Article: NY Times: What if the Placebo Effect is Not A Trick

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By Gary Greenberg, Special to the New York Times Magazine, 2018 11 07

https://www.nytimes.com/2018/11/07/maga ... e=Homepage

An incredibly interesting article. Talks about how the placebo effect was recognized and used as a negative noise in medical research, whereas it may not be simply a psychological trick. Several serious and dutiful scientists have endeavoured on finding out microbiological details of how the placebo effect is useful.

In the process, it is revealed that while it has always been recognized as a working something, it was not embraced as a healing tool by the medical profession.

In the process, it is revealed that the healing process is hugely impacted by expected and familiar, but not frequent rituals in a person's life, such a going to the doctor's office, taking off your coat, waiting in the waiting room, going in to the examination room, etc.

In the process it is revealed that there are some genotypes that respond better to placebos than others. Some of the genes have been found responsible for this.

It is revealed that some religious research scientists who are involved in the research of explaining the placebo effect fear that this last bastion of faith- and impression-based branch of medicine (by that we mean that the actual effective medical healing is not causationally explained) will be turned into materialistic-based medicine.

An incredibly fascinating article. The second best I read in my life.

[BadgerJelly]

I thought this was old, old news?

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I thought this was old, old news?

This is the new part:

"In the process it is revealed that there are some genotypes that respond better to placebos than others. Some of the genes have been found responsible for this."

It is new because it is not merely a conjecture-theory any more. Some evidence has been found.

[zetreque]

I thought this was old, old news?

I thought so too. I donno about genotype but can't they just simply see it in the psychology generating better stats like better blood pressure levels, better metabolism/digestion due to hormone release, etc? I'm not sure I find the genotype finding as interesting as possible mechanisms of hormones, apoptosis, and metabolism changes that result from placebo inducing psychological changes.

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I thought this was old, old news?

I thought so too. I donno about genotype but can't they just simply see it in the psychology generating better stats like better blood pressure levels, better metabolism/digestion due to hormone release, etc? I'm not sure I find the genotype finding as interesting as possible mechanisms of hormones, apoptosis, and metabolism changes that result from placebo inducing psychological changes.

Right on. This is what makes placebo usage a science. To know and predict whom it works on and whom it does not.

Aside from this, the article was very, very well written; as a reading for pleasure is also warranted. Not just for its information value.

And absolute kudos for the research efforts of the author, Mr. Greenberg, I believe.

[BadgerJelly]

It’s not new news that some people are more susceptible than others. I’ll need to read more about this to figure out what the fuss is about.

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Zetreque, and BadgerJelly, I don't know if you persons read the article or not. From your responses I get the feeling that you have not. I say that because the article is exactly about your reservations that you voice here.

It will assure you that there has been correlational biomolecular evidence found that the placebo effect is more likely to work on some people than on others. It is no more a guess work, it is no longer mere random distribution over a sample of the placebo effect. At least not conceptually.

In other words there are real and tangible predictive characteristics that can be pointed out to tell whether the placebo effect will work on someone or not even before administering the placebo.

The article is long (over 5000 words) but it is light and easy reading. I really highly recommend it.

[BadgerJelly]

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I’ve read it, but I’m VERY cautious about claims relating genes to human behavior. I am ignorant enough to be skeptical.

This is a topic that REALLY REALLY interestes me so I’ll be looking more closely at this before the year is out.

Do you have any other links to this?

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OK, I understand your concern better now, BadgerJelly. I have no more links. Your skepticism is warranted, as genetic behaviour understood as a function of DNA is convoluted due to recessive / dominant genes, many genes acting upon the same quality, many qualities relying on several genes, etc. There is also gene-masking et cetera.

So by all means I support your skepticism. For me it's not so important to get independent checks; I am gullible. I believe everything unless there is contrary evidence to make it doubted. And I don't go out to look for contrary evidence. It's just me, my personality type, or learning type, if you will. But yours is more thorough, more dependable on getting true factual knowledge, yours is more reliable. Mine is quick and dirty -- believe it while it's reasonable to believe it.

[doogles]

I read the OP article and like others, I thought that it was very well written.

I found it hard to read the posts without repeatedly thinking of the prevalence of psychosomatic conditions in humans and the possibility that favourable responses to placebos in research trials in humans could be a responses by those subject to psychosomatic conditions which are well documented in human medicine. (Type 'psychosomatic illnesses' into Google Scholar). I did not research whether such mindsets have a genetic basis or not.

We can 'think' ourselves into feeling 'unwell' as easily as we can 'think' ourselves into feeling well even though we may have half a dozen real minor problems.


In all of my years of veterinary practice I did not diagnose such a thing as a psychosomatic condition in a sick non-human animal.


Just a thought that might make some sense out of favourable responses to placebos.

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"In all of my years of veterinary practice I did not diagnose such a thing as a psychosomatic condition in a sick non-human animal."
I guess it takes a certain level of complexity of thought. I believe animals think, some animals anyway, outside of humans; but to develop a psychosomatic illness would take abilities such as remorse, planning, and their extremes, such as shame, guilt, worry.

