There's an urban legend that doctors will write prescriptions for 'Obecalp', which the patient then takes to the pharmacy, who then know what it means and give them a placebo.
I repeat though, there's *an urban legend..*
Essential oils at least *smell* good. And olfaction is a very primal sense, and one rich in association. It’s probably particularly effective as a placebo. 🤷🏼♂️
Breathing deeply will also help a lot of stress related symptoms, so just smelling something pleasant can help with anything from nausea to high blood pressure, temporarily.
This article is very misleading. The article briefly touches on the differences between US studies and elsewhere and then leans hard into possible psychological responses. It seems more likely that the problem is dedicated research companies being involved in trials as opposed to academic research organisations. The financial incentive for misleading data seems pretty blatant here.
All of our pain meds are just synthetic versions of opium, created to patent and sell for higher prices because opium (morphine/codeine) couldn’t be patented.
Hydrocodone/oxycodone/morphine/codeine etc. all more or less target the same receptors and have the same risk of dependency and side effects but could be sold for higher prices for a time because they were under patent. And when they first came out pharmaceutical reps could mislead doctors about how these drugs somehow were safer and less likely to lead to patients abusing them. Tramadol was touted as a miracle drug that patients could never become addicted to, until they did.
Those are decent are reducing inflammatory response or taking the edge off.
But if you’ve just had your impacted wisdom teeth removed, your finger cut off, or any kind of severe pain etc. they don’t hold a candle to opiates. Because opiates mimic our bodies natural response to pain, as endorphins (which actually stands for endogenous morphine) bind to our opioid receptors. The sad reality is they’re still needed for bouts of severe acute pain, and dependency can be developed rather quick. When I took codeine for two weeks after surgery my first week or two off the drugs was very uncomfortable as I’d developed a minor physical dependency already.
Not sure where you heard this, but studies have shown that opioids are not more effective than mild analgesics at reducing physical pain.
https://jamanetwork.com/journals/jama/fullarticle/2661581
https://www.nsc.org/getmedia/8ecdc0e5-ae58-43e8-b98b-46c205e1c2b2/evidence-efficacy-pain-medications.pdf
I’m curious, do you believe doctors and medical professionals prescribe extremely risky controlled substances like opioids with high risk profiles because they’re all just ignorant of their lack of efficacy?
The first article you linked describes a very specific scenario, and makes no commentary on opioids overall ability to reduce pain for other injuries.
I’m not a specialist on this. Just a former student with a background taking some biomed classes. The idea that opioids are useless and needlessly prescribed and that all pain can be easily managed with OTC options is far from the consensus established by the greater medical field to my knowledge. There’s a reason ambulances keep Fentanyl and Ketamine on hand, and why these drugs are still prescribed despite the huge risks.
My examples of severe pain that necessitate opioids were probably not great. But surely in cases where inflammation isn’t the primary cause of pain doctors can’t rely on NSAIDs alone? My medical info is all dated at this point, but you have me curious and I’m gonna see if I can find some PubMed articles comparing the two in a more broad way.
its also ridiculous they seemingly let any joe shmo publish a "research paper" (and actually encourage publishing for the sake of publishing) yet those research papers are locked behind a paywall/license wall, and, somehow even more ridiculous, this blog post - yes, blog post - that is written based on the authors interpretation of the "research paper" has itself been cited a couple times. no wonder our medical "industry" in the us is a \[REDACTED\] joke
it is, but it is also unfortunately the reality. [this article](https://news.stanford.edu/stories/2015/11/fraud-science-papers-111615) was actually published the same year as the OP, appropriately enough. its not a new problem, but it does seem like it started to be [taken much more seriously](https://undark.org/2020/07/23/cracking-down-on-research-fraud/) around 2020 for reasons i can only imagine
There’s a fascinating bit from Nerdstock a few years ago where [Dr. Ben Goldacre](https://youtu.be/O1Q3jZw4FGs?si=ohkI5sitnN2pqQN3) talked about nocebo and placebo weirdness.
You may have to slow the video down. He talks like he’s late for a bus.
Too many popups on my phone, but why wouldn’t placebo be a major factor? It’s very well documented the effects of placebo, and this isn’t some new study done by big Pharmaceutical, we are very well aware of how ridiculously heavily placebo effects things
I've always found asprin, ibuprofen, and paracetamol (Americans call it acetaminophen). It never feels like it's doing anything. I'm sure it does do something, but because there's no noticeable effect of my mood or brain, it feels like nothing is happening. Opiates on the other hand, feel like God's gift to mankind until you do them too much, and you realise only Satan could invent something like this. (I don't mean literally, of course, as I'm not religious).
