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Discussion Starter · #1 ·
Guy noted in another topic that the placebo effect can exceed 80% in ibs clinical trials. this was an issue in the initial lotronex recall. i'm interested in what people here think about the placebo effect and whether it's all in the mind.tom
 

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Alos keep in mond the assessment of placebo effect in IBS is specific to pharmacotherapy. Thst is, open trilas have shown the placebo response in pharmaceuticals to have run as high as 80% and as low as 40% depending upon selection and protocol. This is not that uncommon, nor unique, to this syndrome. It is how "statistical significance" of a new drug effect is compared to "cliical efficicy". That is they may find a highe enough difference between the placebo and the drug (esp. in crossover studies) to be "statistically significant" but that does not necessariliy correlate to clinical efficacy being sufficient to justify its use. Academicians love that part of the debate. MNL_______________ www.leapallergy.com
 

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Psychosocial issues are a big part of all diseases, particularly IBS.Generally I find that patients in clinical trials generally get treated pretty well. Good bedside manner, the doctors want to see you, the listen attentively to you, you get taken seriously and are not dismissed as a problem patient...All the things that make any treatment for any disorder in a medical setting work much better.It's why you do placebo controlls. Generally a goodly percentage of people get better when the docotor experience is good. When you are listened to, when you are taken seriously, and when there is some hope that the treatment may work.It is one of the reasons that some alternative practioners have pretty good sucess. They do all the things that heal even when the treatments they offer are ineffective. Arthritis and Asthma are two other condtions that also tend to have high placebo cure rates, so this isn't just an IBS thing. It happens in other diseases that are more traditionally seen as "being real" rather than "in one's head". Although asthma spent a long time in the "all in one's head" pile.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html
 

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I love placebos for IBS symptoms. I wish the placebo rate was 100% and stayed that way long term. This is nothing more than a demonstration of the so called "mind over body" effect, which is a real neurobiochemical effect, not imaginary, anyway.If giving a patient a ten cent sugar pill produced reliable long-term remission, this is a damned-sight-better than $3,500 per year for life in costs for followup visits and drugs post-diagnosis in IBS patients.We need More and Better Placebos. Cheapest therapy there is! Damn things wear off too quick, though, but I think if we told everyone that this pill will work for about a month..then we will followup..then give them another one in a different colored capsule that should be good for another 30 days...hell how long could we keep that going? The cost-benefit analysis is extremely attractive compared to the cost of pharmaceutical development and marketing and distribution and intellectual-property security etc.Hmmmm.....worth thinking about. I do have this big box of green gel caps in the warehouse and 50,000 placebo Rafani pills...anybody got some little empty pill boxes? A Community Joint Venture opportunity.Eat well. Think well. Be well.MNL_____________ www.leapallergy.com
 

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Mike--I've actually read some papers debating whether there is an ethical way to use placebos in medical practice. Especially since alot of disorders are self-limiting and may clear up on there own.Just have a variety of placebo prescriptions and set up names for them that sound good. Tell the patient they help a pretty good percentage of the patients with X (which is true) and it's the treatment with the lowest risk of side effects (which is also true, although some people get side effects even on placebos). and have them call back in 2 weeks or a month or a few days depending on the disorder and let the office know if it worked or not. If it doesn't give them a script for an active compound, but that doing this may reduce the amount of drugs people take (thus reducing the population burden of drug side effects).K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html
 
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Discussion Starter · #7 ·
as a psychologist it's a 'real' issue for me, but also there is some very interesting new research, i think in the latest _Nature_ that shows that placebos can have a real effect - thinking that you are going to get a medicine produces anticipatory physical responses in the body as if you had actually gotten the medicine.tom
 

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I don't believe the placebo effect had any bearing on the effectiveness of treatment for my daughter's IBS. Over a period of 10 months she was prescribed at least 6 different drugs.Each time we were both hoping desperately they would help.None did.When lotronex became available it was just another drug to try,yet it worked for 8 months. Symptoms returned within 1 week of not taking it.
 
