BBC trust me I’m a doctor tests a placebo for back pain and sees significant results

Just watched it. The researchers say they have evidence from brain scans that when the placebo works it's because the body produces its own natural endorphins.

In the experiment they did for the TV they put the group, who all had long term back pain, on placebos for 3 weeks. 45% said they had some benefit. The program focused most of its attention on a few who said they had benefited. After telling them all that they had been on placebo, quite a lot of the group that benefited decided to stay on the placebo and he went back 3 weeks later and some were still saying it helped.

Given that activity is now recommended for back pain, perhaps the fact that the ones who felt some relief from natural endorphins then became more active, so a 'virtuous circle' enabled their backs to improve from the exercise.

It was such a short term experiment it's impossible to say whether it was partly also the excitement of being on TV and all the attention they were getting that helped too.
 
The article says a placebo could be given as treatment if a dr was honest but how, surely the placebo has to be believed it’s something else for it to have effect?
 
Cinders66 said:
The article says a placebo could be given as treatment if a dr was honest but how, surely the placebo has to be believed it’s something else for it to have effect?
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Who cares about the effect, they only have to persuade themselves and politicians, hence CBT and GET. Both placebos but zero effect. Both form healthcare policy.

No one knows the difference between a placebo and a placebo effect anyway. Why bother when you can just accept the magic exists.
 
The Horizon program is available on bbc iplayer
https://www.bbc.co.uk/programmes/b0bmblb8

I thought it was interesting, but they did also get some of the participants to have extra-long, more attentive GP appointments (30 mins instead of 10), don't know if that was throughout the experiment or a one off. They also didn't say (as far as I remember) how many of the people at the end who said they had improved had had these longer sessions (although they did say that it had definitely helped some). The other issue that they skimmed over was which of the participants had stopped their existing meds while taking the placebo (one man did say that he had stopped taking morphine).

I thought the stuff about the scientist looking at transplant patients was of greater interest, and this was the 'experiment' the presenter tried on himself to 'trick' his brain into producing an effect.

But neither seemed to offer evidence of long-term effectiveness.......
 
Trish said:
Just watched it. The researchers say they have evidence from brain scans that when the placebo works it's because the body produces its own natural endorphins.

In the experiment they did for the TV they put the group, who all had long term back pain, on placebos for 3 weeks. 45% said they had some benefit. The program focused most of its attention on a few who said they had benefited. After telling them all that they had been on placebo, quite a lot of the group that benefited decided to stay on the placebo and he went back 3 weeks later and some were still saying it helped.

Given that activity is now recommended for back pain, perhaps the fact that the ones who felt some relief from natural endorphins then became more active, so a 'virtuous circle' enabled their backs to improve from the exercise.

It was such a short term experiment it's impossible to say whether it was partly also the excitement of being on TV and all the attention they were getting that helped too.
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Does the brain scan measure the release of endorphins or an area that triggers the release of endorphins?

Were any endorphins actually measured
 
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Trish said:
Given that activity is now recommended for back pain, perhaps the fact that the ones who felt some relief from natural endorphins then became more active, so a 'virtuous circle' enabled their backs to improve from the exercise.
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Agreed. There are definitely some back conditions (this occasionally happens to me) that you do have to gently exercise your way back out of. (There is nothing wrong with this strategy when applied to conditions which respond favourably to it). If my back 'goes', I take pain killers for a few days so that I can sensibly do fairly normal stuff, but gently; if I gave up on it instead, things would just get worse as my back became weaker.

Also I doubt they did any comparison in the follow-up unblinded test, by comparing those favourable respondents who continued to take the placebo, versus favourable respondents who stopped.
 
Sly Saint said:
The Horizon program is available on bbc iplayer
https://www.bbc.co.uk/programmes/b0bmblb8

I thought it was interesting, but they did also get some of the participants to have extra-long, more attentive GP appointments (30 mins instead of 10),
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Did the GP offer any other treatment during such time or carry out a more thorough investigation offer more advice etc? Perhaps along the lines of, "be positive think positive" unofficial CBT that could affect how someone could report on things? Did everyone stop all other meds or just some of them? How many took over the counter painkillers etc during the trial?
 
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I think they said most of them continued their current pain meds during the trial but some were able to reduce or stop them. It was all very vaguely reported. As far as I could see there was no measure of how much pain relief the participants experienced - no questionnaires etc. Just a crowd of people standing in large room after 3 weeks and told - go and sit over there if you felt any improvement, and over there if you didn't. Completely unscientific.
Made for TV junk science.
 
Jonathan Edwards said:
Looking more closely it seems that people were told they might get a placebo but they were not told the objective of the study or that everyone was going to get a placebo. That sounds equally illegal.
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There’s a brief interview with Dr mosely here http://www.bbc.co.uk/programmes/m0000ml6 about fifty minutes in. He’s quite happy with there being “deceit” there. He’s also saying some of the people were so bad as to be in wheelchairs etc.
 
Cinders66 said:
There’s a brief interview with Dr mosely here http://www.bbc.co.uk/programmes/m0000ml6 about fifty minutes in. He’s quite happy with there being “deceit” there. He’s also saying some of the people were so bad as to be in wheelchairs etc.
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Gets a bit tricky. Placebo is intrinsically reliant on an element of deceit. Just that you should tell people beforehand that you might be going to deceive them.
 
Barry said:
Gets a bit tricky. Placebo is intrinsically reliant on an element of deceit. Just that you should tell people beforehand that you might be going to deceive them.
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I don’t see how it’s ethical to tell people in wheelchairs on morphine they’re trying a great new pain relief or placebo and then give them all placebo. If the trial had failed, they might justifiably feel WTH. But the info derived is interesting. Did get odd when it was discussed if drs should openly prescribe placebos, NHS dream no doubt.
 
Barry said:
Gets a bit tricky. Placebo is intrinsically reliant on an element of deceit. Just that you should tell people beforehand that you might be going to deceive them.
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That's a common assumption, but do we really know that?

I remember reading an interview with an illusionist, saying he found people either knowing or suspecting he was - ehm - 'doing his thing to influence them', was easier to actually trick. Maybe that's not entirely the same situation, but I do wonder if it could have the same effect on people knowing they took a placebo?
 
And, someone have actually tested this:

"Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had 'placebo' printed on the bottle," said Kaptchuk. "We told the patients that they didn't have to even believe in the placebo effect. Just take the pills."

The results, published in the scientific journal PLoS ONE, showed that the placebo pills were more effective at relieving symptoms compared with doing nothing at all.
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https://www.theguardian.com/science/2010/dec/22/placebo-effect-patients-sham-drug

But didn't read the study itself, to see if it might be valid:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015591
 
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Cinders66 said:
I don’t see how it’s ethical to tell people in wheelchairs on morphine they’re trying a great new pain relief or placebo and then give them all placebo. If the trial had failed, they might justifiably feel WTH. But the info derived is interesting. Did get odd when it was discussed if drs should openly prescribe placebos, NHS dream no doubt.
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All I'm saying is that if people give their informed consent to knowing they may be given a real medication or a fake one, then that to me is OK, though I'm not sure if that was properly done in this TV-drama version.
 
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