The document discusses the placebo effect through several sections:
1. It introduces the placebo effect as a psychosomatic phenomenon where symptoms improve from exposure to treatment due to endorphins, even without active ingredients.
2. It explains that the placebo effect is influenced by expectations, meaning, and cultural factors. Alternative medicines generally don't perform better than placebos in controlled trials.
3. It explores strange aspects of the placebo effect like responses in animals/babies, dose-response curves, and placebos seemingly overriding real drugs' effects.
4. The nocebo effect is introduced as the negative counterpart where expecting negative effects can generate or worsen them.
5. A landmark study finding
Cure, how placebo works, placebo, placebo effect, What is the placebo effect, Mechanism of the placebo effect, How does the placebo effect works, How are placebos used
Dr. Nazuk Sharma will present on placebos, including:
1. Defining placebos and exploring their history and mechanisms of action.
2. Examining factors that influence placebo response and their applications in clinical trials and research.
3. Discussing ethics and guidelines around the use of placebos in human research.
The placebo effect refers to the positive health effects experienced after taking an inert substance. Placebos are often used in clinical trials and may be prescribed by doctors. The placebo effect is triggered by a person's belief in the treatment and expectation of feeling better. Research shows that factors like pill size, color, and whether it's a pill or injection can influence the strength of the placebo effect. Conversely, the nocebo effect describes negative health effects from inert substances when a person expects negative effects. Both effects demonstrate the power of the mind-body connection and our ability to influence our health through belief and expectation.
This document discusses placebos, including their definition, history, mechanisms, clinical utility, individual variation, symptoms/conditions treated, and use in research. Key points include:
- A placebo is an inert substance or procedure used in clinical research trials and practice to compare against actual medical treatments.
- The placebo effect is a therapeutic improvement in a patient from an inert substance due to psychological factors like expectations and conditioning.
- Placebos can activate areas of the brain related to expectations and the release of endorphins, helping to relieve symptoms.
- While placebo effects can last for months in some cases, their clinical significance is considered small and hard to distinguish from reporting bias alone. Placebos are not recommended
The document discusses the role of placebos in clinical trials. It defines placebos as inert substances with no therapeutic value used as dummy medicines. Placebos are used in clinical trials to compare effects to active drugs and exclude placebo responders. The placebo effect is psychological and based on expectations. Mechanisms involve neurobiological and psychological factors. Guidelines state placebos can only be used when no alternative exists and risks are justified, with informed consent and risk monitoring. A placebo washout period terminates prior drug effects to observe the trial drug's effects. Problems include imperfect placebos, impure placebos, selection bias, and overestimating placebo effects.
Placebos can produce real physiological effects through mechanisms like decreased anxiety, learning, expectations, and the body's natural painkilling endorphins. Studies show placebo interventions relieve symptoms in 5-55% of patients across conditions like asthma, ulcers, angina, postoperative pain, and back pain. Certain patient and provider factors influence placebo responses; warmth, empathy, and positively conveying realistic optimism about treatment are important.
Placebo effect in clinical research is a fascinating and widely researched phenomenon in biomedical research and medicine in general. Presentation is an overview of origins and impact of placebo effect in development of new medicines.
The document summarizes research on the placebo effect in clinical studies. It discusses how placebos can produce physiological effects through psychoneuroimmunological responses and the patient's expectations of treatment. Studies found placebos helped reduce depression, asthma attacks, and aided wound healing by influencing immune system responses. While placebos may provide relief, their effects are ultimately mediated by the patient's beliefs about the treatment rather than an actual medical intervention.
Cure, how placebo works, placebo, placebo effect, What is the placebo effect, Mechanism of the placebo effect, How does the placebo effect works, How are placebos used
Dr. Nazuk Sharma will present on placebos, including:
1. Defining placebos and exploring their history and mechanisms of action.
2. Examining factors that influence placebo response and their applications in clinical trials and research.
3. Discussing ethics and guidelines around the use of placebos in human research.
The placebo effect refers to the positive health effects experienced after taking an inert substance. Placebos are often used in clinical trials and may be prescribed by doctors. The placebo effect is triggered by a person's belief in the treatment and expectation of feeling better. Research shows that factors like pill size, color, and whether it's a pill or injection can influence the strength of the placebo effect. Conversely, the nocebo effect describes negative health effects from inert substances when a person expects negative effects. Both effects demonstrate the power of the mind-body connection and our ability to influence our health through belief and expectation.
This document discusses placebos, including their definition, history, mechanisms, clinical utility, individual variation, symptoms/conditions treated, and use in research. Key points include:
- A placebo is an inert substance or procedure used in clinical research trials and practice to compare against actual medical treatments.
- The placebo effect is a therapeutic improvement in a patient from an inert substance due to psychological factors like expectations and conditioning.
- Placebos can activate areas of the brain related to expectations and the release of endorphins, helping to relieve symptoms.
- While placebo effects can last for months in some cases, their clinical significance is considered small and hard to distinguish from reporting bias alone. Placebos are not recommended
The document discusses the role of placebos in clinical trials. It defines placebos as inert substances with no therapeutic value used as dummy medicines. Placebos are used in clinical trials to compare effects to active drugs and exclude placebo responders. The placebo effect is psychological and based on expectations. Mechanisms involve neurobiological and psychological factors. Guidelines state placebos can only be used when no alternative exists and risks are justified, with informed consent and risk monitoring. A placebo washout period terminates prior drug effects to observe the trial drug's effects. Problems include imperfect placebos, impure placebos, selection bias, and overestimating placebo effects.
Placebos can produce real physiological effects through mechanisms like decreased anxiety, learning, expectations, and the body's natural painkilling endorphins. Studies show placebo interventions relieve symptoms in 5-55% of patients across conditions like asthma, ulcers, angina, postoperative pain, and back pain. Certain patient and provider factors influence placebo responses; warmth, empathy, and positively conveying realistic optimism about treatment are important.
Placebo effect in clinical research is a fascinating and widely researched phenomenon in biomedical research and medicine in general. Presentation is an overview of origins and impact of placebo effect in development of new medicines.
The document summarizes research on the placebo effect in clinical studies. It discusses how placebos can produce physiological effects through psychoneuroimmunological responses and the patient's expectations of treatment. Studies found placebos helped reduce depression, asthma attacks, and aided wound healing by influencing immune system responses. While placebos may provide relief, their effects are ultimately mediated by the patient's beliefs about the treatment rather than an actual medical intervention.
