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[edit] Placebo effect

Maybe it's only me, but I think the article should be names Placebo effect and not Placebo. 90% of the article is about the effect, with a few lines about the origin of the word Placebo. Would you agree? Thanks Kvsh5 (talk) 11:11, 13 April 2009 (UTC)

A year ago I found the article in a chaotic state and organised it into three chapters: Placebo, placebo effect, and placebo-controlled studies. In January, LittleHow improved the article and split off a large part of its material into Placebo-controlled studies. I think it's logical to split off the material on the placebo effect as well. Since there isn't all that much that can be said about placebos themselves as well, and since it is less technical than much of the material on the placebo effect and placebo-controlled studies, I think we should preserve Placebo as an introductory article that summarises Placebo-controlled studies and Placebo effect as sub-articles.
In practice this means either moving Placebo to Placebo effect, and then moving the material about placebos and placebo-controlled studies back from Placebo effect to Placebo (which will then become a new article). Or splitting off Placebo effect in the same way that Placebo-controlled studies was split off. --Hans Adler (talk) 14:26, 13 April 2009 (UTC)
As I said below, there's no such thing as a placebo without a placebo effect. This article should probably be retitled to the placebo effect.—Preceding unsigned comment added by ImperfectlyInformed (talk • contribs)
I don't see how your first sentence is an argument for anything. This article is large and may have to be split. There should be enough material for an article discussing types of placebos: Mass-produced placebos using names such as Obecalp, sham operations, sham acupuncture; also certain cultural and ethical aspects. The material that you have put into Placebo in history could fit there. Why not have an article Placebo directed primarily to lay readers and an article Placebo effect of a more technical nature. Each could summarise the other. --Hans Adler (talk) 00:20, 30 April 2009 (UTC)
Thinking about this again, I wasn't thinking clearly. I do think placebos always have some sort of placebo effect and they should be discussed together, but placebo is the basic concept and that should be the title of the article. I don't think we need more split-offs right now if proper trimming is done. Maybe after some more trimming has been done it will be necessary due to the amount of brain research/clinical trial info, but I don't think so. II | (t - c) 07:57, 1 May 2009 (UTC)
That works for me as well. But I'd like to make it clear that my idea would basically just mean moving placebo to placebo effect, moving placebo in history to placebo, and broaden the scope of the latter article so that some material can be moved from here to there. So it's not about spawning off even more articles than we have now. --Hans Adler (talk) 12:11, 1 May 2009 (UTC)
Any perceived effect of an inactive treatment can be referred to as a placebo effect. However, it is not uncommon to have a placebo treatment with no detectable effect (i.e., compare placebo-treated versus untreated)--this is the basis for the disputed nature of the existence of the effect. Additionally, the placebo effect can be considered a component of some demonstrably active treatments as well (particularly in metrics of qualitative effects), thus a "true" placebo isn't required for the effect. With this in mind, I think it's clear that placebo ≠ placebo effect, although they're obviously heavily related. I don't think this article is too big right now, but Hans Adler's plan isn't unreasonable if it gets there, particularly since the bulk of the article focuses on the effect. — Scientizzle 00:09, 2 May 2009 (UTC)
I agree, the name should be Placebo effect. As far as "placebo" is concerned, it is nowhere (AFAIK) in an English text mentioned except as a shorthand for "placebo effect". ... said: Rursus (bork²) 08:13, 8 July 2009 (UTC)
I change my mind. The text below treats "placebo" as the inert preparate served to achieve the "placebo effect". Nevertheless, "placebo" preparates are always occuring when to achieve the "placebo effect", so the name should IMHO be Placebo effect. ... said: Rursus (bork²) 08:19, 8 July 2009 (UTC)

[edit] Newman and deception in placebos in the intro

I will remove the following statement from the intro --"The deceptive nature of the placebo creates tension between the Hippocratic Oath and the honesty of the doctor-patient relationship." -- unless someone can come up with a compelling reason why it should remain. It is unsourced, and there is no sourced text in the article to justify it. There are situations where it is patently ethical for a physician to use placebo as a diagnostic tool, for the benefit of the patient and faithful to the Hippocratic Oath. A google search would help the naysayers. Comments? Kaiwhakahaere (talk) 23:58, 21 April 2009 (UTC)

