alco: Placebo

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Groups

Placebo are an English alternative rock band, formed in London in 1994 by singer-guitarist Brian Molko and guitarist-bassist Stefan Olsdal. The band were soon joined by drummer Robert Schultzberg, who was replaced in 1996 by Steve Hewitt. Hewitt left the band in 2007 and was replaced by Steve Forrest in 2008.

Brian Molko (Guitar) since 1994 Robert Schultzberg (Drums) between 1994 and 1996 (2 years) Stefan Olsdal (Bass) since 1994 Steve Forrest (Drums) since 2008 Steve Hewitt (Drums) in 1994 Steve Hewitt (Drums) between 1996 and 1 October 2007 (11 years) Robert Schultzberg between 1994 and 1996 (2 years)

Brit Award for British Video

Kerrang! Award for Best British Band

Kerrang! Award for Best Single

Kerrang! Classic Songwriter Award

Echo Award for Best International Rock/Alternative Group

Kerrang! Award for Best Single

Kerrang! Award for Best Video

Kerrang! Award for Best Album

MTV Europe Music Award for Best Alternative

Echo Award for Best International Rock/Alternative Group

World Music Award for World’s Best Song

World Music Award for World’s Best Album

Echo Award for Best International Rock/Alternative Group

Placebo is a musical group.

Marc Moulin between 1971 and 1976 (5 years) Philip Catherine Jean-Pierre Onraedt Yvan de Souter Garcia Morales Francis Goya Bruno Castellucci Nicolas Kletchkovsky Freddy Rottier Johnny Dover Richard Rousselet since 1971

Neurobiology of the placebo effect Edit

Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo - and active-controlled clinical trial performed in Europe

Chapple Ch. R. Montorsi F. Tammela T. L.J. Wirth M. Koldewijn E. Fernandez Fernandez E.

1 Urology Department, Royal Hospital, Sheffield, UK; 2 Urology Department, Vita Salute San Raffaele University Hospital, Milan, Italy; 3 Urology Department, University of Tampere Hospital, Tampere, Finland; 4 Urology Department, Carl Gustav Carus University Hospital, Dresden, Germany ; 5 Urology Department, Catharina Hospital, Eindhoven, The Netherlands; 6 Urology Department, Ramin Kayal Hospital, Madrid, Spain

Background: Silodosin is a new selective therapy with a high pharmacologic selectivity for the a1A-adrenoreceptor.

Objective: Our aim was to test silodosin’s superiority to placebo and noninferiority to tamsulosin and discuss the findings in the context of a comprehensive literature review of the new compound silodosin.

Design, setting, and participants: We conducted a multicenter doubleblind, placebo-and active-controlled parallel group study. A total of 1228 men ≥50 yr of age with an International Prostate Symptom Score

(IPSS) ≤13 and a urine maximum flow rate (Qmax)>4 and ≤15 ml/s were selected at 72 sites in 11 European countries. The patients were entered into a 2-wk wash-out and a 4-wk placebo run-in period. A total of 955

patients were randomized (2:2:1) to silodosin 8 mg (n=381), tamsulosin 0.4 mg (n=384), or placebo (n=190) once daily for 12 wk.

Measurements: We calculated the change from baseline in IPSS total score (primary), storage and voiding subscores, quality of life (QoL) due to urinary symptoms, and Qmax. Responders were defined on the basis

of IPSS and Qmax by a decrease of ≥25% and an increase of ≥30% from baseline, respectively.

