Talk:Placebo

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This article is within the scope of WikiProject Psychology, which collaborates on Psychology and related subjects on Wikipedia. To participate, help improve this article or visit the project page for details on the project. Start This article has been rated as start-Class on the quality scale. High This article has been rated as high-importance on the importance scale. Article Grading: The following comments were left by the quality and importance raters: (edit comments - comment history - watch comments · refresh this page) Needs more reference, these could be drawn from other placebo articles probably Irongargoyle 18:48, 19 September 2006 (UTC)

Contents 1 Canadian study 2 More discussion 3 Suggestion to merge 4 Symmetry in usage 5 Redirect 6 Merger into paradox/irony/oxymoron 7 Merging 8 Inline text or ref footnotes? 9 Obecalp 10 Article length 11 Intro

[edit] Canadian study

A group of Canadians have done an indepth analysis of the use of placebos for Health Canada and the Canadian Institutes for Health Research under Chair Heather Sampson the report can be found at http://www.cihr-irsc.gc.ca/e/25139.html. -- 24.156.8.4300:59, 1 March 2005

[edit] More discussion

Hello. This article needs many more off article talk. Placebo is confusing and many use it as excuses for misconduct in medicine and getting money for sugar tablets or holy water snake oil. Article is very good, but I will see if I can be adding some more info to the talk. Hylas Chung 08:52, 25 May 2006 (UTC)

[edit] Suggestion to merge

It is my intention to edit a merge of these two pages for several reasons.

(1) to make the placebo article symmmetrical with the article on the counterpart, derivative term nocebo.

(2) a certain amount of the confusion within and between the two current articles, and right throughout the available literature, is caused by the fact that there are several different applications of the term placebo, which are in their origins, correct application, and function, so different that they are clearly homonyms (rather, that is, being examples of an essentially contested concept, where people are disputing about what is the best and most ideal instantiation of a notion upon which they all agree).

(3) the historical reasons for the emergence of certain of these terminological usages need to be explained; in particular because some of them have been responsible for the emergence of derivative terms and concepts (e.g., nocebo).

(4) much of the controversy is generated by a failure to distinguish which kind of placebo is being spoken of.

I am suggesting that a combined entry, with clear sections on, for example, "what does the term placebo denote?", "Why placebo effect?", "why placebo response?", "Ambiguity of usage of terminology" and similar important items can be discussed, clearly described and elaborated, before any of the issues relating to the role, ethics and relevance of placebos in drug trials can be either understood or discussed.

Anyway, produced the current article on nocebo, I would be prepared to submit a merged article within a short time, for all to view and edit further.

Such a presentation, would then also allow readers to understand the issue in the realm of medicine, as raised by:

Stewart-Williams, S. & Podd, J., "The Placebo Effect: Dissolving the Expectancy Versus Conditioning Debate", Psychological Bulletin, Vol.130, No.2, (March 2004), p.326:

Finally, it is sometimes argued that placebo effects are, by definition, desirable effects. After all, the word placebo comes from the Latin meaning “to please,” and the archetypal placebo event involves an improvement in health. The undesirable effects of inert agents have been dubbed nocebo effects, and the agents producing them nocebos (Hahn, 1997). Just as inert agents can produce analgesia, they can also produce hyperalgesia (Benedetti & Amanzio, 1997). In the latter case, the inert agent would be a nocebo and the hyperalgesia a nocebo effect. However, there are several problems with the placebo–nocebo distinction. Inert agents may sometimes simultaneously produce both desirable and undesirable symptoms. For example, the response may mimic not only the healing effects of drugs and other treatments, but also some of their side effects (Shapiro, Chassan, Morris, & Frick, 1974). In such instances, we would have to say that the agent in question is both a placebo and a nocebo. It would be more parsimonious to say that the same agent (a placebo) can simultaneously produce both desirable and undesirable effects. Another problem is that the same effect might be desirable for one person but undesirable for another. For instance, placebo immunosuppression may be undesirable to most people but desirable to people suffering an autoimmune disorder (Olness & Ader, 1992). In this case, we would have to say that the former group had taken nocebos but the latter placebos, and we could not know which we had administered until we had established whether the recipients considered the effects desirable or not. Furthermore, although the same effect was produced in both cases, and presumably through the same mechanisms, by labeling one a placebo effect and one a nocebo effect, we would in effect be treating it as two different phenomena, simply because it was desirable to one group but not the other. These considerations lead us to suggest that, despite the origin of the word placebo, the desirability of the effect should not be part of the definition [of the terms placebo and placebo effect].

• References
• Benedetti, F., & Amanzio, M. (1997). The neurobiology of placebo analgesia: From endogenous opioids to cholecystokinin. Progress in Neurobiology, 52, 109–125.
• Hahn, R. A. (1997). The nocebo phenomenon: Scope and foundations. In A. Harrington (Ed.), The placebo effect: An interdisciplinary exploration (pp. 56–76). Cambridge, MA: Harvard University Press.
• Olness, K., & Ader, R. (1992). Conditioning as an adjunct in the pharmacotherapy of lupus erythematosus. Journal of Developmental & Behavioral Pediatrics, 13, 124–125.
• Shapiro, A. K., Chassan, J., Morris, L. A., & Frick, R. (1974). Placebo-induced side effects. Journal of Operational Psychiatry, 6, 43–46.

