Interesting podcast on placebos

Hi all,

I listen to a lot of podcasts and one of my favorites is Adam Ruins Everything, which brings in various experts/scientists to discuss a range of topics. This week, there was an episode on placebos with the Director of Placebo Genetics at Harvard Medical School, Dr. Kathryn Hall.

I expected there to be some possible overlap with TMS, because placebos are definitely an area where beliefs and thoughts tie heavily with pain perception.

She describes how some of the science they're doing is now catching up to what the TMS community has been practicing and experiencing for decades. Not all she said matched 100% with the TMS experience, but it was exciting to hear someone at Harvard Medical School basically admit that many surgeries and treatments (for instance she cited a study on bone spur surgery not being better than placebo) are likely just placebos and that some conditions, such as carpal tunnel (which she had herself and she seems to attribute to a psychogenic cause) or IBS are psychogenic are at least have psychogenic components. She also touches on how expectations on pain or relief from pain can result in better or worse outcomes.

Not sure I learned anything new that would be applicable towards my practice of addressing TMS symptoms, but it makes for a very interesting listen. It's also encouraging that a place like the Harvard Medical School has people taking more of a mind-body route to chronic pain conditions.

Here's the link if you're interested in listening:
http://www.maximumfun.org/adam-ruins-everything/adam-ruins-everything-episode-45-dr-kathryn-hall-surprising-power-placebos (Adam Ruins Everything Episode 45: Dr. Kathryn Hall on the Surprising Power of Placebos | Maximum Fun)


(Apologies if this belongs in the Research sub-forum - almost placed it there, but since she's discussing research and the podcast isn't about an actual study, I thought this was the most appropriate place to post this)

 

Thanks for this. I also listen to a lot of podcast and have never heard of this one. This sounds like an episode to catch.

Plum x

 

I just listened to this yesterday! (Been catching up on my podcasts, as on the above post!) Really interesting and awesome that this kind of research is going down at Harvard. I also didn't learn a ton of new information that the TMS community doesn't already know but its great to have some empirical research to back this stuff up so the medical establishment can take all this more seriously!

She made one interesting point about the question of what to replace the placebos with...it's a good thing to consider. Of course there is a percentage of the population that can be helped with TMS and other neural pathway type theories but it's not everyone. For those who just don't respond to TMS methods it is important to have other benign placebo-type interventions available...preferably PT, massage, acupuncture or other low risk options as opposed to surgery, injections and drugs. I am guilty of being somewhat of a purist and rolling my eyes at people getting miracle cures from a massage or a session of Reiki but I have to remember that those are good options for some folks and that the placebo effect isn't necessarily a bad thing all the time!

 

Meant to tell you earlier, Thank you so much for posting this link. I have told many people about it's fascinating findings. I'm a skeptical person so I like the real science info. There's a lot of stuff out there about the placebo affect, but much of what we see is from people who are not what I would call fact based.

 

I especially found it interesting that drug companies are finding it harder and harder to beat the placebo. With the big drug epidemic that's going on, I'd rather see people taking sugar pills.

 

Yes, I did listen to it last week. Thanks so much for posting this.

The research on placebo effect has definitely moved forward since the mid-nineties. Dr. Hall also made a point of noting that even though people know they are using a placebo it still works as a cure. Placebos do not have to necessarily 'pretend' they are a 'real pharmaceutical'.

I don't think that a placebo cure is to be looked down upon. Dr. Sarno emphasized that he stopped using the PT's because patients would often find that after a while their TMS symptoms occurred elsewhere, so he said that PT was just a placebo. So, maybe use a placebo plus apply cognitive changes is another key to healing with TMS.
Whatever works, works.

Lainey

 

Thanks JanA. It is good that research is still being advanced. For me, I have no problem with the idea of placebo, never did. I think we all need to be our own best advocate and use what we deem works best for us. I am sorry that in todays world most M.D.s have little time to spend with their patients, leaving many (both the docs and the patients) feeling that something is not being heard, or understood, or listened to.
Lainey

 

Thanks for posting - fascinating. I liked the bit about morphine not working so well if the patient is not old they are taking morphine- the placebo must be working for us constantly in everything we do.

 

Sounds interesting. I'll check it out. Tnx.
Lainey

 

I highly recommend it too! In my darkest days just over four years ago, when the pain and the IBS were so bad all I could do was struggle through every minute of my day and listen to audiobooks I downloaded onto my phone from my library site, I listened to this book. It was a lifeline to me.

 

A question: in the podcast they mention many drugs not being able to out-perform a placebo. Does that mean the drug is actually doing anything? I mean, let’s say a drug and the placebo both reduced a person’s symptoms by 50%. What would happen if you could administer the drug without any knowledge on the part of the recipient? Would they experience any benefits? I suppose it varies from case to case?

 

Already in the double blind testing method used, the participants receiving the drug (and the doctor administering) don't know if they are receiving the drug or the placebo. I can't think of an ethical way that a drug could be administered without the participant's knowledge of receiving anything.
Is there something in particular you are thinking of?

 

No, I’m just wondering how they establish the drug has any value whatsoever in situations where it doesn’t outperform placebos because in the interview they talk about it being a bad thing these drugs can’t pass the test - but do they even have value?

 

Jan, I loved your post. I just stumbled across an article which said catastrophic thinking was a predictor of whether patients would have a chronic pain in the future after shingles neuralgia. I was actually shocked, as I am as catastrophic as they come. I have duly changed my attitude to "I will be better by the summer".