

Genetic tests can predict when placebos may be the best medicine - dnetesn
http://nautil.us/issue/16/nothingness/take-two-sugar-pills-and-call-me-in-the-morning?utm_source=tss&utm_medium=desktop&utm_campaign=linkfrom

======
tokenadult
Now why did I know that Ted Kaptchuk[1] would be the quoted "expert" (he is
not a medical doctor) in this 14 August 2014 story even before I read it?
Because he is always the guy pushing this line[2] in press releases[3] that
get picked up by the popular media.

Meanwhile, the medical researchers who look at the issue with proper study
designs and statistical controls know that placebos are essentially useless,
as they at most have influence just on self-reported subjective symptoms, not
on any sign that affects the progression of a disease or maintenance of good
health.[4] Ladies and gentlemen, you know you aren't going to seek "placebo
medicine" if you have cancer or congestive heart failure, and you know that no
compassionate parent would seek "placebo medicine" for minor children who have
a childhood disease. So why does this topic keep coming up over and over and
over here on Hacker News? I wonder if it's because programmers (the plurality
participants here) make their livings by the power of their minds, and Hacker
News participants skew younger than the general population. Please take the
time and effort to learn a bit more about the actual research base before
assuming that this story is anything other than the outcome of carefully
crafted press campaign. As you grow older, and your body is no longer young,
you may develop warranted doubt about the power of placebo treatments and
begin seeking more actually effective treatments. My hope for all of us is
that ongoing medical research will keep finding more safe and effective
treatments that actually do more than what placebos do (which is nothing,
really) so that we can all be part of a continuing trend toward longer and
healthier lifespans.[7]

Findings on placebo effects by researchers who have considered the issue
carefully include

"Despite the spin of the authors – these results put placebo medicine into
crystal clear perspective, and I think they are generalizable and consistent
with other placebo studies. For objective physiological outcomes, there is no
significant placebo effect. Placebos are no better than no treatment at
all."[5]

"We did not find that placebo interventions have important clinical effects in
general. However, in certain settings placebo interventions can influence
patient-reported outcomes, especially pain and nausea, though it is difficult
to distinguish patient-reported effects of placebo from biased reporting. The
effect on pain varied, even among trials with low risk of bias, from
negligible to clinically important. Variations in the effect of placebo were
partly explained by variations in how trials were conducted and how patients
were informed."[6]

[1] [http://harvardmagazine.com/2013/01/the-placebo-
phenomenon](http://harvardmagazine.com/2013/01/the-placebo-phenomenon)

[2] [http://www.sciencebasedmedicine.org/dummy-medicine-dummy-
doc...](http://www.sciencebasedmedicine.org/dummy-medicine-dummy-doctors-and-
a-dummy-degree-part-2-1-harvard-medical-school-and-the-curious-case-of-ted-
kaptchuk-omd-cont/)

[http://www.sciencebasedmedicine.org/dummy-medicine-dummy-
doc...](http://www.sciencebasedmedicine.org/dummy-medicine-dummy-doctors-and-
a-dummy-degree-part-2-2-harvard-medical-school-and-the-curious-case-of-ted-
kaptchuk-omd-cont-again/)

[http://www.sciencebasedmedicine.org/dummy-medicine-dummy-
doc...](http://www.sciencebasedmedicine.org/dummy-medicine-dummy-doctors-and-
a-dummy-degree-part-2-3-harvard-medical-school-and-the-curious-case-of-ted-
kaptchuk-omd/)

[3]
[http://www.phdcomics.com/comics/archive.php?comicid=1174](http://www.phdcomics.com/comics/archive.php?comicid=1174)

[4] [http://www.sciencebasedmedicine.org/michael-specter-on-
the-p...](http://www.sciencebasedmedicine.org/michael-specter-on-the-placebo-
effect/)

[http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-
plac...](http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-placebo-
effects-again/)

[5] [http://theness.com/neurologicablog/index.php/the-rise-and-
fa...](http://theness.com/neurologicablog/index.php/the-rise-and-fall-of-
placebo-medicine/)

[6]
[http://www.ncbi.nlm.nih.gov/pubmed/20091554](http://www.ncbi.nlm.nih.gov/pubmed/20091554)

[7]
[http://www.nature.com/scientificamerican/journal/v307/n3/box...](http://www.nature.com/scientificamerican/journal/v307/n3/box/scientificamerican0912-54_BX1.html)

------
westoncb
From the article:

"For patients, however, the notion of genetic testing for placebo
responsiveness might be less equivocal. Many people, notes Brown, “don’t
believe drugs are good for you. They believe in the power of self-healing.”
And for at least some of them, the reality of self-healing might literally be
a self-fulfilling prophecy."

Doesn't it seem more likely that when placebo's work it's in situations where
someone already had a sort of self-fulfilling prophecy which was making them
(psychologically) ill? Their proposition seems to be that patients may be sick
in the way it's ordinarily understood, but some are able to 'self-heal'
themselves by believing they are receiving a legitimate cure. Sounds
backwards.

My understanding is this sort of scenario is common and well documented: a
person believes there is something wrong with them, and subjectively it's the
same as that thing actually being wrong with them; then they are given some
treatment which they believe fixes what's wrong with them, and they feel
better.

------
lakeeffect
Considering that all double blind medical studies are compared against a
placebo, its really important to know who in the group the placebo would
effect.

~~~
DanBC
Aren't a lot of them using "treatment as usual" as the control group? It's
ethically difficult to withhold treatment from a group of people which is what
you'd be doin with the placaebo control group.

~~~
refurb
This is correct. If a disease if life threatening or potentially disabling AND
therapies already exist for it's treatment, you can't ethically put them on a
placebo for a trial.

However, there are many diseases that aren't that severe and diseases with no
current therapies, so a decent number of trials are still run with just
placebos as controls.

