Talk:Placebo/Archive 3

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Placebo effect

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

A year ago I found the article in a chaotic state and organised it into three chapters: Placebo, placebo effect, and placebo-controlled studies. In January, LittleHow improved the article and split off a large part of its material into Placebo-controlled studies. I think it's logical to split off the material on the placebo effect as well. Since there isn't all that much that can be said about placebos themselves as well, and since it is less technical than much of the material on the placebo effect and placebo-controlled studies, I think we should preserve Placebo as an introductory article that summarises Placebo-controlled studies and Placebo effect as sub-articles.

In practice this means either moving Placebo to Placebo effect, and then moving the material about placebos and placebo-controlled studies back from Placebo effect to Placebo (which will then become a new article). Or splitting off Placebo effect in the same way that Placebo-controlled studies was split off. --Hans Adler (talk) 14:26, 13 April 2009 (UTC)

As I said below, there's no such thing as a placebo without a placebo effect. This article should probably be retitled to the placebo effect.—Preceding unsigned comment added by ImperfectlyInformed (talk • contribs)

I don't see how your first sentence is an argument for anything. This article is large and may have to be split. There should be enough material for an article discussing types of placebos: Mass-produced placebos using names such as Obecalp, sham operations, sham acupuncture; also certain cultural and ethical aspects. The material that you have put into Placebo in history could fit there. Why not have an article Placebo directed primarily to lay readers and an article Placebo effect of a more technical nature. Each could summarise the other. --Hans Adler (talk) 00:20, 30 April 2009 (UTC)

Thinking about this again, I wasn't thinking clearly. I do think placebos always have some sort of placebo effect and they should be discussed together, but placebo is the basic concept and that should be the title of the article. I don't think we need more split-offs right now if proper trimming is done. Maybe after some more trimming has been done it will be necessary due to the amount of brain research/clinical trial info, but I don't think so. II | (t - c) 07:57, 1 May 2009 (UTC)

That works for me as well. But I'd like to make it clear that my idea would basically just mean moving placebo to placebo effect, moving placebo in history to placebo, and broaden the scope of the latter article so that some material can be moved from here to there. So it's not about spawning off even more articles than we have now. --Hans Adler (talk) 12:11, 1 May 2009 (UTC)

Any perceived effect of an inactive treatment can be referred to as a placebo effect. However, it is not uncommon to have a placebo treatment with no detectable effect (i.e., compare placebo-treated versus untreated)--this is the basis for the disputed nature of the existence of the effect. Additionally, the placebo effect can be considered a component of some demonstrably active treatments as well (particularly in metrics of qualitative effects), thus a "true" placebo isn't required for the effect. With this in mind, I think it's clear that placebo ≠ placebo effect, although they're obviously heavily related. I don't think this article is too big right now, but Hans Adler's plan isn't unreasonable if it gets there, particularly since the bulk of the article focuses on the effect. — Scientizzle 00:09, 2 May 2009 (UTC)

I agree, the name should be Placebo effect. As far as "placebo" is concerned, it is nowhere (AFAIK) in an English text mentioned except as a shorthand for "placebo effect". ... said: Rursus (bork²) 08:13, 8 July 2009 (UTC)

I change my mind. The text below treats "placebo" as the inert preparate served to achieve the "placebo effect". Nevertheless, "placebo" preparates are always occuring when to achieve the "placebo effect", so the name should IMHO be Placebo effect. ... said: Rursus (bork²) 08:19, 8 July 2009 (UTC)

The term placebo warrants it´s own article. But it has not been properly defined. The placebo effect or the placebo effect in studies, may warrant seperate articles but they are effects that are definitly linked to the use of placebo´s. I get the uncomfortable feeling that some of the editors (and maybe the original writer) feel cheated or have received placebo´s. JHvW (talk) 20:10, 22 July 2009 (UTC)

As one of the earliest contributors to what was, in the beginning, a strong and powerful, scientifically and historically correct set of inter-locking articles -- that have since been cut, pasted, destroyed, and invaded by irrelevant information in order to preserve current imprecise language use and unscientific thinking -- I most certainly do!!

The entire original set of articles has been kidnapped by those who really don't understand any of the issues involved - and, as a consequence, I have simply given up on trying to present what is both conceptually correct and what is historically correct.

There are far too many people attempting to impose their current erratic views (such as the abomination of "placebos pleasing" and "nocebos displeasing") upon both the past and the present; and there are even more serious distortions of the true history that have been perpetrated simply in order to allow those "invaders" and "contaminators by stealth" to assert things and make claims that seem to historically justify their current imprecise language use, and current pseudo-scientific ideas. Yes! It is a real shame!

But that is what happens when poorly-informed people confuse the professional task of presenting historical fact, with that of providing accounts of current folk-beliefs (such as, for example, the nonsense that the term placebo was adopted because placebos pleased).

However, given all of this, the greatest abomination of all is their persistence in speaking of a placebo effect, when all of the original literature without exception, and all of today's intelligent scientists exclusively speak of a placebo response. Lindsay658 (talk) 06:19, 23 July 2009 (UTC)

This is the point I am trying to make. It may may have been a good article (see also my statement under 8) once, but it no longer is. As the original contributors do not feel like a rewrite and a rewrite is needed, what is to be done? There is the risk that a new article will again be subjected to all sorts of opinions and not fact. Locking an article after it has been scrutinesed by some experts seems the only solution, although this may be contrary to Wikipedia policy.

It is my opinion that the subject matter of placebo, placebo effect or response and the use of placebo´s in controlled studies should be contained within one article as they are definitely related. This is quite common (not always rightly so) in the Wikipedia.

