Talk:Placebo/Archive 6

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Important

Rtc is very keen to use the word important. In context his preferred text is:

However, research has found placebo interventions result in no important effect on clinical outcomes in general, and only in certain settings (especially for pain and nausea) they can influence patient-reported outcomes, though it is difficult to distinguish true placebo effects from biased reporting by the patient.

The actual authors' conclusions from the first cited source:

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.

And the second:

We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.

I would say that Rtc's wording is a clear misrepresentation of the overall tone of these sources, noting that while Hróbjartsson and Gøtzsche do speak and write excellent English, their language is very formal, and they are not native speakers. Hence the somewhat clumsy "We did not find that placebo interventions have important clinical effects in general" rather than "We found that placebos have no clinically important effect in general", which is almost certainly what a native English speaker would have written.

I think the correct form of words, based on these sources would be:

Reviews find no evidence of significant effects on objective outcomes. There are possible small benefits on subjective outcomes (such as pain or nausea) but these are hard to distinguish from bias. There is no justification for the use of placebos outside of clinical trials.

That seems to me to be the closes to the sources. Both find no clinically relevant effect on objective measures, both play down the relevance of the nonspecific effects. What do others think? Guy (Help!) 21:09, 17 June 2018 (UTC)

I’m not sure that it’s to do with not having English as a first language; rather it’s simply the way scientists tend to write. One of the problems we have here is that there is a difference between writing for a peer-reviewed science journal and writing for a general encyclopaedia, so we have to translate “scientific” English aimed at a specialised audience into plain English aimed at the general public. And, of course, we also have to avoid close paraphrasing to avoid copyvio issues. This will always give people the opportunity to object that what we have written for the encyclopaedia isn’t exactly what the source says, ignoring the fact that we have to paraphrase. The paraphrase you suggest seems perfectly OK to me. Brunton (talk) 22:50, 17 June 2018 (UTC)

Yes and no. Their style is more formal than most English scientists, currently. Gøtzsche speaks excellent English but distinctly British-formal, whereas science writing now is dominated by American-informal. Guy (Help!) 22:54, 17 June 2018 (UTC)

The accusation that I am misrepresenting the overall tone of the paper because I use the exact words of the authors themselves for their core judgements is just one more completely ridiculous claim. Yes, I support the crazy idea that the authors acutally meant to say what they said and that they certainly don't need Wikipedia authors to invent a "correct" way to represent the alleged overall tone by changing their "clumsy" words into others because they "are not native speakers". The proposal "Reviews find no evidence of significant ...." suffers from a multitude of issues: 1) "signficant" is not "important" either and is a highly ambiguous term. it can mean statistical significance, or the entirely different clinical (or practical) significiance and even if one would qualify it it would still be easy to misunderstand. The authors chose the word "important" carefully and I still don't get why anyone could even consider changing it (except to distort the author's opinion to match the biased opinion of the users). 2) the version clearly tries to avoid the use of the word "effect" despite the fact that the authors use it (including, quote, "true placebo effect"). There's no need to avoid that word, since the authors clearly consider such effects a possibility. 3) "distinguish from bias" is very ambiguous, too; there are a lot of biases after all. 4) "There is no justification for the use of placebos outside of clinical trials" is not a statement for which this study is relevant. This is the personal opinion of the authors. And a very strange and obviously incorrect opinion indeed, given the fact that placebos are regularly used uncontroversally and regularly for purposes of increased compliance when medicine has to be taken only with breaks (eg. the pill which has one week of placebo pills in every blister) --rtc (talk) 22:39, 17 June 2018 (UTC)

There is a distinction here that is important to scientists. To a scientist, "we did not find an effect" is very different from "we found that there is no effect". A common way of putting this is that absence of evidence is not evidence of absence. Looie496 (talk) 00:11, 18 June 2018 (UTC)

It is hard to prove a negative, but the burden of proof lies with those seeking to prove an effect. The fact that a substantial and careful analysis found none, is telling. That said, my proposed wording says exactly that. Guy (Help!) 04:45, 18 June 2018 (UTC)

Really? Then, how do you manage to "find there is no effect", except by trying to find one and failing? ~~Both are just other wordings for measuring the effect and finding a value of zero, within error bars.~~ --Hob Gadling (talk) 13:03, 18 June 2018 (UTC)

In the vast majority of cases (at least in medicine, biology, and psychology), failing to find an effect means conducting a statistical test and getting a p value larger than 0.05. Looie496 (talk) 13:57, 18 June 2018 (UTC)

Which is the same, in principle, as "measuring the effect and finding a value of zero, within error bars", as I put it.

You did not answer my question. So, how do you manage to "find there is no effect"? --Hob Gadling (talk) 15:55, 18 June 2018 (UTC)

It isn't possible to legitimately "find that there is no effect". It is, as you say, possible to place a bound on a size of the effect with a specified confidence. This is common in physics but rarely done in biology or medicine. The typical approach in those fields is to conduct a statistical test (such as a t-test), get a P value larger than 0.05, and conclude that there is no difference. I make my living by editing medical manuscripts, and I assure you I'm telling the truth. Looie496 (talk) 16:27, 19 June 2018 (UTC)

If P>0.05 that is usually claimed to be evidence of effect, not the opposite, but in fact the test is only legitimate for plausible treatments - there are other factors such as experimental design, P-hacking and experimenter bias that can easily tease a P>0.05 result out of a null result. In subjects like homeopathy, for example, P>0.05 has been abused for decades despite the absence of any remotely plausible reason to expect it should work (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877414/, or of course Ioannidis). There's a growing literature on use of Bayesian methods to offset this and reduce the abuse of clinical trials to "prove" bullshit. Guy (Help!) 19:08, 19 June 2018 (UTC)

Um, how shall I say this? -- please note the distinction between P>0.05 and P<0.05. Looie496 (talk) 20:57, 19 June 2018 (UTC)

Yes, you made the trivial mistake of saying "get a P value larger than 0.05" instead of "get a P value smaller than 0.05", and JzG knew what you meant, not paying heed to the wording, and copied the wording, meaning the same thing you did. --Hob Gadling (talk) 04:35, 20 June 2018 (UTC)

For God's sake! I meant exactly what I wrote. JzG failed to notice the direction of the inequality and assumed I was saying the opposite of what I was actually saying. This is becoming farcical. Looie496 (talk) 12:48, 20 June 2018 (UTC)

Sorry, you are right. The trivial mistake was on JzG's part. --Hob Gadling (talk) 06:26, 21 June 2018 (UTC)

Actually the point I was trying to make was that the P<0.05 test (yes I did mistype the inequality) is used to find evidence of presence, not absence. It's rare for anyone to go in looking for a non-effect, and use that test to prove it. "We looked for X and did not find it" rather than "We looked for not-X and found it". But I was probably misreading the intent of the original comment anyway. "We found not-X to > 95% confidence" would be a highly unusual formulation, at least as far as my reading goes. Guy (Help!) 10:43, 25 June 2018 (UTC)

Ah. You sounded as if you thought both were legitimate but different results. Now it is clear that we all know that "we found that there is no effect" is not possible.

But "we found that there is no important effect" is the same as "we did not find an important effect". Another wording would be "we found that there is either no effect or an effect so tiny it does not matter". As I said above: "finding a value of zero, within error bars".

And that was what the discussion was actually about: Important effects. You dropped the word "important" and thus changed the subject. I did not notice and copied your wording. Just now I struck out a sentence of mine above that is not true. Here is the true version:

Really? Then, how do you manage to "find there is no important effect", except by trying to find one and failing? Both are just other wordings for measuring the effect and finding a value of zero, within error bars. --Hob Gadling (talk) 04:35, 20 June 2018 (UTC)

Looie496, I note you are ignoring the substantial question (the one where you are wrong) while responding to the trivial part (where you are right). --Hob Gadling (talk) 06:26, 21 June 2018 (UTC)

My original post here was a comment on a statement that appeared during the discussion, not on the post that started the section. I'll just note that the question of importance is completely distinct from the question of statistical significance, although they are often confused in the literature. Importance is quantified by measures of effect size. In medicine it is often measured using constructs such as the odds ratio or number needed to treat. Looie496 (talk) 13:10, 21 June 2018 (UTC)

"Completely distinct" - yes. Nobody said any different. --Hob Gadling (talk) 05:51, 22 June 2018 (UTC)

We should avoid significant per MEDMOS. We should avoid "important" to avoid WP:CLOP (and the fan of the word admitted[1] they did not understand what it meant anyway - so we should avoid it because it's not clear to some readers). Important here (in the context of clinical effect) means of no import, or not worth bothering with. Good synonyms would be "meaningful", "worthwhile" or "useful" or even "therapeutically useful" in this context I think. (So just WP:ASSERT "Placebos are not a useful means of therapy" to keep it plain and to paraphrase it, as we should). Alexbrn (talk) 04:52, 18 June 2018 (UTC)

OK, please add your preferred version. Guy (Help!) 05:27, 18 June 2018 (UTC)

I'm thinking now about how due any of this history is in the lede, especially since we have a Placebo in history article (itself not problem-free). Perhaps once the body is in better shape it should be more apparent what the structure of the lede should be? Alexbrn (talk) 07:47, 18 June 2018 (UTC)

Not sure. For me, the important thing is to establish the facts: placebo is an inert treatment, it is normally encountered in the context of trials, there was a historical belief that the "placebo effect" was a thing, that is no longer viewed as true. Guy (Help!) 08:14, 18 June 2018 (UTC)

Yes, from the sources those seem the salient points (together with some big ethical considerations). The position that actual disease healing happens seems to be a fringe position and is not supported by RS, so that must be clear. Alexbrn (talk) 08:16, 18 June 2018 (UTC)

"and the fan of the word admitted[4] they did not understand what it meant anyway - so we should avoid it because it's not clear to some readers" -- So what you are saying is that the objectively ambigous word consciously and carefully chosen by the authors as their judgement should not be used and that this is justification for you to instead write your own WP:OR opinion of what the "real" judgement should be into the article, showing a clear bias towards your personal views, which are not supported by the source at all, that placebo effects are completely a myth in every respect. You claim "It is hard to prove a negative, but the burden of proof lies with those seeking to prove an effect" but no no no, that's not true. The source says the authors find it hard to distinguish a possible true effect (which they didn't rule out) from reporting error. Then it should be said precisely like that and not decided based on philosophical arguments about "burden of proof" to say something different -- which would be ultimately presupposing positivist philosophy (with its core tenet of demanding positive proof for claims to be valid), which is exactly what I criticized, and thus very obviously violates NPOV. --rtc (talk) 07:45, 18 June 2018 (UTC)

You just came off a block for edit warring and your first action was to revert again, despite the obvious lack of consensus here for your change. That is.... unwise. Guy (Help!) 22:41, 24 June 2018 (UTC)

You better be silent about wisdom, for your are the more severe sinner among us two, in fact you are responsible for my block because you violated 3RR yourself. You simply have the more powerful cabal behind your back, which doesn't make your ideological edits in any way more valid, as they are clearly against the rules. --rtc (talk) 22:55, 24 June 2018 (UTC)

Ideological? What ideology? The facts are pretty clear: the study that kicked off the "placebo effect" as a thing, was bullshit, and recent studies show the "placebo effect" to be indistinguishable from the collection of artifacts it is assumed to be in placebo controlled trials. Guy (Help!) 23:44, 24 June 2018 (UTC)

The ideology, nicely outlined here ("piece of advice") that inclines you to distort "not important" into "not useful" and the like. --rtc (talk) 01:03, 25 June 2018 (UTC)

Ah, so the ideology of providing concise lay summaries instead of arcane technical terms of art that will be exploited by charlatans. OK, I admit to that. Guy (Help!) 05:47, 25 June 2018 (UTC)

You're like a catholic church priest, as if it were your job to tell the layman audience how the holy scripture of MEDRS metastudies has to be understood. Yes, fighting charlatans is what you are really here for, not actually for writing an encylopedia. While I have some sympathy for this goal I cannot tolerate it that Wikipedia policies are violated while pursueing it, in particular putting your own WP:OR judgements (or "concise lay summaries" as you call them) into the article. --rtc (talk) 07:26, 25 June 2018 (UTC)

Wikipedia's job is precisely to summarise the best available evidence in lay language. The fact that you don't know what it means to find no clinically important effect is your problem, not mine. You could probably do with reading Ernst & Singh or Goldacre. And incidentally Goldacre has repeatedly peddled the "placebo effect" myth, but he is sound on the business of what a study outcome consistent with placebo means: the treatment doesn't work. Guy (Help!) 10:48, 25 June 2018 (UTC)

Wikipedia should be understandable to the layman, that's correct, but that's not a justification to change judgements of MEDRS sources. It is well possible to write in an understandable way without changing core judgements. Your argument is pretextual. You know very well in fact that you changed the judgement, not summarized it in layman's terms. --rtc (talk) 13:38, 25 June 2018 (UTC)