Funnily, I was given some opiates for severe stomach pain back in March and have used three or so since. They honestly don't feel like they work at all. Maybe because I wait until the pain is unbearable to take them but it doesn't do shit for me, I still feel like I'm dying. Advil does seem to have some slight effect though.
I was given opiates after a surgery. I stopped taking them and just stuck to Tylenol as they made me feel so nauseous and it didn't feel as though they actually helped at all.
Good for me I guess, 0 chance of every getting addicted, but better pain relief would have been appreciated
I had an accident resulting in the partial amputation of a finger and a bone fusion.
During my recovery, I found that waiting for high levels of pain to take opiates led to much less effectiveness and higher dosing levels. What worked better was a kind of pre-emptive dosing right away in the morning, even though I generally woke up with minimal pain.
If I waited until my pain got acute (usually by late morning), I'd end up taking 2-3 doses before dinner and then one before bedtime. If I took one in the morning, I often wouldn't need another dose until after dinner whch would last until the morning.
I think with pain there's some kind of cumulative effect that takes much higher doses to manage, but if you take a pre-emptive painkiller it inhibits it from getting to acute levels and you end up taking less total medication.
What seemed odd about it all was how weird both my surgeon and her PA were when I asked questions about dosing strategy and physical dependence. They both got kind of weird and their only response was "well, we don't have to prescribe any". I would think that a *hand surgeon* would have extensive experience in pain management and might have both academic and clinical experience knowledge on effective dosing strategies. Instead it was just medication with a "use as needed" kind of instructions.
I suspect there are some basic usage strategies that physicians could teach patients which would be more effective at pain reduction and result in less total pain medication consumption. And I'm not talking (mostly ineffective) advice like "get more exercise". But doctors either don't know them or just don't want to talk about them with patients for kind of weird reasons, like they're worried about encouraging use or afraid that their liability is somehow increased.
Opiates aren't really for stomach pain, depending on the actual issue there are probably far more appropriate remedies, some that aren't even 'painkillers'.
Naproxen Sodium (Aleve) is the only OTC pain killer that I've found actually works for me. The rest do absolutely nothing.
Codeine is the good stuff though, that shit works a treat
I wish I could take nsaids like that all the time as they really do work but they mess up my stomach before the kidney problems even start.
So they just give me endless codeine. I would prefer morphine for when codeine can't cut it but over long term usage codeine seems to work better, I theorise it's because the morphine your liver does create from it is more effective with opiate receptors flooded with codeine and the lesser metabolites.
Same with over the counter pain meds, even morphine doesnt feel like its doing anything, it wasn't until they put me on hydromorphone that I started to feel it.
I live in a state where kratom is legal. I know the plural of anecdote is not data. However it helps my chronic pain, and supplements my monthly tramadol prescription.
Kratom also helped blunt the cravings for alcohol when I stopped drinking. (I'm a recovering alcoholic, nearly two years sober)
I live in a state where kratom is legal. I know the plural of anecdote is not data. However it helps my chronic pain, and supplements my monthly tramadol prescription.
Kratom also helped blunt the cravings for alcohol when I stopped drinking. (I'm a recovering alcoholic, nearly two years sober)
is it though? in this [pediatric study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428788/), oxycodone was not more effective than ibuprofen for fracture pain
Adult study, [Not better than weaker Acetaminophen + Codeine](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786200)
Adult study, [back pain, opioids not better than ibuprofen + acetaminophen](https://www.aafp.org/pubs/afp/issues/2018/0301/p348.html)
If you have liver disease, on a blood thinner, or are just stupid, you can very easily run into issues. And as an American RN, I see it often enough but probably have a bit of confirmation bias
I know plenty of people who take about 20 tylenol a day because they no longer get prescribed effective pain meds. there's gonna be a shitload of liver failures in America's near future.
No the point of that comment was in response to whether Oxy is more effective than a placebo. Chill out lol
If it is as effective as acetaminophen or ibuprofen, then it’s obviously more than just placebo.
They are anti-inflammatory. They are not more effective than a placebo effect where a person thinks they received opioids.
They are more effective than someone who does not get the placebo effect when they are made to think they're getting opioids.
They are still anti-inflammatory, and they also attack your liver and stomach lining by the way. Aspirin does not attack the liver however.
For the two adult studies...
