Talk:Placebo/Archive 4

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Reverted addition

I just reverted a lengthy addition by user:Brett Benedetti that appears to need some discussion first. Comments welcome. LeadSongDog come howl! 04:25, 4 May 2011 (UTC)

It's just relatively well-written (though obviously not in an encyclopedic tone) nonsense. One example that stood out to me because of its obvious bogosity:

The first instance of the use of placebo can be dated back to World War II.

Compare that to the following, from a 1999 scholarly article entitled Placebos and placebo effect in medicine: historical overview:

Until the first half of the 20th century the use of placebos seems to have been widespread in medicine. In 1807 Thomas Jefferson, recording what he called the pious fraud, observed that 'one of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together'. [1]

After occasional attempts at this article to paint placebos as somehow criminal, it's refreshing to see someone vigorously pushing in the opposite direction, but that's about the only positive thing I can say about the contents of this text. Hans Adler 05:44, 4 May 2011 (UTC)

washout

I think Placebo Washout should be added. --Dana60Cummins (talk) 18:23, 8 May 2011 (UTC)

Ted Kaptchuck's research

If any one heard a recent edition of All in the Mind, s/he may know that placebos work even if people are told that there is nothing in them. Kaptchuck explained this by arguing that the placebo works in a way similar to classical conditioning, and as this latter topic is covered in the article, I wondered whether this could go in here. ACEOREVIVED (talk) 19:50, 19 May 2011 (UTC)

This is already in the article --sciencewatcher (talk) 20:01, 19 May 2011 (UTC)

Impure placebo effect

The article could use some discussion of the exploitation of placebo effect in conjunction with standard treatments:

• Breidert M, Hofbauer K. (2009 Nov). "Placebo: misunderstandings and prejudices". 106 (46): 751–5. PMC 2795335. PMID 20019863. The mechanisms of action of placebo administration, with which positive therapeutic effects can be achieved with little effort, should be consciously exploited by physicians when giving their patients pharmacologically active medications as well. {{cite journal}}: Check date values in: |date= (help); Cite journal requires |journal= (help); Text "Dtsch Arztebl Int." ignored (help)
• Fässler M, Meissner K, Schneider A, Linde K (2010 Feb 23). "Frequency and circumstances of placebo use in clinical practice--a systematic review of empirical studies". BMC Med. 8: 15. PMC 2837612. PMID 20178561. The use of 'impure' or 'active' placebos (for example, antibiotics for viral infections) is likely to be much more frequent. {{cite journal}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)

Any ideas on how to fit this in? LeadSongDog come howl! 14:26, 15 November 2011 (UTC)

As the use of placebos specifically in clinical practice (as opposed to its use in clinical trials), has generated quite a few studies, these two papers and similar ones should perhaps be mentioned in the 'Doctor-patient relationship' section? In addition to an 'impure' use of placebos, their 'pure' use (in an ethically justified fashion) is also well studied. Sleuth21 (talk) 10:05, 25 November 2011 (UTC)

Intersting article?

The NEW YORKER of 12.12.11 has an article on The Power of Nothing [Placebo Effect]

http://www.newyorker.com/reporting/2011/12/12/111212fa_fact_specter

An interesting read, I think. Sleuth21 (talk) 08:41, 4 January 2012 (UTC)

Placebo effect may be genetically determined

The placebo effect may be genetically determined, by alleles in the COMT gene. Those without the specific alleles are not so susceptible to the placebo effect. These are the findings of just one study on IBS, and need to be replicated, but this Wikipedia article may wish to mention these new findings, which may well turn out to be a groundbreaking discovery in the understanding of the placebo effect.

Placebo's Effect May Depend on Your Genes

Published paper:

Catechol-O-Methyltransferase val158met Polymorphism Predicts Placebo Effect in Irritable Bowel Syndrome

Drgao (talk) 17:07, 11 December 2012 (UTC)

Every aspect of our life and biology is affected by our genes, so the LiveScience report is essentially useless. I think we should wait for this to be reviewed by a more reliable source. Looie496 (talk) 19:43, 11 December 2012 (UTC)

You are saying that: genes are involved in many aspects of biology, therefore this particular gene study is useless. I don't quite follow your logic.

