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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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High traffic

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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. 93.161.104.53 (talk)

How would you ever be able to objectively say that a patient who claims to "feel better" is in error? Looie496 (talk) 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. 93.161.106.25 (talk) —Preceding undated comment added 15:36, 3 October 2009 (UTC).
I believe Looie496 was addressing the presumption that "feel" is subjective. Of course in this era of functional magnetic resonance imaging that presumption is no longer necessarily accurate, but for most purposes we still assume that meaning unless further qualified. User:LeadSongDog come howl 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:

-- John Broughton (♫♫) 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. Iminrainbows (talk) 00:52, 13 January 2010 (UTC)

Please see WP:Article titles and WP:MOSMED#Naming conventions 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.User:LeadSongDog come howl 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 coat rack 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 WP:UNDUE and WP:ONEWAY: 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

Common placebos are inert tablets, sham surgery, and other procedures based on false information.

to

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 sham surgery and mentions other procedures. It is extremely jarring to refer to these as things, 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.
  • Homeopathy has no business being mentioned in the first paragraph, per WP:ONEWAY 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 WP:ABF. 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 this. "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. Hans Adler 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 placebo are expecting to learn about placebos. The sourcing is almost certainly there to justify using homeopathy 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 Oscillococcinum, 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. - 2/0 (cont.) 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 lactose, which I guess can cause trouble with lactose intolerance. And it is not uncommon for people to develop lactose allergy (an unrelated condition) while on an anti-fungus diet (which avoids other sugars). Once they have it, I guess even the small amounts of lactose in a sugar pill become a problem. Hans Adler 14:47, 20 March 2010 (UTC)
Regarding another pseudoscience Arbcom case: Carcharoth has proposed addressing the obvious problems at Ghost, 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. Hans Adler 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 WP:MINOR, minor edits do not make content changes. II | (t - c) 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. Hans Adler 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. II | (t - c) 20:03, 20 March 2010 (UTC)
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. Hans Adler 20:43, 20 March 2010 (UTC)

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

" 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

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!)--Hauskalainen (talk) 01:54, 25 April 2010 (UTC)

It sounds like you're discussing the same issue that Hrobjartsson & Gotzsche 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. II | (t - c) 02:54, 25 April 2010 (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. Hans Adler 08:57, 25 April 2010 (UTC)


II | (t has put it very succinctly. Thanks.
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. LeadSongDog come howl 15:44, 25 April 2010 (UTC)


Clinical misuse of placebos`???? Are you by any chance referring to this text which got deleted recently??.....

"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 therapeutic effect, causing the patient to feel their condition has improved. This phenomenon is known as the placebo effect."......

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.

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 acetaminophen tabs to their well "worrier" patients with mild aches and pains not telling them that it is something more commonly known by another name.--Hauskalainen (talk) 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.LeadSongDog come howl 22:57, 28 April 2010 (UTC)
Hauskalainen, please read the article closely before doing a lot of changes and making broad statements. The second reference in the article is a survey of mainstream doctors and the use of placebo. 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 you changed the use of this reference 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 this edit, 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. II | (t - c) 23:12, 28 April 2010 (UTC)

Inert, or Sugar?

Question: are placebos inert, or do they actually contain sugar (sucrose)?

If they are inert, I think it should be noted that 'sugar pill' is misleading, as an inert pill would not contain sugar. But if they contain sugar I believe it should be noted that they are not wholly inert (just mostly inert) as rms notes that sugar "can make you fat." —Preceding unsigned comment added by 207.65.109.10 (talk) 07:15, 6 May 2010 (UTC)

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