too early to say.}} ] (]) 04:24, 29 August 2019 (UTC)
::::{{u|Anywikiuser}}, to be fair, alt med is also largely unethical... ''']''' <small>(])</small> 12:03, 12 December 2019 (UTC)
===Parkinsons===
::{{u|Anywikiuser}}, correct, any other use is unethical. ''']''' <small>(])</small> 12:02, 12 December 2019 (UTC)
]: I disagree that the Parkinsons evidence is tentative. There is strong empirical evidence, and the neurobiology has been elucidated. As for analgesia, there is again strong empirical evidence and again, the neurology has been elucidated. It is hard to deny the existence of an effect that is not only understood empirically, but biologically as well. Again, fourteen ] studies find that the placebos can alter objective outcomes in some conditions. To completely ignore them all in favor of one decade old study is ], and possibly even endorsing a fringe view. --] (]) 07:44, 9 October 2019 (UTC)
: You make a fine argument for includsion in the body, and an equally fine argument for exclusion from the lede. Which invites the question: why did you edit-war it back in? The consensus does not show objective effects. Most of the research showing effects on pain, references self-reported subjective measures. Parkinson's is, as far as I can tell, the only area where there has been any demonstration at all of an objectively measurable effect, and the attribution to placebo is questionable since there is good reason to think that an actual therapeutic intervention tarketing the same pathways would be more effective. Remember always that the goal of quacks is to pretend that the placebo effect is real and powerful, whereas the finding inreality is that it is almost entirely illusory. <b>]</b> <small>(])</small> 09:00, 9 October 2019 (UTC)
:: I would like it known that I did not edit war, and the material is not back it. Per ], the article should reflect the status quo while dispute is in progress. It was ] that (successful) edit warred against the status quo. He has been doing that to me a lot lately. With regards to objective effects, the fourteen studies cited above all find evidence that they exist for some conditions. ] mandates that they deserve at least ''some'' weight, if not all of it. We seem to have some degree of consensus on Parkinsons-- you noted that placebos ''do'' have effect, but argued that other treatments are more effective. I do not dispute that other treatments are more effective-- since placebos are inert, they are certainly less effective than any active treatment that targets the disease. However, this is not about whether placebos should be prescribed. This is about biology. Placebos produce a biological response, and this has implication to their role as controls in scientific studies and to the nature of how the brain works. It is unlikely that pure placebos will ever make good prescription drugs, but that's a bit of a distraction from the main point. --] (]) 09:12, 9 October 2019 (UTC)
::: The history shows you did. <b>]</b> <small>(])</small> 17:00, 9 October 2019 (UTC)
:::: Please read up on edit war guidelines and discuss sources, not editor behavior, and not truth. Now it the time that your cabal must explain why they should be allowed to ignore fourteen ] studies in favor of one ten year old Chochrane review that was never updated. --] (]) 19:39, 9 October 2019 (UTC)
::::: Mate, you might want to check my user page. <b>]</b> <small>(])</small> 15:13, 10 October 2019 (UTC)
:::::: I am not impressed by your status. Reverting without discussion is edit warring, and reverting with discussion to maintain the ] is not. I certainly hope that you will not attempt to use your status to push for false consensus-- we must abide by the consensus of high-quality sources, and we cannot simply ignore fourteen ] sources in favor of one decade old Cochrane review that was never updated. --] (]) 15:31, 10 October 2019 (UTC)


== Creating a redirect from ]? ==
===Empirical evidence===
The term "empirical evidence" is much repeated above, but it doesn't appear to match tbe definition given the article ], which specifies that outcomes be testable and measurable. I wonder if the terms "anecdotal evidence" or "subjective reporting" are closer to what is intended? --] (]) 11:08, 9 October 2019 (UTC)
: The outcomes have been tested and measured in terms of neurotransmitter release in the brain. Also, motor function may be objectively assessed in the case of Parkinson's. But you are arguing truth, not verifiability. It is clear from examining the ] studies that there is consensus for this in the scientific community. --] (]) 13:44, 9 October 2019 (UTC)
::Well actually I'm just arguing for careful choice of words. (FWIW, I do recognise that some, perhaps many, patients perceive real positive responses to placebo treatments. Unfortunately the alleviation of symptoms doesn't last because there has been no measurable change in the underlying condition. Doctors should have no scruples whatever in advising 'complimentary therapies' for psychosomatic illnesses. The major issue is dishonest snake-oil salesmen who take advantage of seriously ill patients who are desperate and willing to try anything. See ], for example). --] (]) 20:44, 9 October 2019 (UTC)
::: That's a good point. This discovery raises a lot of difficult questions that will have to be navigated with nuance. --] (]) 00:01, 10 October 2019 (UTC)
: The correct distinction is certainly between objectively testable and subjective outcomes, if there is no objectively demonstrated outcome then I would say there is no empirical evidence of effect. <b>]</b> <small>(])</small> 15:23, 10 October 2019 (UTC)
:: The correct distinction is between verifiability and truth. If there are no ] sources supporting a conclusion, than we cannot. If there are, we go ahead. I am tired of debating truth with people who go around in circles. I want to improve the article. --] (]) 15:33, 10 October 2019 (UTC)