Just as well were not doing that, then. The fact tat you don't understand the meaning of clinical importance is not a reason fro those of us who do, to pretend we don't either. Guy (Help!) 20:11, 25 June 2018 (UTC)

You don't need to pretend anything about your personal understanding, you just need to keep it out of the article. --rtc (talk) 20:41, 25 June 2018 (UTC)

In favour of a technical term of art misrepresented as supporting the magical power of the placebo? How about "no". Guy (Help!) 19:27, 1 July 2018 (UTC)

WP:STICK --rtc (talk) 07:15, 3 July 2018 (UTC)

I find your lack of self-awareness disturbing. Guy (Help!) 11:43, 3 July 2018 (UTC)

There Is No Cabal (TINC). We discussed this at the last cabal meeting, and everyone agreed that there is no cabal. An announcement was made in Cabalist: The Official Newsletter of The Cabal making it clear that there is no cabal. The words "There Is No Cabal" are in ten-foot glowing letters on the side of the International Cabal Headquarters, and an announcement that there is no cabal is shown at the start of every program on the Cabal Network. If that doesn't convince people that there is no cabal, I don't know what will. --Guy Macon (talk) 03:38, 25 June 2018 (UTC)

Wait..what? the Placebo effect doesn't exist?^{[Citation Needed]} --Guy Macon (talk) 18:53, 18 June 2018 (UTC)

I don't think anybody's saying that (other than invoking that position as a straw man). Alexbrn (talk) 18:57, 18 June 2018 (UTC)

It certainly does. It's a powerful way of making people say they feel better. Evidence for anything beyond that is lacking, mind. Guy (Help!) 19:14, 18 June 2018 (UTC)

The claim that nobody is saying that is demonstrably untrue.[2][3][4] But I had never heard anyone question it until I read the above. Then I did a bit of research and found the above citations. What I didn't find was anything MEDRS-compliant, but that's not unusual; as an engineer I have a really hard time understanding most MEDRS sources or knowing what to search for. --Guy Macon (talk) 20:09, 18 June 2018 (UTC)

O you mean in external sources. Yes - some more skeptical sources take the view it doesn't exist. The current "central" consensus is (I take it) more that it might not exist, but if it does, it isn't important other than as a phenomenon to be accounted for in clinical trials. Alexbrn (talk) 20:54, 18 June 2018 (UTC)

Yes, Mike Hall says it - a lot - but nobody here is. Guy (Help!) 22:00, 18 June 2018 (UTC)

Like most things related to medicine, I stay away from editing articles or suggesting changes (I have this mental picture of a non-engineer M.D. trying to "fix" our Cockcroft–Walton generator or Hall effect articles...) but I am really good at asking possibly-stupid-possibly-insightful questions. --Guy Macon (talk) 22:11, 18 June 2018 (UTC)

Types of Placebos

From the very first sentence, this current definition of a placebo is very wrong on several points.

"A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient" - placebos are seldom, if ever, prescribed or administered to deceive the recipient. Even in clinical studies, the recipient must be advised that some patient will receive a placebo. - placebos are often medically effective. Placebo effects are real improvements in the condition of the patient. Placebos are 'believed to be medically ineffectual', but in reality, they can be very effective. - placebos are treatments for an illness, a specific case of an illness. They are not treatments for a 'disease', a class of illnesses. The patient presents an illness. The physician diagnoses a disease, but treats the illness. This is an important, non-trivial distinction.

How to understand placebos 101

==============================

There are two fundamental types of placebos, although this is seldom explicitly stated in any literature. The two types of placebos are prescribed with two different intentions, neither of which is 'to deceive the recipient'.

Placebos (real placebos) are medications or treatments prescribed by a physician with the intent to help the patient, when the physician does not know how to help the patient. The physician might believe that the prescription has no 'physical benefit' to the illness - but prescribes because he does believe it will benefit the patient in some small way. The physician's beliefs might be right, or wrong.

Note: The benefits resulting AFTER the placebo prescription has real causes. However, in many cases assigning them to the placebo causes much confusion and in many cases avoids actual investigation Calling them "placebo effect" is navel gazing, when the challenge is to understand what is going on outside of the medical system, outside of the medicine prescribed.

Clinical Placebos (fake placebos) are false medicines or treatments. They are not prescribed by a physician and there is no intention to provide any benefit to the patient. There is no intent to deceive the patient. Clinical placebos are used in scientific experiments to provide a statistical measure of the so called 'placebo effect'.

Note: The benefits resulting AFTER a clinical placebo is administered also have real causes. Ignoring these causes, naming them "placebo effects" assigning them to 'the mind of the patient' is simplistic nonsense, avoiding true investigation of the facts.

There are many fundamental difference between a real placebo and a clinical placebo. Unfortunately most references do not notice, much less attend to this distinction resulting in total nonsense and confusion. It's as if we used the same name for bears and teddy bears. Here's a comparative list of some differences:

Placebos - prescribed by a doctor - doctor doesn't know what is best - doctor intends to improve the health of the patient - prescribed to sooth the patient - can be active or passive. Active are more effective - works, statistically, but we don't understand (and seldom study) why or how - patient believes they are getting a medicine (in normal cases)

Clinical Placebos - administered by a scientist physician - researcher believes that the placebo is useless - researcher has no intention to improve the health of patients who receive a placebo - administered to measure statistically, the effects of medicine, by subtraction of 'clinical placebo effect'. - often specifically designed to simulate the activity of the drug or treatment being tested - when the placebo works, the research has failed - patient hopes they are NOT getting the placebo

When we assume that clinical placebos are the same as real placebos, we create nonsense because the assumption is nonsensical.

Because of this fundamental difference between real placebos and clinical placebos, it is very difficult to measure the effects of real placebos in a clinical study - and as far as I am aware this has never been accomplished. To create the real life placebo, it would require the doctor to be allowed to decide when to prescribe a placebo, and to choose the placebo being prescribed.

Thus, we can also see that 'real placebo effects' are quite different from 'clinical placebo effects', but that's another story....

Until this reality about, and distinction between a real placebo and clinical placebo is recognized, we will continue to publish nonsense about placebos, because we simply don't understand.

Open-label placebos

There seem to be enough sources on open-label placebos to establish notability for an independent article; could we include some mention of them in this main article, please? HLHJ (talk) 16:56, 19 August 2018 (UTC)

RfC on

Clear consensus that this particular RfC is malformed. (A title would have been nice, for one thing!) There was a strong argument that we should put more in about paper(s) on the placebo effect, but since the lead is to summarize the body, we shouldn't be including information in the lead until and unless we go into it more detail in the body; but just "malformed" was even stronger. --GRuban (talk) 14:28, 21 August 2018 (UTC)

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.

Should the fourth paragraph in the lede of Placebo:--

Option 1-As written in the current version, quote from the paper's abstract that:--
- but a 1997 review of the study found "no evidence [...] of any placebo effect in any of the studies cited".

or

Option 2-As written in this version, quote from the main text and the conclusion of the full-text which says
- but a 1997 review of the study found a wide range of "conceptual and methodological mistakes" in the study as well as "a total of 800 articles on placebo". It noted that the reported outcomes could be "fully ... explained without presuming any therapeutic placebo effect" and concluded that "the existence of therapeutic effects of placebo administration seems questionable".

And in general:-
- Should the article present it as the settled scientific consensus that the placebo effect is more or less a myth?

Initiated by --rtc (talk) 22:08, 16 June 2018 (UTC)Heavily refactored by ∯WBG^converse.

!voting

This rfc is malformed and not neutrally stated. That said, of course it should reference Beecher, as the father of the placebo myth, along with Kienle and Kiene's refutation, which is unambiguous, and yes it should reference the fact that the scientific consensus is that the "placebo effect" is in fact a combination of a number of biases and confounders such as regression to the mean, natural course of disease, expectation effects and so on, and also that objective measurements repeatably fail to show any clinically significant effect size. Asthma studies, for example, show great improvement in patient-reported symptoms but not objective measurements. One of Kaptchuk's papers claiming marvellous effects of sham acupuncture on asthma has, as figure 3, a set of bar charts that unambiguously show identical zero effect on maximum forced respiratory volume from the two placebos and no treatment, versus a substantial effect from albuterol. Guy (Help!) 22:24, 16 June 2018 (UTC)
- Feel free rephrase the rfc such as to make it more compliant with your views on neutrality and well-formedness. --rtc (talk) 22:27, 16 June 2018 (UTC)

Why would I? I don't see anything needing changing. Guy (Help!) 00:10, 17 June 2018 (UTC)

Well you said it was "malformed and not neutrally stated" and to me that seemed to be implying it could be improved. --rtc (talk) 00:12, 17 June 2018 (UTC)

It could best be improved by not existing. Guy (Help!) 07:22, 17 June 2018 (UTC)

Right, that's what you wanted to say. I got that. And me being blocked or topic banned, because of troublemaking and being a timesink. --rtc (talk) 10:12, 17 June 2018 (UTC)

Per revised question, option 1 is straight from the abstract so preferable to option 2, which quote mines the report to give wiggle room to something the 1997 paper clearly rejects. Guy (Help!) 07:24, 17 June 2018 (UTC)

As shown above ("simply ignore the statement") it is in fact option 1 that quote mines to make a biased statement. Even the abstract clearly contradicts that cherry-picked statement directly by qualifying it by mentioning the important fact that there actually, uncontroversially, were "reported improvements in patients in these trials", though according to the authors of the study not ones that they most likely attributed to placebo effects. --rtc (talk) 10:15, 17 June 2018 (UTC)

Malformed RfC (especially asking for a vague "in general" ruling). WP:LEDEs should summarize the body, so cramming in a load of quotations from two papers, of 1955 and 1997, which is not also discussed in the body is quite wrong. It is also wrong to boil a Cochrane review down to a statement that it "concluded" just one thing, when that paper's conclusions are in fact extensive and more far reaching that the proposed text suggests. I propose getting this article's body in shape then having the lede follow it, rather than using an RfC to try and have one flawed lede "win" over another flawed lede. In general, this articles sourcing also needs to be brought into line with WP:MEDRS and fringey claims of placebo's power toned down to match current accepted reality.Alexbrn (talk) 04:21, 17 June 2018 (UTC)

Agree with the diagnosis of Malformed RfC. Option 2 was better than option 1, but good luck getting a really suitable treatment out of this RFC. JonRichfield (talk) 08:02, 6 July 2018 (UTC)

Delete as malformed. --Guy Macon (talk) 11:27, 6 July 2018 (UTC)

