My interest arose out of my early work on the placebo effect in chronic pain.
The placebo effect could thus be attributed to a lifetime of being conditioned to believe in medicine.
Unlike their conventional counterparts, practitioners of alternative medicine often excel at harnessing the placebo effect, says Dr Ernst.
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"It might just be the placebo effect or marketing, but it tastes crisper, " said Ngo, who lives in Miami.
More recent trials mainly include outpatients many with milder depression and so more likely to feel the placebo effect.
And a lot of what people think of as the placebo effect is just the natural tendency of people to improve.
See also this great 2009 Wired piece on how drug companies are struggling with the placebo effect, by Steve Silberman.
The story of Natrecor highlights the enormous impact of the placebo effect, the power the expectation improvement to influence patients subjective assessment of symptoms.
Harvard researcher Ted Kaptchuk trained for five years in traditional Chinese medicine, but then became one of the leading researchers into the placebo effect.
Much of the placebo effect seen in clinical trials is the combination of the natural tendency of patients to get better and measurement error.
The key with the placebo effect is the expectation of improvement.
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There is something to be said for the placebo effect, and for some conditions, it appears to work whether a patient believes it will or not.
Many more of these substances are not providing much more of a benefit other than acting as placebos, although the placebo effect in athletes is very strong.
Fabrizio Benedetti, professor of neurophysiology at the University of Turin Medical School, Italy, warned that dopamine may not be the only chemical involved with the placebo effect.
And consider the role perception plays in helping patients improve in ailments ranging from pain and depression to Parkinson's disease through a phenomenon known as the placebo effect.
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While the exact mental state that allows the placebo effect to kick in remains a mystery, the belief that something will work seems to be a necessary ingredient.
Unfortunately, most of the studies that came to these conclusions were flawed: many results were anecdotal, and control groups were not established to take account of the placebo effect.
In considering the effectiveness of any medicine, conventional or herbal, it's important to remember that the placebo effect, or the patient's desire to believe in a cure, can have a powerful influence.
Kirsch says it's a common pattern in medicine to think a new drug has great benefits, only to discover years later that the apparent efficacy is mostly due to the placebo effect.
Whether American doctors addicted to expensive high-tech treatments whose apparent efficacy may be largely due to the placebo effect (think many types of back surgery) would ever do this is another question entirely.
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The best example of expectations influencing outcomes occurs with the placebo effect: if you administer a placebo to a hundred patients with a headache, thirty to forty of them will report excellent pain relief.
Though the placebo effect remains largely shrouded in mystery, researchers attribute some aspects of the placebo response to active mechanisms in the brain that can influence bodily processes such as the immune response and release of hormones.
CNN: The power of perceptions: Imagining the reality you want
Four years later, Plumlee saw a "60 Minutes" news program in which the key expert witness since hired for her case, Irving Kirsch, said his research on antidepressants indicated most improvement in depressed patients was from the placebo effect.
But early studies reporting positive results for the vertebroplasty procedure did not have control groups, making it unclear whether the purported benefits were simply due to the placebo effect or the natural tendency of chronic pain to subside over time.
"There is the potential that the majority of surgery we do for symptom relief is only effective because of the placebo effect--with significant potential of harming the patient, " says Dr. Nelda Wray, research chief at the U.S. Department of Veterans Affairs.
And that's without even considering the possible placebo effect, the idea that the psychological boost of believing in the bands can improve performance.
However, in each of the three studies, the placebo-adjusted effect of lorcaserin was statistically significantly less than 5%.
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All three studies had similar estimates of the placebo-adjusted effect of lorcaserin 10 mg bid at 52 weeks (TABLE 1).
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This process, he points out, is fundamental to the widely accepted " placebo effect, " which is created by a hopeful outlook.
He said Pfizer produced two studies showing Zoloft worked better than placebo the FDA's requirement for approval but most Zoloft studies showed its effect was the same as a placebo.
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