Results and limitations: The change from baseline in the IPSS total score with silodosin and tamsulosin was significantly superior to that with placebo ( p

reduced nocturia versus placebo (the change from baseline was -0.9, -0.8, and -0.7 for silodosin, tamsulosin, and placebo, respectively; p=0.013 for silodosin vs placebo). An increase in Qmax was observed in all groups. The adjusted mean change from baseline to end point was 3.77 ml/s for silodosin, 3.53 ml/s for tamsulosin, and 2.93 ml/s for placebo, but the change for silodosin and tamsulosin was not statistically significant versus placebo because of a particularly high placebo response (silodosin vs placebo: p=0.089; tamsulosin vs placebo: p=0.221). At end point, the percentage of responders by Qmax was 46.6%, 46.5%, and 40.5% in the silodosin, tamsulosin, and placebo treatment groups, respectively. This difference was not statistically significant (p=0.155 silodosin vs placebo and p=0.141 tamsulosin vs placebo).

Active treatments were well tolerated, and discontinuation rates due to adverse events were low in all groups (2.1%, 1.0%, and 1.6% with silodosin, tamsulosin, and placebo, respectively). The most frequent adverse event with silodosin was a reduced or absent ejaculation during orgasm (14%), a reversible effect as a consequence of the potent and selective a1A-adrenoreceptor antagonism of the drug. The incidence was

higher than that observed with tamsulosin (2%); however, only 1.3% of silodosin-treated patients discontinued treatment due to this adverse event.

Conclusions: Silodosin is an effective and well-tolerated treatment for the relief of both voiding and storage symptoms in patients with lower urinary tract symptoms suggestive of bladder outlet obstruction thought

to be associated with benign prostatic hyperplasia. Its overall efficacy is not inferior to tamsulosin. Only silodosin showed a significant effect on nocturia over placebo.

Objective or subjective effects? Edit

An alternate opinion attributes the false perception of a placebo effect to the fact that patients who have been given a placebo report improvement earlier and more eagerly in order to please and thank the care giver. These patients may even do this when there is no real physical improvement attained. One quoted figure is that about one third of patients improve on a placebo, but a recent study has called that number into question. Hróbjartsson and Götzsche reported in 2001 that the placebo effect is much smaller than previously thought, if it exists at all. The 30 percent figure derives from a paper by Henry Beecher, published in 1955 (H. Beecher, 1955). Beecher was one of the leading advocates of the need to evaluate treatments by means of double-blind trials and this helps to explain why it has been so widely quoted.

The Hróbjartsson & Götzsche study demonstrated that in many studies where a control group was used that did not get any treatment at all, the effects in the no-treatment group were almost equal to the effects in the placebo group for studies with binary outcomes (e. g. well treated or poorly treated). The authors concluded that the placebo effect does not have "powerful clinical effects," and conceded that placebos have "possible small benefits in studies with continuous subjective outcomes and for the treatment of pain." They therefore concluded that there was no justification for its use outside of clinical trials.

In a follow-up study in 2004. the same authors were able to confirm their previous results and concluded: "We found no evidence of a generally large effect of placebo interventions. A possible small effect on patient-reported continuous outcomes, especially pain, could not be clearly distinguished from bias " .

If their conclusions are correct, the placebo effect is reduced to a subjective placebo illusion. while retaining its importance as a statistical research tool. As such it is imperative to use it in research, but unethical to use it in normal clinical treatment of patients.

These conclusions contradict what some would now consider to be a great deal of folklore that has evolved around the whole idea of the placebo effect. That folklore has evolved in a "research vacuum" of ignorance about the true nature of the placebo effect.

What is new about these conclusions is an emphasis on the key words "subjective" and "pain". This explains the well-established fact that the placebo effect is most "effective" in conditions where subjective factors are very prominent or significant parts of the problem. Some of these conditions are: headache, stomach ache, asthma, allergy, tension, and especially the most subjective of them all - pain, which is a significant part of most serious (and many mild) illnesses.

It also explains why there is no conclusive documentation for placebos causing significant healing effects in serious biological pathologies.

The placebo response as an index Edit

In certain clinical trials of particular drugs, it may happen that the level of the "placebo responses" manifested by the trial's subjects are either considerably higher or lower (in relation to the "active" drug's effects) than one would expect from other trials of similar drugs. In these cases, with all other things being equal. it is entirely reasonable to conclude that:

considerably higher

active ingredient

not efficacious

considerably lower

placebo

not simulating

However, in particular cases such as the use of Cimetidine to treat ulcers (see below ), a significant level of placebo response can also prove to be an index of how much the treatment has been directed at a wrong target.

