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The powerful Nocebo effect!

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  • #16
    .......The compliance of patients also influences the outcome of treatment, irrespective of whether the patient received a placebo or a drug. A study of beta-blockers to prevent myocardial infarction found that patients who took more than 80 per cent of the doses had a better outcome (15 per cent mortality) than those with poor compliance (25 per cent mortality), irrespective of whether they received a beta-blocker or a placebo. "Placebo effects are shaped by factors that influence the meanings patients attribute to their illnesses and to the treatments they receive......."

    Placebos: can you get something for nothing?
    If this is occurring in other trials too .... this is truly bizarre, how can a person not faithfully taking a placebo be affected by the placebo when they didn't have enough faith or fear to take it regularly? Could it be that others in the drug versus placebo trial felt that if not taking it, serious consequences upon their own health outcomes if missed? And that collective belief is stronger and can override the individual belief in some circumstances?

    Of course these sort of explanations are impossible to most people in conventional medicine .... so it doesn't look fo these, any other explanation will be adopted, rather than testing the unconventional hypothesis.
    Last edited by Open Mind; November 16th, 2011, 09:42 AM.

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    • #17
      Originally posted by JLI View Post
      I am a pathologist, so I don't interact directly with patients. But it is no surprise that being given a bad message can make people feel crappy/depressed. But that is not the same as accelerating death.

      Personally I think it is a bad idea to give time frames about life expectancy to individual patients, because those are not very reliable. At least not until the very end. But I suppose, that if someone was told back in 1973, that he had only two months to live, he would be in a pretty sick at that time.

      In my junior days as an intern working in the wards, I have used placebo boosts to enhance the (symptomatic) effect of medications.
      Sorry, I didn't realise you were a pathologist. I suppose the general point is that ethical issues prevent much experimentation in this area.

      I mean you can't (I imagine) take a random subset of patients and deliver more pessimistic (or more optimistic) assessments and discover it that affects the course of their illness!

      Likewise, I wonder if placebo treatments have been tried in a serious way for fundamental medical problems. Again, I would have thought there might be impossible ethical issues in the way.

      So when you wrote:

      <quote>I don't think there is evidence to support, that the nocebo effect can accelerate death, as the first paragraph in the article suggests. Just as there is no evidence to support the placebo effect can postpone death.
      </quote>

      Did you mean, "no evidence" in the sense of experiments have been performed and come out negative, or in the sense, "experiments can't be done for ethical reasons"?

      David

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      • #18
        Originally posted by Interesting Ian View Post
        Anything which gives us reason to increase the assessed likelihood of some given hypothesis or theory being correct.
        Don't think I have met a skeptic who would disagree with you on this point.
        So if someone reports seeing a pink Unicorn in their back garden, this gives evidence that pink unicorns exist.
        That explains where your anger is coming from, when someone disagrees with you about the 1973 example as evidence of lethal effect of nocebo. Sorry if my disagreement offended you.

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        • #19
          Originally posted by David Bailey View Post
          I mean you can't (I imagine) take a random subset of patients and deliver more pessimistic (or more optimistic) assessments and discover it that affects the course of their illness!
          They did in this study:General practice consultations: is there any point in being positive?
          The patients suffered for minor self limiting conditions. One group was given a firm diagnosis and told they would be better in a couple of days. Another group was given a negative consultation, being told by the doctor, that the diagnosis was uncertain. And sure enough, the patients in the first group recovered quicker.
          Likewise, I wonder if placebo treatments have been tried in a serious way for fundamental medical problems. Again, I would have thought there might be impossible ethical issues in the way.
          Here is a fairly recent systematic review of trials including a placebo group and a no treatment group: Wiley Online Library: Book Article
          202 such trials met their inclusion criteria. And in some of the trials, serious diseases such as asthma and hypertension were studied.
          The authors of the review concluded:
          AUTHORS' CONCLUSIONS:
          We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.
          Did you mean, "no evidence" in the sense of experiments have been performed and come out negative, or in the sense, "experiments can't be done for ethical reasons"?
          The latter. We only have anecdotes of:
          1) People who were told they had a short life span and died shortly after being told.
          2) People who were told they had a short lifespan, and lived longer.

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          • #20
            Originally posted by JLI View Post

            Here is a fairly recent systematic review of trials including a placebo group and a no treatment group: Wiley Online Library: Book Article
            202 such trials met their inclusion criteria. And in some of the trials, serious diseases such as asthma and hypertension were studied.
            I only looked at this study in a cursory way, but I did notice that they reported that placebos were found to have no significant effect in treating depression. This seems interesting, because as I understand it, a major recent study found that placebos were at least as effective as prozac!

            I also noticed that this paper had been challenged by another paper by B. E. Wampold, T. Minami, S. C. Tierney, T. W. Baskin, and K. S. Bhati , and that this had in turn been attacked by the original authors!

            I guess this seems to be typical of hotly contested areas of science - it is very, very hard to tell who is telling the whole unvarnished truth!

            David

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            • #21
              Originally posted by JLI View Post
              Don't think I have met a skeptic who would disagree with you on this point.
              I, on the other hand, have never met a skeptic who agrees with it. And I've talked to plenty. For example I never met one person on the James Randi Education foundation discussion board who agrees with my definition of the word evidence.


              That explains where your anger is coming from, when someone disagrees with you about the 1973 example as evidence of lethal effect of nocebo. Sorry if my disagreement offended you.
              In real life there are multiple causes for a given effect. All of these causes need to transpire for the effect to happen.

              The question here is do our conscious states affect our health. Obviously they do, yes? For example, if I worry about something, or feel tense, this might have some influence in my blood pressure rising.