Blinding in clinical trials refers to keeping participants and investigators unaware of treatment group assignments after randomization. This helps reduce performance bias and ascertainment bias. Blinding is accomplished through placebos, sham interventions, and coding of group assignments. It is important for subjective outcomes but not always possible, and sometimes must be purposefully broken.
Randomization aims to equally distribute participant characteristics between treatment groups to prevent bias. There are several types of randomization including simple, block, and stratified block randomization. Blinding, such as double or triple blinding, helps prevent performance, detection, and other biases by keeping parties unaware of treatment assignments. Bias can still occur through factors like selection, performance, detection, laboratory, or sample size biases if randomization and blinding are not properly implemented.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
This document discusses different methods for disseminating research findings, including oral presentations, written papers, and posters. Oral presentations allow for clarification and persuasion but information may be omitted. Written papers are a permanent record but are time-consuming. Posters visually attract audiences but have limited space. The document suggests using multiple dissemination methods together for maximum impact of research findings.
Basic introduction to clinical trials and the placebo effect. Definitions, examples and cartoons illustrating the subject. Ends with short info on informed consent.
Randomization and blinding are important aspects of controlled clinical trials to reduce bias. Randomization assigns participants to treatment groups using chance to balance both known and unknown prognostic factors. Blinding, such as double blinding where neither participants nor investigators know assignments, prevents bias from expectations of treatment effects. Methods like block randomization and stratification can help balance groups for small trials. Unequal randomization may be used when treatments have different risks or costs. Placebos and coding are used to conduct double blind trials when possible.
Randomisation is a process that randomly assigns participants in a clinical trial to treatment groups in order to prevent bias. It distributes characteristics of participants evenly across groups and ensures comparability. Common randomisation methods include simple randomisation using a coin flip or computer generation, block randomisation which assigns participants in blocks to balance group sizes, and stratified randomisation which divides participants with prognostic factors into subgroups before randomisation. Bias can still occur if the randomisation process is not properly implemented or if those involved in the trial are aware of participant group assignments.
This document discusses types of bias that can occur in epidemiological studies. It defines bias as a systematic error that can lead to conclusions that differ from the truth. The main types of bias discussed are selection bias, information bias, and confounding. Selection bias occurs when the study sample is not representative of the target population. Information bias relates to errors in measuring exposures or outcomes. Confounding occurs when an independent variable other than the exposure of interest influences the outcome. The document provides numerous examples of biases that can arise in specific study designs such as case-control, cohort, and cross-sectional studies.
Placebos are inactive substances or interventions that are used in controlled studies for comparison with potentially active drugs. Placebos are harmless substances given to patients to make them feel better through the power of suggestion, even though they contain no actual medical treatment. Common examples of placebos include sugar pills used in clinical trials. The main difference between placebos and drugs is that placebos have no actual physiological effect - any improvement in symptoms is due to the placebo effect, whereas drugs produce consistent, physiological effects regardless of suggestion.
This document discusses ethics in medical research. It begins by outlining the lesson objectives which are to explain ethics, describe important historical events related to research ethics, list important guidelines, describe informed consent, and describe the role of institutional ethics committees. It then discusses the definition of ethics, important historical incidents like the Nuremberg trials, Thalidomide tragedy, and Tuskegee syphilis experiment. It also describes key documents that outline research ethics guidelines like the Nuremberg Code, Helsinki Declaration, ICH Guidelines, and ICMR Guidelines. It concludes by explaining informed consent and the responsibilities of institutional ethics committees in research.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
This document discusses various types of epidemiological study designs. It describes observational studies like case studies, case series, cross-sectional studies and ecological studies which are descriptive in nature. Analytical observational studies include case-control and cohort studies. Experimental studies involve intervention and comparison groups like randomized controlled trials. The stages of epidemiological investigations are also outlined, from the diagnostic and descriptive phases to the analytical, intervention, decision-making and monitoring phases. Common epidemiological terms like relative risk, odds ratio and attributable risk are defined.
Motivation plays an important role in alcoholism treatment. Researchers have shown interest in how motivation impacts recovery. Patients can be classified into stages of change regarding their readiness to change drinking behavior. Motivational treatment approaches like brief motivational intervention, motivational interviewing, and motivational enhancement therapy are designed to enhance a patient's intrinsic motivation to change. These approaches provide feedback, support self-efficacy, and help patients explore the pros and cons of change to increase motivation and commitment to reducing or stopping drinking. Internal motivation generally leads to better long-term outcomes than external motivation.
Doctor-patient communication has evolved from a paternalistic model to one emphasizing mutual participation. Effective communication is important for accurate diagnosis, treatment adherence and patient satisfaction. It requires listening skills, managing expectations, and tailoring information to individual patients. While doctors value diagnostic skills most, patients prioritize listening. Shared decision-making is preferred but preferences vary between patients. Qualitative research is needed to fully understand patient satisfaction.
The document provides an overview of reviewing literature for research. It discusses that a literature review summarizes previous research related to the topic of study. The review helps identify what is already known, research gaps, and informs the research design. It also describes the various types of literature reviews, sources of literature, characteristics of a good review, and the steps involved in conducting a review. These include developing an annotated bibliography, organizing sources thematically, integrating new findings, writing individual sections, and tying the sections together with an introduction and conclusion.
This document discusses several topics related to research methodology and biostatistics including cultural concerns, truth-telling, online business practices, and control resolution. Cultural concerns involve understanding a patient's culture, language, beliefs, and removing barriers to equal participation. Truth-telling focuses on honesty with patients about diagnoses and errors while balancing autonomy and mental stability. Online business practices emphasize making medical practices mobile-friendly and directly connecting patients to providers through online booking and medical centers. Control resolution ensures ethical considerations in hospitals through effective accreditation addressing integrity, interests, research, and organ ethics.
Randomization is a key process in clinical trials that assigns participants to treatment groups in a way that limits bias. It aims to balance groups so they are similar in all ways except for the intervention received. Common randomization methods include coin tossing, random number tables, and computer generation of sequences. Block and stratified randomization can help produce balanced groups with comparable characteristics. Blinding of participants, investigators, and assessors is important to prevent biases from influencing outcomes. Inclusion and exclusion criteria define who can participate in a clinical trial based on factors like age, sex, disease characteristics, and medical history.
