Harnessing Placebo Effects for the Treatment of Functional Cognitive Disorder: A Feasibility Pilot Study 2024 Burke, Perez et al

Abstract

Objective:
Limited research has directly investigated whether and how placebo effects can be harnessed for the treatment of functional neurological disorder (FND), despite a long-standing and controversial history of interest in this area.

Methods:
A small exploratory study was conducted with adults with a cognitive subtype of FND recruited from a single cognitive neurology center in the United States. Participants were given the expectation of receiving cranial stimulation that could benefit their memory symptoms; however, the intervention was sham transcranial magnetic stimulation (placebo). Outcomes included measures of short-term memory testing, subjective memory rating, and state anxiety before and after stimulation. After the study, the true objective and rationale for investigating placebo effects were explained in a scripted debriefing session. Acceptability of the study design and qualitative feedback were collected. Institutional ethics approval and signed consent were obtained.

Results:
Three patients (female, N=2; male, N=1; average age=57 years) were recruited. Outcome data were analyzed descriptively at the patient level. Trends of improvement in subjective memory rating, but not objective cognitive test scores, and decreases in state anxiety were observed. After the debriefing session, all patients found the study design to be acceptable (ratings of 70%, 90%, and 100%), and two of the three patients believed that withholding mechanistic information about the intervention was needed to leverage placebo effects as treatment.

Conclusions:
In the first study to prospectively investigate the feasibility of harnessing placebo effects for the treatment of FND, promising preliminary findings were obtained, and methods and resources for use in larger future studies are offered.

Paywall, https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.20230118

 

Just laughable, and morally offensive. "Let's lie to patients so that they answer our questionnaire in such a way that they indicate a non-existent treatment effect".

 

"Institutional ethics approval and signed consent were obtained."

Er, how?

Dubious much. How's this OK? Wow.

 

Haha

 

Perez is building an FND empire at Mass General.

 

How is it useful as an outcome for a patient to think their memory is better, when objectively it isn't any better than it was?

I mean how is that helpful to anyone?

That would be like treating Alzheimer's by making patients think their memory had been improved. Then having to tell them it was all a trick.

Anyone around them would just call you a 'proper nutcase' for even of thinking doing something like that to someone so ill - and I'd hope have licenses removed and potentially some sort of safeguarding warning put on you?

... but it's OK for this 'cos it's not Alzhiemer's'? and they'll I'm sure focus on sly descriptions tiptoeing around it being demographics of the patients and their biases towards them as the reason 'it's different'?


The bloke has failed to prove the bit where there is any justification for the violation he has somehow got ethics for is [ergo yes @Joan Crawford - how the heck did he get ethical approval? ] .. it didn't have some down the line impact on anything. The 'confidence' didn't suddenly make them remember more or anything.

And almost certainly any 'improvement in anxiety' (about having memory loss being improved by a treatment) would be short-lived once you realise that the 'treatment' was a lie and didn't/doesn't exist?

And long term, just like the boy who cried wolf he has ensured that all reactions to medical treatment will be met with reduced trust. That's the thing with 'playing placebo' or otherwise known as being a lying trickster. It's a short-lived profession - you can only con people once before all you've done is taught them you're a metaphorical used car salesman.

Isn't this just some weirdo charter for 'gaslighting people for no reason is good and acceptable and I don't have to provide justification'?

I mean it's this kind of crap that nearly got psychology closed down as a science, callous 'let's not measure the harm' experimentation.

They might have invented a different subject to sidestep the comparisons but is this any different to the famous scandals from times gone by?

 

I vote for introduction of the 'Perez sign': writing papers on FND is a positive diagnostic sign of:

FND.

It is a sign found in no other medical condition and only occurs when the patient is at work. When they are playing football it disappears.

 

and just because they had to tell them after what an hour, they've assumed that it hadn't already 'worn off' anyway. As soon as they start thinking of going home and where they put their coat..

As if the 'effect' wasn't just coerced for the questionnaire 'give em an extra mark to keep them happy', rather than 'perceived subjective improvement' and even if it was that bubble would burst as soon as they were back in the real world and meeting their significant others/catching a bus/remembering the receptionists name .