I Googled "psychosomatic healing", and all I got was healing psychosomatic illnesses. I was wondering if psychosomatosis can have a healing angle... the same mechanism, reversed, as what causes psychosomatic illnesses. But instread of reverse psychosomatosis healing psychosomatic illness, it would heal real illness, the psychosomatic way. (Meaning, if it can cause a healthy body to produce real symptoms of an illness, then the same mechanism could cause a sick body to not show symptoms, but show good health.)

You Doogles, seem to imply that the placebo effect is such a thing, although you did not spell it out that strongly as I stated its likelihood or rather, its potential possibility being precisely that, here.

I don't know anything about psychosomatosis, so I had better stop talking now.

[doogles]

"In all of my years of veterinary practice I did not diagnose such a thing as a psychosomatic condition in a sick non-human animal."
I guess it takes a certain level of complexity of thought. I believe animals think, some animals anyway, outside of humans; but to develop a psychosomatic illness would take abilities such as remorse, planning, and their extremes, such as shame, guilt, worry.

I Googled "psychosomatic healing", and all I got was healing psychosomatic illnesses. I was wondering if psychosomatosis can have a healing angle... the same mechanism, reversed, as what causes psychosomatic illnesses. But instread of reverse psychosomatosis healing psychosomatic illness, it would heal real illness, the psychosomatic way. (Meaning, if it can cause a healthy body to produce real symptoms of an illness, then the same mechanism could cause a sick body to not show symptoms, but show good health.)

You Doogles, seem to imply that the placebo effect is such a thing, although you did not spell it out that strongly as I stated its likelihood or rather, its potential possibility being precisely that, here.


I don't know anything about psychosomatosis, so I had better stop talking now.

-1-, thanks for commenting on my post. Yes, it was my intent to suggest that human beings prone to psychosomatic conditions could be more prone to positive responses to placebos.

Google Scholar is the search engine to use. You will see multitudes of references. Use the keywords 'Psychosomatic Conditions'.

Apparently there was a Journal of Psychosomatic Medicine back in the 1960s. I don't know whether it is still extant.

[Lozza]

Doctors used to be able to use placebos, but it was banned, likely due to overuse and subsequent bad results when the doctor thought it was psychosomatic, but wasn't.

There's a real problem with a General Practitioner (GP) using placebos...doctors are not psychiatrists. A GP is the bottom end of the doctor's spectrum....not qualified enough to be a specialist, or not capable enough. Don't get me wrong, there are some very good doctors that are General Practitioners working beneath their potential for whatever reasons, or because that's where their real interests lay. But a lot of doctors are not capable of making this determination. I have issue already with GP's prescribing psychotropic drugs when they are NOT psychiatrists, and a psychiatrist is a medical doctor first, then does another doctorate in psychiatry....so how does a GP get away with prescribing medications that they are not really qualified to do? They're not qualified to assess the person as having a psychiatric condition in the first place.

If there's a certain genotype that is conducive to the use of a placebo, what is the doctor going to say?..."You have to have a blood test so that we can then determine your genotype, to see if I can give you a sugar tablet instead of a medication."?!? Fair enough if doctors already know that a person is of that genotype, but in the first instance, how are they going to determine that surreptitiously in a world of "full disclosure"? It kind of defeats the purpose, doesn't it?

But my main issue is GP's prescribing outside of their scope of practice, and a GP is NOT qualified to assess whether or not a person has a psychiatric condition like hypochondria or a psychosomatic condition. Granted, these people aren't usually difficult to determine, but that's not the point, the point is operating outside a person's scope of practice, and "usually" is not synonymous with "always".

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Some of us are saying that the placebo effect works on gullible people who are prone to such conditions as psychosomatic diseases, and people in general are not divided by a line "these are gullible, those are not".

But I think we are losing sight of what the article said.

The article articled articulately that this is not a fine line, this is not a psychological effect, this is an actual scientific phenomenon that has direct and detectable causation, and it pointed at the causative relationship.

I thought I would add this as we were getting farther and farther away from the message of the article, and closer and closer to voicing our own strongly subjective unscientific opinion on the topic, and edging toward some consensus that is neither here nor there.

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That said, I am not sure if the article is right, and our unscientific opinion is wrong. I am saying, instead, that the article talks about research that has come to a conclusion of sorts, and our opinion on the other hand is not research-based but intuitively sourced. I wanted to gear the discussion to some sort of scientific (evidence-based) flow, instead of letting our own otherwise useful and valuable insights and intuitive opinions rule the day on the topic.

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The only practical effect and profitable discovery is not that sugar pills work. It is also that on some people even the drugs don't work. There is an effect of compassion and empathy that the patient feels the doctor is extending by caring for the patient, that helps the healing process, and for some patients, this effect is more important than the actual biochemical healing that the prescription pills provide.