              Thus if we have all the other causal factors in place then our mental states can be the crucial ingredient which can determine whether we live or die.

              Comment


              • #22
                Originally posted by Interesting Ian View Post
                I, on the other hand, have never met a skeptic who agrees with it. And I've talked to plenty. For example I never met one person on the James Randi Education foundation discussion board who agrees with my definition of the word evidence.
                You probably have. The problem is there are some particularly loud people over there who don't understand what evidence is and who constantly describe it wrongly. They drown out the correct people. I've had this mini debate a couple times already over there. Some people got it right, and others stuck to the wrong definition. Your definition is essentially correct, though I think JLI was disagreeing with you because he didn't believe it supports the contention at all.

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                • #23
                  Originally posted by Arouet View Post
                  You probably have. The problem is there are some particularly loud people over there who don't understand what evidence is and who constantly describe it wrongly. They drown out the correct people. I've had this mini debate a couple times already over there. Some people got it right, and others stuck to the wrong definition. Your definition is essentially correct, though I think JLI was disagreeing with you because he didn't believe it supports the contention at all.
                  Nobody over there agreed with my definition of evidence. Most of them think it's the same as proof. And all of them seem to believe that the word evidence is only ever used in the context of science.

                  I'm not sure what the contention is? That ones mental states cannot bring about ones death? What about feeling stressed out and hence experiencing a rise in blood pressure which contributes to ones death? So it's obvious that ones mental states can bring about ones death in some instances.

                  Is the argument that although ones mental state can bring about a disease which ends in ones death, ones mental state in and of itself will not kill you in the absence of any accompanying disease?

                  JLI? Arouet?

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                  • #24
                    I haven't looked into this topic. I don't know.

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                    • #25
                      Originally posted by Arouet View Post
                      I haven't looked into this topic. I don't know.
                      OK I'll just wait for JLI's comprehensive reply!

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                      • #26
                        Originally posted by Interesting Ian
                        Is the argument that although ones mental state can bring about a disease which ends in ones death, ones mental state in and of itself will not kill you in the absence of any accompanying disease?
                        The problem here is that you are separating mental state from disease. For example, I'll agree that severe depression can result in suicide, which will kill you. However, if that severe depression is an illness, then there is an accompanying disease.

                        Not sure what the point of this argument is.

                        ~~ Paul

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                        • #27
                          Originally posted by Paul C. Anagnostopoulos View Post
                          The problem here is that you are separating mental state from disease. For example, I'll agree that severe depression can result in suicide, which will kill you.
                          That's the result of voluntary activity on ones part! Why do you always introduce irrelevances and red herrings??



                          However, if that severe depression is an illness, then there is an accompanying disease.

                          Not sure what the point of this argument is.

                          ~~ Paul
                          I don't understand what you're saying or how it remotely addresses my post.

                          I'll wait for JLI's response. In all my many thousands of posts "arguing" with you, you've never answered any of my questions. That's not going to ever change and therefore I find it a waste of time discussing anything with you.

                          Comment


                          • #28
                            Originally posted by Interesting Ian
                            That's the result of voluntary activity on ones part! Why do you always introduce irrelevances and red herrings??
                            So you won't acknowledge that severe depression might be a disease and thus suicide could be involuntary? Interesting.

                            I don't understand what you're saying or how it remotely addresses my post.
                            I'm addressing this question of yours:

                            "Is the argument that although ones mental state can bring about a disease which ends in ones death, ones mental state in and of itself will not kill you in the absence of any accompanying disease?"

                            There is no mental state in and of itself.

                            ~~ Paul
                            Last edited by Paul C. Anagnostopoulos; November 17th, 2011, 09:07 AM.

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                            • #29
                              Originally posted by Paul C. Anagnostopoulos View Post
                              So you won't acknowledge that severe depression might be a disease and thus suicide could be involuntary? Interesting.
                              Not unless someone threatens you with a more even painful death unless you commit suicide. But we have control over our own limbs.

                              I'm addressing this question of yours:

                              "Is the argument that although ones mental state can bring about a disease which ends in ones death, ones mental state in and of itself will not kill you in the absence of any accompanying disease?"

                              There is no mental state in and of itself.

                              ~~ Paul
                              Ah, you're assuming reductive materialism then.

                              Try this then. Those particular physical activities identical to consciousness (a small subset of the brains activity?) can not possibly kill you in the absence of any accompanying disease.

                              Now perhaps you can answer the question instead of your stupid games?

                              I still want JLI's response though too.

                              Comment


                              • #30
                                Originally posted by Interesting Ian
                                Not unless someone threatens you with a more even painful death unless you commit suicide. But we have control over our own limbs.
                                All the time? When someone throws a ball at my face, do I have the ability not to raise my hands? Mostly no.

                                Ah, you're assuming reductive materialism then.
                                No, I'm not. Regardless of metaphysic, my mind has some relation with my brain. There is no pure mental state in living humans.

                                Try this then. Those particular physical activities identical to consciousness (a small subset of the brains activity?) can not possibly kill you in the absence of any accompanying disease.

                                Now perhaps you can answer the question instead of your stupid games?
                                This question?

                                "Is the argument that although ones mental state can bring about a disease which ends in ones death, ones mental state in and of itself will not kill you in the absence of any accompanying disease?"

                                Since there is no mental state in and of itself, the question is moot. Now, if you want to assume reductionism and ask whether the brain functions that give rise to consciousness could possibly cause me to kill myself in the absence of any brain disease whatsoever, I'd say the answer is yes. For example, I could sacrifice myself for my child. However, we're still not separating disease from genetic predisposition.

                                ~~ Paul
                                Last edited by Paul C. Anagnostopoulos; November 17th, 2011, 10:01 AM.

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