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Discussion Starter · #9 ·
gilly, I wasn't really asking about any particular individual and their treatment but trying to get a feel for general understanding of what placebo means to people. placebo effects generally disappear after six months to a year so you are probably correct in thinking it was a real effect. On the other hand if that neurochemical (serotonin) had it's effect in the mind would it be thought of as a physical or mental effect? If it has it's effect on the body as perceived through the mind is that physical or mental or 'in the mind'. As some pretty good authorities are saying (iffgd, for one example) current opinion is that ibs is both physical and psychological. I'm NOT trying to start an argument here - I know this is a touchy subject for many - I'm just interested in what people here think about placebo, that is, "what does it mean to you"?tom
 

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Yes, K:While my tongue is sort-of-in-cheek it is actually not-fully-in-cheek for the precise reason you mention. It sounds almost heretical to some, but if one steps back and assimilates the scope and breadth of medical practice as a whole, One Can see the wisdom in using what Thomas Edison said once as a starting point: ________________________"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease". ________________________Tom did not foresee, in his clarity of wisdom, the development of the American Medical System being driven by the mass-resources of the pharmaceutical industry. HOWEVER it is a beast of our own making. One who understood this, and the coming danger, was the famed William Osler, MD who spake this amongst his many truisms: ________________________"The desire to take medications is one of the greatest features that distinguishes man from 'animals'". ________________________So to some people who have spent a lot of years caring for the sick, medically and paramedically including myself, truly the ideal situation would be to utilize our base of understanding concerning safe dietary and other lifestlyle practices as a foundation of medical prophylaxis, and upon it create an environment such as what you describe which would utilize the tool of "phsychoneuroimmunohormonal" consequences, the self-fulfilling beliefs rooted in our desire for pill-cures, as a primary treatment protocol in any disease deemed "functional" (whereby, using the allopathic means possible, organic/infective causes for the symptom set are first ruled-out. Allow that substantial-portion of the population to fulfill their placebo-effect destiny as the first step in treatment. Indeed facilitate it. It is the easist way to invoke the mind-body response system (simplified but true). This, of course, would of necessity require all fututre pharmacotherapy to be at least single-blind.A protocol would be needed which would sustain that effect as much as possible in that large population, but then one could focus the more traditional methods on a smaller-population, and/or reduce the need to throw as many resources at those who achieved only a partial-remission through the "placebo pill protocol".Yes, this would have a tremendous benefit (if it were conceivably implementable) on the cost and effectiveness of healthcare in our culture from the patient (consumer) side.However, this would be difficult to do without careful cooperation of the Economic Might of the Drug Industry. Unless managed carefully in trnsition, it would wreck earnings growth, undermine stock value, eradicate investor equity, and crash a major underpinning of the public equity markets and a large block of the revenue source to medical practitioners overall. Short term lending rates would climb, mortgage rates skyrocket, new home sales plummet, long-bond yields would crumble, and the full faith and trust of the US Treasury would not be worth the paper the unbacked tender was printed upon! Chaos would reign, and a new Dark Age would descend upon the land, unseen since the days of the Hoover Adminstration.However, it implemented discreetly, think of how this could be avoided. BAsically, using the placebo drugs, ALL THE COST IS IN THE PACKAGING! NO development (just use the existing production equipment to shape various pseudo-drug configurations) so the cost is in the gel caps and electricity to run the mechines, and acquisition of simple-sugars and binders! The marketing departments would be in heaven! All resources could be focused on media, extravagant packaging and claims beyond your wildest dreams, as the more grandiose the claims, and the better you burn-them-in, the more potential for patient benefit in better outcomes! The prices to the consumer could be dramatically cut but the same profits maintained as development cost would be reduced to nil, and the gross margins between revenues and costs of goods sold would be HUGE, so everyone wins (same profits on lower gross sales, and reduced consumer prices). You could charge ten cents for Viagra, and still have a firm 1000% gross margin!Then take the millions spent now on marketing-under-ther-guise-of-continuing-education-of-medical-professionals (paid attendance at company sponsored seminars on drug useage at Palm Springs golf resorts, CEU cruises, and weekly party trays for the office staff) and just call it what it is...perks for the docs. A celebration of anew age of cooperative cost-containment between industry and government. FDA budgets and staff slashed to the bone. tax cuts. Smaller government. And since there is no longer any basis for conflict of interest, everyone could be wholly open and above board."Hey Doc, wanna go on a cruise to the Bahamas this weekend with us and party?" [uh, how many CEU's will ya give me]. "Oh we don't need to do that anymore. Lets just go take some time off (your patient-days are down, you are fully-capitated, so no one is gonna lose a buck) and enjoy the sights! We got a case of Chivas with your name on it pal!!!".Man, would the world be a better place or what? ____________________Wow, look what you just wrote MNL! ...what the Hell WAS That stuff she poured into my drink?....I better go lie down for awhile.Uh, go ahead take the Immodium.Eat well. Think well. Be well.MNL_______________ www.leapallergy.com
 