This document discusses mental health risk assessment and management. It notes that clinicians have poor ability to predict suicide or homicide. It identifies static risk factors like previous self-harm and dynamic factors like suicidal ideation. Guidelines are provided for asking patients about suicidal thoughts and developing safety plans. Involuntary referral criteria and processes are outlined when significant short-term risk is present.
The document discusses the roles and responsibilities of ethics committees (ECs) or institutional review boards (IRBs). It states that ECs are independent bodies composed of medical, scientific, and non-scientific members who ensure the protection of human subjects in clinical trials. Their key responsibilities include reviewing and approving study protocols and informed consent documents. The document outlines that ECs should have a diverse membership including specialists in different areas like science, medicine, ethics, law, and lay persons. It explains the perspectives and expertise that different member types, such as basic scientists, legal experts, and social workers, provide to the EC. Finally, it states that the primary purpose of EC/IRB review is to assure the protection of subjects' rights
The document discusses the placebo effect, which is when a fake or inactive treatment seems to improve a patient's condition due to their expectation that it will help. Expectation plays a large role, and the more a patient believes a treatment will work, the more likely they are to experience benefits. The placebo effect is influenced by many factors like positive thought, stress reduction, and cultural meanings around medical treatment. However, deliberately prescribing placebos, known as placebopathy, is considered unethical as it involves deceiving patients and could delay treatment of real conditions.
Placebos can have real physiological effects through expectation and conditioning, but distinguishing the "true" placebo effect requires removing confounding factors. Studies show placebos reduce pain as measured by brain imaging similarly to opioids, but the effect is removed when combined with an opioid antagonist. A trial of asthma treatments found no difference between a placebo inhaler and no treatment when using an objective outcome measure and a cross-over design without patient expectations.
Blinding in clinical trials refers to keeping participants and investigators unaware of treatment group assignments after randomization. This helps reduce performance bias and ascertainment bias. Blinding is accomplished through placebos, sham interventions, and coding of group assignments. It is important for subjective outcomes but not always possible, and sometimes must be purposefully broken.
Randomization aims to equally distribute participant characteristics between treatment groups to prevent bias. There are several types of randomization including simple, block, and stratified block randomization. Blinding, such as double or triple blinding, helps prevent performance, detection, and other biases by keeping parties unaware of treatment assignments. Bias can still occur through factors like selection, performance, detection, laboratory, or sample size biases if randomization and blinding are not properly implemented.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
This document discusses different methods for disseminating research findings, including oral presentations, written papers, and posters. Oral presentations allow for clarification and persuasion but information may be omitted. Written papers are a permanent record but are time-consuming. Posters visually attract audiences but have limited space. The document suggests using multiple dissemination methods together for maximum impact of research findings.
Basic introduction to clinical trials and the placebo effect. Definitions, examples and cartoons illustrating the subject. Ends with short info on informed consent.
Randomization and blinding are important aspects of controlled clinical trials to reduce bias. Randomization assigns participants to treatment groups using chance to balance both known and unknown prognostic factors. Blinding, such as double blinding where neither participants nor investigators know assignments, prevents bias from expectations of treatment effects. Methods like block randomization and stratification can help balance groups for small trials. Unequal randomization may be used when treatments have different risks or costs. Placebos and coding are used to conduct double blind trials when possible.
Randomisation is a process that randomly assigns participants in a clinical trial to treatment groups in order to prevent bias. It distributes characteristics of participants evenly across groups and ensures comparability. Common randomisation methods include simple randomisation using a coin flip or computer generation, block randomisation which assigns participants in blocks to balance group sizes, and stratified randomisation which divides participants with prognostic factors into subgroups before randomisation. Bias can still occur if the randomisation process is not properly implemented or if those involved in the trial are aware of participant group assignments.
This document discusses types of bias that can occur in epidemiological studies. It defines bias as a systematic error that can lead to conclusions that differ from the truth. The main types of bias discussed are selection bias, information bias, and confounding. Selection bias occurs when the study sample is not representative of the target population. Information bias relates to errors in measuring exposures or outcomes. Confounding occurs when an independent variable other than the exposure of interest influences the outcome. The document provides numerous examples of biases that can arise in specific study designs such as case-control, cohort, and cross-sectional studies.
Placebos are inactive substances or interventions that are used in controlled studies for comparison with potentially active drugs. Placebos are harmless substances given to patients to make them feel better through the power of suggestion, even though they contain no actual medical treatment. Common examples of placebos include sugar pills used in clinical trials. The main difference between placebos and drugs is that placebos have no actual physiological effect - any improvement in symptoms is due to the placebo effect, whereas drugs produce consistent, physiological effects regardless of suggestion.
This document discusses ethics in medical research. It begins by outlining the lesson objectives which are to explain ethics, describe important historical events related to research ethics, list important guidelines, describe informed consent, and describe the role of institutional ethics committees. It then discusses the definition of ethics, important historical incidents like the Nuremberg trials, Thalidomide tragedy, and Tuskegee syphilis experiment. It also describes key documents that outline research ethics guidelines like the Nuremberg Code, Helsinki Declaration, ICH Guidelines, and ICMR Guidelines. It concludes by explaining informed consent and the responsibilities of institutional ethics committees in research.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
This document discusses various types of epidemiological study designs. It describes observational studies like case studies, case series, cross-sectional studies and ecological studies which are descriptive in nature. Analytical observational studies include case-control and cohort studies. Experimental studies involve intervention and comparison groups like randomized controlled trials. The stages of epidemiological investigations are also outlined, from the diagnostic and descriptive phases to the analytical, intervention, decision-making and monitoring phases. Common epidemiological terms like relative risk, odds ratio and attributable risk are defined.
Motivation plays an important role in alcoholism treatment. Researchers have shown interest in how motivation impacts recovery. Patients can be classified into stages of change regarding their readiness to change drinking behavior. Motivational treatment approaches like brief motivational intervention, motivational interviewing, and motivational enhancement therapy are designed to enhance a patient's intrinsic motivation to change. These approaches provide feedback, support self-efficacy, and help patients explore the pros and cons of change to increase motivation and commitment to reducing or stopping drinking. Internal motivation generally leads to better long-term outcomes than external motivation.
Doctor-patient communication has evolved from a paternalistic model to one emphasizing mutual participation. Effective communication is important for accurate diagnosis, treatment adherence and patient satisfaction. It requires listening skills, managing expectations, and tailoring information to individual patients. While doctors value diagnostic skills most, patients prioritize listening. Shared decision-making is preferred but preferences vary between patients. Qualitative research is needed to fully understand patient satisfaction.
