Placebo Effect Lecture Flashcards
Define evidence-based medicine
systematic, explicit and judicious use of best evidence in patient care
Define evidence-based pharmacotherapy
Systemic, explicit and judicious use of best evidence in making decisions about drug treatments in patients
How do you get all the information you need to be good at your job?
Lectures, textbooks, talking to your colleagues, reading journal reviews and attending conferences
Why are the pharmacology, clinical and epidemiological findings, and clinical studies not perfect sources?
Pharmacology: does not prove clinical effectivity
Clinical and epidemiological findings: my be biased by errors of desgin
Clinical studies: placebo effect
Define placebo
Drug formulation without specific therapeutic ingredients
Define placebo effect
Describes the clinical observation that the health of diseased patients may improve after intake of placebo
Uses of placebo
Used in clinical trials to distinguish specific and unspecific therapeutic effects
Used therapeutically in disease states with high subjective component
In what situation that placebo treatment is effective?
Headache, motion sickness, cough, anxiety, postoperative wound pain, angina pectoris, surgery, migraine, rheumatic pain, cold, sleeplessness, GI disorders
When is there no placebo effect?
Unconscious patients, hidden treatments and if there is no expectation
Why do patients show spontaneous health improvement after visiting a physician?
Because patients seek help when their illness is at its height and spontaneous healing occurs at this stage
- To seek advice is to accept being sick
- Now ready to spend time to change
What is the psychology of placebos?
Largely subconscious
Prescription, filing and intake are ritual (conditioning)
Positive attitude towards placebo
Taking meds reminds them that a lifestyle change may be necessary
Do bitter pills work better as a placebos than sweet pills?
YES
Placebos work better in men?
NO
Injections are more effective than suppositories?
YES
Stimulating pills should not be blue?
NO; they should be
High-priced placebos work better?
YES
Pharmacy professors are resistant to the placebo effects?
YES
What is the true placebo effect in treatment of pain?
Placebo evokes opiate-like effects in responsers but non in non-responders
Naloxone antagonizes the placebo response
What are some examples of true physiological effects of placebos?
Release of endorphins in pain
Release of dopamine in Parkinson’s disease
Reduction of stress hormones in plasma and urine (+ reduction of heart rate)
How are placebos used in therapeutic practices?
Use of placebos in clinical trails
Rational use of the placebo effect in ambulatory setting
Use of pseudoplacebos (non-evidence based medicines)
Importance of placebo concepts for the evaluation of “alternative drugs”
How are placebos used in clinical trials?
Important i distinguish putative drug effects from non-specific effects
Not allowed if drug treatment exists
Will placebos work in
1) toothache
2) chronic pain
3) schizophrenia
4) Chronic fatigue syndrome
5) Irritable bowl syndrome
6) Loss of concentration with aging
7) Diabetes
8) Lack of libido
1) Y
2) Y
3) N
4) Y
5) Y
6) Y
7) N
8) Y
What are some examples of psychosomatic diseases that have high placebo response?
Viral diseases (flu, cough) Irritable bowel syndrome, nausea Anxiety, irregular heart beat, vegetative syndrome Impotence Sleep disorders Hot flashes sweating
What are some examples of situations that are not susceptible to placebos?
Diabetes
AIDS
Neurological disease (epilepsy)
Genetically based disease (sickle cell anemia)
How can placebos be therapeutic drugs?
Successful for psychosomatic disease for which:
- no other drug therapy is available OR
- stronger meds should be avoided OR
- patients refuse standard treatment
Define pseudoplacebos
Registered drugs which are used/prescribed in an ineffective way
Uses of pseudoplacebos?
Disease for which the drug hasd no indication
Prescriptions in too low doses
Given in non-absorbable forms
What ethics stand with pseudoplacebos?
Popular because the patient cannot easily ID the meds as a placebo
–> often seen as unethical by physicians/pharmacist
What is the Nocebo effects?
Describes feeling of sickness in patients treated with placebo which is due to patient’s expectations
- 10% of patients complain of headache, dizziness, vertigo, nausea, etc
What are the guidelines for placebo?
If you have an effective treatment, USE IT
If you are dealing with psychosomatic disease, consider placebo
Ethical consideration of placebo therapy
How do you maximize the placebo effect in herbal medicine?
Mystic atmosphere or oriental smells Guru-type ealers Ritulized treatment Intensive physician-patient relationship Pain and discomfort with treatments
What is the task towards evidence-based herbal medicines?
Evaluate whether these are effects are objective (due to organic responses) or subjective (due to the placebo effect)