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quote:If it has it's effect on the body as perceived through the mind is that physical or mental or 'in the mind'.
This is a real interesting question. Sometimes I wonder about imagination or to take it to an extreme about hallucinations. When those are happening I am sure chemical changes are taking place in the body. So are hallucinations(or imagination)mental or physical? Just thought I'd throw it out there even though it is way off topic. Couldn't resist it[This message has been edited by bonniei (edited 04-26-2001).]
 

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80% placebo effect, I guess that explains Caltrate. I don't buy into the drug companies and the Doctor's hiding the effects of Caltrate in some big plot to make more money. When I asked to see one study,(on this site) I was told that no studies on Caltrate were done so to keep it a secret because Caltrate is a cheap cure. Wow the Caltrate pushers have watched way to many movies. The drug companies have done a good job because I didn't hear the word Caltrate used once at the Symposium in Wisconsin.Tim
 

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Tim, oddly enough there may be something to the calcium other then placebo and that maybe it helps moods and nerves. Something they say on tv in the tums commercials about a clinical test they did or something, I still have not seen that much information about it all yet. Who knows.Bonnie, the mind can certainly effect the body. Hypnosis is not a placebo, but here is something Mike wrote, just fyi."When you are hypnotized, certain physiological changes take place including decrease in heart rate, decrease in blood pressure, decrease in metabolic rate and oxygen consumption, decrease in skeletal muscle tension, and increase in alpha brain activity to mention just a few alterations. "Everything is a chemical and electrical process and the mind and body are both you physically, but the mind controls all of the systems.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com
 

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This placebo question made me think back to the first P/Doc I saw about 25 yrs ago. He interviewed me and then told me I was a worrier and perfectionist and put too much pressure and stress on myself. Told me to tell my bosses to shove it. Yeah, right! Anyhow, he would reach into his desk and fill a pill bottle then tell me to take them until we met again in two weeks. Now I'm not a rocket scientist but it should be apparrent to anyone that a MD wouldn't give a patient drugs with no label in a totally unmarked bottle. This didn't last long and I didn't take his "medicine". ha ha ha Several years back I visited another P/Doc for a while. He couldn't give me a placebo if he wanted, I thoroughly studied all psyche meds on the internet and probably knew more about them than he. He was a very good MD and would allow me to try anything but nothing ever had much effect on my IBS/D. While I admit that my IBS is sparked by GAD and stress, if benzo's and antidep's couldn't fool my IBS, I don't think a sugar pill would. I gave all these meds a fair trial with a positive attitude and open mind. Also, Lotronex completely stopped the IBS/D and all anxiety symptoms immediately from the first dose. Sorry to ramble on, I just retired yesterday and don't know who or what I am yet!! Good luck to all, Norb
 
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Discussion Starter · #15 ·
intresting point, eric, but it may turn out that the mind has trouble controling the seconc brain in the gut and it is this lack of control that leads to some types of ibs?Norbert, you are probably correct in your feeling that loronex helped but you're also buying into public citizen's analysis of the results of the trilas and their petition was based on the results which showed lotornex was not much better than a placebo.tom
 

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quote:Everything is a chemical and electrical process and the mind and body are both you physically, but the mind controls all of the systems.
So rather than feel every thing is purely physical, eric you like to think of the mind as a controlling element. Doeas that mean then the mind controls all diseases and that is why placebos work some of the time in all diseases?
 

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The mind is the controling element, that controls the electrical and chemical processess for the whole body. Some of the systems are self intergrated, but the mind connects them and governs them all for the most part.You could say both mentally and physically.The mind certainly plays a part in diseases that are organic and can have profound physiological effects on them. Including a placebo_On a side note.An interesting thing about this is thought itself, to me it is almost a pure form of energy cause by a physical electrical chemical action of the brain.What has thought done? Everything around us physically man-made was some persons thought at one time or another.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com
 
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