The conflict the sentence tries to convey is important enough to be pointed out in the introduction. To some degree the problem of dishonesty is expressed in the body of the article (see doctor-patient relationship) and may need further elaboration. It is also right that there are legitimate uses for a placebo (i.e. a prospective drug study where the subject is aware that either the drug or a placebo is given). I would leave out the Hippocratic Oath part and propose to rephrase the sentence perhaps this way:-"The use of a placebo in a deceptive manner creates a conflict with the honesty of the doctor-patient relationship."(cite book |author=David H. Newman |title=Hippocrates' Shadow |publisher=Scribner (2008)| page=154-7 |isbn=1-4165-5153-0). Ekem (talk) 02:56, 23 April 2009 (UTC)
The sentence is basically correct, although it is misleading to cherrypick this sentence from Newman. Newman's chapter on placebos comes off as ambivalent about placebos, and he makes a strange distinction between "meaning responses" and "placebo effects". On page 156 he says "while antibiotics are no more effective than placebo pills [for sore throat], what if you compare antibiotic pills to nothing"? He says they're often effective in such cases and says "it seems unethical not to use something that heals". Then later he says that "we may as well be handing patients an inert pill and all the deceptions, moral compromises, and long-term harms that come with it". His main point is against using active drugs which don't really work for the condition they're purported to treat. Ultimately he concludes that the "meaning response" can be gained without deception (ie ineffective drugs or homeopathy) through "listening and doctoring". Basically he seems to say that if the doctors explain that things will go away with time, they will resolve. He doesn't seem to support this contention with data all that well though. II | (t - c) 08:14, 27 April 2009 (UTC)
I think it's important that the sentence stay in something close to its original form. It's worded pretty well: any kind of deception of the patient creates a tension for the physician. That doesn't mean the physician believes he/she is doing something wrong, just that he/she feels a bit uncomfortable about it. Looie496 (talk) 16:20, 27 April 2009 (UTC)


The issue about deception in this context while present is fairly complex. Medicine has an element of theater and play acting. Nurses often distract patients attention while giving injections so they do not focus upon the needle when it is inserted. Doctors are aware people come to be reassured and will give a full examination even if they do not think it is necessary because that is what is expected. Doctors will tell minor lies so that they can tell a patient "bad news" when there is sufficient time to properly explain the situation, or with a relative with who they can then discuss it. Deception is not itself wrong, it is deception with bad intent. The tension is medicine is what might be considered good intent: in the past (and presently in countries such as Japan) that included lies that reassured patients when they had cancer, for example.
One additional problem is that even clinically effective treatment has a placebo effect (see below): should a doctor warn a patient that while a drug has an active effect a large part of the positive effects that will happen to them is due to an additional effect of their own expectation that it will work. Should they tell the patient this in such a way to remove that additional placebo effect or just leave it as a bonus? What when a drug can have a clinical effect but that in half the cases it will not but still have that expectation effect? And what then a quarter of the time or less? The issue is about what is appropriate good "intent" and that is a very complex topic in the way it intermixes with deception.
The introduction has shrunk in the last few months and no longer mentions that the placebo effect also applies as an additional enhancement of treatments with real clinical effects. for example, Eccles R, Eccles, K.S.J. Placebo effect (2007) Encyclopedia of life sciences . John Wiley & Sons doi:10.1038/npg.els.0004114 ISBN 978-0470066515

The therapeutic response to any medicine is made up of several components (Eccles, 2003) including a perceived placebo effect (see Figure 1). The figure shows that the active medicine has three components that contribute to the overall effect of the medicine on the disease (pharmacological, true placebo and nonspecific components).

I suggest lead starts with the Placebo effect rather than Placebos so that can be mentioned. I suggest it reverts to something like: The Placebo effect is the medical phenomena in which a person’s beliefs about an inert substance or a sham therapy results in that treatment having the expected consequences of those beliefs upon health. The placebo effect can also be an additional boost for a real therapy or drug beyond that warranted solely by its actual physiological action. --LittleHow (talk) 03:58, 28 April 2009 (UTC)
I think a lot of good points have been made. Newman struggled with the placebo dilemma and so it seems do we. I expanded the "Motivation and meanings section" a little bit, but feel that this dilemma should not be avoided in the introduction. Also Eccles' point can be introduced in the intro showing that the placebo effect is an integral part of the effect of "active medicine". When I came to the "Placebo" article I found it jarring that it started at that time with "The placebo effect..." and changed it to begin with "The placebo...", to have the horse in front of the cart so to speak. The Placebo effect may deserve its own article, though, but that is a tall order.Ekem (talk) 14:08, 28 April 2009 (UTC)
There's no such thing as a placebo without a placebo effect. This article should probably be retitled to the placebo effect. II | (t - c) 21:28, 29 April 2009 (UTC)
Hróbjartsson and Norup indicate that about "30% (28-36) of the clinicians believed in an effect of placebo interventions" (see ref #2 of article) and you are saying placebo interventions always have an objective outcome? Ekem (talk) 12:06, 30 April 2009 (UTC)
Hmm. How did you get that from what I said? A placebo is just an inert substance which, through some manner of expectation, deception or promotion, exerts a placebo effect. Without that effect, it's just an inert substance ... actually, thinking about this a bit more maybe I'm wrong. Maybe a placebo is just an inert substance used as a control, which just happens to exert a placebo effect. Even if there was no placebo effect, there would still be a placebo. On the other hand, under a definition of placebo as a "control procedure" non-placebos can obviously have a placebo effect; for example, Moerman's example of expensive swimsuits. II | (t - c) 16:39, 30 April 2009 (UTC)
The statement is an important indication on what is the general philosophical/ethical trouble with exploiting the "placebo effect" 100% if that is possible, and maybe also an indication on why the effect is not very well understood. By my gut-feelings, it is some kind of "instantiation" of a general "tailbiter paradox" (where the statement over a thing affects the truth of the same thing) related to self-fulfilling prophecies and possibly also Heisenberg's uncertainty principle (measurement of things affects the truth of the same things). ... said: Rursus (bork²) 08:32, 8 July 2009 (UTC)