--- It would look something like this (given that I have already merged 4, 5 & 6 under nocebo): I believe that we need the following six divisions to clearly disambiguate the mess:

(1) Placebo: describing the evolution of the term placebo, from the Septuagint version of the Psalms, as translated by Jerome into his first version of the Vulgate, and how this translation was used as the text for the Roman Catholic "Office of the Dead" ritual, etc.,etc. and how, following this thread, how the original term placebo has only one meaning: a simulator.

Then all of the applications of such a dummy simulator in medicine and pharmacology could be discussed.

A second section would also need to appear to detail the pejorative use of the term placebo -- in the period where modern scientific medicine was emerging from the morass of herbal medicine and traditional physic, and was atempting to dissociate itself from so-called "heroic medicine" -- to designate therpies that had once been thought efficacious, but were now found (per medium of this fore-runner of evidence based medicine) to be bereft of active ingredients.

A third section would need to appear to deal with the therapist-delivered placebo (essentially the legendary sugar pill) which embodied the notion that a placebo was a "pleaser".

All of this is because the issue of elaborating all of the considerably different aspects of all of the different sorts of placebo, requires such a sort of exposition.

(2) Placebo Effect: Stressing that this description ascribes agency to the drug. A short note stating that this was either the consequence of being given either a sugar pill, or of being given a dummy, inert, simulator (it didn't matter which) -- and, as a consequence, the administraion (in either case) of something which, both by definition, and by stipulation, contained no active substances, and therefore, could not logically be spoken of having any sort of substance-centred agency (as it was all subject-centred response). But, in addition, once the term placebo began to be used by some people to denote "an active and pleasing drug", it was then technically possible to speak of a placebo effect.

(3) Placebo Response: Essentially a matching piece to that which I have written about "nocebo response".

This would then lead on to (4) Nocebo; (5) Nocebo Effect; and (6) Nocebo Response: as it now apppears under nocebo.

Finally, due to the interwoven histories of the terms placebo, placebo effect, placebo reaction, placebo response, nocebo, nocebo effect, nocebo reaction, and nocebo response,I believe that everyone would be far better served if the two placebo sections are merged; and, as a consequence are symmetrical with article on nocebo.

Given all of the above, I must also add that I have thought about things for a very long time, and I really can't come up with any single argument against merging thhe two articles. Anyway, I offer this up for your consideration cogtrue 00:29, 1 June 2006 (UTC)

Surprised to see no response to your post for such a long time. I offer my views with regards to your arguments:

1. The symmetry argument doesn't necessarily hold in my opinion as the terms "placebo" and "placebo effect" are well known while "nocebo" and "nocebo effect" are not. A search on Google results in 1,200,000 pages on "placebo effect" and 18,600 pages on "nocebo effect". So there is no symmetry in usage.
2. The confusion within the articles will not necessarily be resolved by a merge. On the other hand, if a merge does resolve the confusion, there is no reasoin why the articles couldn't be separated again without causing confusion again.
3. Could the emergence of various terms be explained satisfactorily but without going into too much detail in the main (placebo) article?
4. Again, would a merge help clarify the term "placebo"? Not necessarily.

Having said all that, I am much in favour of your presentation of the article's structure. Providing such a structure will go a long way to alleviate all issues you are talking about. However, since the term "placebo effect" is widely used, I doubt you could simply merge ii into the main article.

In summary, I would favour a structured presentation of "placebo" as outlined, but also keeping the "placebo effect" article. This solution would integrate all features of your suggestion while leaving open the possibility for a detailed explanation of the "placebo effect." Aquirata 22:09, 15 June 2006 (UTC)

Hello. I think placebo and effect should be merge. But it should also be kept seperate. The merging one will be the top hierarchy and be summarized over time. The other ones can be linked. Redundant lines can be cut by good editing. Thanks. Hylas Chung 05:50, 27 July 2006 (UTC)

Hello, as a personn working in pharmaceutical industry, I think that placebo and placebo effect are two different things. A placebo is the reconstitued medicine without the active ingredient and if used by human can give a placebo effect, but placebo is also made for analytical tests. In this case no placebo effect. Secondly, placebo effect can be obtained by taken a placebo, but also for many other reason. for example when you take a medecine by oral route, you often feel better in few minutes in spite of it is still not in your blood.

that's why i think that it not the best idea to merge placebo effect and placebo.--Leridant 08:30, 1 August 2006 (UTC)

I also oppose the merge, the placebo effect is a significant topic worthy of its own article. Addhoc 12:54, 9 August 2006 (UTC)

I oppose too, Wiki should be easy to browse with common intuition which dictates in opposition to merger. (I'm an unregistered user) - a chemistry student from Israel.

