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Christopher Henry's avatar

I agree the placebo effect is real. However, the designs of most trials do not allow us to differentiate between placebo response (any improvement that happens in the placebo group) and placebo effect (the physiologic response). For example, a large amount of the placebo response seen in seizure trials can be accounted for by the high levels of natural seizure frequency variability, regression to the mean, inaccurate seizure diaries and the use of change from baseline statistics with dichotomization. See the work done by Dr. Goldenholz's lab at MGH. This does not discount that there isn't a placebo effect in seizure frequency, but certainly shrinks the possible size of the effect.  I recently made a video on migraine trials and why trial design makes them difficult to interpret and can exacerbate the placebo response. I hypothesize migraines have a large placebo effect compared to the effect in seizure trials, but the size is hard to measure based on current trial design. See https://www.youtube.com/watch?v=wqhWYmRfJPI

Lastly, if the argument is a plea for physicians to be validating, warm and kind to their patients because placebos work then I worry we are attracting the wrong people to the profession. Being warm and kind to others is good irregardless if it heals. It is something we should want to do. I once read a book on parental influence that summed it up nicely. After reviewing all the different parenting methods and being inconclusive of what was effective she wrote, don't hug and kiss your kids because you think it will make them better people, do it because that's what you want to do, you love them and want to be with them. 

I have never met you, but everything I have read about you makes me think you are a genuinely kind and compassionate human being. I am willing to wager that you would not change one iota of how you treat your fellow human beings if you read a trial that lessened your belief in the power of the placebo effect.

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Adam Cifu, MD's avatar

Love this statement: "Being warm and kind to others is good irregardless if it heals."

Amen.

Thanks for reading and commenting.

--A

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