Modern clinical application Edit

Experimenters typically use placebos in the context of a clinical trial. in which a "test group" of patients receives the therapy being tested, and a "control group " receives the placebo. It can then be determined if results from the "test" group exceed those due to the placebo effect. If they do, the therapy or pill given to the "test group" is assumed to have had an effect.

Etymology Edit

The word placebo is Latin for "I will please". It is in Latin text in the Bible (Psalm 114:1-9, Vulgate version), from where it became familiar to the public via the Office of the Dead church service (see Placebo (at funeral) for details).

Whenever a placebo is requested in a medical prescription it may imply a statement by the prescribing doctor that "This patient has come to me pleading for a treatment which does not exist or which I cannot or will not supply; I will please him by giving him something ineffectual and claiming that it is effectual." It could also indicate a belief that the effect was due to a subconscious desire of the patient to please the doctor. Since the placebo effect is in the patient not the doctor this may be more self-consistent. Early usage of the term does not indicate why it was chosen.

Obecalp Edit

Sometimes a doctor who does this, says that the fake medicine is `Obecalp', which is "placebo" spelled backwards. [1] [2] (and many other links)

Methodology of administration Edit

Placebos are things like sugar pills, that look like real treatments but in fact have no physical effect. They are used to create "blind" trials in which the participants do not know whether they are getting the active treatment or not, so that physical effects can be measured independently of the participants' expectations. There are various effects of expectations, and blind trials control all of these together by making whatever expectations there are equal for all cases. Placebos are not the only possible technique for creating "blindness" (= unawareness of the treatment): to test the effectiveness of prayer by others, you just don't tell the participants who has and has not had prayers said for them. To test the effect of changing the frequency of fluorescent lights on headaches. you just change the light fittings at night in the absence of the office workers (this is a real case).

Related to this is the widespread opinion that placebo effects exist, where belief in the presence of a promising treatment (even though it is in fact an inert placebo) creates a real result e. g. recovery from disease. Placebos as a technique for "blinding" will remain important even if there is no placebo effect, but obviously it is in itself interesting to discover whether placebo effects exist, how common they are, and how large they are. After all, if they cure people then we probably want to employ them for that.

Claims that placebo effects are large and widespread go back to at least Beecher (1955). However Kienle and Kiene (1997) did a reanalysis of his reported work, and concluded his claims had no basis in his evidence. Beecher misinterpreted his data. Also, Beecher's methodology was very questionable. Then Hrobjartsson & Gotzsche (2001) did a meta-analysis or review of the evidence, and concluded that most of these claims have no basis in the clinical trials published to date. This opinion is widely spread in the placebo literature. The chief points of their skeptical argument are:

Only trials that compare a group that gets no treatment with another group that gets a placebo can test the effect. Most claims are based on looking at the size of the improvement measured in placebo groups in trials comparing only placebo and experimental (active) treatments. This is misleading since (for instance) most diseases have a substantial clearup rate with no treatment: seeing improvements does not mean the placebo had an effect. (Put more technically, comparing with the baseline (pretest measure) is vulnerable to regression to the mean.)

Nevertheless, even they conclude that there is a real placebo effect for pain (not surprising since this is partly understood theoretically: Wall, 1999)); and for some other continuously-valued subjectively-assessed effects. A recent experimental demonstration was reported: Zubieta et al. (2005) "Endogenous Opiates and the Placebo Effect" The journal of neuroscience vol.25 no.34 p.7754-7762

This seems to show that the psychological cause (belief that the placebo treatment might be effective in reducing pain) causes opioid release in the brain, which then presumably operates in an analogous way to externally administered morphine.