>identical capsules containing ibuprofen (400 mg) plus acetaminophen (1,000 mg); oxycodone (5 mg) plus acetaminophen (325 mg); hydrocodone (5 mg) plus acetaminophen (300 mg); or codeine (30 mg) plus acetaminophen (300 mg).
Wouldn't a fairer comparison be:
Ibuprofen 400mg + paracetamol 1000mg versus oxycodone 10mg + paracetamol 1000mg?
5mg is a very low dose, as is 300/325mg of paracetamol.
Hell, 30mg of codeine isn't what I consider to be a "normal" post-op dose (60mg) either.
Questions whether a painkiller is better than a placebo. Provided evidence: other painkillers are more effective.
I don't think this supports your argument very well.
It's easy to cherry pick studies with off kilter results, particular in an over studied discipline like that.
I find it insane that MDs are trying to push that paracetamol is as good a painkiller as a moderate opiate.
A lot of people being sent home from surgery in extreme uncontrolled pain due to these dodgy studies.
I’ll say this for me. Pain killers do not actually “kill” the pain but what they do is improve your mood so much that the pain signals become background and are no longer as pronounced.
If I have significant pain APAP/NSAIDs will not touch the pain. A little swelling, tight muscle? Sure those work great.
Opioids/opiates most certainly do a fantastic job in dulling moderate to severe pain.
Doctor gave me a non addictive opiate after my knee replacement. I asked for oxy or dilauded. I was in so much pain after they took me off the morphine drip and sent me home with that garbage I ended up back in the emergency room for uncontrollable pain. The reason these pain pills don’t get approved is because they don’t fucking work. Drug companies need new patents to charge top dollar when we already have generic drugs that work great. Then bribe the doctors to give you the new less effective drugs so they can both line their pockets at the expense of the patient.
Interestingly the placebo effect is real in that a person tricks their body into releasing the endogenous drugs.
A study gave painkillers and to the placebo group they administered naloxone the opioid antagonist, without their knowledge, either the administrator or the patient as double-blind is, and it reversed the effects.
A couple other interesting points, they found different color pills work better for different Placebo effects.
Some people experiencing the placebo effect are made to know it is a placebo and it still works.
I will believe somebody has achieved true enlightenment like Buddha if they can induce their body to release endogenous drugs at their will.
I am sorry this is paywalled, there are ways around it but I have trouble finding them myself. But here is the source:
https://www.newyorker.com/magazine/2011/12/12/the-power-of-nothing
To be fair, Naloxone gives me more pain from baseline so even if I only thought that the placebo was working, Naloxone would appear to reverse the effect. I do believe it, just pointing out a flaw
I think this knowledge and exposure might also have an unintended consequence where it amplifies the response from placebo further.
It’s known that placebo induces a response regardless of whether you are even aware you’re taking it for treatment. But research has found that the *expectation* a placebo will work paradoxically increases the response effect severalfold. This actually still holds even if you are aware of the placebo effect and know that what you’re taking is only placebo. It’s a really fascinating phenomenon, and its effects become more robust if you study it for pain relief in particular
I think that it’s an ethical gray area which would involve a doctor using a patient as a test subject without their knowledge, so there’s not much in the way of robust studies to document it in humans. Even if it’s technically harmless from a chemical standpoint.
But the corollary to the placebo effect is that a negative counterpoint exists called the nocebo effect. Where if a patient is told a pill is harmful in some way, it can have outsize undesirable side effects in an otherwise inert substance. And it can severely burden the patient with physical side effects
New Zealand allows it but you will rarely see actual ads on TV. Here is a saved comment that explains why:
We have it in new zealand too but for a very good reason.
In the late 1980's our government set up a department called Pharmac.
Think of it as a bulk buying club with 5 million members.
Each year, pharmac puts out tenders for the drugs that cover whatever 99% of newzealanders would need in their lifetime.
Things like paracetamol, insulin, cancerdrug and antihistamine etc.
They say "Hey all you drug companies, New Zealand wants to buy 10 million hayfever tablets of these specifications for this upcoming summer. Who wants to give us the best price?"
While canadians and americans pay $140 for a medication, we pay $5.
As a drug company, you either win the pharmac contract, or you completely miss out on any sales within new zealand of your product.
So they drop their prices real low.
When a doctor writes a prescription on his computer and looks up antihistamine, anything pharmac funded appears highlighted in the list.
Drug companies were somewhat unhappy about this - initially there were more cases challenging it going through the courts than pharmac had staff on its payroll.
So the government decided to let the drug companies advertise on tv.