Discussion

I'm with Alexbrn. Guy (Help!) 07:20, 17 June 2018 (UTC)
I can only condemn the rush to create facts to present placebos as one more fringe science thing like homeopathy, before this RfC has actually seen some comments. The article is more and more getting into a state where it is completely and totally hopelessly biased. Everything that even slightly contradicts the opinion that the placebo effect is fringe science is systematically being eliminated with completely outrageous claims (just take an example this edit which in its comment claims "A flurry of criticism from Wayne Jonas, tireless defender of hoemopathy, the best-known placebo" while in fact the cited paper merely lists the dozens or so references that give dissenting opinions and criticize the study, mostly published in the next volume of the exact same journal that originally published the study). --rtc (talk) 09:35, 17 June 2018 (UTC)
- Something I'm seeing in the sources is that just invoking "the placebo effect" as a kind of monolith is fringey, as there is no such single phenomenon - only localized placebo effects in some circumstances. Getting the endemic fringeiness out of this article is necessary work. The means is to use decent WP:MEDRS and cut out poorly-sourced material. Alexbrn (talk) 09:41, 17 June 2018 (UTC)
  - Fair enough, but the way the article was changed goes way beyond "there is no such single phenomenon". It goes into the direction of claiming that there cannot possibly be placebo effects, anywhere. And it is systematically downplaying the controversy by presenting the ethically biased claims of one single study as the accepted scientific consensus while not mentioning at all the many dissenting opinions that criticize that study. --rtc (talk) 09:50, 17 June 2018 (UTC)
    - Incorrect. We explicitly define what the response and and effect are. In clinical trials these are universally recognized phenomena. What is problematic is all kinds of of non-WP:MEDRS being used to imply that placebos are some kind of effective treatment. There is also a deafening silence about how CAM advocates have appropriated placebos as a kind of marketing ploy. All this needs to be fixed. Alexbrn (talk) 09:55, 17 June 2018 (UTC)
      - I agree. Novella makes this case well. Guy (Help!) 10:05, 17 June 2018 (UTC)
        Look at the intro. It says "no worthwhile effect on clinical outcomes in general". This is wrong: The study says no important effect (whatever that highly subjective judgement means). It doesn't contain the word "worthwhile". That is one significant example of how the sources are twisted to make them fit the bias. Also, it is not mentioned that in special cases significant effects could not be ruled out. It is not mentioned either that the study has been criticized a lot and is controversial. It is further not mentioned that the study partly relies on ethics to make its point. --rtc (talk) 10:08, 17 June 2018 (UTC)
        "Worthwhile" is a fine paraphrase of "important". We are supposed to use our own words. Alexbrn (talk) 10:28, 17 June 2018 (UTC)
        It is certainly not fine to extend a statement more about quantity than practical value into one that is more about practical value than quantity. Those are subtle points and such a central highly nuanced judgement should never be paraphrase, but given as is. --rtc (talk) 10:32, 17 June 2018 (UTC)
        Novella is a research scientist, a clinical neurologist. He has written and spoken extensively on what "clinically important" and "clinically relevant" mean, so we don't need to guess. He presents them as scientific terms of art that translate, in lay language, to "worthwhile". An effect that is not clinically relevant means the treatment is not worthwhile. Actually he goes further: if it has no clinically important effect, it doesn't work. We're fine with ditching real medical treatments on this basis, but purveyors of pseudomedicine have more of an issue with it. Guy (Help!) 10:40, 17 June 2018 (UTC)
        So you mean you can use the opinion of one research scientist as a justification for biasing the article and twisting the judgements of the papers cited? --rtc (talk) 10:43, 17 June 2018 (UTC)
        It's not twisting. Since you admitted above you didn't understand what the word meant I'm not sure how you can now argue about its meaning? Alexbrn (talk) 10:54, 17 June 2018 (UTC)
        I don't see any point in discussing this. In doubt, the wording of the source should be used, not wording based on linguistic theories of evidence-based research scientist bloggers. --rtc (talk) 10:59, 17 June 2018 (UTC)
        Do you actually understand the meaning of the term "clinically important"? As in "We did not find that placebo interventions have important clinical effects in general"? It means that the treatment has no demonstrable effect on clinical outcomes. It is clinically worthless - you might as well try tea and sympathy. Guy (Help!) 12:22, 17 June 2018 (UTC)
        What I understand is that "important" is a different word from "worthwhile" and has a lot of different nuances, and I understand as well that the word "important" is in the source while the word "worthwhile" is not. This discussion is not worthwhile. The core judgement of the source should be given as is, not in the way a philosophically biased wikipedia editor would have made it. --rtc (talk) 12:44, 17 June 2018 (UTC)
    - Is that how you perceive it? Odd, since nobody has actually said that. The question is not whether a "placebo effect" could exist, but whether there is good evidence that it does exist, as a concept separate from confounders in clinical trials. The interesting part for me is the timeline. Beecher, from the heyday of eminence-based medicine, established a mythos, and as it began to be challenged Kienle & Kiene went back and looked at his data and found that he had invented the entire thing from whole cloth, that there was no evidence of any "placebo effect" - and now we are into a situation with many parallels in the world of quackademic medicine where True Believers are churning out crappy studies with n=not many and the wider scientific population is largely ignoring them because they mainly view the scientific question as answered: observed effects in placebo arms of trials are due to biases and confounders and are visible only in subjective endpoints, objective measures fail to support the hypothesis of a placebo effect. I personally find that very interesting as a story of how science works, and how pseudoscience works, and the comparisons and differences between them. When you get studies saying that because there is no difference between sham acupuncture and real acupuncture, thus acupuncture uniquely harnesses the placebo effect and this proves the power of acupuncture, you know you have cranks at work, and comparing their reasoning with people like Gøtzsche, whose focus is not on "prove hypothesis X" but ""test hypothesis X", is fascinating. Guy (Help!) 10:02, 17 June 2018 (UTC)
      - "The question is not whether a "placebo effect" could exist, but whether there is good evidence that it does exist" Actually neither the one nor the other. The question is whether and which placebo treatments do have effects (above no treatment). Your statement presupposes the philosophical framework of "evidence-based medicine", which is really logical positivism applied to medicine in disguise and thus a fundamentally highly biased opinion. --rtc (talk) 10:08, 17 June 2018 (UTC)
        There is no doubt in RS that such effects exist (as they can be measured), but they are effects of measurement resulting from adjustments to subjective assessment ("I think I feel better because of taking the pill"). There is no disease "healing" effect. Alexbrn (talk) 10:27, 17 June 2018 (UTC)
        That is your opinion. The study does not contain a final judgement on whether those effects are a reporting error or real. A neutral intro should thus state that those effects are observed and that there are two significant positions on how they can be explained (1. reporting error, 2. real effect). --rtc (talk) 10:29, 17 June 2018 (UTC)
        Two positions? No, because that would be a textbook WP:PROFRINGE trumpeting of the WP:GEVAL fallacy. Alexbrn (talk) 10:33, 17 June 2018 (UTC)
        Right, that's always the excuse to violate NPOV. The study says both are possibilities and they thus have to be presented as such, and it is not okay based on philosophical presuppositions of the wikipedia users to reject the one as fringe and the other as scientific and thus not mention the allegedly fringe one. --rtc (talk) 10:39, 17 June 2018 (UTC)
        
        Have you ever heard of the fallacy of reversed burden of proof? That's what you're doing here. A "placebo effect" is an extraordinary claim. Many mundane explanations exist and are covered in the literature. It is now up to those who advocate a separate and distinct "placebo effect" to prove their case. Which they are trying to do with tiny studies using self-reported subjective endpoints. For some reason they seem surprised that this is not working. Guy (Help!) 10:36, 17 June 2018 (UTC)
        The fact is that the huge 2010 study says in some areas placebo effects cannot be ruled out. --rtc (talk) 10:39, 17 June 2018 (UTC)
        To be precise, they say placebos have no effect except for patient-reported outcomes. The idea that the "effect" is actually a "healing" effect (e.g. shrinking tumours) is on the extreme fringe. Alexbrn (talk) 10:51, 17 June 2018 (UTC)
        Wrong, they conclude that "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" They're explicitly admitting that both are possibilities, though with the reservation that "The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important" which suggests their personal opinion is that those are biased reporting rather than the other possibility. --rtc (talk) 10:57, 17 June 2018 (UTC)
        Ah yes, the old "you haven't definitively proved a negative" ploy. Guy (Help!) 11:00, 17 June 2018 (UTC)
        Rather the old "you are twisting the source until it fits your presupposition" diagnosis. --rtc (talk)
        
        @Rtc: Again, I don't think their words mean what you think they mean. I agree we should reflect the Cochrane review's claim that placebo is either an influence on patient-reported outcomes, or maybe reporting bias. The paper nowhere states or implies anything about a real "healing" effect. Alexbrn (talk) 11:00, 17 June 2018 (UTC)
        You're again twisting the source. it says the placebo can "influence patient-reported outcomes". That is the fact. The possibilities are now either those are 1) "patient-reported effects" (my emphasis) or 2) merely "biased reporting". --rtc (talk) 11:04, 17 June 2018 (UTC)
        The source says: 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. So any assertion of clinically meaningful "placebo effect" is clearly into "god of the gaps" territory, based on this review. You do seem to have a tendency to misidentify direct quotations from sources as misrepresentation, and your own creative interpretation of selected text as the opposite. That's a bit of an issue. Guy (Help!) 11:06, 17 June 2018 (UTC)
        Sorry, but nowhere does the study talk about "god of the gaps". You're simply making this up. What I say is not "creative interpretation", but direct quotation, which is completely identical to what you quote (and then interpret creatively) --rtc (talk) 11:09, 17 June 2018 (UTC)
        I think you're having a comprehension problem here. Of course giving people with headaches pills (maybe labelled "pain-away") can "influence patient-reported outcomes". That is the essence of the placebo effect. Cochrane says so. The only person saying that in the process disease was treated, appears to be you. Alexbrn (talk) 11:16, 17 June 2018 (UTC)
        Certainly I am mentally retarded in understanding texts compared to your PhD in English. Yet, my basic understanding is that Cochrane notes the possibility that those observations may explained by "patient-reported effects" (direct quotation, my emphasis) as an alternative to mere reporting error. --rtc (talk) 11:30, 17 June 2018 (UTC)
        I don't see your point. Of course they are patient reported effects ("The effect of taking the pill was my headache got a bit better"). What else could they be? I repeat the only person talking about actual healing is you - and it's not a view supported in any decent source so far as I can see. Alexbrn (talk) 11:33, 17 June 2018 (UTC)
        From basic logic, either there is an actual effect or not. If the patient reports an effect, but it is actually not there, then this is, by definition, a reporting error. This is the second alternative mentioned by Cochrane. Now Cochrane's first alternative is "patient-reported effects" (my emphasis). If we make an assumption of sanity (that Cochrane doesn't intend to give two identical possibilities as hard-to-distinguish alternatives), we have to conclude that he means real effects correctly reported by the patient as such. --rtc (talk) 11:37, 17 June 2018 (UTC)
        This is just wrong. "Biased reporting" refers to things like falsified/skewing results from the researchers. For a trial where the patient is asked "On a scale of 1 to 10, how bad is your pain?" the response cannot suffer from a disparity with reality because the response is in itself entirely subjective and ipso facto correct. Alexbrn (talk) 11:45, 17 June 2018 (UTC)
        And that means that it is based not just on the patient's actual pain but also on the patient's expectation of what the pain should be after the treatment and the patient's expectation of what the doctor wants to hear. --Hob Gadling (talk) 11:59, 17 June 2018 (UTC)
        
        Right. Placebo is plausibly effective for diseases of the feels, it's objective effects that are in short supply. Guy (Help!) 12:05, 17 June 2018 (UTC)
        So what you are trying to say is that diseases of the feels are illusions, as with all this nonsense about consciousness, not objective states of affairs but subjective chimera that objectively are nothing but the brain causing the patient reporting a metaphysical and thus nonsensical thing -- a feeling -- that does not actually exist. --rtc (talk) 13:16, 17 June 2018 (UTC)
        
        "refers to things like falsified/skewing results from the researchers" No. It refers to the patient reporting in a biased way. It's "patient-reported", not researcher reported things that passage is talking about. "the response cannot suffer from a disparity with reality" That's blatant positivist nonsense. The patient has a feeling of pain. If the patient has no pain but says it's 10 that answer clearly suffers from a disparity with reality. If you kick the patient harshly and he reports 0 this answer apparently most likely also suffers from a disparity with reality. The response is by no means ipso facto correct. --rtc (talk) 12:39, 17 June 2018 (UTC)
        ~~You need to read, and understand, the paper. WP:CIR. There is really nothing more to say.~~ Alexbrn (talk) 12:45, 17 June 2018 (UTC); amended 13:39, 17 June 2018 (UTC)
        Now we're starting again with arguments from authority. You are competent with your PhD in English, I am not, so you must be right, despite objectively you suffer a huge disparity with the reality of the sources. What comes next now? Closing this discussion? Blocking or topic banning me because of troublemaking and being a timesink, and for sealioning? --rtc (talk) 12:49, 17 June 2018 (UTC)

Actually, I beg your pardon as the paper does gloss this particular mention of bias as "response bias" ("as polite patients may tend to report what they think socially most acceptable"). However, this does not bear on the question of "actual healing" as this merely means that the responses may be biased to over-state the effect the subject feels: e.g. they may say their headache feels better even when they don't really think it does! Alexbrn (talk) 13:39, 17 June 2018 (UTC)

Sigh. Yes. The authors say they don't know. It might be response bias. It might be, quote, "a true effect". The authors claim it's difficult to distinguish. I am not so sure. Brain scanners have been used to study the use of placebo for pain management, to distinguish real pain from reported one, if I remember correctly. The original version of the study was harshly criticized by a number of opposing letters in the next volume of the journal. This discussion is really too tedious to me. Have a nice day. --rtc (talk) 13:46, 17 June 2018 (UTC)

LOL - "Honest Doc, it doesn't hurt". "No, you lie! the machine says it must be hurting!". At this point we're into the astrology-like world of reading brain scans. But crucially, if we're to include material in the article we need WP:MEDRS to support it. Alexbrn (talk) 13:57, 17 June 2018 (UTC)

Just because computers have been used to compute horoscopes does not make computers artifacts astrology. [5] has some information ("Expectations and anticipation of pain are also known to be major contributors to placebo analgesia...") And I stand by the fact that if this one 2010 study is being given such an extreme weight, then so should be the criticism (which was raised with respect to the older journal version but nevertheless has not become any less relevant). --rtc (talk) 14:42, 17 June 2018 (UTC)

It's a fundamental tenet of WP:MEDRS that weak sources (like letters) are not used to undercut strong sources (like a multiply-updated Cochrane systematic review). Alexbrn (talk) 15:17, 17 June 2018 (UTC)

