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NL1205: The Continuing Ed Chronicle -- December 2005
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PLACEBOS:
A Scientific and Ethical Perspective
TAKE
COURSE
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OBJECTIVES
A.
Define the Placebo Effect and discuss the healing power of placebos.
B. Define and distinguish between:
1. the placebo effect
2. the placebo response
3. the placebo manipulation
4. the drug effect
5. the drug response
6. no treatment effect
C. Identify and describe the ethical issues surrounding the use
of a placebo group
OUTLINE
Article
#1 : The Healing Power of Placebos
- Benefiting from
Belief
- Proof in the
Placebo
- Placebos in
the Doctor's Office: Opposing Views
Article
#2: Placebo Effect Produces Real Painkillers
Article
#3: Pain and the Placebo: What We Have Learned
THE PLACEBO EFFECT
VERSUS THE PLACEBO RESPONSE: A PLEA FOR CLEAR TERMINOLOGY
THINGS MISTAKEN
FOR THE PLACEBO RESPONSE
- Natural History
- Regression to
the Mean
EXPERIMENTAL STUDIES
OF PLACEBO ANALGESIA: A SIGNIFICANT EFFECT
LOOKING AT INDIVIDUALS:
RESPONDERS AND NON-RESPONDERS
- Probability
of Response
- Magnitude of
Response
- Type and Severity
of Pain
PSYCHOLOGICAL MECHANISMS
INVOLVED IN PLACEBO-INDUCED ANALGESIA
NEURAL MECHANISMS
UNDERLYING PLACEBO-INDUCED ANALGESIA
- Strategy 1:
Naloxone
- Strategy 2:
Proglumide
BRAIN ACTIVITY
CORRELATED WITH PLACEBO ANALGESIA
CONCLUSION
Article
#4: Listening to Prozac but Hearing Placebo:
A Meta-Analysis of Antidepressant Medication
The
Effects of Medication and Placebo
-
Study
Characteristics
- The Calculation
of Effect Sizes
-
Effect Sizes
Natural
History Effects
- Study Characteristics
- Effect Sizes
- Comparison
of Participants in the Two Groups of Studies
- Estimating
the Placebo Effect
Article
#5: Ethics of a placebo group
What is a placebo?
How is a placebo
used in research?
Scientific merit
of placebos
Hiding information
from patients
Community equipoise
versus individual equipoise
Equipoise in one
or both directions?
Changes in equipoise
Adaptive randomization
Patient choice
Developing countries
Special placebo
designs
Examples
- AIDSVAXX.
- Placebo surgery
- Lung volume
reduction surgery
- Laparoscopic
cholecystectomy
SUMMARY
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