A recent and more extensive review of the overall dispute is: M. Nimmo (2005) Placebo: Real, Imagined or Expected? A Critical Experimental Exploration Final year undergraduate Critical Review, Dept. of Psychology, University of Glasgow. PDF copy.

It has been observed often enough, yet still frequently overlooked, that the notion of placebo as it occurs in modern clinical discourse is not a rigorous concept, and despite many attempts, it has not been possible to provide a coherent definition. The most cited one is probably that of Arthur Shapiro [4]. which together with others in the same vein, makes use of the idea of "non-specific" therapeutic effects, and thus merely shifts the explanatory burden to this equally undefined concept. In addition, as Moerman has pointed out [5]. such definitions assert at the same time that placebos are inert and that they produce the placebo effect, which is self-contradictory. In a detailed critique of Shapiro's approach, Grunbaum attempted to formulate a logically consistent definition, [6] but this in turn has been criticized on the grounds that it is uninformative in respect of the phenomenon itself – that is, the behaviour in a clinical setting of patients, bodies, physicians, and therapeutic maneuvers. In the view of Moerman and others, clinical science has burdened itself with a pseudo-concept, more confusing than useful, the correction of which will entail a revision of some foundational thinking in clinical medicine.

Recent studies published in Proceedings of the National Academy of Sciences using advances in neuroscience (PET scans) have shown that placebos can demonstrably reduce pain in humans. Researchers at Columbia and Michigan University have shown that the brains of volunteers who believed that what they were taking was pain medication were shown to be spontaneously releasing opioids, or natural pain relief. [7] According to that ABC report the Food and Drug Administration contends that as many as 75 percent of patients have had responses to sugar pills. It pointed out that all major clinical trials use placebo groups because the effect is significant and to be expected.

This effect has been known for years. Generally, one third of a control group taking a placebo shows improvement and Harvard’s Herbert Benson says that the placebo effect yields beneficial clinical results in 60–90% of diseases, including angina pectoris, bronchial asthma, herpes simplex, and duodenal ulcers. [8]

The following are some of the issues pointing to a fundamental problem:

any

The concept of placebo Edit

The placebo effect is the term applied by medical science to the therapeutical and healing effects of inert medicines and/or ritualistic or faith healing manipulations. [1] [2]. When referring to medicines, placebo is a preparation which is pharmacologically inert but which may have a therapeutical effect based solely on the power of suggestion. It may be administered in any of the ways in which pharmaceutical products are administered. [3] An active placebo is a placebo that mimics the side effects of the drug under investigation but which lacks the therapeutic effect. They are important in drug trials where the tested drug produces sidef effects that could act as clues to participants as to whether they were in the control or experimental group.

Sometimes known as non-specific effects or subject-expectancy effects. a so-called placebo effect occurs when a patient's symptoms are altered in some way (i. e. alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. Some people consider this to be a remarkable aspect of human physiology; others consider it to be an illusion arising from the way medical experiments are conducted.

The placebo effect occurs when a patient takes an inert substance (a "sugar pill") in conjunction with the suggestion from an authority figure that the pill will aid in healing and the patient’s condition improves. This effect has been known for years.

The word "placebo" has been used in many somewhat varying meanings; see below.

Mechanism of the effect

Because the placebo response is simply the patient response that cannot be attributed to an investigational intervention, there are multiple possible components of a measured placebo effect. These components have varying relevance depending on study design and the types of observations. [ 24 ] While there is some evidence that placebo interventions can alter levels of hormones. [ 25 ] endocannabinoids [ 26 ] or endogenous opioids. [ 27 ] other prominent components include expectancy effects. regression to the mean. [ 20 ] [ 28 ] and flawed research methodologies.