It has indeed become fashionable to believe that "strong" scientific authority must be given undue weight and "weak" criticism must be kept out of the articles. I disagree with that distortion of the NPOV policy. --rtc (talk) 15:36, 17 June 2018 (UTC)

This is not the right venue to discuss changing WP:MEDRS. If you want to argue that letters may be used to undercut systematic reviews, argue that at Wikipedia talk:Identifying reliable sources (medicine). Alexbrn (talk) 15:41, 17 June 2018 (UTC)

Your use of the word "undercut" clearly shows your ideological bias. You know as well as me that the tight-knit gang of evidence-based enthusiasts defends this distortion of the NPOV to its teeth and it is currently basically impossible to change it. The gang is too strong and too established and has shooed out every critic so there's no chance whatsoever to undercut its strong and powerful but illegitimate authority. --rtc (talk) 15:48, 17 June 2018 (UTC)

That's consensus you're dissing, whose mighty tide keeps our content in good shape - and our medical content is probably Wikipedia's most highly-regarded. With more work this article can become part of that quality corpus. I think this conversation is now at an end. Alexbrn (talk) 15:58, 17 June 2018 (UTC)

consensus is just an euphemism for group think. Consensus is a bad thing. And the content is in very bad shape, too; it is clearly biased towards positivist ideology and this article is just about to become the next in a long series of articles mutilated by the gang such as to be in line with its naive, defective philosophy, which is "So confident. So clueless". What is still lacking is the application of the gang's tenet that "The pseudoscientific view should be clearly described as such", so I guess the statement "the placebo effect is pseuodscience" quickly needs to be added. --rtc (talk) 16:08, 17 June 2018 (UTC)

Clearly you are opposed to the aims of The Project. As for WP:PSCI it seems you get it! But no, placebos are not pseudoscience -- but there are some invocations of them in the altmed universe which are. We shall get there in time once the more fundamental aspects of this topic are sorted, I should think. aybe start thinking about sourcing starting here. Alexbrn (talk) 16:22, 17 June 2018 (UTC)

Clearly I am not opposed to the aims of the project, which is to build a neutral, freely licensed encyclopedia, not to build an instrument of propaganda for positivist philosophy. --rtc (talk) 16:24, 17 June 2018 (UTC)

You use the word positivism (aka falsificationism or empiric-analytic model) as a way of attacking science. An article about a scientific topic should be science based. Tgeorgescu (talk) 16:37, 17 June 2018 (UTC)

No I am attacking positivism to attack positivism. I know positivists believe their philosophy actually is identical to science, just a different word for it, and keep spreading the legend that it is identical to falsificationism. An article about a scientific topic should be as neutral as any other and should not give the alleged scientific point of view any undue weight. --rtc (talk) 16:47, 17 June 2018 (UTC)

Actually you are attacking editors, not positivism. You apply your idiosyncratic diagnosis of "positivism" in order to frame the discussion as one of evil positivists versus you as the force of righteousness. That's not working well for you right now. Guy (Help!) 20:57, 17 June 2018 (UTC)

Is the diagnosis wrong? I was responding to "Clearly you are opposed to the aims of The Project". Is that not attacking editors? --rtc (talk) 19:07, 24 June 2018 (UTC)

-Can the trio of you (Rtc, JzG and Alexbrn) please refrain from any further posting at this section? You're clearly talking past each-other and the sole output is nothing but a meaningless banter.Till date, outside-participation in the RFC is nil.∯WBG^converse 18:58, 25 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.

The placebo effect is real and relevant

Hi everyone. I relay like this article, it is very well written and documented. But I think it can be even improved. The lead paragraph gives the impression than in modern science the general consensus is that there is no such thing as "placebo effect" or that its effect is irrelevant. Such a description is completeley false. Many contemporary studies (if not most) do defend that the placebo effect does have substantial effects on clinical outcomes (at least for some diseases). Remember, the point is not to discuss here whether there is or not a placebo effect, but to reflect ALL the modern views ont he issue. And there are many papers on genetics, neuroscience, medicine or psychology defending the reality and relevance of the placebo effect. The placebo effect can be difficult to understand in medicine (even though it is also present in medicine) but in psychology is obviously a relevant variable. For example, Blease (2015) defends that psychoanalysis is non-scientific and that patients do not improve because of the psychoanalytic therapy per se: it is the placebo effect the responsible of the patients' improvement. Again, the point is not whether these authors and publications are or not right. The point is to represent ALL the modern views: those who dismiss the relevance of the placebo effect, and those (probably the majority) who defend the relevance of the place effect. It would be a really biased article if it were to avoid mentioning all the current research which defends the importance and reality of the placebo effect.

The article's lead paragraph cites a 2010 meta-analysis of (reportedly) all medical conditions, which showed no substancial placebo effect. However, in science no study is absolutely definitive or conclusive. The meta-analysis was made in 2010 and all the sources I give are from 2014-2018, so of course that relatively "old" meta-analysis did not analyze the studies that I include in the references. Also, why would a single study be more reliable than ALL the other studies made on the topic?

In addition, in the lead paragraph of the article it is said that "Placebos have no impact on disease itself; at most they affect peoples' assessment of their own condition." and it is cited a webpage of the American Cancer Society. Such a claim is problematic for three reasons: 1) it is too general (they are obviously talking about cancer, not psychological diseases like depression or social anxiety dissorder, so that source can't exclude avery kind of disease), 2) it is a webpage, not an academic article or book and 3) it is disputed, since many academic articles say that placebos do affect some diseases. Because of these three reasons I did delete that problematic claim. Some articles/chapters which defend that the placebo effect does affect some kind of diseases:

Placebos "can have substantial effects on clinical outcomes" according to this Annual Review in Clinical Psychology. https://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-021815-093015

"Women receiving placebo improved 3.62 (95% CI 3.29–3.94) on the Female Sexual Function Index." "This meta-analysis of Level I evidence demonstrates that 67.7% of the treatment effect for female sexual dysfunction is accounted for by placebo." Article in Obstetrics in Ginecology. https://cdn.journals.lww.com/greenjournal/Abstract/2018/08000/Female_Sexual_Dysfunction_and_the_Placebo_Effect_.24.aspx

"Expensive placebo significantly improved motor function in Parkinson disease" Published in Journal Neurology http://n.neurology.org/content/84/8/794.short

"more detailed attention needs to be given to understanding how psychotherapy works, including whether psychoterapy just is placebo". (Blease also talks about the clinial importance of the placebo effect). Published in the chapter "Informed consent, the placebo effect and psychodynamic psychotherapy" from the Springer Book New Perspectives on Paternalism and Health Care https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false

Some of the other references I added to support the relevance of the placebo effect in modern research:

Ashar, Y. K., Chang, L. J., and Wager T. D. (2017). Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account. Annual Review of Clinical Psychology DOI: https://doi.org/10.1146/annurev-clinpsy-021815-093015

Wager, T. D. and Atlas L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience DOI: https://doi.org/10.1038/nrn3976

Blease, C. R. (2015). Informed consent, placebo effect and psychodynamic psychotherapy. In New Perspectives on Paternalism and Health Care (pp. 163-182). Springer. URL= https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false

Colloca, L., Jonas, W. B., Killen Jr., J., Miller, F. G., Shurtleff, D. (2014). Reevaluating the Placebo Effect in Medical Practice. Zeitschrift für Psychologie DOI: = https://doi.org/10.1027/2151-2604/a000177

Weinberger, J. et al. (2018). Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis. Obstetrics and Ginecology DOI: https://doi.org/10.1097/AOG.0000000000002733

Espay, A. J. et al. (2015). Placebo effect of medication cost in Parkinson disease: a randomized double-blind study. Neurology DOI: https://doi.org/10.1212/WNL.0000000000001282

Flick, C. E. et al. (2017). Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World Journal of Gastroenterology DOI: https://doi.org/10.3748/wjg.v23.i12.2223

Kathryn, T. H., Loscalzo, J., and Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine DOI: https://doi.org/10.1016/j.molmed.2015.02.009}}

Thanks for your time. Best, User:James343e (talk). 3:03, 3 October 2018 (UTC)

I think there are some useful sources there that could be worked into the article, but the way it's been done is problematic. Statements by the ACS are WP:MEDRS and should not just be deleted; likewise the conclusion from Cochrane on therapeutic worth should not be howevered from multiple sources on clinical outcomes (not quite the same thing). No reference should be novel to the lede, the lede must always summarize referenced content in the body. All our sources must be WP:MEDRS (so, not trials, or quirky book chapters on paternalism, or discussion pieces in obscure journals like PMID 25360397). Finally, references should really conform to the format in MOS:MED. Alexbrn (talk) 05:05, 3 October 2018 (UTC)

Thanks for your response Alexbrn (talk). Thanks for your suggestion. I added the references in the body text of the artcile as well. I also maintained the American Cancer Society source, but added a report from the American Medical Association which disagrees with the notion that placebos have no effect on the clinical condition. There is a logical fallacy known as argument from authority. Only because the American Council Society states that placebos have no effect on disesase we cannot put it as an undisputable fact, specially when it is far from the scientific consensus, it is still disputed.

I also followed your advice and deleted the reference to the German "obscure" journal. I did not delete, however, the book chapter. The book is about health care the chapter is about the effect of placebo effect on psychodynamic (psychoanalytic) psychotherapy on the patients. So of course it has to do with the placebo effect.

In general, I included all these sources because the article was not representing all the modern views on the placebo effect. It is far from a scientific consensus that there is no placebo effect. It is a matter of dispute. In addition, only one meta-analysis from 2010 cannot account for all the research which has been done on the placebo effect. All my sources are from 2014-2018 so of course an older 2010 mata-analysis could not account for it.

Please, I would really appreciate if you do an effort to make complementary changes rather than destructive changes (for example, adding new references, rather than simply deleting all of my references).

Anyhow, thanks for your advises. Best, User:James343e (talk). 12:25, 3 October 2018 (UTC)

Please read the archives. Wayne Jonas and Ted Kaptcuk, in particular, are engaged in propaganda trying to boost the idea of a "placebo effect" in order to then claim that their favoured forms of woo somehow uniquely harness this effect. Guy (Help!) 14:20, 3 October 2018 (UTC)

a report from the American Medical Association which disagrees with the notion that placebos have no effect on the clinical condition. That is not accurate. "Therapeutic benefit" and "[beneficial] effect on clinical conditions" are not synonymous terms. Laughter has a well-documented therapeutic benefit, as does sex, backrubs, spending time with friends & family and anything else that contributes to emotional well-being. Feeling good is therapeutically beneficial, but has no clinical impact on any condition except clinical depression (and even then, it's only temporary). ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 14:37, 3 October 2018 (UTC)

Guy You are the most biased Wikipeida editor ever. You deleted 9 of my references... 9!! Stop deleting references because they don't fix your agenda. The scientific consensus is NOT that the placebo effect is not real. Why would it be the scientific consensus that the placebo effect is not real? Because of a 2010 meta-analysis? I only inclused studies from 2014-2018 so that meta-analysis cannot account for them. I included references from different scientific publciations like Nature Reviews Neuroscience, Neruology, Reviews of Clinical Psychology, Springer, etc. And you deleted all like nothing only because they don't fix your preconception that the placebo effect is not real. And no, contrary to what you say, I don't defend any pseudotherapy like homeopathy or acupuncture, I just want this article to be honest from an intellectual point of view and represent the current view of the placebo effect in modern research. Paradoxically, non-scientific thereapies (like psychoanalytic therapy) are suspected to be useful because of the placebo effect, rather than being an effect of psychoanalysis per se. I included many references from journals in medicine, neuroscience, psychology and genetics. Let us be honest from an intellectual point of view and represent ALL the current scientific research on the placebo effect, not only the one which suits a particular agenda. The scientific consensus is far from being that the placebo effect is not real or relevant. User:James343e (talk). 04:35, 3 October 2018 (UTC)

We don’t use primary sources here. Roxy, in the middle. wooF 15:08, 3 October 2018 (UTC)

As soon as you started ranting about "bias" you lost most the respect the editors here were affording you. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 15:12, 3 October 2018 (UTC)

I was only referering to Guy, since I found it extremely disrespectful to delete all of the scientific sources I put. I was not talking about youᛗᛁᛟᛚᚾᛁᚱPants. Thanks for your suggestion. I deleted the "on the other hand" line, but not the whole quote, since I think it is still a relevant information that it is beneficial from a therapeuthical point of view. User:James343e (talk). 16:35, 3 October 2018 (UTC)

First off, stop copying and pasting user names like that. Or at least pay more attention when you do. Just above, you claimed "This article is biased as hell." which is a ridiculous statement. You then claimed "You are the most biased Wikipeida editor ever." which is a personal attack and a fallacious argument: being biased doesn't mean he's not right. In the edit you tried to edit war over, you created a false dichotomy between a statement on "therapeutic benefit" and "clinical effects". Most of the sources you have used were published to push a pseudoscientific agenda and lack the impact necessary to convey the weight you gave their conclusions. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 15:22, 3 October 2018 (UTC)