The document provides an overview of reviewing literature for research. It discusses that a literature review summarizes previous research related to the topic of study. The review helps identify what is already known, research gaps, and informs the research design. It also describes the various types of literature reviews, sources of literature, characteristics of a good review, and the steps involved in conducting a review. These include developing an annotated bibliography, organizing sources thematically, integrating new findings, writing individual sections, and tying the sections together with an introduction and conclusion.
This document discusses several topics related to research methodology and biostatistics including cultural concerns, truth-telling, online business practices, and control resolution. Cultural concerns involve understanding a patient's culture, language, beliefs, and removing barriers to equal participation. Truth-telling focuses on honesty with patients about diagnoses and errors while balancing autonomy and mental stability. Online business practices emphasize making medical practices mobile-friendly and directly connecting patients to providers through online booking and medical centers. Control resolution ensures ethical considerations in hospitals through effective accreditation addressing integrity, interests, research, and organ ethics.
Randomization is a key process in clinical trials that assigns participants to treatment groups in a way that limits bias. It aims to balance groups so they are similar in all ways except for the intervention received. Common randomization methods include coin tossing, random number tables, and computer generation of sequences. Block and stratified randomization can help produce balanced groups with comparable characteristics. Blinding of participants, investigators, and assessors is important to prevent biases from influencing outcomes. Inclusion and exclusion criteria define who can participate in a clinical trial based on factors like age, sex, disease characteristics, and medical history.
This document discusses mental health risk assessment and management. It notes that clinicians have poor ability to predict suicide or homicide. It identifies static risk factors like previous self-harm and dynamic factors like suicidal ideation. Guidelines are provided for asking patients about suicidal thoughts and developing safety plans. Involuntary referral criteria and processes are outlined when significant short-term risk is present.
The document discusses the roles and responsibilities of ethics committees (ECs) or institutional review boards (IRBs). It states that ECs are independent bodies composed of medical, scientific, and non-scientific members who ensure the protection of human subjects in clinical trials. Their key responsibilities include reviewing and approving study protocols and informed consent documents. The document outlines that ECs should have a diverse membership including specialists in different areas like science, medicine, ethics, law, and lay persons. It explains the perspectives and expertise that different member types, such as basic scientists, legal experts, and social workers, provide to the EC. Finally, it states that the primary purpose of EC/IRB review is to assure the protection of subjects' rights
The document discusses the placebo effect, which is when a fake or inactive treatment seems to improve a patient's condition due to their expectation that it will help. Expectation plays a large role, and the more a patient believes a treatment will work, the more likely they are to experience benefits. The placebo effect is influenced by many factors like positive thought, stress reduction, and cultural meanings around medical treatment. However, deliberately prescribing placebos, known as placebopathy, is considered unethical as it involves deceiving patients and could delay treatment of real conditions.
Placebos can have real physiological effects through expectation and conditioning, but distinguishing the "true" placebo effect requires removing confounding factors. Studies show placebos reduce pain as measured by brain imaging similarly to opioids, but the effect is removed when combined with an opioid antagonist. A trial of asthma treatments found no difference between a placebo inhaler and no treatment when using an objective outcome measure and a cross-over design without patient expectations.
This document discusses the ethics of placebo treatment in clinical settings. The author argues that while placebos are commonly seen as deceptive, this view stems from a misunderstanding of what makes something a placebo and how placebos work. The central question addressed is whether there is something about the nature of placebo treatment that always makes it against a patient's best interests and thus impermissible. The author aims to provide a precise definition of placebos and the placebo effect to clarify this debate.
This document discusses the ethics of placebo treatment in clinical settings. The author argues that while placebos are often thought to be deceptive, this view misunderstands why placebos are considered deceptive. The goal of the paper is to develop a precise definition of what constitutes a placebo in order to clarify the ethics around placebo treatment. The central question addressed is whether there is something inherent in the nature of placebo treatment that always makes it against a patient's best interests and therefore always impermissible.
This document discusses clinical research and the placebo effect. It defines observational and interventional clinical studies. It describes the phases of clinical trials from Phase 0 to Phase IV. It explains that the word "placebo" comes from Latin meaning "I shall please." It discusses the placebo effect and nocebo effect, and the potential mechanisms of the placebo effect involving the release of endorphins. Examples of conditions responsive to the placebo effect include cancer, IBS, depression, and Parkinson's disease. A case study found that depressed people who responded to placebos also responded well to real antidepressants.
Drugs and the Body discusses the pharmacokinetics and pharmacodynamics of how drugs act on the body. Pharmacokinetics describes the absorption, distribution, metabolism and excretion of drugs in the body. Pharmacodynamics examines how drugs produce their effects by interacting with receptor sites or replacing missing chemicals. Nursing management of drug administration involves ensuring the "rights" of giving the right drug to the right patient via the right route and dose. The nursing process - which includes assessment, nursing diagnosis, planning, interventions and evaluation - is used to properly manage a patient's drug therapy.
This document discusses the history and use of placebos in clinical research and medicine. It provides background on the origins of the term placebo and how placebos have been used historically in fields like homeopathy. The document then discusses how placebos are currently accepted as having clinically important effects, though the mechanisms are not fully understood. It notes placebos can produce effects in many medical conditions and even surgery. Placebos are seen as particularly relevant in psychiatry given uncertainties about disease origins and drug mechanisms of action. Examples are given of placebo response rates in depression and variability between individuals and cultures.
Dr. Nazuk Sharma presented on placebos. Some key points:
1. A placebo is a dummy medicine containing no active substance that can produce physiological or psychological effects through a patient's expectations.
2. Placebos have been used since the 18th century and the placebo effect is thought to be mediated by factors like conditioning, expectations, and the endogenous opioid system.
3. Placebo response rates in clinical trials average around 35% but can be as high as 70-80% when patients don't know they are receiving placebos. Placebos are used in clinical trials to compare to active treatments and identify placebo responders.
1. Placebos are inert substances or procedures that are intended to deceive patients into thinking they are receiving real medical treatment. Placebos can induce physiological effects and improve symptoms through psychological mechanisms like expectations and conditioning.
2. Factors that influence the placebo response include patient characteristics, characteristics of the healthcare provider, the appearance and delivery of treatments, and the patient-provider relationship.
3. Placebos are used in clinical trials to compare the efficacy of new treatments to no treatment and to help control for biases, but their use is also controversial from an ethics perspective when real treatments exist. Guidelines aim to ensure patient safety and fully informed consent when placebos are used.
