Comments on: The Nocebo Response http://thehealthyskeptic.org/the-nocebo-response/ Challenging mainstream dogma on nutrition, health and disease. Sat, 22 Nov 2008 08:33:31 +0000 http://wordpress.org/?v=2.6.2 By: admin http://thehealthyskeptic.org/the-nocebo-response/#comment-81 admin Mon, 16 Jun 2008 14:04:34 +0000 http://thehealthyskeptic.org/?p=34#comment-81 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://thehealthyskeptic.org/the-nocebo-response/#comment-80 Bruce Mon, 16 Jun 2008 04:20:31 +0000 http://thehealthyskeptic.org/?p=34#comment-80 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

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