And you are the one critizicing me for calling some editors biased? Calling someone biased is an argumentum ad hominem ONLY if it is not accompanied by arguments to discuss the topic. If you say "X is biased" and don't discuss the topic, then it is an argumentum ad hominem. If you say "X is biased, he is deleting all the scientific references I included" then that is not an argumentum ad hominem, it is a well explained critique since I discuss the topic. Also, you say that the publications in Nature Reviews Neuroscience, Annual Review of Clinical Psychology, Neurology or Springer are pseudoscientific, without analyzing their articles per se. You just made the general claim "they are pseudoscientific" just because they don't fix your preconception of ehat the placebo effect is. And then you get angry if somebody calls you biased. OK, I won't call anybody "biased", to focus on the topic. Paradoxically, to deny the concept of placebo effect suits the agenda of pseudoscientist. If the placebo effect is not real, then the psychoanalythic therapy works because it is a well-sustained scientific method, not because of the placebo effect (as some have objected). Seriously, the point is not who is right. The point is not to discuss whether there is or not a placebo effect. The point is to represent an impartial view of the issue. I did not create a false dichotomy, since I ddeleted the "on the other hand" line. I onmly included a reference which said that the placebo effect is beneficial froma therapeutical porint of view, which is an important information. The articles I included in the references, DO talk about the clinical relevance of the placebo effect. (Read again, clinical, not only therapeutical). The articles I included (which you didn't bother to read because they didn't fix your preconception of the placebo effect, explicilty talk about the improvement of some clinical conditions because of the placebo effect and emphazize the CLINICAL relevance of the placebo effect. I think it is very dishonest form an intellectual viewpoint to just delete all the references I included because they don't fix the preconception of some WIkiepdia editors. The scientific consensus IS NOT that the placebo effect is not real or relevant. AGAIN, THE SCIENTIFIC CONSENSUS IS NOT THAT THE PLACEBO EFFECT IS NOT REAL OR RELEVANT. It is important to give an objective account of the state and reflect both views (the studies which deny the relevance of the placebo effect and the ones who emphasize its importance). Stop cheating the readers and let's be honest fomr an intelelctual point of view. The scientific consensus is not that the placebo effect is not real or relevant. It is necessary to reach a consensus. We can't jsut delete all of the scientic articles which suport the placebo effect notion just because you don't like them. Some of those articles are published in well-respected journals like Nature Reviews Neuroscience, Neurology or Annual Review of Clinical Psyhology. Your claim that it is "pseudoscience" is just an "argumentum ad hominem" applied to the articles. You don't criticize the content of the articles per se, you just employ the ad hominem "they are pseudoscience". User:James343e (talk). 16:42, 3 October 2018 (UTC)

Calling someone biased is an argumentum ad hominem ONLY if it is not accompanied by arguments to discuss the topic. That's a very weird thing to say, considering that it's not true and doesn't make any sense: fallacious arguments don't become sound just because they are adjacent to others. A sound ad hominem argument consists of an accurate claim that the other party is possessed of some quality that undermines claims of fact that they make. Nothing you said did that.

Also, you say that the publications in Nature Reviews Neuroscience, Annual Review of Clinical Psychology, Neurology or Springer are pseudoscientific, without analyzing their articles per se You can assume that I haven't reviewed them all you want, but you know what they say about assuming.

You just made the general claim "they are pseudoscientific" No, I did not, I said something different. If you're not going to copy and paste from my comment, you should avoid putting quotes around it.

AGAIN, THE SCIENTIFIC CONSENSUS IS NOT THAT THE PLACEBO EFFECT IS NOT REAL OR RELEVANT.^{[citation needed]}

Your claim that it is "pseudoscience" is just an "argumentum ad hominem" applied to the articles. Soup cackles purple jumps in the fall peacoat with a seamless chili pepper. See? I'd say my nonsense statements are much better than yours. Because they're lyrical, you know? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 16:07, 3 October 2018 (UTC)

Roxy, what do you mean by "primary sources"? I can include sources anywhere from 2005 to 2018, not only the recent ones, if that bothers you. The scientific consensus is far from being that the placebo effect is not real or relevant, so I won't have any problem to find those articles. User:James343e (talk). 16:51, 3 October 2018 (UTC)

Read the talk page archives linked above, and read WP:MEDRS. Also read the article on journal impact factor and check the IF of the sources you are looking to cite (hint: generally very low indeed). Now read the history of Jonas and Kaptchuk, both of whom are primarily shills for inert "treatments" (homeopathy and prayer for Jonas, acupuncture for Kaptchuk). Also read the critiques of Beecher, which is classic pseudoscience. This is a mature article and lots of us here are intimately familiar with the subject - your assumption appears to be that your peerless wisdom is all we poor fools need to "correct" our "bias", and that is pretty arrogant. Guy (Help!) 17:19, 3 October 2018 (UTC)

@James343e: Dude, you have just over 600 edits, most of them on sports topics. You are not well placed to start throwing around accusations of bias against editors and admins with tens to hundreds of thousands of edits. Guy (Help!) 17:08, 3 October 2018 (UTC)

James343e, get out of here quickly. There is a strong cabal of editors here that try to keep this and other articles free from anything that contradicts their overly skeptic world view, and be it even only the presentation of what a source actually says rather than what they would like it to say (you might notice that "useful means" occurs nowhere in the one source that is cited in the lede to support their view, and that the other source contains a lot more of a nuanced view than what "no evidence [...] of any placebo effect in any of the studies cited" might suggest). If you continue voicing your opinion here, they will continue to harass until they succeed tricking you into violations of the rules and use that as leverage to get you blocked. They have a lot of experience with this and resistance is completely futile. Many other editors agree with you but do not have the experience and energy that the tight-knit gang has to game the system that successfully. --rtc (talk) 19:05, 3 October 2018 (UTC)

There is a strong cabal of editors here that try to keep this and other articles free from anything that contradicts their overly skeptic world view And that cabal goes all the way to the top, MUAH HA HA HA HA!!!. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 19:48, 3 October 2018 (UTC)

What about discussing content and sources rather than editors and avoiding to use article talk pages as forums? What is the WP:MEDRS policy to you? Successful corruption of Wikipedia policies by said cabal? WP:CONSENSUS forming processes are also not harassment. —Paleo Neonate – 21:17, 3 October 2018 (UTC)

Does the WP:MEDRS somewhere say you may reformulate the wording of such sources to fit your point of view, or selectively quote from it? Does the CONSENSUS policy say you may do so if a hundred cabal members agree it's the way to best educate the public about the pseudoscientific nature of the placebo effect? --rtc (talk) 21:19, 3 October 2018 (UTC)

break

I started this section, because the other one was too long and difficult to follow. Guy (Help!)), ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. I apologize for being disrespectful with you guys, I won’t use any personal attack anymore and will focus on the topic. I would love to reach consensus with you!! Let us see if with good forms and good manners from my part we can reach some consensus.

Hi Snow ^{let's rap}, I consider you one of the greatest Wikipedia editors. You make contributions to Wikipedia articles about medicine, neuroscience and psychology and you are always very respectful. That is why I wanted you to enjoy this conversation. I would really appreciate your opinion on the issue.

First of all, by no means I am doing this because I want to support a pseudotherapy. I consider homeopathy, acupuncture or psychodynamic (psychoanalytic) therapy to be pseudosciences. I only want to reflect the current scientific view on the placebo effect.

I was a bit skeptical on the neutrality of this article, since I do not think it reflects all the current views on the placebo effect. This Wikipedia article explicitly defends that the placebo effect has no impact on any disease and is considered not relevant in contemporary science. However, the scientific consensus is NOT that the placebo effect is not real or relevant.

It would be really desirable to reach a consensus. As of now, 2 of us agree that some changes are necessary rtc (talk) and I, but ideally I want to reach universal consensus with all of you. I think that some of the numerous papers which defend the reality and clinical relevance of the placebo effect should be cited in this article to reach neutrality.

I listed below 16 scientific articles (I could have included more) which defend the reality and clinical relevance of the placebo effect. 8 of them have a high Impact Factor (over 10.000). The remaining ones have an average Impact Factor (2.000-9.000). To my knowledge, no meta-analysis excludes articles from journals with an average Impact Factor. Thus, papers published in journals with an average Impact Factor are also part of science and should not be ignored here. In any case, half of the papers I cited are from journals with a High Impact Factor:

Collapse WP:WALLOFTEXT source list.

    1. Ashar, Y. K., Chang, L. J., and Wager T. D. (2017). Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account.  Annual Review of Clinical Psychology DOI: https://doi.org/10.1146/annurev-clinpsy-021815-093015  (It claims the placebo effect is relevant for the clinical development of many patients. Direct quote: "they can have substantial effects on clinical outcomes.").

High Impact Factor for the Annual Review of Clinical Psychology: 13.278 the second highest Impact Factor among journals of Psychology: http://www.bioxbio.com/if/html/ANNU-REV-CLIN-PSYCHO.html http://psychology.wikia.com/wiki/Impact_factors_of_psychology_journals

   2. Wager, T. D. and Atlas L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience DOI: https://doi.org/10.1038/nrn3976 (Article which claims that the placebo effect is both real and relevant for pseudoscience).

High Impact Factor for Nature Reviews Neuroscience: 32. 635. https://www.nature.com/nrn/about/journal-metrics

   3. Blease, C. R. (2015). Informed consent, placebo effect and psychodynamic psychotherapy. In New Perspectives on Paternalism and

Health Care (pp. 163-182). Springer. URL= https://books.google.es/books?id=LSjMCQAAQBAJ&pg=PA169&dq=Psychodynamic+therapy+Longer+than+CBT&hl=es&sa=X&ved=0ahUKEwiR5vXW8-DdAhUH3xoKHYBGCU4Q6AEIMDAB#v=onepage&q=Psychodynamic%20therapy%20Longer%20than%20CBT&f=false (It claims that the pseudoscientific psychodynamic (or psychoanalytic) therapy works by means of placebo effect, not the therapy per se. It is a book, so of course it lacks Impact Factor. But it is from the Editorial Springer, which is prestigious enough to be reliable.

  4. Elsenbrunch, S. and Enck P.  Placebo effects and their determinants in gastrointestinal disorders. Nature Reviews Gastroenterology & Hepatology. DOI: https://doi.org/10.1038/nrgastro.2015.117 (It defends the reality of the placebo effect, Direct quotes: “rain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias.”, “Brain imaging studies have demonstrated that the placebo response is not merely a response bias, but exhibits neurobiological and psychobiological properties along the gut–brain axis”).

High Impact Factor for Nature Reviews Gastroenterology and Hepatology: 16.990 https://www.nature.com/nrgastro/about/journal-metrics

  5. Weinberger, J. et al. (2018). Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis. Obstetrics and Ginecology  DOI: https://doi.org/10.1097/AOG.0000000000002733 (2/3 of the Female Sexual Dysfunction recovery is due to the placebo effect rather than any specific therapy. according to the article):

Average Impact factor for Obstetrics and Ginecology: Obstetrics & Gynecology's 2017 impact factor is 4.982. The journal's ranking is the fifth highest impact factor out of all 82 obstetrics and gynecology journals. https://journals.lww.com/greenjournal/Pages/citationsandimpactfactor.aspx

  6. Espay, A. J. et al. (2015). Placebo effect of medication cost in Parkinson disease: a randomized double-blind study. Neurology DOI: https://doi.org/10.1212/WNL.0000000000001282    (It defends that the Placebo effect is real in the Parkinson disease, since the placebo condition's patients showed improvement).

Average Impact Factor for Neurology: 8.320. Neurology is the most widely read and cited journal about neurology. http://www.neurology.org/about/about_the_journal http://n.neurology.org/

  7. Flick, C. E. et al. (2017). Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World Journal of Gastroenterology DOI: https://doi.org/10.3748/wjg.v23.i12.2223 (It defends patients do exhibit some improvement because of the placebo effect, rather than the therapist's action):

Average Impact Factor for the World Journal of Gastroenterology: 3.300 ranking WJG as 35 among 80 journals in gastroenterology https://www.google.es/search?ei=igm1W_bHIdDSkgWo27cg&q=%27World+Journal+of+Gastroenterology+impact+factor&oq=%27World+Journal+of+Gastroenterology+impact+factor&gs_l=psy-ab.3..0i67k1j0i30k1l5j0i8i30k1l4.1639.1639.0.1850.1.1.0.0.0.0.119.119.0j1.1.0....0...1.1.64.psy-ab..0.1.119....0.U6XUwL-ZlD0

  8. Kathryn, T. H., Loscalzo, J., and Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine  DOI: https://doi.org/10.1016/j.molmed.2015.02.009}} (It claims that the placebo effec is relevant for the study of genetics, and could be to some degree inheritable).

