Comments on: The Nocebo Response http://chriskresser.com/the-nocebo-response Medicine for the 21st century Wed, 08 Feb 2012 18:48:53 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: admin http://chriskresser.com/the-nocebo-response#comment-143 admin Mon, 16 Jun 2008 14:04:34 +0000 http://chriskresser.com/?p=34#comment-143 Thanks for your comment, Bruce. I couldn't agree more that trials need better controls for both the placebo and nocebo effect. Some have argued (rightly, I believe) that an inert placebo control isn't enough, however, to guarantee a double-blind trial. Patients taking the active drug in a study often experience side effects, which of course leads them to suspect they are taking the drug and not the placebo and ruins the blind. A more accurate alternative would be an "active placebo", which is a substance that does not address the disease in question but has some relatively benign physiological effects like producing dry mouth or stimulation (like a caffeine pill, perhaps). In studies done with active placebos, the difference between the efficacy of antidepressants and placebo was virtually nil. Thanks for your comment, Bruce. I couldn’t agree more that trials need better controls for both the placebo and nocebo effect.

Some have argued (rightly, I believe) that an inert placebo control isn’t enough, however, to guarantee a double-blind trial. Patients taking the active drug in a study often experience side effects, which of course leads them to suspect they are taking the drug and not the placebo and ruins the blind.

A more accurate alternative would be an “active placebo”, which is a substance that does not address the disease in question but has some relatively benign physiological effects like producing dry mouth or stimulation (like a caffeine pill, perhaps). In studies done with active placebos, the difference between the efficacy of antidepressants and placebo was virtually nil.

]]> By: Bruce http://chriskresser.com/the-nocebo-response#comment-142 Bruce Mon, 16 Jun 2008 04:20:31 +0000 http://chriskresser.com/?p=34#comment-142 I read about the nocebo effect recently in a scientific paper reviewing all the popular low-carb diet books. Two examples were given of studies comparing low-fat to low-carb diets. All subjects met with a dietitian several times, who probably reinforced the low-fat diet (placebo effect) and discouraged the low carb dieters (nocebo effect). This variable needs to be controlled. All subjects should be given reinforcement or none of them should. http://www.scientificexploration.org/jse/articles/pdf/18.1_kauffman.pdf I read about the nocebo effect recently in a scientific paper reviewing all the popular low-carb diet books. Two examples were given of studies comparing low-fat to low-carb diets. All subjects met with a dietitian several times, who probably reinforced the low-fat diet (placebo effect) and discouraged the low carb dieters (nocebo effect). This variable needs to be controlled. All subjects should be given reinforcement or none of them should.

http://www.scientificexploration.org/jse/articles/pdf/18.1_kauffman.pdf

]]>