The study may have its limitations (it is relatively small, has not been replicated, and only focused on IBS, for example), but I don't follow your objection about this study being useless just because genes are involved in many aspects of biology. Please explain.

The study does offer an enlightening perspective on the the possible mechanism and nature of the placebo effect, which is why it might be considered for inclusion. Drgao (talk) 20:53, 11 December 2012 (UTC)

I agree with Looie496. Given what is know about genetics the idea that "placebo effect may be genetically determined" is unremarkable. On the basis of our background knowledge it is safe to say that all aspects of physiology are at least partly determined by genes. Hall et al (2012) is limited as you acknowledge, so why incorporate a truism accompanied with such a early/provisional/tentative result into an encyclopedia? An encyclopedic article should endeavour to communicate more established science. AnotherPseudonym (talk)

Non-specific Effects: Support for a separate article?

I noticed that there isn't an article dedicated to non-specific effects of treatment and that name redirects to the placebo article. Placebo is just one of many non-specific effects so I don't think the topic can be legitimately subsumed under placebo. Are there any objections/issues/concerns in relation to creating an article dedicated to the non-specific effects of treatment? Articles exist for most of the non-specific effects that immediately come to mind, e.g. regression toward the mean, Hawthorne effect, confirmation bias, natural history of disease. Opinions welcome. AnotherPseudonym (talk) 13:18, 28 July 2013 (UTC)

"Non-specific effects of treatment" doesn't seem to me to be the right term for the concept you have in mind -- those things are really not effects of treatment at all. Can you cite any substantial literature that uses the term in the way you propose to? Looie496 (talk) 15:02, 28 July 2013 (UTC)

It was my mistake in appending "of treatment" without explanation. I should have just written non-specific effects. A distinction can be made between non-specific effects (e.g. regression toward the mean, natural history of disease see [1], [2], [3], [4]) and non-specific effects of treatment (e.g. patient/doctor rapport, Hawthorne effect, Pygmalion effect, anxiety reduction, therapist charisma, optimisim/reduction of demoralisation see [5], [6], [7], [8], [9], [10], [11]). Note also that the terms is used in the article in (In 1998, a meta-analysis of published antidepressant trials found that 75% of the effectiveness of anti-depressant medication is due to the placebo effect and other non-specific effects, rather than the treatment itself.[142]) but without any explanation and without a wikilink to an article. The term non-specific effect is a technical one and it can not be assumed that the reader knows what it means. AnotherPseudonym (talk) 02:41, 29 July 2013 (UTC)

Possible video source for "citation needed" tag

A reader misplaced a message about a source possibly needed by this article at Template talk:Citation needed#Protected edit request on 25 February 2014. They suggested that http://www.cbsnews.com/news/how-the-powerful-placebo-effect-works/ is a "video clip that cites a Harvard researcher on the ways a placebo can be effective. It should go in the paragraph with the "Citation needed" note, between current note 6 and note 7." I am not sure they meant this article but it seems to match. I can't view the video on my browser. Jason Quinn (talk) 16:46, 25 February 2014 (UTC)

Duplicate sentence

This sentence appears exactly the same twice in the same paragraph in the "Placebo-controlled studies" section:

"The placebo effect in such clinical trials is weaker than in normal therapy since the subjects are not sure whether the treatment they are receiving is active."

(I kind of think I noticed other redundant info elsewhere in the article, but I'll have to check for other examples later...I'm tired. @_@;;)

Anyway, I'm not sure which one to remove or re-word. Does anyone have suggestions? Zeniff (talk) 07:58, 15 August 2014 (UTC)