High Impact Factor for Trends in Molecular Medicine: 11.021 https://www.journals.elsevier.com/trends-in-molecular-medicine

  9. Finnish, D. F.  Kaptchuk, J., Miller, F., Benedetti, F. (2010). Biological, clinical, and ethical advances of placebo effects. The Lancet. DOI: https://doi.org/10.1016/S0140-6736(09)61706-2  (The article emphasizes the well-stablished fact that the placebo effect is real).

High Impact Factor for The Lancet: 53.254. The most cited journal of general medicine. https://www.journals.elsevier.com/the-lancet

  10. Colagiouri et al. (2015). The placebo effect: from concept to genes. Neuroscience. DOI: http://dx.doi.org/10.1016/j.neuroscience.2015.08.017

(The article emphasizes the clinical relevance of the placebo effect. Direct quote: "which demonstrate the broad range of effects that placebo interventions caninduce and their clinical relevance." Page 172). Average Impact factor: 3.382. https://www.journals.elsevier.com/neuroscience

  11. Fraguas et al. (2009). A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: The relevance of the placebo effect and psychological symptoms. Contemporary Clinical Trials. DOI:  https://doi.org/10.1016/j.cct.2009.01.007

(It defends the importance of placebo effect for depression). Average Impact Factor: 2. 658 https://www.journals.elsevier.com/contemporary-clinical-trials

   12. Peciña et al. (2015). Association Between Placebo-Activated Neural Systems and Antidepressant Responses Neurochemistry of Placebo Effects in Major Depression. Journal of the American Medical Association. DOI: https://doi.org/10.1001/jamapsychiatry.2015.1335  (This article clearly emphasizes both the reality and relevance of the placebo effect. Some direct quotes: "High placebo responses have been observed across a wide range of pathologies" (abstract), "These data demonstrate that placebo-induced activation of the µ-opioid system is implicated in the formation of placebo antidepressant effects in patients with MDD and also participate in antidepressant responses" (Conclusions)).

High Impact Factor for JAMA: 47.000 The Journal for American Medical Association is the second journal with higher Impact Factor in Medicine. https://jamanetwork.com/journals/jama/pages/for-authors

   13. Rutherford et al. (2016). Patient Expectancy as a Mediator of Placebo Effects in Antidepressant Clinical Trials. The American Journal of Psychiatry. DOI: https://doi.org/10.1176/appi.ajp.2016.16020225 (It defends the importance and reality of the placebo effect by means of patient expectancy in antidepressant clinical trials. Direct quote: "Expectancy-related interventions should be investigated as a means of controlling placebo responses in antidepressant clinical trials and improving patient outcome in clinical treatment." (Conclusions). They want to control the placebo effect to improve patiens's outcome in clinical treatment, as the direct quote indicates).

High Impact Factor for The American Journal of Psyquiatry: 13.391, the third highest cited Psychiatry Journal. https://www.appi.org/American_Journal_of_Psychiatry

   14. Role of placebo effects in pain and neuropsychiatric disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry. DOI: https://doi.org/10.1016/j.pnpbp.2017.06.003 (It emphasizes placebo's effect clinical relevance. Direct quote: "The placebo (and the nocebo) effect is a powerful determinant of health outcomes in clinical disease treatment and management.").

Average Impact factor for the journal: 4.185 https://www.journals.elsevier.com/progress-in-neuro-psychopharmacology-and-biological-psychiatry

   15. Using the placebo effect: how expectations and learned immune function can optimize dermatological treatments. (2016). Experimental Dermatology DOI: https://doi.org/10.1111/exd.13158  (This paper emphasizes the importance of the Placebo's effect for dermatology. Direct quote: "The role of placebo and nocebo effects—that is positive or negative treatment effects that are entirely a consequence of the patient's expectations and beliefs about a treatment outcome in terms of efficacy, safety, usability or side effects—has been shown for almost all types of diseases and physiological response systems. Evidence for the relevance of placebo and nocebo effects in dermatology is also increasing".

Average impact Factor: 2.608 https://onlinelibrary.wiley.com/journal/16000625

   16. Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus. (2018). Psychotherapy and Psychosomatics. URL Free access: https://www.researchgate.net/publication/325725713_Implications_of_Placebo_and_Nocebo_Effects_for_Clinical_Practice_Expert_Consensus   (This paper has the EXPERT CONSENSUS THAT PLACEBO EFFECTS ARE BOTH REAL AND RELEVANT FOR THE OUTCOME OF THE DISEASE'S TREATMENT. Direct quote: "There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects." (Page 2) Placebo and nocebo studies constitute a scientifically mature field of interdisciplinary research with applications in different medical disciplines and conditions. This burgeoning research calls for evidence-based recommendations for health professionals in medical practice." (Page 6).

High Impact Factor for Psychotherapy and Psychosomatics: 13.122 http://www.ovid.com/site/catalog/journals/4862.jsp

Guy (Help!)), ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it., Snow ^{let's rap} What do you guys think? I think to achieve neutrality we could cite some of these articles and maintain the ones which are already present. In that way, both views (the view which gives no relevance to the placebo effect, and the view acknowledging the reality and clinical relevance of the placebo effect) would be included. Can we reach consensus and include some of the recent research which points out the reality and clinical relevance of the placebo effect? Can we cite some of these 16 articles or should we ignore them all? You decide, but I would love to reach consensus. User:James343e (talk). 3:03, 3 October 2018 (UTC)

I smell an accusation of sealioning coming up. --rtc (talk) 20:52, 3 October 2018 (UTC)

Your logical fallacies are: begging the question and false middle. We already have consensus, arrived at over a period of months. Your lengthy screed is predicated on the idea that the article as thrashed out over many months of debate is somehow false, and neutrality somehow best achieved through an average between the current article and the writings of placebo shills. See also WP:ALLCAPS. No thanks. Guy (Help!) 21:02, 3 October 2018 (UTC)

@James343e I can only recommend not to waste any energy here. Go to a different article that you like such as sports which is not one of those guarded by the gang, and you will be a lot happier than wasting your time here. --rtc (talk) 21:10, 3 October 2018 (UTC)

@Rtc:If you're not going to contribute productively to this thread, stop posting here. I'm going to start reverting any comments which aren't about improving the article, and if you start edit warring over that... Well, you've been here long enough to know what happens when an editor edit wars over off-topic talk page comments.

@James343e: If you expect anyone to read your wall of text you're sadly mistaken. Also, the article doesn't even say what you keep claiming it says. If the placebo effect is "not real" then we would have phrases like "purported" and "according to proponents" and "there is little scientific support for the existence of any 'placebo effect'." ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 21:28, 3 October 2018 (UTC)

- @Pants: The article selectively quotes "no evidence [...] of any placebo effect". No sane reader would assume now there are opposing views if you don't say there are. The article may not say explicitly that the placebo effect is not real but that's what any sane reader will understand reading your biased piece of propaganda. --rtc (talk) 21:42, 3 October 2018 (UTC)

You know that I know what quote mining is, right? And that I can go look at the article and see that you purposefully left off the end of that quote in order to deceptively imply that the article is coming to a conclusion that it doesn't actually come to?

that's what any sane reader will understand reading your biased piece of propaganda. Yeah, that was the point at which the last vestiges of any respect I had for your opinion went out the window. Go be butthurt somewhere else. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 21:49, 3 October 2018 (UTC)

@Tell me all about it.If you didn't read my message then you didn't notice my argument. At least 16 scientific articles postulate the existence and clinical relevance of the placebo effect. So my question is: can I cite some of those 16 articles which explicitly defend the clinical relevance of the placebo effect?

@Guy That is a logical fallacy known as argument from authority. Only because some Wikipedia editors arrived to a consensus many months ago it doesn't mean that the "Wikipedia consensus" is more relevant than the current scientific evidence. I found 16 articles which suggest clinical relevance of the placebo effect. I think it is neccessary to cite some of those articles to avoid hiding information to the reader. In the Wikipeida article it is said that the placebo effect has no clinical relevance on any disease. That is far from the scientific consensus. (I think the scientific consensus is more relevant than the Wikipedia consensus).User:James343e (talk). 22:47, 3 October 2018 (UTC)

If you didn't read my message then you didn't notice my argument. Hypocrisy, thy name is James343e. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 22:01, 3 October 2018 (UTC)

@James343e, he already said you can't cite them: "No thanks." This means the cabal has decided to not acccept your proposal, because it is very obviously against their belief, based on actually good moral intentions, that the public must be protected from views that give too much credibility to pseudomedicine and that citing those studies would thus mislead the public and undercut the strong scientific authority of MEDRS sources, which must have priority over other views. Just go on and do something meaningful now. @Pants Oh yeah it makes such a huge difference the part of the quote I omitted. See, if you don't name any examples of opposing views the reader will assume there aren't any. In fact, the study says there is some evidence for placebo effects (p. 3) but the study authors assume it might as well be the patient misreporting because of social expectations. Now you might counter, well, that's mostly based on accupuncture studies and the authors didn't get it right that those studies use quite a different type of "placebo" from the others; something that one usually wouldn't call a placebo at all. But that would be cherrypicking based on personal judgement. --rtc (talk) 22:04, 3 October 2018 (UTC)

ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it., focus on the topic of discussion please. At least 16 scientific articles (which I mentioned above) suggest the clinical relevance of the placebo effect. So my question is: can I cite some of those 16 articles which explicitly defend the clinical relevance of the placebo effect?User:James343e (talk). 22:47, 3 October 2018 (UTC)

focus on the topic of discussion please. Hypocrisy, thy name is James343e. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 22:13, 3 October 2018 (UTC)

(talk) 22:04, 3 October 2018 (UTC)Paradoxically, they are helping pseudosciences to emerge. If the placebo effect is not clinically relevant, then all the "clinical evidence" of the psychoanalytic therapy can't be due to a strong placebo effect, since the placebo effect has no clinical relevance according to this Wikipedia article.User:James343e (talk). 22:47, 3 October 2018 (UTC)

The study admits patients clearly get better when treated with placebo, it just says it's insignificantly better than no treatment in most cases. In most cases. The article currently makes it seem as if it were in all cases. Which simply isn't true, at least given what the study actually says. --rtc (talk) 22:21, 3 October 2018 (UTC)

ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. Can you reply to my question, please? At least 16 scientific articles (which I mentioned above) suggest the clinical relevance of the placebo effect. So my question is: can I cite some of those 16 articles which explicitly defend the clinical relevance of the placebo effect?User:James343e (talk). 22:47, 3 October 2018 (UTC)

He aleady said "No thanks." --rtc (talk) 22:21, 3 October 2018 (UTC)

No, only Guy (Help!) said "no thanks". (And his reason was that the "Wikipedia consensus" is more relevant than the "Scientific consensus"). But ᛗᛁᛟᛚᚾᛁᚱPants hasn't replied to my question.

Yeah, right, it was Guy, sorry about that mistake. However, it doesn't matter who says it because if one of them says it and nobody says any different (and they rarely do), it's consensus. --rtc (talk) 22:42, 3 October 2018 (UTC)

James, are you planning on listening to anything that's been said to you? STOP COPYING AND PASTING SIGNATURES. Just type out the usernames, or use shortened version or nicknames (not intentionally offensive ones, per WP:CIVIL). I respond to MPants, Mjolnir, HammerPants, Thunder Britches, and "O Wise One" (but never "sir" I work for a goddamn living). All you're doing is introducing a bunch of un-closed HTML tags because of how sloppy your copypasta is.