Expectancy and conditioning

The placebo effect is related to expectations

The placebo effect is related to the perceptions and expectations of the patient; if the substance is viewed as helpful, it can heal, but, if it is viewed as harmful, it can cause negative effects, which is known as the nocebo effect. In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different. [ 29 ] According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Placebos can act similarly through classical conditioning. wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. [ 30 ] Both conditioning and expectations play a role in placebo effect, [ 31 ] and make different kinds of contribution. Conditioning has a longer-lasting effect, [ 32 ] and can affect earlier stages of information processing. [ 33 ] Those that think that a treatment will work display a stronger placebo effect than those that do not, as evidenced by a study of acupuncture. [ 34 ] [ 35 ]

A placebo presented as a stimulant will have this effect on heart rhythm. and blood pressure. but, when administered as a depressant. the opposite effect. [ 36 ] Perceived ergogenic aids can increase endurance, [ 37 ] speed [ 38 ] and weight-lifting ability, [ 39 ] leading to the question of whether placebos should be allowed in sport competition. [ 40 ]

Because placebos are dependent upon perception and expectation, various factors that change the perception can increase the magnitude of the placebo response. For example, studies have found that the color and size of the placebo pill makes a difference, with "hot-colored" pills working better as stimulants while "cool-colored" pills work better as depressants. Capsules rather than tablets seem to be more effective, and size can make a difference. [ 41 ] One researcher has found that big pills increase the effect [ 42 ] while another has argued that the effect is dependent upon cultural background. [ 43 ]

Motivation may contribute to the placebo effect. The active goals of an individual changes his/her somatic experience by altering the detection and interpretation of expectation-congruent symptoms, and by changing the behavioral strategies a person pursues. [ 44 ] [ 45 ] Motivation may link to the meaning through which people experience illness and treatment. Such meaning is derived from the culture in which they live and which informs them about the nature of illness and how it responds to treatment. Research into the placebo treatment of gastric and duodenal ulcers shows that this varies widely with society. [ 18 ] The placebo effect in treating gastric ulcers is low in Brazil, higher in northern Europe (Denmark, Netherlands), and extremely high in Germany. However, the placebo effect in treating hypertension is lower in Germany than elsewhere. [ 46 ]

Placebo effect and the brain

The higher brain works by regulating subcortical processes. High placebo responses link with enhanced dopamine and mu-opioid activity in the circuitry for reward responses and motivated behavior of the nucleus accumbens, and, on the converse, anti-analgesic nocebos responses were associated with deactivation in this part of the brain of dopamine and opioid release. [ 48 ] (It has been known that placebo analgesia depends upon the release in the brain of endogenous opioids since 1978. [ 54 ] ) Such analgesic placebos activation changes processing lower down in the brain by enhancing the descending inhibition through the periaqueductal gray [ 48 ] on spinal nociceptive reflexes. while the expectations of anti-analgesic nocebos acts in the opposite way to block this. [ 50 ]

The brain is also involved in less-studied ways upon nonanalgesic placebo effects:

Parkinson's disease. Placebo relief is associated with the release of dopamine in the brain. [ 55 ] Depression. Placebos reducing depression affect many of the same areas that are activated by antidepressants with the addition of the prefrontal cortex [ 56 ] [ 57 ] Caffeine. Placebo-caffeinated coffee causes an increase in bilateral dopamine release in the thalamus. [ 58 ] Glucose. The expectation of an intravenous injection of glucose increases the release of dopamine in the basal ganglia of men (but not women). [ 59 ] Methylphenidate. The expectation of intravenous injection of this drug in inexperienced drug users increased the release of dopamine in the ventral cingulate gyrus and nucleus accumbens, with this effect being largest in those with no prior experience of the drug. [ 60 ]

Functional imaging upon placebo analgesia has been summarized as showing that the placebo response is "mediated by "top-down" processes dependent on frontal cortical areas that generate and maintain cognitive expectancies. Dopaminergic reward pathways may underlie these expectancies". [ 61 ] "Diseases lacking major 'top-down' or cortically based regulation may be less prone to placebo-related improvement". [ 62 ]

Brain and body

The brain has control over the body processes affected by placebos.