Finally I would like to point out that placebo´s are an important part of modern medicine and deserve a place in the Wikipedia. But it should be a good article. Although I am against deletism, some editorial supervision is obviously needed in this subject.

JHvW (talk) 07:07, 23 July 2009 (UTC)

Interesting New Zealand study

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

The word Sham

For the meaning of "sham" look at the wiktionary definition of sham

1. A fake; an imitation that purports to be genuine.

   The time-share deal was a sham.

2. Trickery, hoaxing.

   A con-man must be skilled in the arts of sham and deceit.

3. A decorative cover for a pillow.

====Synonyms====

• See also fake

====Antonyms====

• genuine
• sincere
• real

To call a placebo a sham therefore implies it is a fake or deceit. Placebos might be this but to use this as a definition of placebo is to rule out many medical treatments that are or have been given in good faith as placebos such a most medical treatments prior to modern era (such cupping and blood letting) and alternative medicines and procedures. The problem is that if these are excluded is that it puts the status of such treatments having a placebo effect in limbo. One solution might be to divide the article into a placebo article and placebo effect article with the placebo article focusing upon the improperness of treatments that have a placebo effect, and the placebo effect focusing upon expectation effects that result from false beliefs about the effectivenss of treatment.

Interestingly, the wiktionary definition of placebo does not mention sham.

1. A dummy medicine containing no active ingredients; an inert treatment.
2. Anything of no real benefit which nevertheless makes people feel better.

Perhaps the article should start with one or both of these definitions--LittleHow (talk) 15:34, 16 July 2009 (UTC)

This is another case in which the academic usage of a word differs with the colloquial. "Sham" treatments, particularly in the context of surgeries, are a common way to refer to the control arm of biomedical studies at all levels. Plug "sham" into PubMed and you'll get on the order of 44K hits (no doubt plenty of those are false positives, but it's meant simply to illustrate my point). The "sham" treatment of a study includes every component of the test minus the independent variable, whatever it may be. In some cases it does need to be "deceptive" to at least the patient (i.e., the sugar pill needs to look like the administered drug) and often the practitioner (i.e., double-blind studies...sepcial case: the sham acupuncture needles that were designed to fool acupuncturists).

Your argument, LittleHow, if I understand correctly, is that the perceived effects of some treatments that currently lack evidence of efficacy but were administered in good-faith based on the assumption that such treatments are/were efficacious can potentially be accurately described under the "placebo effect" but it may be inflammatory to refer to them as "shams". I partially agree with this, mostly based on potentially-confusing terminology, but see a larger issue...

This page deals with two issues in one, and those issues may need separate articles for greatest clarity:

• Placebo, as the actual practice of using a high-quality control in biomedical research, particularly an inactive ingredient to compare against a drug
• Placebo effect, the generalized explanation for perceived benefits ascribed to a treatment with no known efficacy

These are obviously related concepts, but very distinct: it is possible to have "the placebo effect" without a placebo (i.e., drugs with demonstrated clinical efficacy sometimes appear to do even better when patients get more time with friendly doctors) and there are multitudinous examples of placebos that provided no discernible positive effects.

I think I know where our wires are crossed: I reverted because I interpreted “placebo” in the form of my first bullet point, and “sham” is a technically correct (if colloquially clumsy) term for an intervention that is meant to be a non-efficacious control. LittleHow’s reversion is clearly closer to the definition of the “placebo effect”. Does this interpretation seem correct? If so, I think would this be better remedied by clearly differentiating “placebo” and “placebo effect”, perhaps by splitting the topics. — Scientizzle 16:36, 16 July 2009 (UTC)

I don't think the academic usage differs from the plain English. The placebo "dummy pill" is indeed a fake which purports to be some drug which it is not. Sugar pills administered as sugar pills are not placebos. Note that a definition from Moerman & Jones [1] appears in the Definitions section. II | (t - c) 16:57, 16 July 2009 (UTC)

Sometimes I think the colloquial use of "sham" edges beyond "deceptive" into "fraudulent" (see def. #2 in the wiktionary entry above), which may be where the resistence lies. The "fraudulent" interpretation imparts nefarious motives to the practitioner, whereas the intended "deceptive" meaning in biomedical research indicates necessary trickery to acheive a laudable goal. I would be open to finding an alternative word that may reduce this ambiguity, though I think "sham" is perfectly correct, and II's link is a great source. — Scientizzle 17:13, 16 July 2009 (UTC)

I baulked at it too (see article history), seeing it as a value judgement and a pejorative one at that. But I saw that Ben Goldacre, whom I respect, uses it in "The Placebo Effect: Do You Believe Your Teacher?" (The Guardian and on Wikibooks) and decided to let it stand when it was reinstated. I'm a strong advoacate of evidence-based medicine and (as per the Goldacre article) am well aware of how charlatans exploit the placebo effect with malice aforethought. However, it seems to me that we have a problem here in that the specialist literature uses it in a value-free way but that it common usage it is value-laden. Wikipedia is primarily a reference of first instance to people unfamiliar with the subject so IMO we ought to address that audience rather than the specialist one. Could we use "dummy" instead? --Red King (talk) 23:59, 18 July 2009 (UTC)

Placebo (what it is, its effect and its use in studies)

I have for some time followed the discussion around this article. There are a few points that I would like to make:

1. None of the contributors in the discussion seem to have any formal training in the subject matter. If Wikipedia is a forum for opinions this is, of course, all right. If Wikipedia is to be a reference for fact, this is a different matter.

2. The article is, like many articles in the Wikipedia, a conglomerate of subjective opinions, subject matter and fact. It is very hard for an outside person, just looking up something, to try to understand the article or to get the desired information.