Oh, and to answer your question: No. You've made it pretty clear that you're engaged in POV pushing with your unfounded complaints about bias. POV pushers never gain consensus on articles watched by conscientious editors. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 23:33, 3 October 2018 (UTC)

The whole push seems based on a false premise, that the article somehow says placebos are "not real or relevant". In fact that phrase occurs nowhere, we define what the placebo response and effect are in the article lede, and spend the article discussing placebos. A few of the new sources mentioned above are useful, but not in the way the OP seems to think. Alexbrn (talk) 06:44, 4 October 2018 (UTC)

"In fact that phrase occurs nowhere" Yet it is precisely what the average reader will assume after having read the lede. --rtc (talk) 06:51, 4 October 2018 (UTC)

Only if they lack basic reading comprehension skills, or maybe have their understanding clouded by an agenda. That said, the lede could usefully be expanded to summarize more of the article body. Alexbrn (talk) 06:55, 4 October 2018 (UTC)

"Only if they lack basic reading comprehension skills" people of high ability tend to incorrectly assume that tasks that are easy for them are also easy for other people. --rtc (talk) 07:07, 4 October 2018 (UTC)

Note I said "basic" skills. You'd have to be an imbecile to read four paragraphs about placebos, see a photo of them, read a definition of the placebo effect, and conclude this meant it is not "real". I think what the OP is pushing for is a statement that placebos cure disease - and that is not going to happen without a mega-strength source. Alexbrn (talk) 07:12, 4 October 2018 (UTC)

To someone with a PhD in English, the average reader must indeed seem like an idiot. With respect to curing diseases the cited studies are more nuanced than what the selective quotes and wording suggest. They do not completely rule out a real effect with respect to pain and such conditions but they say it's difficult to distinguish from reporting error and emphasize that the significance of the observations is mainly caused by just a few German studies on accupuncture. --rtc (talk) 07:20, 4 October 2018 (UTC)

Thanks for your polite response @Alexbrn. No, Alexbrn, the problem is that the article clearly says that "Placebos have no impact on disease itself; at most they affect peoples' assessment of their own condition". That statement is completely false or at least controversial. That statement is based on the American Cancer Society (ACS) webpage. But the ACS are thinking of cancer when making that over-general statement, not in depression or social anxiety disorder. Of course the placebo effect has an efffect on psychological diseases. A 2014 meta-analysis found that "Provision of a psychological placebo was associated with a significantly greater reduction of symptoms than placement on a waiting list." on anxiety disorder.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311105/

Of course, it can be said that it is only "self-reported". But that is an assumption, it is far from clear that it is only self-reported. Crutically, PET scaner in the brain confirms that the placebo effect's improvement of symptoms is located in brain (not only self-reported). This 2016 PET brain scaner study found that "Higher baseline µ-opioid receptor binding in the nucleus accumbens was associated with better response to antidepressant treatment (r = 0.48; P = .02). Reductions in depressive symptoms after 1 week of active placebo treatment, compared with the inactive, were associated with increased placebo-induced µ-opioid neurotransmission in a network of regions implicated in emotion, stress regulation, and the pathophysiology of MDD".

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2443355

That is, even PET brain scaners show that placebo's improvement of symptoms in psychological diseases is not merely a subjective response, but a brain response. Thus the claim "Placebos have no impact on disease itself; at most they affect peoples' assessment of their own condition" is incompatible with the avalaible scientific evidence. It needs to be deleted or accompanied by references indicating that the placebo effect does have an effect on the symptoms of some psychological diseases like depression or social anxiety disorder. User:James343e (talk). 10:15, 3 October 2018 (UTC)

I don't see the difference between "subjective response" and "brain response". Do explain. Tgeorgescu (talk) 09:30, 4 October 2018 (UTC)

@Tgeorgescu. Ok, so why do you assume a dichotomy between the report of the symptoms and the symptoms per se? Such a dichotomy is not present in the studies, it is only objected by you. Can't they both (report of the symptoms and symptoms per se) occur together? If someone who has experienced depression or social anxiety dissorder, after receiving some type of placebo reports an improvement... why is it supposed here that the placebo effect has had zero impact on the disease? Can't the symptoms of depression or anxiety improve because of the placebo effect,as the research suggests? User:James343e (talk). 10:34, 3 October —Preceding undated comment added 09:36, 4 October 2018 (UTC)

Don't know, but if you ever quote another WP:PRIMARY source on this page, you might get topic banned. And Chinese journals have never ever found a therapy to be ineffective. Tgeorgescu (talk) 09:40, 4 October 2018 (UTC)

I cited a secondary source (a meta-analysis, which is an analysis of several studies). I mentioned a 2014 meta-analysis which found that "Provision of a psychological placebo was associated with a significantly greater reduction of symptoms than placement on a waiting list." What is the difference between citing a 2014 meta-analysis and the 2010 meta-analysis cited in this article?User:James343e (talk). 10:43, 3 October

The meta-analysis is Chinese, and the Chinese have never found a therapy not to work. As for the placebo trial of 35 patients with MDD (Marta Peciña, MD, PhD; Amy S. B. Bohnert, PhD; Magdalena Sikora, BS; et al. 2015), that's manifestly a primary source. Tgeorgescu (talk) 09:52, 4 October 2018 (UTC)

I cited a Chinese journal discussing a psychology issue, not acupuncture. Anyhow, if you think that Chinese journal is not reliable for whatever reasons... What about The Lancet? The Lancet is the journal of general medicine with the highest Impact Factor, and it is Brittish not Chinese. In this meta-analysis (secondary source), it is said that the psychodynamic (psychoanalytic) therapy has had greater effects in outcomes than the waiting list, but equal effects in outcomes than the placebo list. Thus, it suggests a dichotomy between the waiting list and the placebo list, with the latter having a greater effect on the outcomes of the social anxiety disorder diseases. Again, why can we cite a 2010 meta-analysis but not a 2014 meta-analysis published in The Lancet which clearly shows that the placebo effect does affect the outcome of the psychological disease to some degree?https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70329-3/fulltext — Preceding unsigned comment added by James343e (talk • contribs) 09:59, 4 October 2018 (UTC)

The source seems OK to me. What exactly do you want it to verify? Tgeorgescu (talk) 10:09, 4 October 2018 (UTC)

My point is that, in this article it is said that "the placebo effect has no impact in the disease". I would prefer to matize it, and say something like "According to the ACS the placebo effect has no impact on the disease" and then cite this 2014 meta-analysis to indicate that some meta-analyses have found that the placebo effect does affect to some degree the outcome of some psychological diseases (since the patients of the placebo list had greater effects in outcomes than the patients in the waiting list). I don't think this is "original reasearch". If the psychodynamic (psychoanalytic) therapy had greater outcomes than the waiting list but the same results than the placebo group, then there is a dichotomy between the placebo group and the waiting list. Do you agree it could be a good idea? James343e (talk • contribs) 11:15, 4 October 2018 (UTC)

I am sure you would prefer to present the facts as if they were an opinion, but we're not going to do that. You can still fing meta analyses saying that homeopathy and a upuncture have objective effects, but the reality is very clear. Guy (Help!) 06:40, 6 October 2018 (UTC)

There is a large systemic problem with Chinese journals, which pretty much never publish negative results. In an area like this, which feeds the acupuncture narrative, a Chinese journal is always going to be suspect. That's why we generally reject suggestions to cite woo-supportive material to Chinese journals. The article correctly identifies the fact that the "placebo effect" is only visible in subjective endpoints - in other words, it's not real. Guy (Help!) 10:19, 4 October 2018 (UTC)

Guy, we are discussing now the inclussion of this 2014 meta-analysis published in the prestigious British Journal "The Lancet":

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70329-3/fulltext James343e (talk • contribs) 11:15, 4 October 2018 (UTC)

@James: Note that this study was very obviously written to promote CBT, and declares a conflict of interest in that respect. @Guy: "the "placebo effect" is ... not real" citation needed --rtc (talk) 10:24, 4 October 2018 (UTC)

@rt But isn't that similar to an argumentum ad hominem? Because one of the article authors works in the CBT tradition, does it refute the content of the article? Isn't that attacking the author rather than the content of the article per se? According to that logic, most (If not all) the articles published in clinical psychology are not reliable, since one of the authors will always work in a particular tradition. Even if most articles don't declare any conflict of interest, the authors always work in a tradition. James343e (talk • contribs) 11:15, 4 October 2018 (UTC)

I don't quite get what you are saying. Is the study unaffected by the conflict of interest? Do all other sources on the subject come to the same conclusion? --rtc (talk) 10:44, 4 October 2018 (UTC)

If by "conflic of interest" you mean that the author works in the tradition the article favours, all articles in psychology have conflict of interest even when it is not declared. For example, meta-analyses favourising psychoanalysis are always made by the same psychoanalist: Flak Leisechring, so of course he has a conflic of interest even when he doesn't declare it. Articles favourising evolutionary psychology are always made by David Buss. I could continue but you get the point. All psychology articles are made by people working in a tradition. Do all other sources on the subject come to the conclusion that "the placebo effect has no effect on the disease" as the Wikipedia article suggests? Clearly not, but you don't want to cite any of the meta-analyses that disagree with that conception.James343e (talk • contribs) 11:15, 4 October 2018 (UTC)

A conflict of interest means that an author has a financial interest in a certain outcome of the study. An author without a conflict of interest generally is paid by research money only. An author with a conflict of interest owns a share in a private company that sells a product (or the like). It has nothing to do with traditions. "Do all other sources..." The source used does not declare a conflict of interest, in contrast to yours. --rtc (talk) 10:55, 4 October 2018 (UTC)

All authors have a (non-finantial) conflict of interest, in the sense that they usually produce studies which favour their tradition. If this article were affected by the (finantial) confilct of interest, then why was it published in The Lancet, the most prestigious medial journal? First, the meta-analysis was "Chinese", now it has a finantial conflict of interest (then I wonder how was it pulished in The Lancet). Ok, what about this article? https://www.div12.org/wp-content/uploads/2014/10/Meta-Analysis-of-CBT-for-Social-Phobia-Taylor-1993.pdf

In this 1996 meta-analysis "All interventions, including placebo, had larger effect sizes than that of the waiting-list control"

Let me guess, now you will say it is "too old" or something. There is always an excuse to avoid citing meta-analyses which illustrate that the placebo effect has an impact on the disease.James343e (talk • contribs) 11:15, 4 October 2018 (UTC)

If conflicts of interests would never make a difference, they wouldn't have to be disclosed. A source with a conflict of interest does not rule out the validity per se but requires careful checking what other sources say and to what degree they agree. Yes, the other is too old. I think the scientific consensus is that the existence of placebo effects is unclear and questionable, and if they exist, then only for pain and such. I am quite okay with the lede as it now is with Pol098's changes. This mostly matches exactly what I argued for here at length and I am astonished it was now changed without much hazzle while I received a lot of retaliation for an equivalent version. At last, rationality has prevailed. --rtc (talk) 14:16, 4 October 2018 (UTC)

break2

I restored the long standing version because Pol098's edits introduced errors such as an explicit statement that the placebo effect is real, which is unsupportable from the source in question. If a test does not prove that the inert treatment is different from classical conditioning, it has not proved it to be real. I understand that some people don't understand why the lack of effect on objective outcomes is so significant. We have discussed this before.

There are good reasons not to cite fMRI as validating savred cows. See https://blogs.scientificamerican.com/scicurious-brain/ignobel-prize-in-neuroscience-the-dead-salmon-study/ for example. Guy (Help!) 06:58, 6 October 2018 (UTC)

Also of note: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928846/ suggests observational learning as a confounder. Guy (Help!) 07:18, 6 October 2018 (UTC)

concur w/ Guy long standing version better--Ozzie10aaaa (talk) 12:29, 6 October 2018 (UTC)

1) the "long standing version" is not a long standing version, it's a controversial version established once by you, with an edit war and arguably a 3RR violation. 2) The version you reverted merely properly represented what the American Cancer Society and the Cochrane study source said. But apparently your pov pushing and personal opinion and the primary sources and ig nobel prize blog articles you cite are okay and trump MEDRS sources when they serve your goal of debunking the placebo effect as a myth. --rtc (talk) 08:05, 6 October 2018 (UTC)

As I recall there was an RfC. We definitely don't want to be copy and pasting wholesale from the source as that is a copyright violation, which is seriosuly bad. Alexbrn (talk) 12:38, 6 October 2018 (UTC)

WP:RD1 applied as requested, discussion now moot

The following discussion has been closed. Please do not modify it.

grm... not sure if serious or trolling... --rtc (talk) 19:26, 6 October 2018 (UTC)

Fair use may apply to proper quotations. Otherwise, what does "real" mean: statistical significance of subjective self-reports or actually healing a real disease? Also, a subjective impression of feeling better will be rendered by another brain scan than not an improvement: so subjective impression and brain scan could mean the same thing. Tgeorgescu (talk) 05:23, 7 October 2018 (UTC)

Quotations are one thing; copy and pasting into Wikipedia's voice is another. As to "real, I hereby suggest we stop using the word since, unsurprisingly, everybody is using it differently. Alexbrn (talk) 05:56, 7 October 2018 (UTC)

It's the same old bullshit. Copyright does not prohibit anything like that. And apparently the MEDRS sources are fine to cite when they serve your purpose and cannot be used when they contradict your opinion. --rtc (talk) 06:31, 7 October 2018 (UTC)

No, it's not bullshit: just copy/paste is illegal. Proper quotes are fair use. Tgeorgescu (talk) 06:39, 7 October 2018 (UTC)

Assuming good faith, you obviously miss the point of copyright completely. Completely. --rtc (talk) 07:52, 7 October 2018 (UTC)

Short quotes between quote marks are fair use. Stating the same text as if it were your own work is stealing (plagiarism). Tgeorgescu (talk) 08:05, 7 October 2018 (UTC)