The document discusses several variables that can affect the outcomes of psychotherapy. It describes how psychotherapy requires motivation from patients and can be challenging, noting factors like a patient's level of distress, age, intelligence, and openness to the process. Gender is also mentioned as a variable, with questions around whether outcomes differ for male and female patients or if sexism influences therapy. The document aims to outline patient characteristics and variables in traditional therapies that can relate to treatment outcomes.
The document discusses Dr. Subrata K. Banerjea's approach to homoeopathic case taking and dispensing techniques. He emphasizes thorough case taking using a questionnaire to ensure all relevant details are obtained. For dispensing, he prescribes a single centesimal potency globule dissolved in water to be sipped over several days, believing this gentle approach avoids aggravations. He finds this centesimal scale technique capable of uprooting deep suppressions.
The placebo effect refers to the improvements in health or symptoms that occur after a placebo treatment despite the treatment having no active therapeutic ingredients. Placebos have been shown to have physiological effects through biochemical responses to the expectation of treatment. While the placebo effect was once thought to be solely psychological, research has demonstrated that placebos can produce real, measurable somatic effects similar to actual medical treatments including surgery. The nocebo effect, where negative expectations lead to adverse health effects, has also been shown to have biological underpinnings. Together, the placebo and nocebo effects show that mind-body connections and expectations play an important role in health beyond just the biochemical properties of treatments.
Dr Sadgun Bhandari - A PRELIMNARY REVIEW. Dr. Sadgun Bhandari is a General Psychiatrist Consultant and an expert at the management of Serious Mental Illness especially Schizophrenia and Bipolar Affective Disorder.
This document provides an overview of addiction psychiatry including:
- The neurobiology of addiction including the role of dopamine in the brain's reward pathway and how chronic drug use impacts this system.
- Assessment and management of patients with dual diagnoses of substance use disorder and other psychiatric illnesses.
- Approaches to treatment including motivational interviewing, relapse prevention therapy, and pharmacotherapy options for various addictions.
- A case example of potential prescription opioid misuse or addiction is presented and approaches to assessment and treatment are discussed.
This document discusses engaging the medical community on the issue of opioid use and abuse. It begins with introductions from Brian Fingerson, President of Kentucky Professionals Recovery Network, and Dallas Gay, Co-chair of the Medical Association of Georgia Foundation's "Think About It" Campaign. The speakers then review learning objectives about describing changing attitudes around prescription drug abuse, defining clinicians' roles in positively impacting the opioid epidemic, and demonstrating programs that are engaging the clinical community on appropriate opioid use and abuse.
This document discusses the over-medicalization and over-prescription of psychiatric medications. It notes that as diagnoses have increased in the DSM, the number of medications prescribed has also increased dramatically without corresponding decreases in rates of mental illness. Long-term use of these medications can cause drug dependency and physical changes to the brain. Alternatives to medication such as lifestyle changes are presented as better solutions to support mental health.
This document discusses the problems with the medicalization and over-prescription of psychiatric medications. It notes that as diagnoses have increased, so too have prescriptions, yet the number of people diagnosed with mental illness has not decreased. It examines how the push for psychology to be taken seriously as a medical field led to a focus on drugs over therapy. Statistics are provided showing rising rates of diagnoses, prescriptions, and disability related to mental illness. Alternatives to medication like counseling, exercise, nutrition, and social support are proposed.
This document discusses four South African women - Sharon, Jane, Nomvulo, and Ashika - who have become addicted to different types of medications that were originally prescribed by healthcare providers. It notes that substance abuse has traditionally been seen as a male issue, but that women are more likely to misuse prescription drugs like painkillers and sedatives. The document explores reasons for this, like women facing greater life stresses and physiological vulnerabilities. It warns that medications prescribed for short-term issues often lead to long-term addiction when taken without review.
Therapy Without Force: A Treatment Model for Severe Psychiatric ProblemsAhmed YaGoub
The standards of care of the modern mental health system all but insist that a therapist use force in working with clients diagnosed with severe psychiatric problems—especially those labeled with schizophrenia or bipolar disorder. The mental health practitioner is taught to be skeptical of their judgment, their self-control, and thus their wishes.
Suicide Prevention through Architecture (Building) and City PlanningGAURAV. H .TANDON
Suicide Prevention through Architecture (Building) and City Planning
Accessing The Potentials Of CPTED Principles In Addressing Safety Concerns Of Suicide Prevention In City Planning
Suicide Prevention through Architecture (Building) and City PlanningGAURAV. H .TANDON
Suicide Prevention through Architecture (Building) and City Planning
Accessing The Potentials Of CPTED Principles In Addressing Safety Concerns Of Suicide Prevention In City Planning
Digital Detoxing in Smart Cities.
Digital Detox for Sustainability: Unplugging/Redesigning technologies of Smart Cities for a Sustainable Future
“How a small Village in Maharashtra, India teaching importance of Digital detoxing to Mega Smart cities of India”
Digital Detoxing in Smart Cities
Digital Detox for Sustainability: Unplugging/Redesigning technologies of Smart Cities for a Sustainable Future
“How a small Village in Maharashtra, India teaching importance of Digital detoxing to Mega Smart cities of India”
The document discusses the importance of premarital screening or testing before marriage. It explains that premarital screening involves testing prospective spouses for infectious diseases, genetic disorders, and compatibility to help ensure a healthy marriage and family. Compatibility is assessed through both traditional Indian kundli matching of astrological charts as well as modern medical testing. While kundli matching provides useful information, medical screening can detect diseases and identify health risks that could impact a couple's well-being and ability to have children. The document recommends couples undergo premarital screening through blood tests, physical exams, and counseling to aid in informed decision making.
A polymath is defined as a person with expertise in various fields of science, humanities, and the arts. Historically, polymaths included great Renaissance thinkers like Leonardo da Vinci and Benjamin Franklin who made significant contributions across multiple disciplines. Nowadays, it is difficult to find true polymaths due to the ever-increasing specialization of knowledge. However, the document outlines characteristics of polymaths such as cultivating curiosity, multiple passions and interests, and not worrying about perfection in order to bring back the Renaissance ideal of a well-rounded thinker.
Godfather-like figures organize complex crash for cash schemes involving staged, induced, and ghost crashes to fraudulently obtain insurance payouts. They recruit drivers, passengers, and professional enablers like doctors and repair shops to carry out the schemes, which can net up to £30,000 per crash. The schemes cost insurers millions each year and ultimately increase premiums for all policyholders.