3. The article can be much shorter, but it also has the potential to be a showcase article. Unfortunately the content of the article is not very well presented, very biased and unscientific. A rewrite is definitly desirable. This, however, does not mean that the original article was not good enough for Wikipedia. Too many people (probably a lot of them not properly trained) have made edits that may not have improved the article. This is always the risk on Wikipedia.

4. If the article is to be rewritten it should be done by someone who knows the subject matter. The article should then be protected for malicious or uninformed edits.

JHvW (talk) 20:04, 22 July 2009 (UTC)

Regarding 1: At least in my case I can explain why non-experts are meddling with this article: Because the experts are not taking care of it and it needs work at such a basic level that it's reasonable for non-experts to do. Just look at Talk:Placebo/Archive 1#Cleanup, where I explained my first edits to this article in April 2008. When I started, the article was about twice as long as it is now. It looked like this and had unused references such as "Hill, R.C. (trans.), St. John Chrysostom: Commentary on the Psalms, Volume Two, Holy Cross Orthodox Press, (Brookline), 1998" in a list of 100 "general" references.

Also note that at the time, WikiProject Pharmacology and WikiProject Medicine were each planning to make this article their Collaboration of the Week. Since they were both planning it, someone had the idea to synchronise it. Since that's hard to do, nothing ever happened.

Regarding 4: I agree with the first sentence. The second sentence sounds as if it refers to protection in the technical sense (described in WP:Protection policy), in which case there is no chance this will happen any time soon (i.e. not before a very strong general consensus about this kind of thing changes). We are supposed to protect articles by watching and maintaining them, not by ossifying them, but then, perhaps that's what you meant.

Obviously a well-written article of reasonable length (since we can use WP:Summary style, with sub-articles, this does not imply dropping relevant details) is much easier to defend than an article that readers and editors don't understand. This version from December 2006 illustrates the problem. I believe this is what Lindsay is referring to above in a related discussion as an earlier good version. In at least one sense it isn't. It consists of no less than 21 sections on the highest organisational level, with no clear sense of progression between them. This is the kind of article that encourages a reader to just add a new section when they can't decide into which of the strongly related sections 9, 23 and 65 the factoid they want to add fits best . Hans Adler 08:52, 23 July 2009 (UTC)

There seems to be some consensus. We all agree that this article needs rewriting and that it should be done by someone who knows the subject matter. Hans Adler has admitted that he may not be qualified, Lindsay has indicated that he has no desire to do so. Hans Adler has also stated that there were two WikiProjects interested in the article but nothing was done.

My proposal is that I rewrite the article after having examined the versions that Hans Adler has outlined in his response. But I also desire to set limits. The article will be about the placebo, the placebo effect, placebo response and the use of placebo´s in trials. If we are agreed I will make a temporary version in my sandbox, which we can then discuss. When we are agreed we can decide wether or not to replace the current article. In my opinion an article about the placebo has no place for subjects like fake or sham drugs or treatments. The nocebo (if there really is such a thing) warrants it´s own article. The article should be free of bias (like: is homeopathy really a treatment or a placebo response?) although some discussion of medical ethics is probably called for.

If and when the current article is replaced, someone should watch over it (as Hans Adler suggests). Who is going to do this?

JHvW (talk) 17:22, 23 July 2009 (UTC)

Could you elaborate on "no place for subjects like fake or sham drugs or treatments"? I thought it was pretty clear that administering a placebo is just a form of sham treatment, and placebos in a narrower sense of the word are sham drugs (although in the context of medicines the word "sham" is not as common in its technical sense). Do you mean to drop the discussion of placebos from this article and discuss only the placebo response? That makes sense, but I think you should do it at placebo effect or placebo response, which are both currently redirects pointing here. These are perfectly good article titles that define that topic better. Choosing such a precise title is one of many things one can do to make it easier to maintain the quality of an article. And then placebo can either discuss sham drugs and sham operations (I am sure sham drugs are an interesting topic of cultural history and the methods of sham surgery are under active research) or give a layman's description of all the related topics and serve as a gateway to the more specific articles. Hans Adler 18:13, 23 July 2009 (UTC)

In modern medicine it is considered to be medically unethical to "treat" a person with either an inert drug or an unnecessary procedure. It still happens sometimes (for example injecting a subject with saline solution which has no remedial effect) and has shown some effect but this is generally referred to as a placebo response. A placebo is by definition a pharmaceutical preparation with no active ingredient. In modern medicine a person is to be informed of the course of action taken. Informing the subject that treatment will be with an inert substance sort of defies it´s use. Any procedure brings with it risk for the well being of a person. Placebo procedures are therefore no longer accepted medical practice.

Historically placebo´s were accepted medical practice. Some of the pharmacopea´s actually contain descriptions of blue, red, yellow or green preparations. The use of these placebo´s is no longer acceptable (in the Western world).

Sham or fake medication are products that are designed to fool a possible consumer to believe it is actual medication. A popular example is Viagra which is sold as the real stuff. It looks the same, is packaged the same, even has a holographic seal but contains no active ingredient. This is fake medication. The words fake or sham by themselves defie informing a person who has decided to be treated.

Placebo´s are only to be used in studies. Why? When the effect of a drug is to be measured it needs to be measured against something. Not treating is not a reference. In a placebo controlled trial a person does not know wether a placebo or the drug on trial is being administered but they are informed that this may be the case. The placebo and drug on trial should be identical: same appearance, same packaging, same information leaflet. The effect of the placebo is zero (by definition). It is not to say that administering a placebo has no effect. But the effect of the drug is measured against the placebo. If the drug has no significant different response to treatment with the placebo, it has no effect. Notice that there is a marked difference between effect and response. Clinical trials have been stopped because side effects were so severe that further treatment was considered irresponsible. Some of these trials were stopped when the person suffering these side effects was actually in the placebo control group! There is much to be said about these trials, I have yet to read the article on placebo controlled trials but it must be clear that treatment with a placebo nowadays is only done in strictly regulated circumstances.