In conditioning, a neutral stimulus saccharin is paired in a drink with an agent that produces an unconditioned response. For example, that agent might be cyclophosphamide. which causes immunosuppression. After learning this pairing, the taste of saccharin by itself is able to cause immunosuppression, as a new conditioned response via neural top-down control. [ 63 ] Such conditioning has been found to affect a diverse variety of not just basic physiological processes in the immune system but ones such as serum iron levels. oxidative DNA damage levels, and insulin secretion. Recent reviews have argued that the placebo effect is due to top-down control by the brain for immunity [ 64 ] and pain. [ 65 ] Pacheco-López and colleagues have raised the possibility of "neocortical-sympathetic-immune axis providing neuroanatomical substrates that might explain the link between placebo/conditioned and placebo/expectation responses." [ 64 ] :441

A recent fMRI study has shown that a placebo can reduce pain-related neural activity in the spinal cord, indicating that placebo effects can extend beyond the brain. [ 66 ]

Dopaminergic pathways have been implicated in the placebo response in pain and depression. [ 67 ]

Evolved health regulation

Evolutionary medicine identifies many symptoms such as fever. pain. and sickness behavior as evolved responses to protect or enhance the recovery from infection and injury. Fever. for example, is an evolved self-treatment that removes bacteria or viruses through raised body temperature. These evolved responses, however, also have a cost that depending upon circumstances can outweigh their benefit (due to this, for example, there is a reduction in fever during malnutrition or late pregnancy ). According to the health management system theory proposed by Nicholas Humphrey. the brain has been selected to ensure that evolved responses are deployed only when the cost benefit is biologically advantageous. To do this, the brain factors in a variety of information sources, including the likelihood derived from beliefs that the body will get well without deploying its costly evolved responses. One such source of information is the knowledge the body is receiving care and treatment. The placebo effect in this perspective arises when false information about medications misleads the health management system about the likelihood of getting well so that it selects not to deploy an evolved self-treatment. [ 68 ]

Definitions, effects, and ethics

A placebo has been defined as "a substance or procedure… that is objectively without specific activity for the condition being treated". [ 20 ] Under this definition, a wide variety of things can be placebos and exhibit a placebo effect. The placebo effect may be a component of pharmacological therapies: Pain killing and anxiety reducing drugs that are infused secretly without an individual's knowledge are less effective than when a patient knows they are receiving them. Likewise, the effects of stimulation from implanted electrodes in the brains of those with advanced Parkinson's disease are greater when they are aware they are receiving this stimulation. [ 21 ] Sometimes administering or prescribing a placebo merges into fake medicine.

The placebo effect has sometimes been defined as a physiological effect caused by the placebo, but Moerman and Jonas have pointed out that this seems illogical, as a placebo is an inert substance that does not directly cause anything. Instead they introduced the term "meaning response" for the meaning that the brain associates with the placebo, which causes a physiological placebo effect. They propose that the placebo, which may be unethical, could be avoided entirely if doctors comfort and encourage their patients' health. [ 18 ] Ernst and Resch also attempted to distinguish between the "true" and "perceived" placebo effect, as they argued that some of the effects attributed to the placebo effect could be due to other factors. [ 22 ]

The placebo effect has been controversial throughout history. Notable medical organizations have endorsed it, [ 23 ] but in 1903 Richard Cabot concluded that it should be avoided because it is deceptive. Newman points out the "placebo paradox", – it may be unethical to use a placebo, but also unethical "not to use something that heals". He suggests to solve this dilemma by appropriating the meaning response in medicine, that is make use of the placebo effect, as long as the "one administering… is honest, open, and believes in its potential healing power". [ 14 ]

Mechanism of the effect [ edit ]

placebo

pla•ce•bo /pləˈsiboʊ/ USA pronunciation n. [ countable ]. pl. -bos, - boes. Medicine, Drugs

. Medicine a substance that is not medicine but is given to a patient who supposes it to be a medicine, either to appease a patient or as a control in an experiment.
See - plac - .

