nocebo effects

Alternative therapists don’t kill many people, but they do make a great teaching tool for the basics of evidence-based medicine, because their efforts to distort science are so extreme. When they pervert the activities of people who should know better - medicines regulators, or universities - it throws sharp relief onto the role of science and evidence in culture. Characters from this community who wonder why people keep writing about them should look at their libel cases and their awesomely bad behaviour under fire. You are a comedy factory. Don’t go changing.

Next: the real story of how the world works is much weirder than anything a quack can make up. The placebo effect is maddening, the nocebo effect more so, but the research on how we make decisions, and are misled by heuristics and mental shortcuts, is the wildest of all. Knowing about these belief-hacks gives you thrills, and power.

Pharmaceutical companies can behave dismally. Most important, they still won’t publish all the results of all the clinical trials conducted on humans. This is indefensible, and because we tolerate it, we don’t know the true effect sizes of the medicines that we give. This absurd situation mocks the whole of medicine: we need legislation to fix it, and popular movements to drive that. I’ll join yours.

Journalists can mislead the public about the answers of evidence-based medicine, which is bad. But they also mislead us on the methods and techniques. We live in a new era of doctors and patients - at our best - making decisions together. For that collaboration to work, everyone needs to understand how we know if something is good for us, or bad for us. The basics of evidence-based medicine, of trials, meta-analyses, cohort studies and the like should be taught in schools and waiting rooms. It’s interesting, but it’s also life and death: people care about it.

Politicians misuse evidence, and distort it to shameful degrees. But more than that, there are endless cases where we could do randomised trials on policies - old and new - to find out if they achieve the outcomes they’re aiming for. There is no honourable excuse for failing to use the fairest tests we can design.

Real scientists can behave as badly as anyone else. Science isn’t about authority, or white coats, it’s about following a method. That method is build on core principles: precision and transparency; being clear about your methods; being honest about your results; and drawing a clear line between the results, on the one hand, and your judgement calls about how those results support a hypothesis. Anyone blurring these lines is iffy.

… Last, nerds are more powerful than we know. Changing mainstream media will be hard, but you can help create parallel options. More academics should blog, post videos, post audio, post lectures, offer articles, and more. You’ll enjoy it: I’ve had threats and blackmail, abuse, smears and formal complaints with forged documentation.

But it’s worth it, for one simple reason: pulling bad science apart is the best teaching gimmick I know for explaining how good science works. I’m not a policeman, and I’ve never set out to produce a long list of what’s right and what’s wrong. For me, things have to be interestingly wrong, and the methods are all that matter.

—  Ben Goldacre, I Think You’ll Find It’s A Bit More Complicated Than That

the trouble with home cold remedies is that I believe most of them do nothing, thus I fail to take advantage of the placebo effect, and I fear that some of them may actually be harmful, thus I suffer from the nocebo effect.

as they say a cold can take up to a week to fully clear, but with home remedies you can cure it in as little as seven days!

The placebo effect has an evil twin known as the nocebo effect. This is when the expectation of harm or pain becomes a self-fulfilling prophesy, even in the absence of any known physical effect. One candidate for the nocebo effect is the discomfort some people report experiencing after using mobile phones. Scientists have failed to identify a physical cause, so it’s possible the adverse effects are caused by negative beliefs about the technology.
—  ― Christian Jarrett

yourfizzyfeed11  asked:

I apologize if this has been asked, but why does the placebo effect work?

For those who don’t know, the placebo effect is when an inert medical treatment—like a sugar pill—actually has a positive effect on a patient’s condition. People essentially trick themselves into becoming better simply because they believe they will.

It’s not just about taking dummy pills; patients who are treated by a warm, caring practitioner seem to recover sooner from mild conditions strep throat and the common cold—which suggests they have a certain expectation that this person will make them better.

We’re not fully agreed on how, why, and when it works. It’s actually one of the strangest and least-understood phenomena in medicine. But studies have shown that when treated with placebos, our brains release pain-relieving opioids, which at least help along the healing process.

There are a few theories about why this happens:

  • It’s all in the patient’s head, and their expectation that a treatment will help actually activates a physiological response
  • It’s all in the patient’s body, which remembers how it felt after taking medication previously, so it automatically releases neurotransmitters that begin the healing process (sort of like conditioning: our body may be conditioned to react positively in medical situations)
  • Or a mixture of both: expectation and conditioning

The effect is highly variable, and seems to work better for “subjective” cases (like simply reducing the feeling of pain) rather than “objective” cases (like reducing blood pressure).

Some fun facts about the placebo effect:

  • It can still work even when you know it’s a placebo. Harvard researcher Dr. Ted Kaptchuk studied migraine-sufferers, and found that even the patients who knew they were taken a dummy pill still experienced pain relief 
  • The opposite of the placebo effect is the nocebo effect—when the patient is expecting a negative outcome, then their injury or illness may be negatively affected. A study in Italy gave what they claimed was lactose to patients, some of whom were lactose-intolerant. Even though the lactose wasn’t really lactose, 44% of those with the intolerance and 26% without it showed symptoms of gastrointestinal discomfort. 
  • The shape, size, colour and branding of the pills subconsciously affect how well they work—yellow pills are “best” at treating depression, green are best at easing anxiety, and pills with brand names on them are more effective than blank ones. 
  • The effect seems to have become more “powerful” over the years. It was first documented in the late 1700s, but has become stronger and stronger up until the present day. This is likely due to social conditioning; humans are becoming more trusting of medicine.

So, to sum up: the placebo effect is weird, so I can’t give you a straight answer!