1. PLACEBO BY Dr . RAVINDRA KUMAR.G

2. 1.Definition, Effects, Ethics 2.History 3.Mechanism of the effect 4.Clinical utility 5.The individual variation 6.Symptoms and conditions 7.In research

3. 1.DEFINITION, EFFECTS, ETHICS- Placebo means I will please(Latin) A substance or procedure that is objectively without specific activity for the condition being used. Ex- inert tablets, vehicle infusions, sham surgery , sham acupuncture, sham electrodes, ultra sound. Inert tablets made up of starch or lactose

4. PLACEBO EFFECT-it is a therapeutic effect in the patient who had received placebo (but not told that it is inert substance) Placebos may also have positive effect on patients, who knows that it is inert substance

5. Placebo reactors-those who responds to the placebo positively Neurotics are great placebo reactors While depressed are resistant

6. The physician has even been called a placebo Placebo effect has sometimes been defined as physiological effect, but it is illogical, as placebo does not directly cause anything Some studies also indicated that animals(dogs) also have relieved symptoms

7. 2.HISTORY- John haygarth was the first to investigate efficacy of placebo Richard cobat said I have not yet found any case in which a lie does not do more harm than good T.C.graves first defined the placebo effect

8. 3.MECHANISM OF THE EFFECT- Placebo effect is highly variable in its magnitude placebo interventions can alter hormone levels or endogenous opioids(endorphins) a)Expectancy and conditioning- Placebo effect is related to the perceptions , expectations of the patient The expectancy can be enhanced through factors such as the enthusiasm of the doctor, differences in size and color of placebo pills

9. Placebos can act similarly through classical conditioning In a trial of anti-depressants, "Once the trial was over and the patients who had been given placebos were told as much, they quickly deteriorated The perceived consumption of caffeine has been reported to cause similar effects even when decaffeinated coffee is consumed

10. Perceived ergogenic aids can increase endurance, speed and weight-lifting ability Proper adherence to placebos is associated with decreased mortality Placebo treatment varies widely with society The placebo effect can work selectively

11. b) placebo effect and the brain- Functional imaging upon placebo analgesia shows activation of some areas in brain Different areas in the brain have different functions High placebo responses link with dopamine activity Nonanalgesic placebo effects: Parkinson's disease-with the release of dopamine

12. C)Brain and body; Research upon conditioning in animals shows the brain can learn control over them placebo effects can extend beyond the brain.

13. 4.CLINICAL UTILITY- a)Duration; Placebo effects can last for a long time over 8 weeks for panic disorder, 6 months for angina pectoris, two and half years for rheumatoid arthritis.

14. b)Clinical significance; The placebo effect does not have "powerful clinical effects" (objective effects) and that patient-reported improvements (subjective effects) were small and could not be clearly distinguished from reporting bias

15. Another researchers noted different conclusions that placebo effects are indeed significant but small in magnitude Placebos used as therapeutic agent that work psychologically To sort out real drug related ADR

16. c)Negative effects inert substances have the potential to cause negative effects Latin nocebo = I will harm a patient who disbelieves in a treatment may experience a worsening of symptoms negative consequence is that placebos can cause side-effects associated with real treatment Withdrawal symptoms can also occur after placebo treatment

17. d)Doctor-patient relationship The most frequently prescribed placebos were antibiotics for viral infections, and vitamins for fatigue The following impracticalities exist with placebos 1.Roughly only 30% of the population seems susceptible to placebo effects 2.Patients rightfully want immediate relief 3.doctors and pharmacists could open themselves up to charges of fraud

18. Critics of the practice responded that it is unethical to prescribe treatments that do not work placebos as a diagnostic tool The placebo administration may prove to be a useful treatment in some specific cases where recommended drugs cannot be used.

19. The House of Commons of the United Kingdom Science and Technology Committee has stated - homeopathy is a placebo treatment - Government should have a policy on prescribing placebos. Beyond ethical issues prescribing pure placebo is bad medicine

20. 5. THE INDIVIDUAL VARIATION- Though not everyone responds to a placebo, neither does everyone respond to an active drug Children seem to have greater response than adults to placebos

21. 6.SYMPTOMS AND CONDITIONS- symptoms such as pain, swelling, stomach ulcers, depression, and anxiety Some list of medical conditions -Asthma -Bipolar mania -Cough -Nausea -Depression -HTN -migraine

22. 7.IN RESEARCH- Placebos are used during clinical trails If a person is given a placebo under one name, and they respond, they will respond in the same way on a later occasion. In double blinded studies the placebo effect is weaker

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