The document discusses arguments for and against lowering the minimum voting age. It notes that while most countries have the age set at 18, some have it as low as 16. Advocates argue that 16-year-olds have adult responsibilities and should have a say, and research shows lower ages increase youth participation without lowering vote quality. However, others argue younger people lack maturity. Countries experimenting with lower ages often do so incrementally. Overall it is a complex debate that intersects with issues of children's rights.
The document provides an overview of the ecological footprint concept. It defines ecological footprint as a method that measures human demand on nature against the Earth's biological capacity to regenerate resources and absorb waste. Key points include:
- Humanity's ecological footprint has exceeded the Earth's biocapacity since the 1970s, meaning more than 1 Earth is needed each year to replenish what is used.
- The ecological footprint is calculated by adding up the productive land and sea area required to produce the resources an individual, group, or activity consumes and absorb their waste, expressed in global hectares.
- Many countries and individuals have an ecological deficit, using more than what local ecosystems can regenerate.
Urban Heat Island Effect occurs when urban areas become significantly warmer than surrounding rural areas due to human activities and infrastructure that replace open land and vegetation. Impervious surfaces like concrete and asphalt absorb and re-emit more solar radiation than natural landscapes, causing surface and ambient air temperatures to increase in cities. Additional factors like reduced evapotranspiration from plants, waste heat from energy usage, and decreased wind speed between buildings exacerbate the higher temperatures. As temperatures rise, greater air conditioning usage produces more waste heat in a self-perpetuating cycle of increasing the Urban Heat Island Effect.
Communication is the exchange of information between individuals through a common system of symbols, signs or behavior. It involves five main steps - ideation, encoding, transmission, decoding and response. Communication can occur through different levels like interpersonal, group, organizational and mass communication. Effective communication requires good command over language and follows certain characteristics. Technical communication is more formal in style and involves technical vocabulary or graphics. It plays a pivotal role in organizations and their success depends on quality information flow. Some important books and Ted talks on developing strong communication skills are also mentioned.
The unethical practice of gift giving to doctors by pharma companiesGAURAV. H .TANDON
The document discusses the unethical practice of pharmaceutical companies giving gifts to doctors in various countries. It notes that while informing doctors about new drugs is acceptable, gifts can influence prescribing behaviors and create conflicts of interest. Regulations in countries like Bangladesh, Australia, China, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, and Vietnam prohibit or limit such gifts. The document calls for India's government to implement uniform marketing codes for pharmaceutical companies to restrict unethical practices like bribing doctors with foreign trips, phones, or other incentives.
The document discusses the concepts of compassionate cities and urban loneliness. It defines compassion and describes how living alone in cities can cause loneliness, especially among the elderly. It suggests ways for urban planners to address this issue, such as creating more green spaces for social interaction and improving transportation infrastructure to encourage community. The goal is to make cities places where compassion for all residents is a priority and people care for one another's well-being. The Charter for Compassion aims to promote compassion as a core value globally.
Copper has natural antimicrobial properties that have been exploited for centuries. It kills bacteria, viruses, and fungi through mechanisms like oxidative stress and damage to cell membranes and proteins. Recent clinical studies show copper alloys reduce bacterial contamination on high-touch surfaces in hospitals by 90-100% compared to other materials like stainless steel. The EPA has approved copper alloys as antimicrobial materials due to their ability to reduce MRSA and E. coli levels by over 99.9% within 2 hours of contact under laboratory conditions. However, while copper was widely used historically, other modern materials have replaced it despite its benefits for infection control.
The Liuzhou Forest City in China will be the world's first forest city, where all buildings are covered in greenery. Designed by Stefano Boeri Architetti, the city will house 30,000 inhabitants in buildings surrounded by over 40,000 trees and 1 million plants. The extensive greenery is intended to absorb air pollutants and carbon emissions while producing oxygen. In addition to environmental benefits, the forest city aims to be self-sufficient through geothermal and solar energy use. Construction is slated to begin in 2020.
Automotive vehicles are increasingly automated and connected to wireless networks, leaving them vulnerable to remote hacking attacks. Security researchers have demonstrated how hackers could potentially access a vehicle's internal computer systems to disable brakes or engine controls from a distance. Recent studies show many modern vehicles built after 2005 are at risk if automakers do not address vulnerabilities in wireless infotainment and connectivity systems that could allow unauthorized remote access and control over critical functions.
Collusion and Fraud Detection on Electronic Energy Meters GAURAV. H .TANDON
The document discusses collusion and fraud detection related to smart energy meters. It covers topics such as collusion, which involves secret cooperation to deceive others; electricity theft; advanced metering infrastructure; reasons for electricity theft; legal aspects; safety and economic impacts of theft; and techniques for theft. The key points are that collusion aims to limit competition through deception, modern meters allow remote monitoring but lack of trust remains a barrier, and electricity theft endangers safety, harms economics, and is considered a legal issue.
Smart buildings use automated systems and sensors to control operations like HVAC, lighting, and security. However, connecting these systems also introduces cybersecurity vulnerabilities. As buildings add more internet-connected devices, they provide more entry points for hackers to potentially access sensitive building systems and data. Cyber criminals are increasingly targeting smart buildings due to their growth and interconnected nature, which could allow access to security cameras, elevators, and other building operations if networks are breached.
Get Covid Testing at Fit to Fly PCR TestNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
4. Introduction
• No one doubts—certainly not I—that the mind exercises
a powerful influence over the body.
• From the beginning of time, the sorcerer, the interpreter
of dreams, the fortune-teller, the charlatan, the quack,
the wild medicine-man, the educated physician, the
mesmerist, and the hypnotist have made use of the
client's imagination to help them in their work. They
have all recognized the potency and availability of that
force. Physicians cure many patients with a bread pill;
they know that where the disease is only a fancy, the
patient's confidence in the doctor will make the bread
pill effective.
• —Mark Twain
6. Introduction
• The placebo effect is a psychosomatic
phenomenon in which symptoms of a disease
or condition lessen — or even appear to be
cured completely — from the patient being
merely exposed to a treatment, as a result of
the body releasing endorphins
10. Introduction
• Believing that their condition will be improved, they
will begin to feel better and perhaps identifiable
symptoms may disappear, irrespective of whether
the treatment has any chemical or pharmacological
effect. Because of this, controlling for the placebo
effect is an essential part of medicine.
