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The point of giving placebos in an experiment is to
prevent
the placebo effect. But what if a participant in an
experiment can detect whether or not they are getting a
placebo? People are not dumb. After all, a sugar pill is
likely to have very different side effects (hardly any)
compared
to the real thing. Test subjects will be
actively
looking for signs to uncover whether they are getting
placebos or the real thing. Almost everyone has an
instinct
for wanting to know the truth, and those who don't think
about it consciously may do so subconsciously looking for
the slightest evidence of whether or not they are taking
placebo or the real drug. Because of the heightened
attention the effects of a pill, the site effects could be
extremely mild and still trigger the placebo effect
because
the patient assumes that side effects = real medication.
Imagine you have a serious disease. You take a pill
nothing happens, you immediately think ... "Hmm, I
must
be in the control group. This sucks, I was hoping to get
the experimental medicine to cure my disease".
Compared
to taking a pill and then feeling "different" couple hours
later. You'll think "Hmm.. I think I feel the medicine
kicking in, I really hope this helps to cure my disease".
At best, uncovering whether or not you're taking a
placebo
will introduce a mild placebo effect. At worst, you'll
stop
taking your medication because you believe it's a waste
of
time because you are in the control group. Either way,
it
really messes up the experiment.
To control for this, placebos should have plausible,
random
side effects consistent to those expected in the real
medication.
[link]
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Why have placebos at all ? Shouldn't there be enough data sets on the delivery systems, placebo effects and on doing nothing for the medical problem in question, to analyse the trial against. |
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[wjt] No, because you never know whether the placebo effect works better against some medical conditions than others, so you always need to control for it. For example a patient with a skin rash may have a very high level of confidence that their doctor will be able to give them some cream to clear it up, and so the placebo effect may be stronger than for another patient with advanced cancer where their confidence that a medical solution is available is low. |
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The only problem I foresee is that it's probably
difficult, regulations-wise, to administer a substance
which you know will have only adverse effects. |
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As an aside, what placebo is used in studies involving patients with diabetes? - sugar-free sugar pills? |
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But are you saying for instance, include a mild
diuretic to make people pee more? Something that
actually DOES induce some mild symptoms that can
be assumed to be indicative of a real drug? |
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// administer a substance which you know will have only adverse effects. // |
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// what placebo is used in studies involving patients with diabetes? // |
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Hydroxypropyl methylcellulose. |
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Thanks, but I've got my own. And, sadly, doctors are
no longer allowed to prescribe them. |
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//Alcohol ?//
I respectfully refer the questioner to my previous
answer. |
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//are you saying for instance, include a mild diuretic to
make people pee more? |
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That could be one of them. But ideally you would want
to have something random that changes from study to
study. That's because otherwise people learn what's a
placebo and what isn't. |
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"Hmm.... I'm going to pee more often, this must be the
placebo that I heard about on half bakery" |
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... the target has to be moving. |
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Cool.
"Why is my pee blue doc?" |
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hmm, I wonder if there has ever been psyche profile comparisons of the differences between those for whom a placebo actually works, and those it doesn't effect. |
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//The only problem I foresee is that it's probably difficult, regulations-wise, to administer a substance which you know will have only adverse effects.// |
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Of course the placebo has a positive effect (by definition), so that's okay.
Much harder to get clearance for the nocebo pill, though. |
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And actually, side-effects don't have to be bad. Tetracycline clears acne, niacin (taken for e.g. arthritis) lowers cholesterol levels etc. |
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...although, it's going to be an issue if the placebo is so successful that no study can find an improvement over it. |
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Are you watching the second series of Fargo that's on at the
moment? A storyline in that made me consider similar
thoughts. Merely knowing you're in a trial and only 50%
likely to be taking "proper" medicine must have a
physiological effect itself. Ideally everyone should believe
that they are taking the real thing, so a placebo that makes
you woozy is a great idea. That, or keep a randomly
selected portion of the population ignorant of these kinds
of practices, and do experiments just on them. |
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Placebos are one of those things that science worshipers
use to lie to their followers. |
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Take, for example, a set of studies to determine the
efficacy of a COX inhibitor in reducing discomfort (pain
and inflammation) in arthritic knees. If I've been tasked
with showing this product actually works, I'm going to run
it up against a corn-oil or corn-starch based placebo. Corn
is "well known" to be "neutral" in its effects, although it
actually does cause low-grade inflammation in a large
portion of recipients. |
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The COX inhibitor, although efficacious for pain, doesn't
help the inflammation; but, since the chosen "placebo"
causes some inflammation, the COX inhibitor appears to
work better. |
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On the other hand, I could run the same clinical study,
same design and doses and controls, except the "placebo"
is now olive oil or olive extract. It exhibits very little
inflammatory effect, so the COX inhibitor comes off not
looking nearly so good. So I sell that study to the
competitor. |
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The *really* cool part is there's no requirement to specify
what placebo was used in any given study. In my last
employer's library of around 22,000 studies on vitamins,
minerals and supplements, about 8 percent stated the
composition of controls. This number didn't change much
when the studies were grouped by to-show versus to-
disprove. |
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I've seen numbers that indicate pharma studies are pretty
much in the same boat as VMS studies in this matter, but I
don't have the personal experience with those. |
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What I was thinking about, was the need for any dual testing with anything other than the drug on trial. |
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The truth, as I see it, is getting a baseline in the recipient, anything you do after that, will show. Modern sensing and data acquisition should make this possible. |
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Though, a placebo with tweaked side effects would make a nice drug for data trial. |
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I think it should give you rainbow coloured shit. |
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// rainbow coloured shit// This means a 'white hole' T shirt is fully deserved. |
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[zen] The second series of Fargo is excellent. I thought the same thing about the placebo storyline. |
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