In an article on placebo responses, in my opinion, there should not be discussions of possible effects of therapies which have no evidence base. There are of course exceptions. Physical therapy has been shown to work, although there is little scientific evidence. The treatment of bipolar disorder with lithium has shown to be effective. Treatment with paracetamol (acetaminophen) is also known to be effective. In all these cases nobody knows how or why, but empirical analasys has shown efficacy. It remains to be seen wether these treatments should be mentioned in an article which is meant to be objective.

There is much more to be said, but I am not writing an article. This is a discussion.

JHvW (talk) 19:53, 23 July 2009 (UTC)

OK, in case it's necessary I would just like to remind you that this is not just an ecyclopedia of modern applied medicine. It's just as much an encyclopedia of the history of medicine, of practical aspects of medical research, etc. You needn't write about these aspects, of course. So long as you don't simply delete them, rather than put them in a place where they can be found, it's all right. I am looking forward to reading your article. Hans Adler 20:48, 23 July 2009 (UTC)

There are at best only half a dozen people in the world that could be probably called "placebo experts" and these would be in considerable disagreement. Apart from the lead introduction the article reflects most of the recent reviews written about placebos. ie

• A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought Donald D. Price, Damien G. Finniss, and Fabrizio Benedetti Annu. Rev. Psychol. 2008. 59:565–90
• Mechanisms of Placebo and Placebo-Related Effects Across Diseases and Treatments Fabrizio Benedetti Annu. Rev. Pharmacol. Toxicol. 2008. 48:33–60
• The Placebo Puzzle: Putting Together the Pieces Steve Stewart-Williams Health Psychology 2004, Vol. 23, No. 2, 198–206;
• Placebo: new insights into an old enigmaEdzard Ernst Drug Discovery Today Volume 12, Numbers 9/10 May 2007;
• Pain and the Placebo what we have learned Perspectives in Biology and Medicine, volume 48, number 2 (spring 2005):248–65 Ginger A. Hoffman, Anne Harrington, Howard L. Fields;
• Placebo Effect Ronald Eccles, Khawla Sadiq Jawad Eccles ENCYCLOPEDIA OF LIFE SCIENCES 2005

It is unfortunate that copyright reasons stop unloading these papers and others so those without access to an university esubscriptions cannot check them out.

What is needed is a split into two separate articles Placebo and Placebo Effect (a parallel here for the entity and the process might be the separate existence of two articles for symbol and symbolism). Also another article given editors concerns would be one for Medical Truthfulness. --LittleHow (talk) 10:33, 24 July 2009 (UTC)

I disagree with your opinion. Supporting your claim with the mentioned literature does not impress me either. Not to worry. I started an article on the placebo in my sandbox but it has already been marked for deletion. I do not paticularly care for wasting my time on writing stuff that will be deleted. So I am leaving it at this. I am going to Paris and have fun. I´ll waste my time on something else (like playing my bass guitar). JHvW (talk) 17:11, 24 July 2009 (UTC)

redirects are messed up

At the top it says "for other articles, see placebo something and placebo effect." Then if you click on "placebo effect" it takes you to another disambiguation page where it asks if you're interested in the placebo effect or some Doctor Who episode called "Placebo Effect." If you click the former, do you know where it takes you? Back to this page!

Would one of you please fix that? —Preceding unsigned comment added by 76.105.144.144 (talk) 06:52, 6 September 2009 (UTC)

It looks to me like it is working as intended. What do you think ought to happen instead? Looie496 (talk) 15:58, 6 September 2009 (UTC)

Inappropriate section: Group support and God as a placebo

It looks like someone just threw this section into the article. It doesn't fit the flow of the article, and it has a lot of uncited, possibly POV info. I've moved the section into "Mechanism of the effect" for now, but I believe it should be removed.Danshil (talk) 14:28, 21 October 2009 (UTC)

I agree with you and have removed the section. For reference, it was added on Sept 19 by leondumontfollower (talk · contribs). Looie496 (talk) 23:32, 22 October 2009 (UTC)

This article completely omits the primary part of the place effect

Which is the 'error in reporting' by the patient. How do you separate when a patient feels better versus he wrongly *thinks' he feels better, convinced by the doctor and the apparent treatment? You state in the article yourself that physical diseases such as wound healing are not improved by placebo when using objective test criteria. Isn't that a little suspicious? I strongly suspect that error in reporting makes up 90% or more of what we perceive as the placebo effect. 93.161.104.53 (talk)

How would you ever be able to objectively say that a patient who claims to "feel better" is in error? Looie496 (talk) 15:38, 28 September 2009 (UTC)

By examining him using objective criteria. Say, he reports that the placebo made his arthritis better but X-ray show it hasn't. Or improved his depression but the objective signs have in fact gotten worse, such as insomnia, weight loss and so on. Maybe the placebo put him in an optimistic mood and he now rates his disease differently, even though nothing has changed objectively. Note also that they usually don't ask him if he feels better(which is subjective) but if his disease is getting better(which is objective). Look at all the miraculous healings at christian TV shows. They proclaim to be instantly cured or that they improved but the week after they realise they feel the same as before and it was just suggestion. That is the placebo effect IMHO. 93.161.106.25 (talk) —Preceding undated comment added 15:36, 3 October 2009 (UTC).

I believe Looie496 was addressing the presumption that "feel" is subjective. Of course in this era of functional magnetic resonance imaging that presumption is no longer necessarily accurate, but for most purposes we still assume that meaning unless further qualified. User:LeadSongDog come howl 18:00, 30 March 2010 (UTC)

Additional information

There's a recent article from Wired that has a lot of information that could be added to the article:

• Steve Silberman (August 24, 2009). "Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why". Wired magazine.