But in reality, when you go to your doctor and say "The TV told me to ask about Cialis because my dick doesnt work" the doctor is going to say "Well sure, here is a prescription - it will cost you probably $50 at the pharmacy. Or i can prescribe you Genericdrug which has the same ingredient but only costs you $5 at the pharmacy since it won the pharmac tender".
And its no surprise, major brand drug companies will repackage their drugs into whitelabel brands and then bid on the supply tenders with the exact same product.
International brand Lopressor is whitelabelled by its manufacturer and my doctor prescribes "Betaloc CR" which won the pharmac tender for a type of beta blocker tablet so that the Lopressor brand retains the more expensive image and price point on the pharmacy retail shelf. A buyer in the USA cant say "your selling Lopressor to New Zealanders for $3, why should we pay $90" because its a different 'product'.
None of the drug companies really bother advertising on tv, knowing that the doctors are just going to prescribe a cheaper option.
Don't blame it all on pharma. The unregulated supplements market is equally as much to blame. People believe just about every snake oil scam that's brought to market. All the supplement company has to say is "These claims have not been evaluated by the FDA"
My parents are elderly, and they and all their friends have tried CBD for just about everything you can use it for. I told them that it basically does jack shit for anything besides a specific type of epilepsy and about a few hundred bucks and a year later they finally told me it didn't help them for anything.
I am starting an experiment. When I get a headache...I take an aspirin. Headache goes away but stomach is upset. Now, I take an aspirin and sniff a lavender thing. Soon, I will take a placebo and sniff the lavender thing. If all goes as planned, headache is gone and no side effects. I expect this to take several weeks.
I used to think that was true but several studies say the placebo effect works even when you know it's a placebo. Weird. My experiment will be to see if this is true for me.
I placeboed myself into having covid.
\*Everyone around me is getting covid at work\*
\*Panic and think I might get covid\*
\*Start coughing, burning up, feel like I’m going to die\*
\*Take a 30 minute power nap\*
\*Wake up fine with literally no symptoms\*
\*Get covid test, clean\*
If nothing else, this suggests delusions may be beneficial to our well-being. Sometimes if you believe something seemingly stupid steadfastly enough, it happens. That's kind of America.
not really, the puritans stopped really being relevant a couple decades before the revolutionary war even started and most of the founding fathers were Episcopal, Presbyterian, Anglican, or deist
Jesus fucking Christ… Reddit… it was a half-joking, tongue-in-cheek dig at the weirdness of the Puritans and the fact that the United States remains an outlier in religiosity in the developed world.
I don't think you know what that word means. But your statement "The US is the leader of self-delusion" is insinuating that the placebo effect is a result of delusion? What a crock of shit.
For bonus points even being aware of the placebo does not diminish the effects of the placebo!
Source: https://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo
The researchers should implement a double blind study. Give placebos and drugs to people who don't even know they are even being drugged and then after a few months ask them how they feel. Simple.
Here I was waiting for someone to somehow blame the FDA for doing their job. But honestly in recent years the FDA hasn't really done that either. A part of me wonders what horror stories will come out in the next few decades and the anti-science movements that will spin off of it.
Back in the heyday of the FDA, the FDA actually ran drug trials and the taxpayer paid for it. It was expensive but the agency was independent. The FDA prevented widespread use of the anti nausea morning sickness drug which caused birth defects. It was a system that worked.
Later congress mandated that drug companies had to pay for the drug studies instead of the FDA, so it meant all the people doing the regulations and safety were financially dependent on drug companies to submit drugs for testing. And then people started to really screw the pooch.
You make it seem like the process doesn't work anymore, when the opposite is true.
There's a reason most new pharmaceutical treatments come out of the US.
I thought the reason most new drugs come out of the US because our lack of pricing controls, IP laws, and the fact the pharmaceutical companies can directly market their nonsense to the consumer by getting a Kardashian or Lady Gaga to shill for them?
Formerly robust and steadily dwindling investment in public research combined with shoveling so much money into the pockets of the pharmaceutical industry that the fraction that doesn't get diverted to advertising and shareholders is still enough to fund the rest?
Plain old opium is so much more calming and pain-relieving compared to all the garbage derivative drugs they've "invented" by studying opium.
Just give people opium.
Holy shit. Makes sense, though. So many people walking around in this country refuse to believe the sky is blue simply because somebody told them it wasn't.
The US isn’t the only place with effective propaganda. It has to be caused by something very unique to the US… possibly related to the countless billions that Big Pharma spends on ads
Much more likely it correlates with religious belief. Last I checked something like 80% of Americans believe in literal angels.