I support the merge, very related topics. --Afa86 21:14, 4 November 2006 (UTC)

[edit] Symmetry in usage

On 15 June, in relation to Nocebo, Aquirata commented as follows:

The symmetry argument doesn't necessarily hold in my opinion as the terms "placebo" and "placebo effect" are well known while "nocebo" and "nocebo effect" are not. A search on Google results in 1,200,000 pages on "placebo effect" and 18,600 pages on "nocebo effect". So there is no symmetry in usage.

Whilst this comment is accurate, in one sense it is not entirely "correct".

The issue with the term "nocebo" (the bringer of harm) is that it is, essentially, a deviant usage that is being ever more actively discouraged in the technical medical literature. The term "nocebo" only exists because somebody has seen a need to produce a counterpart of the benefactor "type" of "placebo" (I am yet to complete that section of Placebo (origins of technical term)) -- the drug that produces a beneficial response -- namely, the drug that produces a harmful response.

Therefore, in a general sense, the 1,200,000:18,600 ratio is misleading; because it is far more a case of "every time somebody uses the deviant term "nocebo" it further cements the inaccurate "benevolent" usage of the corresponding term "placebo". Thankfully the majority of usages of the term placebo refer to an inert simulator; not to a "pleaser".

From the above, it is my intention to ensure that the "nocebo" and "placebo" articles reflect one another in an appropriate way -- when it is necessary -- and that the rest of the placebo article speaks of the dummy simulators. Lindsay658 05:49, 28 July 2006 (UTC)

Merge the articles.--Ncosmob 21:19, 4 August 2006 (UTC)

[edit] Redirect

The article for Derbisol redirects here, but Derbisol isn't mentioned on the page. Jeremymiles 18:40, 11 September 2006 (UTC)

[edit] Merger into paradox/irony/oxymoron

I think it would be more appropriate if placebo effect, as a phenomenon or whatever you call it, be merged under the class "oxymoron" or "irony". "Placebo", it must be stressed would be appropriate, but not the term "placebo effect". There is a vast difference between the two. Merging the two would only serve to blur the distinction and that would just confuse one and everybody. This is my humble perspective.Sriram sh 13:34, 18 October 2006 (UTC)

 ???? What do those subjects have to do with placebo or placebo effect? -- Fyslee 14:21, 18 October 2006 (UTC)

All that I wanted to say was that for anyone acquainted with pharmaceuticals and drugs, placebo and placebo effect are two different things. Of course, placebo effect could be broadly used in any sense one wants so long as the term gives the full extent of the meaning, which is, to say, a contradiction of sorts, and not just in the medical sense of the term. So, the articles MUST be separate and there is no ground for a merger.Sriram sh 10:09, 19 October 2006 (UTC)

[edit] Merging

I merged Placebo (origins of technical term) and Placebo (medicine) and Placebo Effect into Placebo, as they were less like distinct subjects and more like content forking of Placebo.

I split off Placebo (at funeral), as medieval funeral meal gatecrashers have no relevance to medicine. Anthony Appleyard 13:31, 13 December 2006 (UTC)

I have tidied and merged in Uses of the term placebo. Anthony Appleyard 09:47, 14 December 2006 (UTC)

• Sugar pill should also be merged. —Quarl ^(talk) 2006-12-16 10:13Z
• Done. Anthony Appleyard 11:26, 16 December 2006 (UTC)

[edit] Inline text or ref footnotes?

I prefer all text (except authors' names and dates and page numbers) to be inline, not in footnotes, as over 40 years of reading books I have had a weariness and tediousness of having to keep on leafing back and forth between the text and notes. Anthony Appleyard 09:47, 14 December 2006 (UTC)

[edit] Obecalp

There is an incoming redirect from Obecalp but no explanation of what Obecalp is in the text (yes, it's "placebo" backwards but there is no mention of context or whether it's an actual product). Wikipedia guidelines say that an incoming redirect should be explained in the first couple of paragraphs. -76.4.49.201 17:10, 29 January 2007 (UTC)

[edit] Article length

This article is rather long - too long? Ben Finn 15:17, 30 January 2007 (UTC)

Way too long! And it's almost unreadable! We need some serious cleanup and splitting here. — Kieff | Talk 19:03, 3 February 2007 (UTC)

[edit] Intro

The introduction is a bit weird, since it starts with a quote rather than a definition, followed by a parenthetical comment qualifying the quote. --Starwed 10:41, 23 February 2007 (UTC)

I agree, it is awkwardly written, almost enough to justify a cleanup tag. If I knew anything about the topic I would rewrite it myself. GofG _|^|_| Contribs 14:01, 06 day of march sincerly melissa seymour miami dade college(UTC)

I took the liberty, and hope this version meets approval of others. --Ginkgo100^talk 20:16, 24 March 2007 (UTC)