-- John Broughton (♫♫) 16:09, 12 November 2009 (UTC)

Placebo Effect?

I kind of think this article should be called The Placebo Effect, not placebo, and the placebo disambiguation page should be called placebo or the band's article should be called placebo. Iminrainbows (talk) 00:52, 13 January 2010 (UTC)

Please see WP:Article titles and WP:MOSMED#Naming conventions both of which pertain. An obscure band's name, and one which is derivative from the effect, is not cause for renaming the article on the effect.User:LeadSongDog come howl 17:49, 30 March 2010 (UTC)

Homeopathy in lead

Two editors are apparently trying to use this article about a key concept of mainstream medicine as a coat rack for discussing homeopathy, a fringe topic. Homeopathy, as a system of therapy that relies mainly on placebos, is of course relevant to this article, as are many other fields of CAM, and as is the widespread abuse of aspirine and other relatively harmless medications as placebos described by GPs. But this fringe topic does not belong in the second sentence, per WP:UNDUE and WP:ONEWAY: When people hear of homeopathy, the think of placebos, but not usually the other way round. (Except for people who are obsessed with homeopathy or have another rare, specific reason to make the connection.)

I can see no valid reason for the change from

Common placebos are inert tablets, sham surgery, and other procedures based on false information.

to

Things that are known to produce a placebo effect are inert tablets, homeopathic preparations, sham surgery, and other procedures based on false and deceptive information.

• There is no need to avoid the word "placebo" for a medical intervention in the sentence right after its definition, and to circumscribe it awkwardly as "things that are known to produce a placebo effect. Especially not before the definition of the placebo effect.
• The list contains sham surgery and mentions other procedures. It is extremely jarring to refer to these as things, as they are obviously not physical things.
• There is no need for the loaded word "deceptive". We already have the equally loaded word "sham" in "sham surgery", which is justified because it is a technical term. That it is effective in getting the message across that placebos can be regarded as deception is evident from the number of complaints about this word on this talk page.
• There is no general agreement that deception that relieves a patient's symptoms is morally wrong. Therefore the pushing of "deceptive" into the second sentence, which already contains "sham", combined with a complete lack of even hinting at the opposite POV, is a severe POV problem. Since this is the lead and supposed to be brief, the solution is not to push one POV in the first place, rather than balance it with the opposing POV.
• Homeopathy has no business being mentioned in the first paragraph, per WP:ONEWAY as discussed above.

I am sick and tired of editors who make no positive contributions to certain articles trying to push their eccentric POVs into them or reverting blindly based on WP:ABF. In the entire history of this article, one of the editors in question has reverted several times, fixed a trivial grammar error (once), and tried to push the word "sham" into the first sentence. That's it. And now this. "Sourced, relevant and informative" is hardly a reasonable justification for adding the words "homeopathic preparations" and "deceptive" to the second lead sentence. And neither is confusion about the meaning of one of the most common English words. Hans Adler 12:52, 20 March 2010 (UTC)

(aside): I would really love to avoid yet another pseudoscience ArbCom. I also changed the section header to make it easier to search the archives.

I think Hans Adler's final bullet point says it best - people clicking on placebo are expecting to learn about placebos. The sourcing is almost certainly there to justify using homeopathy as a notable historical example in the body of the article, but there is really no need to burden the lead with unfamiliar terms and qualifying that "low potency" homeopathic preparations can have biological effects. If we are considering only homeopathic preparations like Oscillococcinum, then homeopathic preparation is entirely redundant with inert tablet, and should be cut out since the lead is already a bit on the long side.

On a semi-related note, we could change inert tablet to sugar pill, as the latter is both more accessible and redirects here. - 2/0 (cont.) 14:34, 20 March 2010 (UTC)

We once had sugar pill, but BullRangifer changed that, claiming that sugar is not inert. He does have a point: Sugar pills are usually made of lactose, which I guess can cause trouble with lactose intolerance. And it is not uncommon for people to develop lactose allergy (an unrelated condition) while on an anti-fungus diet (which avoids other sugars). [added later: I mixed something up here] Once they have it, I guess even the small amounts of lactose in a sugar pill become a problem. Hans Adler 14:47, 20 March 2010 (UTC)

Regarding another pseudoscience Arbcom case: Carcharoth has proposed addressing the obvious problems at Ghost, which have somehow managed to spill over all the way to this page, via an amendment to one of the earlier cases. I am currently preparing a related RfC/U. Let's wait if such an amendment is still necessary afterwards. Hans Adler 14:51, 20 March 2010 (UTC)

I don't really care either way on this, but I do want to note that Hans mistakenly marked an edit as minor which was not. Please do not do that. Per WP:MINOR, minor edits do not make content changes. II | (t - c) 18:52, 20 March 2010 (UTC)

Oh, sorry for that. I often use rollback + Javascript edit summaries for simple reverts for convenience, but I completely forgot that it marks edits as minor. I will try not to do this again. Hans Adler 19:44, 20 March 2010 (UTC)

Maybe you can tweak the program so it doesn't? I know we can tweak the monobook so Twinkle doesn't do that. II | (t - c) 20:03, 20 March 2010 (UTC)

It looks as if the API can't do that. I tried the "notminor" parameter, which is not documented for rollbacks, and it doesn't seem to work. (I don't know how it usually works, so I used "notminor=true".) Too bad. Hans Adler 20:43, 20 March 2010 (UTC)

Depression section: Placebo effect is NOT MEASURED in Double Blind trials but discounted

Am I the only one who is confused by the text and the reference in the depression section? Surely if there is a double blind trial the placebo effect should be discounted. If there is a large rate of recovery in both the placebo group and the active drug group the reason could be that a very large number of patients with depression get better over time regardless of whether they are on active medication or not. The placebo effect will be the same for both groups.

