How Superstitions Really Work

[erwins]

I don't understand the eyerolling. I'm just asking questions. If the answer is no, you don't think they're lying, that's fine. I'm interested in understanding your view.

[crescent]

Originally Posted by ganzfeld

Reporting less pain does not mean feeling less pain.

However, even if they don't feel less pain, but only think they feel less pain, then they feel "better" than they think they otherwise would. They feel relieved - this is only an emotional response, but it is still real, in a way. To me, that has always been my understanding of the placebo effect.

[Esprise Me]

Originally Posted by crescent

Of course a placebo effect exists - without it, homeopathy and a good bit of herbal medicine* would not be around.

Not true. The placebo effect differs from spontaneous remission; in the former case, you feel better because you believe the treatment is working, while in the latter case you just happen to get better, regardless of whether you are aware you're taking a sugar pill. Even if the placebo effect didn't exist, spontaneous remission could account for a substantial number of cases in which people take some kind of quack medicine, recover, and believe the quack medicine cured them.

[crocoduck_hunter]

Originally Posted by crescent

However, even if they don't feel less pain, but only think they feel less pain, then they feel "better" than they think they otherwise would. They feel relieved - this is only an emotional response, but it is still real, in a way. To me, that has always been my understanding of the placebo effect.

What Ganzfield is talking about (I think) isn't whether or not people think they're feeling less pain, it's that they think they should be feeling less pain and therefore report that they're feeling less pain regardless of whether or not they're actually feeling any relief- like how people with chronic illnesses that go to faith healers will announce that they've been healed even though they haven't because they think they should be healed.

[ganzfeld]

Originally Posted by crescent

However, even if they don't feel less pain, but only think they feel less pain, then they feel "better" than they think they otherwise would.

No, that is an erroneous assumption. People do not, in fact, report what they think accurately in many situations, especially this kind of situation in which they have some feeling about how they think they are expected to respond. (Summing up 60 years of cognitive science: People don't always know what they think.)

They feel relieved - this is only an emotional response, but it is still real, in a way. To me, that has always been my understanding of the placebo effect.

Yes, that is one common understanding that has remained an open question. What we do know is that the more strictly we control for the common errors (such as the reporting error mentioned, which is only one of many) the smaller the nonspecific effects.

I use the word nonspecific because it's a lot like dealing with UFO sightings. Before we consider that a specific set might be extraterrestrial crafts, we have to first eliminate the specific known causes of error. But eliminating all of them still does not mean we've shown ETs are here! What we are left with is an unidentified object, in medical treatment and experiment known as a non-sepcific effect, not necessarily a placebo effect.

I honestly don't want to get snarky, erwins, but it does no one any good when we have non-sequiturs such as: Are you calling all those people who saw these UFOs liars? No, of course not. But I think we can all agree that such questions miss the mark by so far that they shouldn't really deserve any comment.

[erwins]

When you referred to what people report vs. what they feel, I thought you might be saying that they were mis-reporting based on pressure or expectations, even if they were in fact feeling the same--i.e., they were lying. I don't consider that a non-sequitur, but if you don't want to answer my questions that's your choice. I don't have any kind of hidden agenda--I was genuinely trying to understand your position.

[ganzfeld]

As in the case of all reported observations, including UFOs and ghosts and many other things, lying is one of many possibilities but not a necessary hypothesis. For example, I don't think people are usually even aware of the reasons they might select one box higher or lower on a score of ten. Nevertheless, many things very unlikely to be related to pain have been shown to influence such responses so it is not unlikely that there are at least several not yet accounted for. Many researchers have suggested ditching the term "placebo effect" for the more accurate "nonspecific effects". It seems to me the only reason that hasn't happened is because of the unfounded assertion that placebos actually have an effect.

[Richard W]

Originally Posted by crocoduck_hunter

What Ganzfield is talking about (I think) isn't whether or not people think they're feeling less pain, it's that they think they should be feeling less pain and therefore report that they're feeling less pain regardless of whether or not they're actually feeling any relief...

One of the latter studies mentioned in the article first linked didn't rely on verbal reports of pain - it relied on requests for further pain relief from the three groups. (The only difference in that experiment was in how the saline drip that they were given was described to each of the three groups. All had the same physical treatment).

That's a "report" in a way, but it seems to me to eliminate most of any "I will say it hurts less because I think I should say that" factor. The patients were allowed to ask for extra pain relief whichever group they were in. Somebody could tell the doctor it hurt much less, and then ask for more pain relief than another patient who wasn't telling the doctor it hurt less. The article doesn't say, but it would be even better if the additional pain relief was measured by the number of button presses to administer an automatic dose, or some other means of eliminating the need to directly ask.

[ganzfeld]

Originally Posted by Richard W

That's a "report" in a way, but it seems to me to eliminate most of any "I will say it hurts less because I think I should say that" factor.

Not at all. And that's not the only factor anyway. If I think I've already received treatment is it even fair for me to ask for more treatment? All we know from these studies is that people who think they are being treated respond differently than people who do not. That's really nothing to base any treatment on. The bottom line is: If you have an ailment, get some attention. It doesn't require tricking the patient into thinking they're being treated (or, in the case of actual placebo-based studies where they do not actually lie to patients, have a 50-50 chance of being treated).

Also, it's such a gross oversimplification to say that this is the "I think I should say that" factor. What we're talking about is a barely statistically significant more likely to tick one box higher on a set of boxes. The reasons for that are complex and numerous. So to go back to the UFO example, that's like saying "well we eliminated the 'Venus on the horizon' factor so that's that". There are thousands of other possible lights besides Venus.

[Richard W]

If there wasn't a placebo effect, it wouldn't need to be controlled for - people would control against groups that weren't receiving treatment at all.

The problem is one of definition, here, I think, and the level that you're looking at. You're taking the "placebo effect" and breaking it down into components, and then saying that because you can do that, the "placebo effect" doesn't exist.

There are times when a reductionist approach does remove the need for an overarching concept - "God", for one, is made up of a lot of unrelated and disparate ideas, some of which are valid and some aren't, and personally I think that the concepts are sufficiently different that the term itself is meaningless and actively confusing. But at other times, it's quite valid to group phenomena together and give them a name, even if you can break these down into more detailed entities. An "atom", say. A "carbon atom" is a useful concept even if, in reality, it's a collection of other waves and particles and ideas, and an "ideal" carbon atom doesn't exist.

I'd say that even if the "placebo effect" is a combination of the other things you've mentioned, it's still an effect. It still needs to be controlled for in a medical situation, and rather than writing out all of those other possible effects in full, usually it's useful to treat it as a single effect so that you can evaluate the effectiveness of the drug you're looking at.

That's no reason not to dive into it further, just as the periodic table is no reason not to look into atomic structure. But equally, the existence of electrons, and covalent bonding, and radioactive isotopes, doesn't mean that there's no such thing as a "carbon atom".

[crocoduck_hunter]

A carbon atom is made up of numerous smaller pieces that are linked together in a specific fashion and exhibits specific properties. The pieces that are cumulatively referred to as the placebo effect aren't really related to each other at all, they just get combined together under the same heading as a convenient catchall.

[ganzfeld]

Originally Posted by Richard W

I'd say that even if the "placebo effect" is a combination of the other things you've mentioned, it's still an effect. It still needs to be controlled for in a medical situation

Yes, it needs to be used for what it was always and only intended for: in experiments to control for non-specific effects on subjective reporting, not as a BS excuse for using treatments that don't work in the hopes that they will do something that they, unlike experimental protocols, have never been shown to do. I wouldn't care what anyone calls it if they didn't abuse it.