POV tag needed

I feel this article needs a POV tag; studies are presented without any criticism, even when the methodology was flawed and the people involved had clear confilicts of interest regarding the outcome of the studies. I would like to point out that meta-analyses are prone to researcher bias, see Meta-analysis#Dangers_of_agenda-driven_bias, not only by choice of studies, but also by the choice of statistical methods. I would think Irving Kirsch is a good example, and the fact that his studies are included without any criticism makes this whole article suspect. Kirsch mixes two criteria for clinical significance to try and prove his views, he uses for example a difference of 3 points on the (cantrememberthenamerightnow) depression scale as norm to say the ADs aren't effective, he switches to a relative difference to claim that the clinical significance in severely depressed patients wasn't because of increased effect from the ADs but a lesser effect from the placebo.
The so-called placebo effects could just as well be explained by spontaneous improvement. Less than 60% of patients finished the short (mostly 6 weeks or less) trials (especially for fluoxetine 6 weeks would be short, given the long half-life). He also ignores that two positive tests were needed for FDA approval and negative tests would not be taken into account, reason enough for the companies to set up short tests as soon as possible without much regard for quality.
Finally, the depression scale in question is biased towards sedating medication, if the SSRI's had an opposite effect, that could result in a higher (worse) score, even when lethargy and fatigue had been significant complaints, because those counted for only two points.
Since the tests I know of are misrepresented, it seems likely others could be as well. DS Belgium (talk) 16:35, 31 October 2011 (UTC)

We really shouldn't be picking apart studies on wikipedia. Any criticism should come from reliable sources. Basically, if it satisfies WP:MEDRS we can include it. However according to MEDRS we should mainly be relying on high quality reviews, so if the study in question is not mentioned in a review then maybe it should be removed.

As for misrepresenting data: if it is the wikipedia article that is misrepresenting a source, then we should change the text. If the source itself misrepresents the data (and it satisfies MEDRS) then there isn't anything we can do unless there is another reliable source criticising it. It irks me too when I see crappy science published in peer-reviewed journals, but that is irrelevant for wikipedia. --sciencewatcher (talk) 18:24, 31 October 2011 (UTC)

I agree with Sciencewatcher. Adding unsourced criticism of research into the Placebo article would be original research, which is not allowed under Wikipedia policy. -- JTSchreiber (talk) 05:30, 1 November 2011 (UTC)

The criticism of Kirsch can be found in reliable sources, one just has to look for them.

http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html?pagewanted=all

http://ebmh.bmj.com/content/11/3/66.full

In this critique, we argue that Kirsch et al.'s is a flawed analysis which relies upon unusual statistical techniques biased against antidepressants. We present results showing that re-analysing the same data using more appropriate methods leads to substantially different conclusions. http://www.ncbi.nlm.nih.gov/pubmed/20571143

I know their are more papers published that show the statistical errors made by Kirsch et al in their study. Don't have the time to look for them, but the previous three critiques were easily found. 84.197.190.98 (talk) 11:02, 11 January 2012 (UTC)

And also, there are thousands of studies on antidepressants. The two studies claiming that AD's don't do better than placebo's are written by Kirsch who is the most prominent advocate of "the power of placebo". Seems to me that there's a clear conflict of interest, maybe one should check the books he published to see that he is not a neutral source when it comes to placebo effects. In the same way one could make the case that homeopathic dilutions work, given the studies done by Hahnemann's followers. 84.197.190.98 (talk) 11:25, 11 January 2012 (UTC)

Does this recent review provide the necessary critical input?: Fountoulakis KN, Möller HJ (2011 Apr). "Efficacy of antidepressants: a re-analysis and re-interpretation of the Kirsch data". Int J Neuropsychopharmacol. 14 (3): 405–12. PMID 20800012. {{cite journal}}: Check date values in: |date= (help)

User:DS Belgium, how do you scientifically define and explain what you are calling a spontaneous improvement ? Is your need for evidence-based science sufficiently satisfied by this term and by this explanation ? (Paulmartin357 (talk) 14:21, 25 January 2015 (UTC))

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Placement of "HISTORY" section in the article

Should 'history' section be placed in the end which is unlike the generally followed wikipedia template of placing history of the subject in the begining sections! Happy sage (talk) 03:57, 10 January 2016 (UTC)

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Rewrite needed

This is the worst article I have read on a very interesting phenomena which never states what the effect is. — Preceding unsigned comment added by 67.249.137.52 (talk) 11:32, 17 May 2016 (UTC)

Literally. The lede has too many pp's. Let's shift them down to topic discussion.Kortoso (talk) 19:05, 22 June 2016 (UTC)

The correct definition of placebo is required

Another reader suggests that this article should be rewritten. I would fully endorse this. The main problem is that there is no section on "definition" and that the definition provided in the section "Types of placebo" is very questionable (currently: "A placebo has been defined as "a substance or procedure... that is objectively without specific activity for the condition being treated""; citing a scientific article from 1983). In fact, there is one definition authorised by regulatory authorities, namely that of the US Code of Federal Regulations (CFR), there in 21 CFR 314, §126, 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." This definition is fully compatible with the fundamental guideline ICH E10 (Choice of control group). The currently given definition, however, uses the attribute "objectively" that incorrectly limits the inactivity and, thus, is misleading. Also the term "specific" could be challenged, furthermore the missing thought to mimick (resemble) the test drug as far as possible.