Here is my reasoning and understanding....

People taking placebo often report better recovery than people taking no medicine. The difference between the two groups is the PLACEBO EFFECT.

The PLACEBO RESPONSE is what is measured in the referenced meta-analysis study along with not the ACTIVE DRUG RESPONSE. The PLACEBO RESPONSE is not the same as the PLACEBO EFFECT because the placebo response will include those who spontaneously recover (or decline) and this factor is discounted when determining a PLACEBO EFFECT

PLACEBO EFFECT = PLACEBO TREATMENT RESPONSE + NO TREATMENT RESPONSE

The "No treatment response" is not the same as the pre-treatment state because Before and after measurements of wellness nust be taken in the No treatment group as well as the placebo group.

In most drug trials the drug is tested double blind against a placebo and the the statistical difference (if any) between the drug group and the placebo group is assumed to be totally due to the effect of the drug. In other words the placebo effect is fully discounted as well as the spontaneous recovery effect. In other words a given response in a double blind trial is assumed to be as follows

PLACEBO GROUP. Placebo Group response = Placebo response + elapsed time response

DRUG GROUP Observed response = Placebo response + Drug response + elaspsed time response

And therefore

DRUG RESPONSE = Drug group response less the Placebo group response

But following reference in the article led me to this in the abstract

" Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 doubleblind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect." http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1999-11094-001

I cannot fathom how they can claim to measure the placebo effect because the very nature of double blind trials eliminates the placebo effect (or more accurately at least it is present in equal measures in both groups) The "i'm taking a pill of some kind but I don't know what it is" effect is present in both groups. The large rate of recovery in the placebo group could simply be spontaneous recovery. A placebo effect, properly defined and measured cannot include spontaneous recovery. That is something else entirely.

Or have I misunderstood something? (quite possible - I am human!)--Hauskalainen (talk) 01:54, 25 April 2010 (UTC)

It sounds like you're discussing the same issue that Hrobjartsson & Gotzsche brought up in their Cochrane review. For the placebo effect to be properly measured there needs to be a no drug group. Many scientists have erroneously assumed that if there is only an active drug and a placebo drug, the placebo effect can be measured, when it really can't - it has to be compared to a no drug group. II | (t - c) 02:54, 25 April 2010 (UTC)

It seems obvious that the section needs work. I have changed the first sentence, based merely on the last sentence of the abstract (perhaps someone with access to the article can verify the change was correct), to say the placebo effect is "half", not 75%. The second sentence doesn't make much sense to me, but I guess it has a similar problem, as does the third. So I have tagged them.

The second paragraph also needs work/removing/replacing, but since it's less explicitly misleading than the rest I have not tagged it. It would be nice if an expert could do the rest. Hans Adler 08:57, 25 April 2010 (UTC)

II | (t has put it very succinctly. Thanks.

The new text is very well put, but I'm not sure I'd agree with the deletion of the text re clinical (mis)use of placebos. In a nutshell, this is the core issue between "mainstream" and "alternative" medicines. The former eschews the clinical use of placebos while the later forms embrace it under numerous elaborate sham methodologies, whether or not the practitioners believe the methodology matters. LeadSongDog come howl 15:44, 25 April 2010 (UTC)

Clinical misuse of placebos`???? Are you by any chance referring to this text which got deleted recently??.....

"In one common placebo procedure, a patient is given an inert pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief may produce a subjective perception of a therapeutic effect, causing the patient to feel their condition has improved. This phenomenon is known as the placebo effect."......

I think it got deleted because there it implies that patients are given an inert pill on the understanding that it will cure them. That is an unsubstantiated claim and if it happened it would, I believe, be totally unethical. AFAIK in clinical double blind trials, all the participants are told quite clearly that thay may be treated with the active drug or with a placebo and that neither the doctor adminstering the pill nor the patient will know which he or she gets. Patients understand this and participate in such trials voluntarily in order to advance medical knowledge. If you know otherwise then as long as you vans support the claim with a reliable source. the text could go back. As I see it, there is no evidence provided to substantiate the claim.

If I recall correctly, there was some discussion at the time about giving placebos to patients with depression given that they are "so effective" - but that was a misunderstanding and a misuse of the term "placebo effect" because there may have been no placebo effect at work at all in those patients who recover on placebo. Depression is a condition that in many people goes away in time anyway. You cannot know whether there is a placebo effect at work in depression unless there us a trial of placebo versus no treatment with measured outcomes. It may be that there isn't (or if there is, it may be clinincally insignificant). The important thing about that research is that it counters the "miracle drug" claims made for prozac and related drugs. They have some effect in the very depressed, but for the mildly depressed the results were clinically not significant for the drug versus placebo. (The outcome scores were statistically different in the meta data (say a 2 point improvement over time - I can't rememeber the actual data - but it is highly unlikely that a patient would cognitiviely detect an improvement of 2 points). The lesson of course is that doctors should be more honest with their patients before prescribing drugs that have imperceptible improvements when patients have heard wonder stories in the press no doubt fuelled by the marketing machines of the pharmaceutical companies. Getting back to the point though, I am not aware of any clinically acceptable method of prescribing a placebo though I am sure some doctors have prescribed acetaminophen tabs to their well "worrier" patients with mild aches and pains not telling them that it is something more commonly known by another name.--Hauskalainen (talk) 22:29, 28 April 2010 (UTC)

