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"In other words, the best research we have strongly suggests that placebo effects are illusions, not real physiological effects"

not true!

see:

" Recent research demonstrates that placebo effects are genuine psychobiological phenomenon attributable to the overall therapeutic context, and that placebo effects can be robust in both laboratory and clinical settings. Evidence has also emerged that placebo effects can exist in clinical practice, even if no placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical harnessing of placebo mechanisms that are inherent in routine clinical care and the potential use of treatments to primarily promote placebo effects."

from:

Placebo Effects: Biological, Clinical and Ethical Advances (Damien G Finniss, Ted J Kaptchuk, Franklin Miller, and Fabrizio Benedetti

PMCID: PMC2832199 / NIHMSID: NIHMS169379

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/

"Conclusions:

It is evident that placebo effects are real and that they have therapeutic potential. Laboratory evidence supports the existence of numerous placebo mechanisms and effects in both healthy volunteers and patients with a variety of medical conditions. Furthermore, clinically relevant evidence demonstrates that placebo effects can have meaningful therapeutic effects, by virtue of magnitude and duration, in different patient populations. Although substantial progress has been made in understanding placebo effects, considerable scientific work remains to be done in both laboratory experiments and translational clinical trial research, with the ultimate aim of harnessing placebo effects to improve patient care. "

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/

I had better respond to this reply, which I see is NOT responsive to the references I supplied in my original post. The link shown here, to a paper co-authored by Ted J Kaptchuk, was surely submitted here in good faith, and I thank the user who submitted it for that, but in fact Mr. Kaptchuk (he is NOT a doctor and does not have good training in human physiology or research methods) is well known as a promoter of ideas about healing through thinking that have no factual basis and are not backed up by science. Basically all roads to strong statements about "placebo effect" lead back to writings by Ted J Kaptchuk, which are heavily promoted by press releases.

So I invite all readers of Hacker News to compare the references I supply in this thread to the references supplied for the proposition that there are clinically meaningful placebo effects that actually heal disease in human patients. I especially encourage everyone reading this thread to review all the cited studies with the checklist by Peter Norvig, Google's director of research, "Warning Signs in Experimental Design and Interpretation"

http://norvig.com/experiment-design.html

in mind as you read the studies. Statistically valid, carefully designed research studies do NOT show clinically useful placebo effects. Preliminary studies by researchers who promote "alternative medicine" occasionally show patient self-reports of benefits in subjective symptoms (pain or discomfort) from placebo. Those have not been replicated by independent researchers.

Careful studies do not show healing of disease from administering placebos or by other mind-over-matter processes. Extraordinary claims require extraordinary evidence, and the burden of proof is on people (people without medical training and clinical experience, let me remind you) who claim that anyone can cure serious disease with a mere placebo effect.

The reply above prompted me to rewrite my original comment here (the comment that is "grandfather" to this comment) as a FAQ file. I'll post that below.

Because the submitted article mentions the placebo effect, in the usual manner of popular articles, perhaps I should share here some links that are helpful for understanding what placebo effects are all about. Some of these online links cite quite a few useful scholarly publications.

http://www.sciencebasedmedicine.org/index.php/michael-specte...

"In other words, the best research we have strongly suggests that placebo effects are illusions, not real physiological effects. The possible exception to this are the subjective symptoms of pain and nausea, where the placebo effects are highly variable and may be due to subjective reporting."

Despite the numerous press releases on the Web pointing to publications co-authored by Ted Kaptchuk, who has NO medical training or credentials,

http://www.sciencebasedmedicine.org/index.php/dummy-medicine...

the statements typically found in those articles, such as "Recent research demonstrates that placebo effects are genuine psychobiological phenomenon [sic] attributable to the overall therapeutic context, and that placebo effects can be robust in both laboratory and clinical settings" are untrue.

http://theness.com/neurologicablog/index.php/the-rise-and-fa...

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

http://www.ncbi.nlm.nih.gov/pubmed/20091554

"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."

Fabrizio Benedetti, a co-author of one of the most cited papers who is also a medical doctor, sums up his view this way: "I am a doctor, it is true, but I am mainly a neurophysiologist, so I use the placebo response as a model to understand how our brain works. I am not sure that in the future it will have a clinical application."

http://www.brainsciencepodcast.com/storage/transcripts/year-...

To sum up, despite claims to the contrary by a person without medical training who is often covered by the lay press, the best-considered view among medical practitioners with clinical experience is that the placebo response has no clinical application.

http://www.skepdic.com/placebo.html

http://www.sciencebasedmedicine.org/index.php/revisiting-dan...

>"the best-considered view among medical practitioners with clinical experience is that the placebo response has no clinical application."

see -> "open-hidden paradigm"

"Placebo Effects are Inherent in Clinical Practice – even when no placebo is given

Some of the clearest evidence supporting the involvement of placebo effects in clinical care comes in the form of the open-hidden paradigm (Figure 3). In this experimental paradigm a treatment is given in a routine manner (the open administration), where the psychosocial context surrounding treatment administration is present, and a hidden manner, where the treatment is given without the patient's knowledge. In the case of drug therapy, the open administration mimics normal clinical care, where the doctor injects a drug in full view of the patient with verbal and contextual interactions. In the hidden administration, the drug is infused by a computer pump in the absence of the clinician and the therapeutic context. Patients receiving hidden administration are aware that at some stage they will receive a drug but they do not experience the expectation component or other contextual factors surrounding the administration. Because the hidden administration removes the psychosocial context of treatment, this paradigm defines the placebo component as the difference between open and hidden administrations, although no placebo is given

The open-hidden paradigm has been used in several clinical settings.

In pain, hidden administrations of five commonly used painkillers (morphine, buprenorphine, tramadol, ketorolac, metamizol) have been demonstrated to be markedly less effective than open administrations. ..." -> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/

You are my favorite person of the day, because when I saw this post title, I said "Oh great, now I'm going to spend my morning writing another comment about how the placebo effect is probably mostly an illusion," and now I am released from that yoke.

The article from science based medicine is fantastic. To quote:

"Recently the main special pleading we have been hearing is that CAM modalities work through the placebo effect. That is why they are so desperate to represent the placebo effect as something more than it is"

I think this is a very important point. In years past, all my 'alternative' friends would throw out all kinds of wild statements on how their treatments would work, safe in knowledge that it had not been conclusively disproved. Now that the gray area they reside in is being shut down, I've noticed a lot more lately that conversations end with "well, I just do it for the placebo affect". I never really noticed how often I hear this until I read the article. And now that even that gray area is being shut down, it makes me wonder what special pleading is going to be next.

You might like Irving Kirsch's book The Emperor's New Drugs. It's all about the placebo effect as it relates to antidepressants, but also more generally. I know with depression specifically the difference between placebo treatment and no treatment is actually quite large.

Also, that skepdic link is severely flawed. There isn't one placebo effect, but rather a series of placebo effects. There isn't any reason to think that using a sugar pill to treat pain would have roughly the same efficacy as using gardening to treat heart disease, which is what the skepdic article basically claims.

That may be true, but in my personal experience I had to try a several different anti-depressants before I found one that worked.

That may have been the case, but research shows that it often takes several different placebos to find one that works. In fact, the chances of depression remitting when changing antidepressants are comparable to the chances of a disease being treated when changing placebos.

> But human beings, with their very complicated behavior > patterns for adaptation to many environments, probably have > a system for regulating immune response that is harder to > observe.

That, and even when playing along with this case, it would seem logical for our immune system to conserve these precious resources by relaxing and taking it easy when we know some medicine is going in to help us rather than go full throttle.