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Class 8: placebo and nocebo effect
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Class notes college 8: placebo and nocebo effect
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PLACEBO AND NOCEBO EFFECTS3 perspectives:
- Clinical research
o Randomized controlled trial (RCT)
o Testing efficacy of new drugs
o Double-blind
o Experimental control
- Patient care
o Everyday doctor-patient interaction
o Treating patients in the best way
o Single-blind (patiënt is er niet bewust v, behandelaar wel)
o Maximize therapeutic success
- Basic science
o Understanding the mechanisms behind the placebo effect
o Different levels: psychological, neurobiological, sociological...
o Main target of research
HISTORY
History I: I shall please...
à to please someone
- William Cullen – Clinical Lectures: “I own that I did not much trust to it, but I gave it
because it is necessary to give a medicine, and as what I call a placebo...“
à iets geven aan mensen om hen ze plezieren
- Geoffrey Chaucer – Canterbury Tales: “placebo singer“ & “to sing a placebo“ à
flattering one‘s superior
à iemand die je baas is een plezier doen en praten zoals zij willen
- Francis Bacon – Of councel: “... counselors will [...] instead of giving free council, sing
him a song of placebo“
à iemand pleasen
- Wo man das Placebo singt, da muss die Wahrheit zurueckbleiben
à Duitse uitspraak: placebo geven dan blijft de waarheid achter, placebo gaat niet
over de waarheid, maar mensen een plezier doen
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,History II: clinical practice:
- Thomas Jefferson: „One of the most successful physicians [...] has assured me, that
he used more bread pills, drops of coloured water [...], than of all other medicines
put together.“
- Samuel Hahnemann: „... kann man dem Kranken zur Stillung seines Verlangens nach
Arznei und Beruhigung seines Gemuets etwas Unschuldiges, z.B. taeglich etliche
Teeloeffel voll Himbeersaft, oder etliche Pulver Milchzucker einnehmen lassen.“
- Arthur Shapiro: „... total of these ancient remedies is about 4785 drugs and 16842
prescriptions [...] with only a few possible but unlikely speculative exceptions, all
were placebos.“
à uitvinder homeopathie: je kan de zieken een pil geven om zijn nood voor
medicatie te vullen, iets onschuldigs geven (bv fruitsap)
Examples of ancient medications:
- Bezoar stone (crystallized tear from the eye of a dear bitten by a snake)
- Usnea (moss from the skull of victims of violent deaths)
- Vigo‘s plaster (viper‘s flesh, live frogs and worms)
- Powdered Egyptian mummy
- Human placenta
- Spider webs
- Mandrake
- Wood lice
- Excreta
à The history of medical treatment is the history of placebo
History III: quackery and clinical trials:
- Benjamin Franklin: Appointed by King Louis XVI to investigate „Mesmerism“ and
showed via control procedures (e.g. blindfolding) that therapeutic success was only
due to imagination
à Mesmerism: Mesmer was een arts en claimde dat hij ziektes kon genezen à Louis
XVI wou weten of het waar was
- John Haygarth: Investigated „Perkinism“ by using sham (i.e. placebo) devices and was
able to show that Perkinism did not have any therapeutic value
à Perkinism: metalen stok werd tegen lichaam gehouden en dat zou ziekte genezen
- Austin Hill: Performed the first randomized clinical trial (double-blind and placebo-
controlled) using Streptomycin to treat tuberculosis
à Emergence of scientific skepticism lead to placebo-controlled trials
2
, History IV: a first meta-analysis: Henry Beecher:
- First systematic investigation of placebo effects in clinical trials
- Pooled across various disorders, he arrived at a 35% placebo response rate
- Hugely influential paper that led to the routine use of placebo-controlled trials
- Many claims have been contested in later years
à Placebos arrived in the medical mainstream
History V: voodoo death and nocebo:
- Walter Cannon: Reports on various cases of death by voodoo / sorcery / fear and
aims to explain them via activation of the sympathetic nervous system
- Walter Kennedy: First mention of the word „nocebo“ in his article „The nocebo
reaction“, shortly followed by Kissel & Barrucand (1964)
à Nocebo: i shall harm negatief
- Robert Hahn: First extensive treatment of the nocebo effect from a psychological and
anthropological perspective
à A younger evil twin of the placebo effect
DEFINITIONS
Fields & Wager (2013): The placebo itself is a dummy treatment such as a sham surgery or a
sugar pill. The placebo effect is an observable difference between groups that is attributable
to the efficacy of the placebo.
à Power of substance that normally has no effects but still works and does some changes
Wikipedia: In medicine, a nocebo (Latin for "I shall harm") is an inert substance that creates
harmful effects in a patient. The nocebo effect is the adverse reaction experienced by a
patient who receives a nocebo.
Hahn (1997): The nocebo effect is the causation of sickness (or death) by expectations of
sickness (or death) and by associated emotional states.
à The more to the right, the better the symptom improvement
à Ook zonder behandeling w het na een tijd beter (bv griep)
à Effectiviteit v behandeling = drug – placebo (niet drug – geen behandeling)
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