Note the (brackets) in "(mis)use". I fully understand that it is regarded as unethical in modern practice to use placebos except with disclosure under approved trial protocols. That has not always been the case. And given the disclosure has happened, the effect rather obviously has potentially been diminished. OTOH, practitioners of "alternative medicine" have no such ethical connundrum because they hold that they are not using placebos but "therapies". Paradoxically, the fullest potency of the placebo effect may only be available to those who are sure they are delivering real therapy, not a blinded pill that they are unsure of. Its a real connundrum, though I have no idea how suitable trials could be constructed to test it.LeadSongDog come howl 22:57, 28 April 2010 (UTC)

Hauskalainen, please read the article closely before doing a lot of changes and making broad statements. The second reference in the article is a survey of mainstream doctors and the use of placebo. It says "Among the general practitioners, 86% (95% confidence interval 81-91) reported to have used placebo interventions at least once, and 48% (41-55) to have used placebo interventions more than ten times, within the last year ...Approximately 30% (28-36) of the clinicians believed in an effect of placebo interventions on objective outcomes, and 46% (42-50) found clinical placebo interventions generally ethically acceptable". The fact that you changed the use of this reference suggests that you read it, and are therefore intentionally making false statements on the talk page. I hope that isn't the case, but you should not be changing the use of a reference without reading it.

In this edit, Hawskalainen added a definition of placebo effect which is unsourced and redundant with the last paragraph.

For these reasons I'm going to revert back to the April 25 version. II | (t - c) 23:12, 28 April 2010 (UTC)

Removal of items from List of medical conditions

Zobango, can you please explain the rationale behind your removal of items from this section? Anthony (talk) 09:00, 3 December 2010 (UTC)

Inert, or Sugar?

Question: are placebos inert, or do they actually contain sugar (sucrose)?

If they are inert, I think it should be noted that 'sugar pill' is misleading, as an inert pill would not contain sugar. But if they contain sugar I believe it should be noted that they are not wholly inert (just mostly inert) as rms notes that sugar "can make you fat." —Preceding unsigned comment added by 207.65.109.10 (talk) 07:15, 6 May 2010 (UTC)

Most modern inert placebo pills are not "sugar pills," as the latter is a euphemism used to refer to older placebos which were actually made of sugar. Instead, modern inert placebo pills are usually made of cellulose and are shaped and colored to look exactly like the drug pill (if used in an experiment - otherwise the color and shape is arbitrary, but may play a role in the placebo effect, e.g. red pills being more often perceived as stimulants than non-red pills). The reason sugar is no longer used is because sugar is not an inert material.

Yep. sugar taken orally affects pain processing. Anthony (talk) 12:12, 1 January 2011 (UTC)

COMPLETE REWRITE OF INTRO? Overt placebo effects not recognized in article.

In the very first paragraph the reader is left with a distinct impression that placebos operate entirely on the user not being fully aware that the item or action is inert in nature---that placebos need be covert in order to be effective. The citation(s) may be misunderstood here. I'm afraid that there is an unwarranted extrapolation: An article discussing the effectiveness of a covert information somehow being read as dictate that covertness is required.

Simply put, a patient can well be told that they are taking a placebo and it can still work. The parts of the brain that are responsible for repair are engaged in ways that we are only beginning to understand here. Just by taking the placebo, *even when the patient truly believes it to not do anything because it is sugar*, there are successes statistically measured. It's not as simple as we are making it seem in the beginning. This was the subject of a recent Scientific American Frontiers documentary. Take a look at the following Scientific American article:

Placebo effect: A cure in the Mind"New research shows placebos can also benefit patients who do not have faith in them"

Note, as I think a prior editor similarly expressed, I too am very wary of alternative medicine supporters using this or that loophole within Wikipedia to present their notions in a false light of established fact. The truth however here is that we are simply not covering it properly in the intro.Tgm1024 (talk) 02:56, 12 September 2010 (UTC)

Thanks for your excellent input and the pointer to an outstanding article. The lead certainly needs to be changed to take account of this information. Hans Adler 10:35, 12 September 2010 (UTC)

The Scientific American article does not really say that placebos don't work if you "truly don't believe in them". The headline suggests that, but the body doesn't have anything which says that. While you can "know something is a placebo" and it can still work on you, my reading of the SA article is that there's a subconscious belief happening. I do not think the article should be revised. II | (t - c) 03:08, 3 December 2010 (UTC)

I believe you may have completely misread it. That something hidden is happening here is precisely the point. Sure, call it a "subconscious belief" if you prefer, but regard what the article is saying: The subject is aware of the fact that they are indeed taking a placebo and it remains working. That is *not* reflected in the intro and in fact, the intro is a disaster in that it states the precisely the opposite. I don't blame anyone for offering resistance to this idea; the notion that placebos are 1:1 with deceit has been a long standing first approximation assumption. But reflect the research as it stands please.Tgm1024 (talk) 18:59, 7 December 2010 (UTC)

Can you find a peer-reviewed review article making the same point? II | (t - c) 08:45, 12 December 2010 (UTC)

This morning someone appended a reference to the Los Angeles Times to the lede. I've replaced it with yesterday's PLoS ONE paper which the LATimes piece mentions, but it is still a primary publication on a small clinical trial. Further, the comments to the paper already include one by Daniel Zigman pointing out that the study design is flawed, subject to significant reporting bias of the subject patients. It's something of a connundrum. How could you measure overt placebo effect without reporting bias? The answer, obviously, is to eliminate the reporting and instead rely on instrumented measurements. LeadSongDog come howl! 18:15, 23 December 2010 (UTC)

This is fascinating. Anthony (talk) 11:49, 1 January 2011 (UTC)

Cleanup of related pages

There was a glut of so-called "related pages" on this article, so I decided to be bold and remove some of the excess ones. The article is still pretty long and cumbersome, so if it isn't a bother, I might edit some information in the actual article as well Zobango (talk) 11:10, 2 December 2010 (UTC)

You're right that linkfarm needed cleanup, though most of the linked articles should be or have been worked into the article text. A good copyedit would certainly help, but please be cautious about trimming substantive content, as this article can be contentious. If in doubt, it's best to discuss first. LeadSongDog come howl! 14:10, 2 December 2010 (UTC)

Fair enough. Feel free to make suggestions about exactly what I should do Zobango (talk) 14:24, 2 December 2010 (UTC)

I have removed Homeopathy from Placebo#See also because it is just one of thousands of interventions whose effect is largely or entirely placebo. Anthony (talk) 14:54, 2 December 2010 (UTC)

User:Cluebot reverted one of my major edits. I'm considering reverting it.