[edit] Chronic Fatigue Syndrome

Previous wording was misleading, citation PMID15784798 full text concludes:

"In contrast with the conventional wisdom, the placebo response in CFS is low."

"In contrast with the initial hypothesis, the pooled placebo response was substantially lower than the usually reported one third response in other medical conditions."

"This comparison of like with like enabled us to conclude that contrary to the received wisdom, the summary placebo response in CFS was actually lower compared with the comparison disorders." Ward20 (talk) 07:14, 3 June 2009 (UTC)

I agree about the problem but not about the solution. A "list of medical conditions" with no further comment beyond references makes no sense to me. Depending on how this is fixed it probably makes sense to include CFS again; after all the low placebo response is unexpected.
I don't remember this section from the last time I worked on the article, and I am not sure what to do about it. --Hans Adler (talk) 08:21, 3 June 2009 (UTC)
Hans, if it can be fixed without the reader the assuming wrong information that's great. AFAIK there is a placebo response for almost all diseases, why pick these few out? I spot checked some conditions to the sources and several talked about substantial or elevated placebo response. The Crohn's disease citation talked about a variable placebo response. IMO the section needs a lot of work to make sense. Maybe present an elevated placebo response illness, a lowered placebo response illness such as CFS, a variable placebo response condition such as Crohn's disease, and whatever other permutations there may be to illustrate different types of responses? Ward20 (talk) 08:54, 3 June 2009 (UTC)

Take list that has no explanation or reason for inclusion in article and park it here for now. The list appears to be placebo studies of illnesses but they can't be inclusive as most studies have placebo controls. Ward20 (talk) 00:55, 2 July 2009 (UTC)

List of medical conditions

The placebo is an inert pill unless otherwise stated[1]

  • ADHD:adult,[2] child[3]
  • Amalgam fillings: attributed symptoms (inert "chelation" therapy)[4]
  • Anxiety disorders[5][6]
  • Asthma (water aerosol inhalant)[7]
  • Asthma[8][9]table 1
  • Autism: language and behavior problems[10][11]
  • Benign prostatic enlargement[12]
  • Binge eating disorder[13]
  • Bipolar mania[14]
  • Cough[15]
  • Crohn's disease[16]
  • Depression (Light treatment; low red light placebo)[17]
  • Depression[18][19][20][21]
  • Dyspepsia and gastric motility[22]
  • Epilepsy[23]
  • Erectile dysfunction[24]
  • Food allergy: ability to eat ill-making foods[25] p. 54
  • Gastric and duodenal ulcers[25][26][27]
  • Headache[28]
  • Heart failure, congestive[29]
  • Herpes simplex[30]
  • Hypertension: mild and moderate[31][32]
  • Irritable bowel syndrome[33][34]
  • Migraine prophylaxis[35]
  • Multiple sclerosis[36]
  • Nausea: gastric activity[37]
  • Nausea: chemotherapy[38]
  • Nausea and vomiting: postoperative (sham acupuncture)[39]
  • Pain[40][41]
  • Panic disorders[42]
  • Parkinson’s disease[43][44]
  • Pathological gambling[45]
  • Premenstrual dysphoric disorder.[46]
  • Psoriatic arthritis[47]
  • Reflux esophagitis[48]
  • Restless leg syndrome[49]
  • Rheumatic diseases[50]
  • Sexual dysfunction: women[51]
  • Social phobia[52]
  • Third molar extraction swelling (sham ultra-sound)[53][54]
  • Ulcerative colitis[55]
  • Vulvar vestibulitis[56]

The list is interesting and provides an useful source of studies and papers that discuss the placebo effect in diverse conditions and should be kept.