Starting an article with a questionable, if not simply wrong, definition causes many subsequent misunderstandings and misinterpretations.

For further criticisms it is referred to:

Kremer HJ. Myths and Facts about Placebo. Journal of Pharmacy and Nutrition Sciences 2016; Vol 6 (2), 43-54. DOI: http://dx.doi.org/10.6000/1927-5951.2016.06.02.2 — Preceding unsigned comment added by HausFr (talk • contribs) 07:58, 24 May 2016 (UTC)

I have made a change to the existing definition by linking it to several definitions from conventional dictionary sources. I hope that this will help to clarify the working definition from which the rest of the article can follow, since many seem to have been concerned about how accurate and reliable the definition was.

Elasticpretzels (talk) 02:50, 22 January 2017 (UTC)

Very good; thank you. I was just coming here to do the same thing when I saw that it had already been done. My issue with the words "deceive" and "deception" is that their connotation definitely does not apply to blinded experiments in which everyone involved has given fully informed consent. "Volunteering not to know" is not the same thing as being "deceived". Fortunately, the new (referenced) lede avoids that problem. Thanks again. Quercus solaris (talk) 15:40, 22 January 2017 (UTC)

Thank you for updating/correcting that detail. "Volunteering not to know" in the context of informed consent is definitely a more accurate way to describe the use of a placebo in blinded experiments. Elasticpretzels (talk) 17:39, 28 January 2017 (UTC)

Removed an incorrect statement about a linked study

I have removed a statement in the lede, in the section which talks about the placebo effect in patients who know they are taking a placebo. It contained a sentence which said that the placebo drugs in some studies might not be inert, "such as a 2010 study involving patients with IBS who were given placebos containing fiber". However, from what I could see, the linked study (the full text is available) makes no mention of what the placebo contained. Indeed the only mentioned of fiber is in relation to the fact that patients were allowed to continue their existing treatments, which might include fiber.

I'm not a regular editor and not sure what to do here apart from remove an inaccurate statement, so I will just add here that this sentence only references a single study which does not really constitute a body of evidence in itself, especially since the paper itself cautions that it had a small size and a short study duration, and that the study should maybe be viewed as ".. a “proof-of-principle” pilot study". I think the section needs better references. — Preceding unsigned comment added by 82.27.27.206 (talk) 16:37, 24 May 2017 (UTC)

Wider context

The placebo effect is also of interest outside of medicine, e.g., is educational research. Kdammers (talk) 14:39, 24 August 2017 (UTC)

Is it real?

A massive meta-study questions the effect of placebos. Why isn't this study mentioned? Hro`bjartsson & Gr0tzsche, 2010, Placebo interventions for all clinical conditions (Review), The Cochrane Library 2010, Issue 1, retrieved from http://www.dcscience.net/Hrobjartsson-Gotzsche-Cochrane-placebo.pdf Kdammers (talk) 14:47, 24 August 2017 (UTC)

Wrong from the start

This article begins with a false premise: "A placebo may be given to a person in order to deceive the recipient..." Placebos are NEVER administered to deceive unless it is done in a bogus study of placebos of which many are mentioned. They are combined with substances under study to account for a mind-body healing effect. Dangnad (talk) 18:42, 27 September 2017 (UTC)

That's true for clinical trials, but not in plain therapeutic settings. Patients are sometimes prescribed dummy pills in the hospital for example, to treat subjective ailments when a true treatment is not appropriate. 89.85.166.204 (talk) 22:08, 29 January 2018 (UTC)

Ah so but it all depends on what the patient is told. You don't just slip a red sugar pill in their medication cup and let it go at that. Anyway, you are saying the same thing I am...maybe. However, I've never heard of "subjective ailments" and "true treatments". Doesn't sound right to me. If you are withholding a "true treatment" then you are deceiving the patient. Dangnad (talk) 01:59, 1 February 2018 (UTC)