Zobango (talk) 15:24, 2 December 2010 (UTC)

I have restored your edits. Anthony (talk) 15:58, 2 December 2010 (UTC)

• I do not understand the statement that homeopathy is "just one of thousands of interventions whose effect is largely or entirely placebo". As far as I am aware, it is the only treatment which is entirely defined by its placebo nature. Other treatments are therapeutic but used as placebos incidentally (e.g. multivitamins or aspirin). II | (t - c) 03:10, 3 December 2010 (UTC)

  There are plenty of different placebos in the world of alt-med. (In fact, if research were to show any one of them as having an effect beyond placebo, they'd move from "alternative medicine" to just "medicine"). How about Reiki or Bach Flower Remedies? bobrayner (talk) 05:20, 3 December 2010 (UTC)

  Be clear here. Placebo's are not themselves definable by alternative medicine. Many alternative "medicines", however, *might* be entirely defined by psychosomatic and/or placebo effects. The very definition of what placebo's truly are (neurological vs. psychological) is changing a great deal of everything else. See my comments on rewriting the intro above.Tgm1024 (talk) 19:08, 7 December 2010 (UTC)

Notification of edits, and a question

I updated the section on "Clinical significance" involving Hróbjartsson & Gøtzsche's meta-analyses. I added a new subsection on chronic fatigue syndrome and provided a summary of the reduced placebo response in this condition. I also have a question regarding the "Gastric and duodenal ulcers" section, the supposed "healing" power of placebos, do the sources discuss research which compared placebo to no treatment ie natural course, or was it just assumed that healing in the placebo control group was due to the placebo effect? - Tekaphor (TALK) 02:56, 17 January 2011 (UTC)

Placebo#List of medical conditions

A month ago, Zobango removed about two thirds of this list. Today I removed the remainder, and Brangifer reverted me. So I've brought it here for a chat. My reason for reverting was simple: I can't see any point for the list which, if complete, will be very long. Can someone offer a justification for keeping it? Anthony (talk) 10:35, 1 January 2011 (UTC)

I have systematically gone through the edit history for the last month (a very time consuming process!) and see what happened. Zobangos edits "on this particular list" were done without discussion or edit summary and were very properly treated by ClueBot as vandalism, and he was also warned on his talk page, for which he apologized. I have restored the whole thing (with a change in number of columns to conserve space), and here's my reasoning: That content was created over a very long time by numerous editors, with lots of debate, and thus that content is a consensus inclusion. Removing such content is a slap in the face for all that hard work, IOW an act of bad faith toward all those editors, and thus rightly qualifies as vandalism. Change or removal must also happen by consensus. It's valuable content which provides readers with "the state of the art", so to speak. When they come to this article, some will be interested to learn how this subject applies to their condition. We've done them a great service.

As far as the See also list which is now gone, homeopathy was left for awhile and then deleted. I'll leave it that way. It is mentioned in the article, and that's fine with me. What's special about homeopathy is that unlike other forms of alternative medicine (which may have various forms of effect (sometimes bad) beyond the placebo effect, just not what they claim!), homeopathy works exclusively as a placebo with NO other proven effects. In fact it's the ideal placebo. -- Brangifer (talk) 20:47, 1 January 2011 (UTC)

That all sounds reasonable to me. Thanks for going to the trouble. For the record, though, speaking just for myself, I'd prefer to see the list gone - altogether or forked off to a list article. I still can't see the point of it here. Anthony (talk) 02:58, 2 January 2011 (UTC)

I think I'm dimly beginning to see the point you and II have been trying to impress on me, and it's dawning on me that medicine cannot, for ethical reasons, ply placebos, but placebo may be the only treatment available for some intractable conditions. So I'd approve of a GP encouraging a patient to try alternative treatments for otherwise intractable conditions known to respond to placebo, but only provided they follow up the patient when an active treatment becomes available. Anthony (talk) 16:49, 4 January 2011 (UTC)

How can this list be anywhere near inclusive since almost every illness is researched with double blind placebo controlled studies? Ward20 (talk) 06:45, 4 May 2011 (UTC)

Some interesting studies

Placebo effect works both ways http://www.sciencedaily.com/releases/2011/02/110226212356.htm Family Physicians Believe the Placebo Effect Is Therapeutic But Often Use Real Drugs as Placebos http://www.stfm.org/fmhub/fm2010/October/Rachel636.pdf Gandydancer (talk) 00:11, 28 February 2011 (UTC)

Long-term effects of placebo

Does anyone know of any research into this field? I just read that the short term placebo effect may constitute as much as 82 per cent of the explanation of the improvement in any patient's conditions. It would be interesting to know what happens when 50 per cent of all patients in a "triple" blind test are informed in advance of medication that believing in the drug is the prime cause of the effect they might achieve. One might expect that as the placebo effect becomes generally known to the public, the whole concept of placebo becomes somewhat watered out.--Teodor 10:24, 29 April 2011 (UTC) —Preceding unsigned comment added by Teodor605 (talk • contribs)