Effects [ edit ]

The placebo effect has sometimes been defined as a physiological effect caused by the placebo, but Moerman and Jonas have pointed out that this seems illogical, as a placebo is an inert substance that does not directly cause anything. Instead they introduced the term "meaning response" for the meaning that the brain associates with the placebo, which causes a physiological placebo effect. They propose that the placebo, which may be unethical, could be avoided entirely if doctors comfort and encourage their patients' health. [24] Ernst and Resch also attempted to distinguish between the "true" and "perceived" placebo effect, as they argued that some of the effects attributed to the placebo effect could be due to other factors. [32]

Research suggests that for psychological reasons, some placebos are more effective than others. Large pills seem to work better than small pills, colored pills work better than white pills, an injection is more powerful than a pill, and surgery gives a stronger placebo effect than injections do. [33]

Research has also shown when it comes to specific psychological disorders, such as mild or moderate depression, placebos have the same effects compared to antidepressants. [34]

Types [ edit ]

A placebo has been defined as "a substance or procedure. that is objectively without specific activity for the condition being treated". [26] Under this definition, a wide variety of things can be placebos and exhibit a placebo effect. However, the placebo effect may be a component of legitimate pharmacological therapies: Pain-killing and anxiety-reducing drugs that are infused secretly without an individual's knowledge are less effective than when a patient knows they are receiving them. Likewise, the effects of stimulation from implanted electrodes in the brains of those with advanced Parkinson's disease are greater when they are aware they are receiving this stimulation. [27] Sometimes administering or prescribing a placebo merges into fake medicine. Common placebos include pills ("sugar pills") or saline injections. Fake surgeries have also seen some use. An example is the Finish Meniscal Legion Study Group’s trial published in The New England Journal of Medicine. which found a sham meniscal surgery to be equally effective to the actual procedure. [28] [29] While examples of placebo treatments can be found, defining the placebo concept remains elusive. [30] A placebo electronic cigarette contains 0 mg of nicotine. [31]

Inertness

Although placebos are generally characterized as pharmacologically inert substances or formulations, sham treatments, or inactive procedures, they are only inert, sham, ineffective, or inactive in the particular sense that they have no known cause and effect relationship with any of the pre-designated, biochemical, physiological, behavioural, emotional and/or cognitive outcomes of the pharmacologically active and known-to-be-efficacious intervention that might have otherwise been applied (see below ). Cause and Effect is considered by many fans to be one of the best episodes of the series Star Trek: The Next Generation. Efficacy is the ability to produce a desired amount of a desired effect. See: Intervention (counseling) - an orchestrated attempt by family and friends to get a family member to get help for addiction or other similar problem. For other uses, see Placebo (disambiguation).

Placebos are inactive or ineffective treatments or formulations; however a patient may experience either a positive or negative clinical effect while taking one. When a placebo is administered to mimic a previously administered drug, it may also incur the same side effects as the prior authentic drug. Most of these effects are thought to be psychological in nature or due to other unrelated factors. Not all placebos are equally effective. A placebo that involves ingestion, injection, or incision is often more powerful than a non-invasive technique. Placebos administered by authority figures such as general practitioners and other experts may also be more powerful than when this psychological authority effect is absent.

They are, however, not inert, sham, or inactive in any other manner of speaking; and they may well, in and of themselves, generate considerable change within any given subject, at any given time, under any given circumstances. According to Shapiro:

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Groups

Neurobiology of the placebo effect Edit

Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo - and active-controlled clinical trial performed in Europe

Objective or subjective effects? Edit

The placebo response as an index Edit

Modern clinical application Edit

Etymology Edit

Obecalp Edit

Methodology of administration Edit

The concept of placebo Edit

Mechanism of the effect

Expectancy and conditioning

Placebo effect and the brain

Brain and body

Evolved health regulation

Definitions, effects, and ethics

Mechanism of the effect [ edit ]

placebo

Effects [ edit ]

Types [ edit ]

Inertness

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