Placebo controls it should always be noted are not placebos because those taking them do not know whether their treatment is "active" or not. (Placebo controls are given for methodological reasons in trial design not to explore the placebo effect). Such uncertainty about receiving an "active" or inactive treatment could effect whether or not a placebo effect occurs. This list contains studies and metastudies that seem to look at the question whether the placebo effect actually applies to a wide range of symptoms and conditions. That makes it relevant in an article upon the placebo effect.--LittleHow (talk) 04:10, 2 July 2009 (UTC)

I don't understand how the reader is expected to know what the studies and metastudies represent since there is no explanation in the article. Is it a see also section in disguise? Then there is a problem of presenting how the group of studies and metastudies are relevant in the article without getting into original research. I will ask for input at Wikipedia talk:WikiProject Medicine here. Ward20 (talk) 05:49, 2 July 2009 (UTC)
These don't seem to be all about studying the effect of placebo. The first[1] one, for ADHD, was actually comparing drugs to placebo . If you're studying placebo, you need an untreated group. The second [2], oddly enough, found that kids openly administered placebo with lowered stimulant doses maintained their status compared to those who weren't given placebo. So the first is not really what we're looking for. We're looking for studies like the second, which study the placebo rather than use placebo as a control. II | (t - c) 05:29, 3 July 2009 (UTC)
However if a reader had a prior interest in ADHD, these papers would seem the kind of literature to which they would appreciate a pointer. The first though lacking a no treatment arm found that 46% of the placebo takers had a 30% improvement on the adult ADHD rating scale -- the comparison drugs at 34% and 49% were not statistically different. That is not marginal and given the surprising finding of the second study of an effect for open-label placebo treatment in ADHD suggests ADHD is a condition that in which there exists placebo findings of interest.
The question about this list seems to me to bewhether there is a general "placebo effect" or a lot of different "placebo effects" each tied to different conditions. If the latter there is a need to provide at least some indications of the conditions to which it might be relevant. --LittleHow (talk) 09:37, 3 July 2009 (UTC)
That's one of the reasons I believe the list is questionable. What does the list represent? The footnote,133 which IMO is original research (I haven't seen a footnote before that is an editorial opinion), states, "In many of these citations concern research that show active treatments are effective. The point is that they also show placebo effects exist as well. It should not therefore be inferred that more effective active treatments for these conditions do not exist, only that placebo effects have been shown." There are other problems with the list. Several small placebo controlled studies are represented. How are those selected over others. A pubmed search of "placebo controlled study" has 88574 articles and 7799 reviews. What is the list inclusion criteria, and why are these medical conditions significant over others? Ward20 (talk) 13:11, 3 July 2009 (UTC)
Also, in the section Gastric and duodenal ulcers the article talks about a meta-study but reference132 doesn't seem to be a meta-study nor support the material. Anyone know what is going on there? Ward20 (talk) 13:19, 3 July 2009 (UTC)
  • The list exists because many readers will have an interest in a particular condition and might want further information upon research relevant to them. It may or may not achieve that--but that is a valid reason for its existence. Being imperfect is not a reason for deletion: one of the key ideas behind Wikipedia is "Wikipedia is a work in progress" and that "Preserve information: fix problems if you can, flag them if you can't.".
  • I do not see in what way the footnote is expressing an opinion or original research. It seems to me to written to warn the reader not to infer that because a treatment is mentioned to show a placebo effect that it might not also show an active effect as well. One responsibility in any discussion of placebos is noting that even if a drug shows a placebo effect it still might have an active one as well--without such a warning a person might mistakenly discontinue treatment.
  • Rereading the titles, abstracts and some of the pdfs the list seems to be made up articles that have either focused upon the placebo effect in these conditions or found something unusual. There may be lots of "placebo controlled studies" but few such placebo effect focused articles.
  • The section Gastric and duodenal ulcers cites a book reference132 as meta-study. Moerman discusses in that book his meta-study that was published earlier in Moerman DE. (2000) Cultural variations in the placebo effect: ulcers, anxiety, and blood pressure. Med Anthropol Q. 14:51-72.(A paper cited elsewhere in the article)
  • What is happening is a discussion.--LittleHow (talk) 14:04, 4 July 2009 (UTC)

[edit] Section using incomprehensible jargon

Article was on the whole understandable until I hit the following sentence:

"upon the N2–P2, a biphasic negative–positive complex response, the N2 peak of which is at about 230 ms, and the P2 one at about 380 ms."

I don't have the background to know where to start fixing it... —Preceding unsigned comment added by 195.241.102.95 (talk) 22:11, 7 June 2009 (UTC)

[edit] New RS article

This article gives excellent coverage of the whole subject:

It is the feature article in the May 20, 2009 issue of Skeptic, and is also featured as a link in the "Articles of Note" section of the June 26, 2009 edition of "Arts & Letters Daily, A service of The Chronicle of Higher Education".

-- Brangifer (talk) 03:35, 27 June 2009 (UTC)

[edit] Interesting New Zealand study

A kiwi newspaper gave this precis today of a report in the NZ Medical Journal which contains material which may, or may not be, suitable for adaption for this article. Anyone? Kaiwhakahaere (talk) 01:59, 4 July 2009 (UTC)


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