The role of (and definition of) deception in clinical placebo use is controversial, as can be seen simply by perusing the titles of the following publications. A more detailed inquiry into this subject would require summarizing and discussing the arguments in publications such as these:

• Foddy, Bennett (December 2009). "A duty to deceive: placebos in clinical practice". American Journal of Bioethics. 9 (12): 4–12. doi:10.1080/15265160903318350. PMID 20013484. {{cite journal}}: Invalid |ref=harv (help) See also the more than a dozen published responses in the same issue.
• Finniss, Damien G.; Kaptchuk, Ted J.; Miller, Franklin; Benedetti, Fabrizio (February 2010). "Biological, clinical, and ethical advances of placebo effects". The Lancet. 375 (9715): 686–695. doi:10.1016/S0140-6736(09)61706-2. PMID 20171404. {{cite journal}}: Invalid |ref=harv (help)
• Groll, Daniel (May 2011). "What you don't know can help you: the ethics of placebo treatment". Journal of Applied Philosophy. 28 (2): 188–202. doi:10.1111/j.1468-5930.2011.00517.x. {{cite journal}}: Invalid |ref=harv (help)
• Kisaalita, Nkaku R.; Roditi, Daniela; Robinson, Michael E. (August 2011). "Factors affecting placebo acceptability: deception, outcome, and disease severity". Journal of Pain: Official Journal of the American Pain Society. 12 (8): 920–928. doi:10.1016/j.jpain.2011.02.353. PMID 21816353. {{cite journal}}: Invalid |ref=harv (help)
• Blease, Charlotte (January 2011). "Deception as treatment: the case of depression". Journal of Medical Ethics. 37 (1): 13–16. doi:10.1136/jme.2010.039313. PMID 20962066. {{cite journal}}: Invalid |ref=harv (help)
• Barnhill, Anne (September 2011). "What it takes to defend deceptive placebo use". Kennedy Institute of Ethics Journal. 21 (3): 219–250. doi:10.1353/ken.2011.0015. PMID 22073816. {{cite journal}}: Invalid |ref=harv (help)
• Miller, Franklin G.; Colloca, Luana (August 2011). "The placebo phenomenon and medical ethics: rethinking the relationship between informed consent and risk-benefit assessment". Theoretical Medicine and Bioethics. 32 (4): 229–243. doi:10.1007/s11017-011-9179-8. PMID 21479794. {{cite journal}}: Invalid |ref=harv (help)
• Brody, Howard; Colloca, Luana; Miller, Franklin G. (June 2012). "The placebo phenomenon: implications for the ethics of shared decision-making". Journal of General Internal Medicine. 27 (6): 739–742. doi:10.1007/s11606-011-1977-1. PMID 22258918. {{cite journal}}: Invalid |ref=harv (help)
• Cohen, Shlomo; Shapiro, Haim (December 2013). "'Comparable placebo treatment' and the ethics of deception". Journal of Medicine and Philosophy. 38 (6): 696–709. doi:10.1093/jmp/jht052. PMID 24225391. {{cite journal}}: Invalid |ref=harv (help)
• Kisaalita, Nkaku; Staud, Roland; Hurley, Robert; Robinson, Michael (December 2014). "Placebo use in pain management: the role of medical context, treatment efficacy, and deception in determining placebo acceptability". Pain. 155 (12): 2638–2645. doi:10.1016/j.pain.2014.09.029. PMID 25267208. {{cite journal}}: Invalid |ref=harv (help)
• Gold, Azgad; Lichtenberg, Pesach (April 2014). "The moral case for the clinical placebo". Journal of Medical Ethics. 40 (4): 219–224. doi:10.1136/medethics-2012-101314. PMID 23750027. {{cite journal}}: Invalid |ref=harv (help)
• Pugh, Jonathan (February 2015). "Ravines and sugar pills: defending deceptive placebo use". Journal of Medicine and Philosophy. 40 (1): 83–101. doi:10.1093/jmp/jhu045. PMC 4288933. PMID 25503607. {{cite journal}}: Invalid |ref=harv (help)
• Barnhill, Anne; Miller, Franklin G. (February 2015). "Placebo and deception: a commentary". Journal of Medicine and Philosophy. 40 (1): 69–82. doi:10.1093/jmp/jhu043. PMID 25503605. {{cite journal}}: Invalid |ref=harv (help)