• For example, sugar pills or saline solutions, which
have no pharmacological properties, are commonly
prescribed as placebo treatments to control for the
effect the simple act of intervening in a patient's illness.
14. Introduction
• Most alternative medicine is suggested to work
through this method — mostly because any
treatment that doesn't work through this
method is labelled "medicine".
• Under placebo control, alternative
medicines do not perform significantly
better.
18. Causes
• The placebo effect is quite a complex
phenomenon.
• It is influenced by a multitude of things,
including positive thought, reduced stress,
the intensity or "drama" of the medical
intervention, a patient's expectations of
what the treatment can do, and the wider
cultural meaning of medical treatment.
20. Causes
• A particularly interesting observation is
how much these factors can be influenced
subconsciously; a doctor merely telling
someone a treatment will work may not
produce such a dramatic effect if the doctor
doesn't actually believe it too.
22. Causes
• Because of the complexity of issues
surrounding what causes a sick patient to get
"better", it's difficult to say if an individual
was cured by a placebo effect, real treatment,
regression to the mean or a complicated
combination of all three.
24. Causes
• So, the placebo effect is best described as a
statistical phenomenon, where prognosis
improves for a certain percentage of
patients simply exposed to a treatment of
some kind.
26. Causes
• However, as the placebo effect is powered by
belief in a treatment and exposure to it, it can
manifest in individuals to a certain extent.
• A homeopathic prescription of water
containing a minute dilution of powdered
oyster shell may bring some improvement to
a patient who has total faith in the
homeopathic method.
28. Placebo Effect
• A patient who is sceptical of homeopathy may
experience a reduced effect or no effect at all,
as demonstrated by James Randi when he
regularly consumes massive overdoses of
homeopathic sleeping pills on stage.
• If these two hypothetical patients begin to feel
better anyway, the former would be likely to
attribute it to the treatment while the latter would
be likely to dismiss it as just feeling better
anyway.
29. Why didn't homeopathic sleeping pills
work on James Randi's body?
Because homeopathy doesn't work.
It does not work on his body, or
anybody else's because it cannot
work.
30. James Randi: Homeopathy, quackery
and fraud
• Legendary skeptic James Randi takes a fatal dose of
homeopathic sleeping pills onstage, kicking off a searing
18-minute indictment of irrational beliefs.
• https://www.ted.com/talks/james_randi?language=en&utm_campaig
n=tedspread&utm_medium=referral&utm_source=tedcomshare
31. Expectation effects
• When I was a boy a farmer's wife who lived five
miles from our village had great fame as a faith-
doctor — that was what she called herself.
• Sufferers came to her from all around, and she laid her
hand upon them and said, "Have faith—it is all that is
necessary," and they went away well of their ailments.
She was not a religious woman, and pretended to no
occult powers. She said that the patient's faith in her did
the work.
• Several times I saw her make immediate cures of
severe toothaches. My mother was the patient.
—Mark Twain
35. Expectation effects
• Expectations of what drugs and medical
treatments can, and do, change over time.
Often the efficacy of real drugs decreases when
a new version is released, as people expect the
new one to be better. New treatments, which are
perceived to be more effective because they
exploit new technologies induce a placebo effect
in addition to their real effect and, sometimes, this
can lead to an overestimate of their real efficacy
over an existing treatment.
37. Expectation effects
• This is why in controlled studies of new
treatments, they are compared not with
inactive placebos but the best effective
treatment available and the experience
between patients is minimised so that they
genuinely cannot tell the difference between
treatment A and treatment B.
39. Expectation effects
• It is an observed phenomenon that placebo
drugs distributed in flashier packaging tend to
produce a stronger reaction than their plain
packaging counterparts.
• There is also evidence that the placebo effect can
work even if the person knows that it is a placebo,
as observed in a study of patients with irritable
bowel syndrome (IBS).
• In short, the placebo effect works if you expect
the placebo effect to work.
40. The Power of Drug Color
A pill's hue can affect how it's judged by patients, how it's
marketed, and even how well it works.
43. Ethical considerations
• There are a number of ethical issues
surrounding the wilful use of placebos as a
treatment — known as placebopathy.
• Many casual complaints can be dealt with by
inactive placebo treatments (involving a sugar
pill and a reassuring visit to a doctor) and this
would save a significant amount of time,
money and lowers the risk of drug dependency
and overdose.
45. Placebopathy
• Yet, despite these potential benefits to willingly
issuing placebos, it is not considered ethical in
modern medicine.
• Firstly, placebopathy involves medical professions
deceiving their patients, which is considered bad ethical
practice, and secondly there is a risk in delaying the
treatment of a real condition due to a doctor mistrusting
or underestimating their patient's symptoms.
• If a patient complaining of a headache is given a
sugar pill to placate it, and it turns out to be a
serious condition that requires non-placebo
treatment then at the very least this would be a
serious lawsuit waiting to happen.
47. .
Use In Medical Trials
• Because the placebo effect is so powerful, efficacy claims
for medical treatments must be tested in an experiment
that controls for this effect. This is usually achieved by
running a double-blind test, where some patients receive
the treatment being examined, and others get a placebo.
• Neither the patients or the administrators of the treatment
know who is in which group. In order for the treatment to
be proved useful, it must produce results that are better than
the placebo at a statistically significant level. In practice the
"placebo" is usually an existing treatment, as being better
than an placebo isn't enough — a new treatment has to be
better than the existing one!
50. The strangeness of the placebo effect
• The power of the placebo effect produces
many strange and interesting quirks.
• These indicate that the placebo effect may
well be more than mere "mind over
matter", and stem from what is known as a
complex intervention.
51. The strangeness of the placebo effect
• The effect has been observed in animals and
babies. However, in practice this requires
conditioning first, which is analogous to just
telling someone a treatment will work when
you can't communicate more directly.
53. The strangeness of the placebo effect
• Placebos that are "more expensive" work
better.
• The effect shows a dose-response
relationship like a real medical intervention;
two pills are more effective than one
55. The strangeness of the placebo effect
• More dramatic placebos are more effective.
Injections work better than pills.
• A full consultation session with a doctor
prior to a placebo is more effective than just
giving a patient a pill dismissively.
57. The strangeness of the placebo effect
• The placebo effect may possibly have the
ability to overpower real pharmacological
effects.
• People who were given very strong drugs to
induce nausea didn't develop symptoms as
they were told the treatment would actually
relieve nausea.
