Looks potentially interesting, athough I’m not yet sure if I’ll watch, or catch later on iPlayer.
It’s examining how dummy drugs can have REAL results - sometimes even if you tell the patient it’s a dummy!
According to the Radio Times write-up, capsules work better than pills, and red ones are more effective for treating pain.
So might I be doing myself a favour if I look for some supplements that just happen to be red, even if they have no known efficacy for anything to do with MS?
Tina
Hi T,
Yes, Horizon is in my view the best programme on TV (boring aint i). From ‘The secret of the Snake’ to Dr. Michael Mosley’s 5-2 diet have been life changers for me all from Horizon.
Placebo is a fascinating subject; I’m sure I read some years ago that trials at UCLA found this would last a maximum of 6 months.
I have always wondered that a double blind, placebo controlled trial involving a drug with a well known reaction; if a placebo is given it must be saline solution; nothing else. Nothing to mimic the known reaction otherwise it could be claimed to make the person better. So therefore 50% of the people on the trial will know they are not getting the real drug?
Still perhaps this is something they will explain tonight.
G
Just bear in mind it will probably be biased, just to make for good viewing, and to ensure first-class reviews.
Take care.
Chris R.
I. El. (Eng). (Rtd).
Thanks for that Tina, I’ve popped it on record. I like to watch DCI Banks 
The placebo effect, is an interesting subject. How the brain works is fascinating. Look forward to watching it. Noreen x
The placebos used in clinical trials are exactly the same as the drug under test - for example a tablet made using exactly the same process as the ‘real’ tablet except that the active ingredient, the drug, is left out. If the drug is based on a saline solution, then the placebo would be based on a saline solution. Probably not a pure saline solution, unless the ‘real’ thing is just saline solution plus the drug and nothing else.
The idea is that no one can tell the difference by looking, or taking the drug under test.
In a double blind trial neither the people running the trial, nor the patients know whether they are taking the placebo or ‘real’ drug. The list of who gets what, when is kept secret!
I am not really sure why a reputable programme like Horizon should be biased. I admit it’s not the heavyweight it used to be, and I rarely bother these days, but that doesn’t mean to say it’s biased. Anyway, there’s absolutely no doubt the placebo effect exists, and the programme isn’t attempting to argue the contrary, so I can’t see what the controversial issue is for it to be biased about! As I understand it, from the review alone, it’s simply exploring how it might work. I find that interesting, without being particularly vulnerable to bias. If I’d said it was about: “How volcanoes work”, would that also merit a bias warning? Presumably not, unless you either don’t believe in volcanoes, or expect the programme to take that stance. Tina
G, I’d heard that in drugs trials people receiving the placebo can still experience the same side effects, so the trial really should be blind.
Anyway, I’ve long been a believer in the usefulness of the placebo. My neuro often dismisses possible remidies as being no better than placebo, but she seems to be ignoring what I think is the crucial thing - that the placebo effect can make people feel better. I don’t care much whether a treatment is ‘real’ or not, as long as it makes people feel better. Surely that’s the whole point of any treatment?
As an interesting aside about the power of the mind, I heard a story about a travelling hobo in America. He jumped on a freight train for a free ride, got into a wagon and pulled the door shut. However he realised too late that it was a refregerated wagon he’d gotten into,and he’d just shut himself in it. He knew he was going to freeze to death, and decided to write down what happened to him, as a kind of gift to science. When the carriage was eventually opened, his body was found, and the notes he’d written contained all the signs of hypothermia. The crazy thing is, the refrigeration wasn’t actually switched on. Which is mental!
Dan
Eek!
I’d be interested to know if that story can be independently verified. In theory, though, I suppose it might work both ways.
The Horizon programme was quite interesting. It made clear it wasn’t “belief” alone that did the trick, but that brain chemistry actually did change in response to that belief, as if the person HAD received an active treatment,
It turned out, though, that the doctor’s manner was also important in predicting the effectiveness of a patient’s response to a placebo. In experiments where the doctor was actually banned from having much interaction with the patient, beyond the basics of introducing themselves, results were much less impressive than when the doctor took time to get the patient’s full history, asked questions about how their health problem was affecting them, and said encouraging things, like: “I really think there’s a good chance this is going to help you.”
So how much the doctor was perceived to care or be interested did have a bearing on the outcome. There is a theory that’s why some holistic therapies seem to help - because the practitioner usually takes quite some time getting to understand the whole person, and the context, so it might be feeling cared about that is the crucial element, more than exactly what the practitioner does.
Tina
Interesting! I think I will watch this on iPlayer. So our rushed 10 minute doctors appointments might explain the state of the nation’s health then?
Hi Puddinglover,
Well, it didn’t go quite as far as that, and certainly didn’t suggest placebo could be a replacement for ALL conventional treatments.
But yes, how concerned or interested patients perceived the doctor to be did have an influence on how effective they found the treatment.
I felt really sorry for a woman in one American study, who’d felt so much better on the placebo - even when she knew it was a placebo - that she asked to continue after the study ended. But U.S. law prevented it being prescribed for her (I expect similar would be true here), because it contained no active ingredients, and therefore couldn’t be a medicine. Doctors only obtained permission to prescribe for the three-week duration of the trial. After that, they couldn’t. And presumably doctors aren’t allowed to just give their patients things with no medicinal value, off-prescription.