Biogeographist (talk) 22:47, 1 February 2018 (UTC)

Placebo pills are by definition pharmaceutically inert. So, if a patient expects a really proven medicine and is given a placebo pill, it is clearly deception (the patient is provided with a make-believe cure which has no real effects). Also, important to stress is that placebo only produces a subjective amelioration of the symptoms, it does not heal anything. If healing happens, we may speak of spontaneous or unexplained healing, but not of placebo. By definition placebo cannot heal anything, it can only lure the patient into thinking that he/she is feeling better. I mean: it's not magic (paranormal), it is more like magic (illusion). So, yeah, placebo has measurable effects on the brain and heart rate. So do music and horror films. Healing by placebo is more like what Rajneesh stated about homeopathy: "imaginary medicines for imaginary illnesses". Tgeorgescu (talk) 07:31, 25 March 2018 (UTC)

Reorganization of the lead

The lead appears to be longer than Wikipedia's styleguide suggests for even the longest articles. Additionally, the different paragraphs seem to be structured as leads for individual sections of the article, and thus would probably be best placed in those locations. I am planning on cleaning up the lead, if anyone else is working on this, please let me know. Kavigupta 04:48, 28 March 2018 (UTC) — Preceding unsigned comment added by Kavigupta (talk • contribs)

This is complete from my perspective, if anyone has comments, please let me know --Kavigupta 23:29, 29 March 2018 (UTC)

Section on Criticism

There are a number of people who are critical of the idea that the placebo effect is a real effect, including the Cochrane Collaboration (see the header) however, there is no section on criticism. I am planning on adding such a section to the end of this article to cover their position (currently the Cochrane report is only cited in the header).

Any objections?

Kavigupta 06:49, 26 March 2018 (UTC) — Preceding unsigned comment added by Kavigupta (talk • contribs)

What do you mean by "real effect"? Placebo is by definition a subjective effect. Tgeorgescu (talk) 08:15, 28 March 2018 (UTC)

I mean that the Cochrane review says that the Placebo effect is only in the data, and only in certain kinds of data (self-reported binary outcomes), the idea being that the placebo effect is primarily statistical effects (regression to the mean, natural progress of the disease) and reporting bias (saying what you think the surveyor wants to see) rather than a psychological or physiological effect. That would invalidate much of this article, and I think it should be pointed out somewhat more explicitly. Kavigupta 08:30, 28 March 2018 (UTC)

That's the problem in psychological surveys: you have to trust the self-report, otherwise you cannot really perform the study. So, this is a problem intrinsic to social and behavioral sciences. The distinction between the patient feels something, patient believes something and patient reports something is blurry. Tgeorgescu (talk) 06:42, 29 March 2018 (UTC)

I don't necessarily disagree with your position, but the view of many since the 50s has been that the placebo is clinically powerful (can effect real change), according to Cochrane, this position isn't supported by the evidence. So I think we should have a section on criticism for those who think the view that the placebo is clinically powerful can find the criticisms of that viewpoint. Maybe the title isn't quite right... Kavigupta 17:21, 29 March 2018 (UTC) — Preceding unsigned comment added by Kavigupta (talk • contribs)

If the illness is imaginary, an imaginary medicine would help. This is I guess the rationale behind the clinical use of placebo. Tgeorgescu (talk) 11:01, 30 March 2018 (UTC)

Sure, but there are definitely a lot of people who believe placebos are useful for real conditions (there are occasional articles in the popular press, for example, saying the placebo effect works like "the secret" for colds: https://www.theguardian.com/lifeandstyle/2016/nov/13/how-to-use-your-brain-power-to-fight-off-a-cold). Someone with this position would find this article consistent with their view, and I think it's important that the article gives them the correct impression (that recent research does not support this position) Kavigupta 19:12, 30 March 2018 (UTC)

Removal of section List of medical conditions

I believe the section List of medical conditions should be removed. Since placebo effects are noted in basically all clinical trials (as mentioned with citations elsewhere in the article), this section effectively amounts to a list of medical conditions that have been studied in a clinical setting.