60. The strangeness of the placebo effect
• The placebo effect may be transferable; a
patient being around someone who believes
that the treatment will work can cause the
patient to do better — even if that person is
a doctor
62. Nocebo effect
• The placebo effect has a somewhat less well-
known, slightly evil cousin; the nocebo effect.
This occurs when an individual's expectation
of negative effects generates or aggravates
those effects
65. Nocebo effect
• For ethical reasons the nocebo effect has not been well
studied directly, but it is probably behind the witch
doctor's ability to cause illness in those people he curses.
• It has also been used to explain unusual phenomenon like the
culture-bound syndrome SUNDS (Sudden Unexpected
Nocturnal Death Syndrome) in immigrants from the
Hmong people of Laos; belief in angry supernatural
forces combined with the phenomenon of sleep paralysis
to convince sufferers that they were under attack, leading
to extremely high levels of stress which could trigger
dormant heart defects.
• As a side note, these same deaths were what inspired film
director Wes Craven to create the fictional dream-using serial
killer Freddy Krueger.
67. Terminology
• Big Placebo
• Big Placebo is a nickname given to alternative
medicine companies, coined as a counterpart
to the name Big Pharma for drug companies.
The term was coined by Lindsay Beyerstein in
2009
69. Terminology
• Folk Remedy
• A folk remedy is any purported health remedy
which comes from a pre-scientific source, usually
through oral tradition.
• They remain popular among people who continue
to use them because it is popular in the culture
they are from or because "this is what grandma
did", but many such practices have also remained
in use through promotion as patent medicines or
alternative medicine fads
71. Terminology
• Faith healing
• Faith healing is a form of medical woo that
attempts to cure a wide range of ailments
primarily through personal prayer and
intercessory prayer, sometimes augmented by
faith-based rituals. God is capable of curing all
diseases and injuries that could ever affect
anybody, assuming He is willing.
73. Case Study
• A fascinating landmark study of placebo
surgery for knee osteoarthritis
• Moseley JB, O’Malley K, Petersen NJ, et al. A
controlled trial of arthroscopic surgery for
osteoarthritis of the knee. N Engl J Med. 2002
Jul 11;347(2):81–8
75. Case Study
• In this landmark and fascinating study, people with
osteoarthritis improved equally well regardless of
whether they received a real surgical procedure or a
sham, which is a particularly striking example of the
placebo effect and implies that belief can have an effect
even on a “mechanical” knee problem.
• From the abstract: “In this controlled trial involving
patients with osteoarthritis of the knee, the
outcomes after arthroscopic lavage or arthroscopic
debridement were no better than those after a
placebo procedure.”
76. In this controlled trial involving patients with osteoarthritis of the knee,
the outcomes after arthroscopic lavage or arthroscopic debridement were
no better than those after a placebo procedure
77. Case Study
• In 2008, these findings were fully supported by
a Cochrane Collaboration review
(Laupattarakasem) which concluded that
“there is ‘gold’ level evidence that arthroscopic
debridement has no benefit,” and by New
England Journal of Medicine (Kirkley) which
reported that “surgery for osteoarthritis of the
knee provides no additional benefit to
optimized physical and medical therapy.”
78. BBC Documentary - Placebo Effect As Good As
Surgery For Outcome In Knee Pain.
https://youtu.be/HqGSeFOUsLI
79. Case Study
• This study inspired more comparisons of
orthopedic surgeries to shams. By 2016, at
least four more popular surgeries have been
shown to have no benefit (Louw 2016).
• ~ Paul Ingraham
80. BBC Documentary - Placebo Effect As Good
As Surgery For Outcome In Knee Pain.
81. Case Study: The Ethics of Homeopathy
• Journal Bioethics, examines the ethics of
placebos, based on an analysis of
homeopathy.
• Homeopathy is the ultimate placebo in routine
use — most remedies contain only sugar and
water, lacking a single molecule of any
potentially medicinal ingredient
83. Case Study: The Ethics of
Homeopathy
• concise summary of the scientific absurdity of
homeopathy.
• Hahnemann’s “Law of Similars”, based on a single
observation of the effects of quinine on malaria, is the
basis for the non-scientific process of “provings” to
match symptoms to substances.
• The results of provings are compiled in the
Homeopathic Materia Medica, which homeopaths
select their remedies from. (So now we have
remedies based on products including “sleep”,
Stonehenge, shipwrecks, ascending colons, light
bulbs, and vacuum cleaner dirt.)
87. Case Study: The Ethics of
Homeopathy
• Hahnemann’s second law, the “Law of
Infinitesimals” is as absurd as the law of
similars.
• That a product can gain potency and effect
with dilution, and that effect persists (and
even grows stronger) even after being
diluted completely away defies physical
laws.
92. Case Study: The Ethics of
Homeopathy
• The research on homeopathy.
• Given its premise is implausible (or
impossible), it is not surprising that the
highest quality clinical trials have
demonstrated no efficacy beyond placebo
effects.
94. Case Study: The Ethics of
Homeopathy
• So it’s implausible, the remedies contain no
medicinal ingredients, and, not surprisingly,
it works no better than a placebo. Yet it is
popular, even among some physicians and
scientists
96. Waste of Resources
• If you’ve never bought it before,
homeopathy is not cheap: its prices are
comparable to conventional products with
active ingredients. Given the lack of efficacy,
every dollar spent on homeopathy is a waste of
resources
97. Credibility Issues
• Most consumers expect the products on
pharmacy shelves to contain medicinal
ingredients, and to have some sort of evidence
to support their sale.
• If I substituted placebos for prescription
drugs, I’d quickly lose my license to practice
100. References
• A fascinating landmark study of placebo surgery for knee osteoarthritis
• https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo-surgery-for-
knee-osteoarthritis.html
• Is the Nocebo Effect Hurting Your Health?
• https://www.webmd.com/balance/features/is-the-nocebo-effect-hurting-your-health#1
• Nocebo
• https://en.wikipedia.org/wiki/Nocebo
• Placebos as Medicine: The Ethics of Homeopathy
• https://sciencebasedmedicine.org/placebos-as-medicine-the-ethics-of-homeopathy/
• Placebo
• https://en.wikipedia.org/wiki/Placebo
• Placebo Effects in Medicine
• https://www.nejm.org/doi/full/10.1056/nejmp1504023
• The placebo effect and homeopathy.
• https://www.ncbi.nlm.nih.gov/pubmed/20471615
• What Is the Placebo Effect?
• https://www.webmd.com/pain-management/what-is-the-placebo-effect#1