The poor lady tried in vain at health food shops, to get some of the “placebo pills”, but staff didn’t understand at all, and just asked: “Why would you want a pill that has nothing in it?” It seemed a real shame that someone who’d got so much benefit couldn’t continue. They’re harmless, after all. But I can see it might set a dangerous precedent if you allowed doctors to prescribe things that aren’t registered medicines, if they believed it might help. It would blur the lines a bit between medicine and quackery. I suppose a harmless sugar pill is one thing (actually, they weren’t even sugar, just cornflour). But what if doctors began prescribing other unorthodox treatments “just in case it might work”?
Tina
On ‘Breakfast’ this morning they had Dr. Michael Mosley who does lots of things to his body on ‘Horizon’ for scientific research.
His latest venture was to swallow a Tape Worm and a camera to record its growth in him.
Just a little snippet he said”There is a lot of research using worms into a cure into Multiple Sclerosis” It’s not on iplayer so can’t confirm if these were the exact words.
As far as placebo is concerned could this be the way LDN or Snake Venom works?
G
So I watched the whole of the Horizon program (thanks for the heads-up Tina). I have just one problem:
It was clearly shown that the effect was/is psychological - but there was no psychologist on the program. This does tend to emphasize the question posed by George (above).
Geoff
Haha,
Michael Mosley has quite a track record of doing gruesome things in the name of popular science, hasn’t he? I saw the series where he stuck a needle through his hand, to demonstrate the effectiveness of local anaesthetic. It was not easy viewing, even though he was obviously not in any distress.
Placebo effect could well be an explanation for how many alternative therapies work. I suppose anything might work if the patient has faith it will. Hence patients actually did better when doctors said things to increase their confidence, like: “I really think this could help you”. BUT placebo won’t work for everything - e.g. curing cancer. It was at its most effective for symptoms like pain, that are not objectively measurable - just self-reported.
Comparisons were made with hypnotism, which also CAN work. But it’s not purely psychological, because the suggestion can bring about real changes in body chemistry - the body producing more of its own painkillers, in other words.
I’m not sure LDN is entirely placebo. It’s known to increase neurotransmitters associated with a sense of wellbeing, so again, it really does change body chemistry - but probably not by the power of suggestion. True placebo was when it couldn’t be explained by any action of the drug itself - because there wasn’t any drug!
I’ve no idea at all about the chemical properties of snake venom, other than it usually being pretty toxic, but many toxins are also medicines, if administered in the right degree - another thing explored by Dr. Mosley in his last series.
So I don’t know if snake venom would change brain chemistry in its own right, or if it’s the belief that counts. You can begin to see how faith healing might work. Again, it wouldn’t cure a serious condition, but it’s entirely plausible a patient who had faith would report feeling better, because their belief would induce changes in brain chemistry.
Tina
Geoff,
Hmmm. I thought it showed it was both psychological and biological. True, mind-body connection is no secret, but it made clear it wasn’t just about planting the belief that pain would be less, or whatever. There were actual biochemical changes associated with that belief. I thought that was the crucial thing - there were changes as if an active drug had been administered, which meant any reported improvement wasn’t just self-delusion or wishful thinking, but could be explained in measurable terms.
Tina
I think the worm treatment he mentioned would be the trials carried out using hookworms
Thanks Floopy, first I’ve heard about this Recruitment starts on MS hookworm trial - The University of Nottingham
G
As I predicted a biased presentation, no real counter argument.
Take care.
Chris R.
I. El. (Eng). (Rtd).
Biased in which direction, Chris? And, what could have there been a counter argument about?
Geoff
Now you are opening up a fresh discussion, Tina (or maybe this is what should have come out if they had a psychologist on the program). Start from the point where the brain can control a lot of bodily functioning - even the autonomic nervous system can be conditioned. So, if a thought can (e.g.) slow down the speed at which the heart beats, it follows that there are changes in the rate of the relevant impulses in the nervous system, and thus that there are changes in the chemistry of the interactions across one or more synapses. So, is that psychological or biological?
In a way it’s a bit like discussing whether a(ny) particular DMD actually affects the progression of MS when it reduces the number of relapses. Obviously, you could take a hard line and say that if it does not actually stop demyelination then it is not affecting the progression - or a softer line and say that, regardless of the biology involved, reducing the number of relapses has affected the progression of the disease.
It’s a bit like your point on LDN above. It would be very easy to design a double blind study to compare LDN against a placebo - the big trick would be getting hold of the participants. Doing that same study to investigate the action of the placebo would be a whole new ball-game. I should add that the problem I have with a lot of the Horizon stuff last night was that it violated a principle that was drummed into me again and again - do not lie to your experimental participants. Obviously, telling someone that this pill contains nothing that will help you is telling the truth - but then would that lady on the program have really believed the researchers, or would she have suspected that there was “something” that produced the favourable effect, as opposed to “nothing”.
Geoff
How is it biased when they presnted what they found? Is the Lancet or Pub Med biased?
George (VD and Scar)