Are there any objections?--Kavigupta 01:07, 19 May 2018 (UTC) — Preceding unsigned comment added by Kavigupta (talk • contribs)

It seems a bit redundant to include it to me. Looks like your removal was reverted with no discussion here. Maybe more input from others is needed. Perhaps a post on the appropriate project page, Wikipedia:WikiProject_Medicine, would lead to more discussion? Rap Chart Mike (talk) 18:00, 21 May 2018 (UTC)

I agree that this section is a) absurd and b) a ridiculously small selection of things that should be here, if we are going to include it. User:BullRangifer please justify keeping this. "it has been there a long time" is not a good enough reason. Thanks. Jytdog (talk) 04:12, 23 May 2018 (UTC)

If it's really bad, then remove it. Otherwise follow WP:PRESERVE and improve, not delete, it. -- BullRangifer (talk) PingMe 05:25, 23 May 2018 (UTC)

Definitely support removal; having a list of medical conditions where placebo testing has taken place would not only be excessive when the list is 'more complete' but also I don't see the purpose in it. --Treetear (talk) 11:18, 23 May 2018 (UTC)

I absolutely support removal as it seems this is out of place being in this article. RobP (talk) 12:25, 23 May 2018 (UTC)

• support removing section--Ozzie10aaaa (talk) 20:32, 23 May 2018 (UTC)
• I think you'll find that it's more complicated than that. First, placebo effects aren't found in everything. Placebos don't stop people from bleeding when they're cut, and they don't set broken bones, to name just two obvious examples. Second, and much more importantly, there is a difference between "an effect was seen in a person taking a placebo" and "the placebo effect". The placebo effect is far stronger and more important in subjective symptoms (e.g., pain and depression) than in objective conditions (e.g., the amount of blood that has to be mopped up after a car wreck). I think that it would be better to talk less about individual conditions and more about general themes here, but this list is not wrong, and it is most informative when you read it with an eye towards both what's present and what's absent. WhatamIdoing (talk) 23:50, 23 May 2018 (UTC)
  • The issue is that this list is a list of conditions for which there are trials that have some effect show up in the placebo wing, which is "an effect was seen in a person taking a placebo", so it doesn't really differentiate the two cases you have above. The only experiment that can draw that distinction is one in which there is a placebo and a no treatment wing (and even then there can be biased reporting), and that is not the kind of experiment that this chart is tracking. An attempt at a discussion of what you're describing would be beneficial (and is in fact the reason I started trying to improve this article, take a look at Placebo#Criticism). Kavigupta (talk) 02:54, 24 May 2018 (UTC)

Instead of telling us to read it "with an eye to" figuring out the inclusion criteria, could you just tell us what that criteria is? It looks like it's just "We found a meta-study about this"?

ApLundell (talk) 05:00, 24 May 2018 (UTC)

My comment isn't about the inclusion criteria for the list. It's about what's in the list (and what you would expect to find in any typical list about placebos) and what's not in the list. So, what's there? Lots and lots and lots of things involving pain and distress. It's all disorders that are primarily characterized by subjective, self-reported symptoms and conditions that are affect and are affected by conscious behavior. What's not there? Infectious diseases, conditions easily treated by surgery, and other disorders primarily characterized by objective problems with clear, direct etiology. WhatamIdoing (talk) 02:33, 25 May 2018 (UTC)

If that's the purpose, I think it's handled well in the text immediately above the chart, and doesn't need a chart (which only partially satisfies your criteria: food allergies, hypertension, and heart failure aren't on there). Also, you wouldn't expect many diseases generally treated by surgery to be on there because placebo testing has only recently become a thing for surgery. [Again, not claiming that there is a real placebo effect for any of these conditions, just that some of the linked studies don't really show one either way]. Kavigupta (talk) 03:01, 25 May 2018 (UTC)

Hypertension and heart failure are affected by behavior, and behavior is affected by placebos (also by the clinical trial effect). A remarkable number of people who believe themselves to have food allergies actually don't (or don't have a clinically significant allergy any longer), so it's not surprising that people who have a reason to be calm about the challenge (namely, that they think the "drug" will protect them) turn out to not report a significant reaction.

