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