This is one of the points, we, critics, seem to overlook in the article.

In other words, we need not select those on whom sugar pills work; for the sugar pills won't work on them unless the feeling of care is felt by them. They won't be healed by drugs, they won't be healed by placebos.They will be healed by drugs or placebos, however, when care is provided.

I think this is a more useful and practical lesson learned from the article than realizing that doctors must be tasked to separate the placebo-healing prone patients from those who are not.

The article even says that whether a patient is prone to heal by placebo, is determined by biochemical analysis; the doctor may or may not use this, in terms of a blood test, but he is certainly not tasked to do a physical or psychological examination to determine if the patient is placebo-healing prone; that is not provided as a working alternative by the article's suggestion.

[Lozza]

Some of us are saying that the placebo effect works on gullible people who are prone to such conditions as psychosomatic diseases, and people in general are not divided by a line "these are gullible, those are not".

But I think we are losing sight of what the article said.

The article articled articulately that this is not a fine line, this is not a psychological effect, this is an actual scientific phenomenon that has direct and detectable causation, and it pointed at the causative relationship.

I thought I would add this as we were getting farther and farther away from the message of the article, and closer and closer to voicing our own strongly subjective unscientific opinion on the topic, and edging toward some consensus that is neither here nor there.

Actually, the article doesn't mention "gullibility", and does mention the mind, which means there is a psychological interaction...the receiving of "compassionate treatment" is a psychological effect. I got the impression that it was speaking of everything in unison.

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Some of us are saying that the placebo effect works on gullible people who are prone to such conditions as psychosomatic diseases, and people in general are not divided by a line "these are gullible, those are not".

But I think we are losing sight of what the article said.

The article articled articulately that this is not a fine line, this is not a psychological effect, this is an actual scientific phenomenon that has direct and detectable causation, and it pointed at the causative relationship.

I thought I would add this as we were getting farther and farther away from the message of the article, and closer and closer to voicing our own strongly subjective unscientific opinion on the topic, and edging toward some consensus that is neither here nor there.

Actually, the article doesn't mention "gullibility", and does mention the mind, which means there is a psychological interaction...the receiving of "compassionate treatment" is a psychological effect. I got the impression that it was speaking of everything in unison.

... and I said some of US, not the article, speaks of gullibility, etc. And you're right, Lozza, the effect is psychological, except it's not determined by psychological make-up as we know it and classified it by types, but instead it is determined by genes.

As to whether the same genes are responsible for similar psychological effects, remains to be seen.

[BadgerJelly]

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Sorry. Not buying this. It’s a article in the NY Times. It’s mean as a sensationalist story. I doubt anyone in the scientific community even blinked and are unlikely to blink until multiple independant studies have been conducted - which will probably not really conclude much other than some correlation produced by multiple unknown factors.

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Sorry. Not buying this. It’s a article in the NY Times. It’s mean as a sensationalist story. I doubt anyone in the scientific community even blinked and are unlikely to blink until multiple independant studies have been conducted - which will probably not really conclude much other than some correlation produced by multiple unknown factors.

Well, you are lord of your own opinion. And I can't argue with your statement that it's not a scientific finding until independent studies verify it. I agree. All I can say it's a finding, an original finding, which needs to be verified or falsified.

I believe it, but it's as much an opinion as your disbelief. There is no science (knowledge) until it gets verified.

[BadgerJelly]

I have problem with scientists expressing speculative ideas and suggetsing possible implications of their results. My qualm is always with their need to push for funding (often by enticing companies to fund by presenting a false/ambiguous hypothesis), the reporters need to sensationalise any story they get, and appeal to genetics as a base answer to all that is human.

It is almost like saying we’ve found the gene that defines personality. It’s an exaggeration as always. It’s so mind boggling complex that we can merely suggest some probable correlation by mechanisms we’re unsure of.

I’ve gotten quite interested in “intelligence” over the years so I’m expressing what I’ve heard from leading figures in the field anout what genes can actually tell us. It all seems quite vague to me, but there are some promising indicators.

Someone said to me recently that there is a clear distinction between nature and nurture. It is that kind of dead-eyed view of genetics that has become an accepted lie; something akin to the whole fallacy of mind-body.

Anyway, I’ve got a week off next week so I’ll hopefully find time to dig into this further (although my knowledge of genetics is, admittedly, infantile at best!)

[TheVat]

As someone whose work has at times involved healing, it strikes me as completely uncontroversial that human contact and caring can augment and accelerate the body's own powers of recuperation and stress remediation. And that some people are more responsive to the power of suggestion than others. I think the causal chain isn't that hard to see (or clarify with further research): genes (and epigenetics) play a role in neurotransmitter balances. Neurotransmitters play a role in response to the power of suggestion, and to the response to stress. The power of suggestion affects healing. Connecting these dots doesn't mean proof that genes are the main navigator of personality, but it does mean that some people do better with placebos, faith healing, and soothing touch, than others. Well, duh.