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).
== Intro ==


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 "no specific therapeutic properties" is fairly vague and is less likely to be understood by the general reader than the previous intro. – ''']''' ] 19:56, 25 August 2019 (UTC)
:The previous definition was not technically correct, as we have established on this talk page that placebos can have therapeutic value in some conditions, such as Parkinson's. --] (]) 20:00, 25 August 2019 (UTC)
::But the change doesn't seem to cover that either, since if it's being used for Parkinson's then it is being used for a specific therapeutic property, or what? (Describing this "supposed to not work vs may work" reminds me of ) – ''']''' ] 20:35, 25 August 2019 (UTC)
::: A specific therapeutic property in the case of Parkenson’s diseases would be a property intended specifically to treat Parkinson’s disease (e.g dopamine agonists) rather than one that works for any condition that responds to placebo. —] (]) 21:09, 25 August 2019 (UTC)
::: The "not designed" wording actually paraphrases the American Society of Pain Management Nursing's definition. ] (]) 15:02, 26 August 2019 (UTC)


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)
== Novel content in lede ==


== Self contradiction ==
{{u|Wikiman2718}} is trying to force an opinion piece into the lede (which is not cited in the body) with the claim it has consensus. What? We are not at liberty to go against ] without good reason, and the source is questionable in any case. ] (]) 15:35, 28 August 2019 (UTC)
: Firstly, I did not place that content there. {{u|Þjarkur}} placed this information in the lede in recognition of consensus established on this talk page. I am just defending the edit. The body reads: "There has also been research aiming to understand underlying neurobiological mechanisms of action in pain relief, ], ] and ].<sup>]]</sup> Dopaminergic pathways have been implicated in the placebo response in pain and depression.<sup>]]</sup>." Note that the sources make stronger assertions than the article. --] (]) 15:44, 28 August 2019 (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.
:A simple solution is to replace the cite given in the lede with a cite to the scholarly article cited in the body. ] (]) 15:49, 28 August 2019 (UTC)
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.
::Let's not start using novel opinion pieces in the lede then. This technical detail (in the body, more properly sourced) looks too trivial to make an appearance in the lede. ] (]) 15:50, 28 August 2019 (UTC)
:::Is it a "novel opinion" that there has been research into placebo effects in pain relief etc..? I don't think so. ] (]) 15:55, 28 August 2019 (UTC)
::::My meaning was it was novel to the lede, not covered in the body as such. ] (]) 16:05, 28 August 2019 (UTC)
::::: Fixed it. Thanks for the suggestion, {{u|Here come the Suns}}. --] (]) 16:12, 28 August 2019 (UTC)
{{od}}
The sentence on Parksinson's is ] in the lead anyway. It's much too early to make any confident statement. <b>]</b> <small>(])</small> 07:36, 9 October 2019 (UTC)


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.
== Chronic Fatigue Syndrome ==
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)
Since ME/CFS has a lower than average placebo effect, it doesn’t seem worthy of being one of the three conditions or symptoms covered. Average placebo effect is 32 - 35%. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130397/
The average effect for ME/CFS is 20%. See cite in article. I have removed the section. Please discuss before restoring. Thank you. ] (]) 15:10, 10 October 2019 (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.... ] (]) 19:34, 19 September 2024 (UTC)
: {{re|Justito}} It's not the magnitude of the placebo response that matters, but rather, the existence/non-existence of a response. Therefore I have returned the section pending discussion per ]. It is also notable that most placebo research is pointing towards the existence of a placebo response in all neurologically-rooted conditions. However, the response has only been ''proven'' to exist in a few so far. --] (]) 15:22, 10 October 2019 (UTC)
: I do find that interesting, because I know that CFS patients are often highly skeptical by now, given the history, so I would expect them to see lower placebo "effect" consistent with placebo "effect" not actually being a thing. <b>]</b> <small>(])</small> 15:24, 10 October 2019 (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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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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