Placebo-controlled surgical trials have been done, but nearly all of them have been done for conditions already on this list. (See this report if you're interested.)

I think that the first two sentences of the ==Symptoms== section should be expanded significantly. We should spend more time talking about the general factors (e.g., works better for subjective than objective; works better if the placebo seems expensive or difficult or special) than we do on detailing just exactly how big it is in CFS/ME. Whether we namecheck things like asthma and irritable bowel syndrome – eh, I don't really care either way. But we need to beef up the overall explanation, and to more clearly explain the difference between spontaneous remission, unintentional behavioral changes, and the effects actually produced by placebos. WhatamIdoing (talk) 06:33, 25 May 2018 (UTC)

I could not agree more that we need to "clearly explain the difference between spontaneous remission, unintentional behavioral changes, and the effects actually produced by placebos". In fact, that is the reason I originally got interested in improving this article, before realizing that I should first try to fix what I viewed as some of the organizational difficulties first. I don't think that this chart really communicates the message of which areas are more affected by placebos than others, however. — Preceding unsigned comment added by Kavigupta (talk • contribs) 17:34, 26 May 2018 (UTC)

• Support removing section or importing all of Category:Human diseases and disorders. Natureium (talk) 21:46, 24 May 2018 (UTC)

Recent changes

These represent a huge improvement, especially the reorganisation to reduce back and forth with one section implying one thing and another something else, from the same studies.

Are there any review studies on fMRI and placebo? I'm concerned that fMRI is rthe medical equivalent of pareidolia, you can show pretty much anything including life after death in fish, so primary fMRI studies seem particularly dangerous per WP:MEDRS. Guy (Help!) 12:32, 17 June 2018 (UTC)

Giving up

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Fighting this well-known, tight-knit gang of evidence-based enthusiasts without support from others is really consuming too much energy and time. Humanity is served in a better way if I put my energy into other, more productive things. I hope someone finds some time to ensure this article does not become another totally biased statement of faith in positivist philosophy. --rtc (talk) 13:25, 17 June 2018 (UTC)

I want to give you a piece of advice, it is not an attack. If you will listen to it you will have a good time around here.

Wikipedia is mainly a venue for parroting mainstream science and mainstream scholarship (and perhaps mainstream press, for certain subjects). Editors are supposed to understand this, to wish this and be competent at doing this.

So supporting mainstream science and mainstream scholarship is required of all editors, failure to do this leads to losing disputes, being blocked and eventually banned. Strong adherence to mainstream science and mainstream scholarship is what made Wikipedia one of the greatest websites. So, dissent from mainstream science and mainstream scholarship will be perceived as an attack upon Wikipedia itself. If you want to win a dispute, you have to show that your claims are mainstream science or mainstream scholarship. If you cannot honestly do that, then refrain from making that particular claim. And remember, Wikipedia is just a mirror, mainstream science and mainstream scholarship exist outside of Wikipedia and cannot be changed through editing Wikipedia, Wikipedia merely reflects them. So if you want to change science/scholarship, you have to be a scientist or a scholar, Wikipedia is not the venue for doing that. Tgeorgescu (talk) 16:40, 17 June 2018 (UTC)

Thanks for stating the prevailing ideology in such clear terms. Honesty is certainly a first step. I actually have a good time around here since 2005 and I have never changed my opinion that Larry's philosophy is right and that the prevailing philosophy about "Wikipedia is mainly a venue for parroting mainstream science" is naive and wrong and I will keep defending the view that Wikipedia is neutral, is not at all "a mirror, mainstream science" and supporting mainstream science and mainstream scholarship" is not required for any editor and any use of blocks and bans to advance the science-savvy ideology (which has been used against me a few of times already) is an illegitimate abuse of power. But, don't get me wrong, science is important. It is just not the definition of neutrality. --rtc (talk) 16:55, 17 June 2018 (UTC)

"All opinions are equal" has never been part of WP:PAGs, see WP:ABIAS. Tgeorgescu (talk) 18:55, 17 June 2018 (UTC)

"All opinions are equal"? I never said that. False dichotomy. --rtc (talk) 19:05, 24 June 2018 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.