There seems to be a misunderstanding of "fair use", which allows limited use of exact quotes (IOW copyrighted) when properly attributed/sourced. The amount allowed varies enormously, depending on their social significance, from short sentences to whole works. The courts usually end up determining how much is too much. -- BullRangifer (talk) PingMe 08:08, 7 October 2018 (UTC)

The removed text was not presented as fair use, instead it was outright intellectual theft (copyvio). Tgeorgescu (talk) 08:15, 7 October 2018 (UTC)

Don't edit war! Whole sentences were copy/pasted without any quote marks and much of the rest is close paraphrasing. Tgeorgescu (talk) 11:26, 7 October 2018 (UTC)

You are completely, utterly, totally wrong. Go take some courses in copyright law. And what a lame excuse to have this deleted btw. The cabal used to be more creative than that. --rtc (talk) 11:49, 7 October 2018 (UTC)

Do you want evidence? Fine: [6], [7], [8], [9], [10]. Tgeorgescu (talk) 11:55, 7 October 2018 (UTC)

You mean evidence for your lack of creativity? [11] --rtc (talk) 12:06, 7 October 2018 (UTC)

Speaking of creativity, most of the text that has been added through the disputed edits is either copy/paste or close paraphrasing. Perhaps one sentence does not count as copyright infringement, but if you remove the copy/pasted or closely paraphrased stuff there is almost nothing left of those edits, except for the added footnotes. Tgeorgescu (talk) 12:26, 7 October 2018 (UTC)

I have more productive things to do than this tedious nonsense. --rtc (talk) 12:45, 7 October 2018 (UTC)

From the hatted discussion: "real" has different meanings and it is not clear what "real" means in "the placebo effect is real". Tgeorgescu (talk) 13:28, 8 October 2018 (UTC)

ROTFL --rtc (talk) 16:43, 8 October 2018 (UTC)

My thoughts: This 2010 Cochrane collaboration article is already cited in the article, including in the lede. The lede cites this article when it says that "Subsequent research has found that placebos are not a useful means of therapy." This sentence ends the lede, so would likely be the last thought it plants in the head of someone who reads the lede. But the Cochrane review does not say that. Later, on, the same article is cited in this article saying "A 2010 Cochrane review suggests that placebo effects are only apparent in subjective, continuous measures, and in the treatment of pain and related conditions." That's a much better summary.

If you look at the "Plain Language Summary" on page 2 of the Cochrane review (page 6 of the PDF) "In general, placebo treatments produced no major health benefits, although on average they had a modest effect on outcomes reported by patients, such as pain. However, the effect on pain varied from large to non-existent, even in well-conducted trials." The "Author's conclusions" paragraph right above it says the same thing.

The Cochrane review is not saying that placebos "are not useful means of therapy." It's saying they can reduce pain and other subjective outcomes. So the lede should be changed to properly represent what the Cochrane article says, though I still think it is good to treat this as the final sentence of the lede. Anywikiuser (talk) 15:42, 9 October 2018 (UTC)

Can you please provide a sourced list of diseases for which inert treatments are objectively proven to be effective? This should be easy, since homeopathy is inert, so you could start with the list of conditions where homeopathy has been proven to cure anybody of anything, ever. Guy (Help!) 18:11, 9 October 2018 (UTC)

I can think of one: FDIS. Of course, that's the only one, and there's a variant that is resistant to all treatment. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 18:57, 9 October 2018 (UTC)

I presume you view this as sarcasm, but you are close to the truth. I used to think medicine was about saying "The test result was positive, so this person has [this ailment], therefore give them [this pill]." But the way a person feels during an illness depends on their perception of it, not just the provable stuff like the existence of a virus or a broken bone. That's why warmth, understanding and professionalism are important in any medical profession.

Are you reluctant to see the article changed because you worry it will promote pseudoscience? Anywikiuser (talk) 21:13, 9 October 2018 (UTC)

Obviously so. They saw me stressing the placebo effect at the homeopathy discussion page, saw a ten years old, stinky block in my block log in one of the pseudoscience articles and decided that I must be a lunatic charlatan supporting various pseudosciences and that this article (which was quite positive about the placebo effect) needs to be completely cleaned and never again be allowed to contain anything that may be misunderstood as the slightest support for pseudoscience. The most obvious indicator for a too positive version of the article seems to be whether it's acceptable for me, which means it's unacceptable for them. --rtc (talk) 22:50, 9 October 2018 (UTC)

Thank you for your thoughts, but the question was really for the editors who opposed my suggestion. Anywikiuser (talk) 08:22, 10 October 2018 (UTC)

The article is not great. It could do in particular with some details on how the altmed world has coopted placebo as a supposed means of therapy. What it most certainly doesn't need is implications that placebos treat disease, which is an extremely fringey position. There is also a lot of guff on this Talk page. Alexbrn (talk) 08:38, 10 October 2018 (UTC)

I agree. People need a good understanding of the placebo effect in order to understand why some people swear by alternative treatments. I'm fine with the article saying that the placebo effect can't cure cancer or kill bacteria. I'm fine with it saying it only affects perception and subjective measurements. But the article in its current form (due to edits this year) seems to be going too far, with the wording often denying that any such effect exists at all. Anywikiuser (talk) 09:33, 10 October 2018 (UTC)

My thoughts are precisely the same. The old version was certainly too positive about placebo effects (and certainly the placebo effect cannot cure cancer or kill bacteria), but this version is too negative. It does not match the letter nor the spirit of what the cited MEDRS sources have to say about the placebo effect. --rtc (talk) 10:29, 10 October 2018 (UTC)

Remember, though, that the "placebo effect" is not actually an effect, it is a control, a comparison with active treatment. It's a measure of the ability of your outcome measure to distinguish real treatment from bias. Objective measurements consistently fail to show any effect, unless conducted by people like Kaptchuk, who have a vested interest in an inert treatment. Guy (Help!) 11:28, 10 October 2018 (UTC)

"the wording often denying that any such effect exists at all" - could you give a few examples of this wording? - I'm not seeing it. We certainly do want to give the impression that the placebo effect doesn't exist, except in the realm of perception and subjective measurements, because that is npov per reliable sources. I suspect the differences of opinion we see on this talk page boil down to differences of understaning in what terms like "real", "exists" and "actual" mean. Any reader reading the article with any care will however see the basic knowledge is here. Alexbrn (talk) 11:41, 10 October 2018 (UTC)

"We certainly do want to give the impression that the placebo effect doesn't exist, except in the realm of perception and subjective measurements" No no no no no, that's not what the sources say. They say the placebo effect may be objective reality for pain sand such, but that this is hard to distinguish from reporting error! --rtc (talk) 11:51, 10 October 2018 (UTC)

As I said (and as the sources say) it is a question of definition. Your concept of "objective reality for pain" is another person's "realm of perception and subjective measurements". Discussion about this are probably futile here. Whatever, we need to be clear the upshot is that there is no evidence base or moral basis for ever prescribing placebo. Alexbrn (talk) 12:02, 10 October 2018 (UTC)

No no no no no, that's not what the sources say. ^{[citation needed]} ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:11, 10 October 2018 (UTC)

@Alexbrn: Almost everyone on this chat agrees that placebos are unlikely to cure an illness, but that they can have an impact on perceived/subjective outcomes. The former can be treated as a fact. The latter is a bit of a murky psychological effect, but I'd argue that firstly, that doesn't mean it can't be a real thing, otherwise nothing that psychologists and psychiatrists deal with is real. The question of whether it is "real" or not is better sidestepped rather than just saying it isn't. And secondly, there is some evidence in its favour. I'm content if we use the 2010 Cochrane meta-analysis as a guide. It doesn't give the 'placebo helps subjective outcomes' hypothesis a ringing endorsement, but it does say that "on average they had a modest effect" while noting that it varied a lot depending on how the trial was conducted.

Saying that there is some evidence for this hypothesis is not saying that it's advisable for doctors to do so, and we'd need wording to be careful at that so that people aren't left wondering "Why don't doctors give them out all the time?" The drawbacks are the ethical issue of deceiving a patient (though it's interesting to read the studies of what happens when the patient knows it's a placebo) and that medication with better subjective outcomes and actual objective outcomes is usually available. Anywikiuser (talk) 13:48, 10 October 2018 (UTC)

As well as the ethical concern, the upshot of the Cochrane paper is that there seems no empirical justification for prescribing placebo, that their clinical effects (such as they may be) are unimportant. So what we don't want to be doing is implying there does seem to be empirical justification for prescribing placebo, or that there is any clinical importance attached to any effect they may have. Alexbrn (talk) 14:25, 10 October 2018 (UTC)

The lede does an unrivalled job at showing that part of the study's conclusion. It still ought to show the remainder of the study's conclusion, that there is some evidence that placebos can make people feel better. That way it can provide a key reason for why some people swear by alternative treatments. I guess you would not want it to end on that note, instead finishing by saying that studies and healthcare systems do not recommend using placebos to treat illnesses? Anywikiuser (talk) 15:03, 10 October 2018 (UTC)

You mean we should put that placebos can affect peoples' assessment of their own condition? I have good news for you! Alexbrn (talk) 15:34, 10 October 2018 (UTC)

While that is true, at least for the short term, it's also unethical as it substitutes something which can have no real effect on the underlying biological condition which is causing the pain. It fools the patient into thinking they are actually getting better, when their underlying condition may actually be worsening. As it worsens, their pain will return, but by then it may be too late to save them. Substituting false hope for real possibilities is wrong, but I know you're aware of this. It just needs to be said. -- BullRangifer (talk) PingMe 15:57, 10 October 2018 (UTC)

I think what "real" really means here is this: Pain reduction by morphines is undoubtedly real, as it is caused by some know chemical reactions in the brain. But it's hard to say about placebos. The deception of the patient might cause a psychological reaction that sets off some chemical reaction similar to morphines, thus actually really reducing the pain. Or the patient might simply err about his level of pain, report a different level of pain while the brain chemistry still says the pain is the same as before the placebo. The patient might report a lower level of pain simply because of social expectations, not because the pain was actually reduced. I think that's it what the sources want to say. --rtc (talk) 14:34, 10 October 2018 (UTC)

Thank goodness we won’t be doing what you think. Roxy, in the middle. wooF 14:41, 10 October 2018 (UTC)

Huh? I don't know what you are talking about. Won't bother you further here for some time. See below. See you. --rtc (talk) 14:55, 10 October 2018 (UTC)

@Rtc: It sounds like the business of someone ignoring an itch or back pain because they're busy. Anywikiuser (talk) 15:05, 10 October 2018 (UTC)

"The patient might report a lower level of pain simply because of social expectations, not because the pain was actually reduced." Ummm.....if the person feels less pain they have less pain. Regardless of whether it has a biological or psychological basis, pain is still a feeling and a subjective experience. That experience is the personal reality for that person.

Yes, that is very much tied up with social and cultural expectations and conditioning, which is why different cultures express pain very differently in some situations, for example childbirth. Women in some cultures literally feel much less pain, and others literally feel much more pain, simply because of their culture. I feel sorry for those growing up where it's expected that one feel much pain. Those in other cultures are more fortunate.

Regardless, the pain is a real feeling, and, as I tell my patients, "I'm the health professional and am the expert in the care of your problem, but out of the 7.4 billion people on Earth, YOU are the only one who can feel your pain, and I will respect what you tell me. Keep me informed so I can better help you."

That doesn't mean I ignore obvious dissembling and manipulative behavior to get more pain killers...

Those things are still a factor in my care of any patient, but my basic starting point is to take the patient seriously and really listen. -- BullRangifer (talk) PingMe 15:09, 10 October 2018 (UTC)

There's data out there that supports the idea that people's attitudes to pain are influenced by the culture around them. Anywikiuser (talk) 15:19, 10 October 2018 (UTC)

Some, yes, but only when the cause is not organic disease. However, that's a digression. I mean, yes, you could say that the placebo effect is the effect whereby self-reported subjective symptoms are improved when you tell people they will feel better while giving them an inert pill, as compared to the situation where self-reported subjective symptoms are improved when you tell people they will feel better while `not giving them any intervention, but very few trials actually compare these two scenarios and I am not aware of a single one that does so with sufficient patients and controls (e.g. no treatment, cross-over) to make anything like a confident statement that the placebo effect itself is actually measurable, let alone how bit it is.

What people typically forget is that most of the data supporting any assertion that the inert pills themselves have any meaningful affect is shockingly poor. Aside form the COI problem, much of it comes from tiny studies, p-hacking, selection of endpoints not declared in advance, often the experimenter is not blinded, and virtually all the studies are based on self-reported surveys of subjective outcomes. Guy (Help!) 17:54, 10 October 2018 (UTC)

An observation.... Properly made homeopathic "medications" are the perfect placebo. "Homeopathy is bullshit. Only very, very diluted. It's completely safe to drink." - Peter Dorn -- BullRangifer (talk) PingMe 02:30, 11 October 2018 (UTC)