It is basically like lying to someone you've just numbed the leg of (with aneasthetic that lasts an hour) that you've healed it and they will be able to walk, then.... asking them whilst it is still numbed 'do you feel better at walking' whilst it is still firmly numb and they have no chance of trying it out.... and then telling them that you lied just before it wears off and you didn't do a thing to make their leg better

I'm sure they'd feel 'a drop in anxiety' (that's not what they are really measuring anyway - it is 'whether someone feels anxious', quite a different thing) in that questionnaire asked right after being told the lie. Pretty sure that wouldn't mean at all that either it was ethical, useful or something that wasn't likely to just screw someone up more.

For no useful purpose other than what most would think was sicko experimentation or toying 'just because someone let you' and it might be interesting 'to see what happens' up close for yourself.

 

here is the other thing. When we are being lied to in everyday life it is a pretty awkward social dilemma. You sort of have to consider whether you can prove the lie and if not ‘go along with it’ is the required etiquette madly. Otherwise the liar gets to do faux outrage and bystanders side with them and so on. Even when you both know it is a lie. It's like this encumbant on you to do a pantomime and pretend for them thing ("mmmmm yes of course I can tell you spent 2hrs cooking it" even though it's blatantly a ready-meal).

it’s a weird situation of society that I can’t help but think all of this part of psychosomatics is all about trying to embed and justify and keep going in that wrong direction.

I think all they are actually showing is that coercive effect (do you call out the liar with no proof, or have to pretend their lie is true and the pantomime associated with that) that would normally be described in social psychology rather than ‘medicine’


Just like I think/am shocked that the annals of social psychology haven’t underlined the fact the con of dodgy psychosomatic pretend mental health treatment (through bad questionnaires, bad design and bad regs) was pushed through in UK was no coincidence. It's another quirk like our queuing that few Brits will ever break, we are utterly trained into it as 'politeness' and 'the rules' .

We are all conditioned to be required to lie and be polite when asked ‘did that improve your back symptoms?’ From someone who just fiddled with your seat position, cricked your neck and you can’t wait to go away so you can put it back where it was.

there is no way the BPS lot didn’t know about this tyranny that game players play on in this country ( where people have to be polite to bad uns if they don’t have proof, and fake it for those ‘pretending good intentions’)

none of this was ever about medicine if people’s health

I’m starting to wonder if it’s a mad game theory where they are wondering how far they can push it and keep getting away with it all

 

It's their model. We're not cognitively impaired, hence they can ignore the objective tests. We just think we are, making us perform worse even though we could do just as well if we didn't disorderly convert our distress into symptoms. Or whatever. This is why it's common for people sent to cognitive tests to perform poorly but the report disputes it for "lack of effort", policy/sickness leave denied. I've seen plenty of those.

It's the perfect pseudoscience. Not only do you not have to prove anything or bother falsifying it, when it's falsified it doesn't count and you can simply "observe a trend" towards improvement and call it not just improvement but obviously effective for everyone. If they put some effort into it.

It's like selling a perpetual motion machine that quickly stops moving as soon as you stop using power to make it move. You can definitely blame the grifters selling the fake machine, but most of the blame lays in the experts and institutions that pretend that the perpetual machine works, as long as you believe in it. This is truly impressive death of expertise stuff.

Same with the lack of objective improvement from physical training program in chronic illness, even on objective physical measures. They just don't bother with those and have been getting away with it for decades. The patients can't do any more than they could at the beginning, but on some questionnaires there's sometimes a tiny distinction and from that they declare it 100% effective. It's insane, but it's the current paradigm.

It's all a scam. All of it. Biopsychosocial ideology is a total fraud, but the emperor has been not wearing golden silky robes that fools can't see since before the time the parents of every practicing MD was even born, and so on and on it goes. Because of course they can see the golden silky robe, they're not fools. Duh.

 

Not helpful to anyone except the likes of these FND scammers. For FND patients, being deceived into thinking your cognition is better than it is could get you injured or killed eg if you are tricked into thinking you can drive a car or use a stove again.