Pla-No-Cebo


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We already know what a placebo is— a fake medication, typically used as a control in a medical trial. There are countless studies that reveal that placebos have a positive effect, relieving real symptoms like pain, bloating or a depressed mood. The placebo effect is a result of the patient’s expectation that the treatment will help.

Nocebo Effect
If people anticipate a pill’s possible side effects, he or she can “suffer ” these side effects even if the pill is fake. Häuser at the Technical University of Munich published a review paper showing that in many clinical trials, placebos produce fully half as many reported side effects as real drugs do. This guy is real big in nocebo research. Practically, every article I read on the topic had his name on it. He believes the nocebo effect stems in part from the warnings physicians give patients before prescribing medication. While it would be unethical to stop 
informing patients about side effects, Häuser suggests doctors should convey the risks in a more measured way. Here is an excerpt from Discover Magazine: which illustrates the nocebo effect.

In 2006 a patient enrolled in a clinical trial for depression tried to overdose on his meds. After taking 29 pills, he began to feel faint; his blood pressure plummeted, and doctors had to administer intravenous fluids to stabilize him. The strangest part of the patient’s grim plan: His pills were placebos. Once he learned the pills were inert, his symptoms vanished.

Placebo
Some scientific evidence suggests that the placebo effect may be partly due to the release of endorphins in the brain. Endorphins are the body’s natural painkillers. However, this theory just seems too simple. There has to be more to it. Well, other scientists believe that the placebo effect occurs because the person believes in the medication, the treatment, or the doctor. This in turn is what changes the patient’s thoughts and even body pain. According to this Cancer website, the patient expects to feel better, and so he or she does feel better for some time. This sounds more plausible because if you feel incredibly stressed that your start experiencing anxiety attacks, you may feel less anxious just because you have faith in your particular treatment, hence your stress hormones drop. Surprisingly, the opposite can also happen, and this seems to support the indication of the ‘expectation effect’ even more. For example, in one study, people with Alzheimer’s disease got less relief from pain medicines. These patients required higher doses — possibly because they had forgotten they were getting the drugs, or they forgot that the pain medicines had worked for them before. So basically this suggests that prior knowledge plays a role in pain placebo effect. Source

These placebo/nocebo effects makes me wonder how credible can drug studies be? How can doctors convey side effects in a more measured way as Häuser suggests? It makes me wonder if people are just lying or is it truly that psychological? Some scientists believe this is because people just want to give the researcher good news. As I ponder about it, I remember about some of the blogs I’ve read regarding lying. I don’t know if saying this is extreme but I just think overall humans are just pathological liars. Sometimes we unconsciously lie to be approved and liked. It may also be that the patient is comparing current symptoms to the worst discomfort he or she has experienced. Also, I wonder how a study can be conducted without medication. Are non-medication placebo trials performed?

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