Belief is a powerful thing - if the mind really believes something it can have observable physiological effects. Kinda whacky, but that's my take.
I think the study is pretty flawed but this was my first thought as well. Basically of course the most effectively propagandized country on the planet has this issue.
This is easily explained when you realize most of these clinical trials in USA are paid and the people who take them will lie for money. Even if you don’t feel anything it worked bc you want your money.
lol for those studies that do involve monetary compensation, the compensation is not at all attached to the outcome. You get paid whether something works or not lol. What kind of smooth brain shit is this?
Yeah, especially with something subjective like pain. I get mind-bending migraines, but I’ve learned to focus the pain to a pinpoint and then just kind of squeeze it out of existence. It takes a lot of focus, but it works.
Oh, hell yeah. When people talk about being at a 7 from 1-10, I’m like, you wouldn’t be taking to me coherently and normally if you were at a 7.
I think a real line we can draw is involuntary vocalizations from pain. Like, when I’m at that level that I literally can’t stop myself from either saying something profane or groaning, that’s when it’s pretty bad.
Correct. It’s called a double blind trial when neither participant nor administrator know who is receiving what dose. It’s part of what makes gold standard research.
A reason longer trials could be a factor is one of the placebo effects (there are really several, it's not just "mind over matter") is natural remission/tolerance. More time may allow more opportunities for those effects.
i wonder if the value of the medication contributes to this.
like would the placebo effect be higher if you think a pill is worth $400 compared to $1 because we've been conditioned to think more expensive = better?
One major difference cited in the trials is nursing care - dedicated nurses vs. those having other responsibilities. So the patients may be responding to lower stress associated with better nursing care, not just placebo effect.
I live in a state where kratom is legal. I know the plural of anecdote is not data. However it helps my chronic pain, and supplements my monthly tramadol prescription.
Kratom also helped blunt the cravings for alcohol when I stopped drinking. (I'm a recovering alcoholic, nearly two years sober)
"My doctor gave me a new drug. It's called 'placebo'. I am so high right now!" -- Steve Martin
[I think it's made by Puh-fizer.](https://youtu.be/SHILxPVLopY?si=KD-85tbQLlUoeJrX)
There's an urban legend that doctors will write prescriptions for 'Obecalp', which the patient then takes to the pharmacy, who then know what it means and give them a placebo. I repeat though, there's *an urban legend..*
Health insurance companies: "We get to dole out fake drugs and charge money? You have our attention."
Homeopathists already have that market cornered.
And err... Essential oil sellers
Essential oils can sometimes do something in theory. Homeopathy is just pathetic all the way down
Some crystals can heal you. If your problem is low sodium.
Magnets can be a useful diagnostic technique, if you're doing Resonance Imaging.
Essential oils at least *smell* good. And olfaction is a very primal sense, and one rich in association. It’s probably particularly effective as a placebo. 🤷🏼♂️
Breathing deeply will also help a lot of stress related symptoms, so just smelling something pleasant can help with anything from nausea to high blood pressure, temporarily.
Yeah, if you spill them your floor becomes slippery.
Ask your doctor if Obecalp is right for you.
Got it. I will continue taking my obecalp prescription.
>obecalp prescription Say what you will, but it really does work well for me.
Man I stopped taking my obecalp prescription and I ran naked through the streets.
I had the same problem, so I drank some Windex. It helps keep me from streaking.
I got addicted to it and sold my family to a cartel for a ninety day script.
Huh. I thought Ninety Day was unscripted…
“Water, with a squirt of camphor to make it taste like medicine.” “Hydrox.. H-2-Oh… Water… it’s only water… it’s all in your head sonny…”
Damn, I was thinking this was the perfect time for an "It" reference
That reminds me of the Pirin tablets in The Birdcage
This is correct, Obecalp is a dextrose pill with Cherry flavor meant to trigger placebo in children.
This article is very misleading. The article briefly touches on the differences between US studies and elsewhere and then leans hard into possible psychological responses. It seems more likely that the problem is dedicated research companies being involved in trials as opposed to academic research organisations. The financial incentive for misleading data seems pretty blatant here.
Yeah, pain meds making on to the market has *not* been the problem. This seems like some PR stunt dreamed up in a boardroom.
We have incredibly effective pain meds. The problem is they're so effective, people get hooked on them.
We don't really have much more effective pain meds today than 150 years ago
All of our pain meds are just synthetic versions of opium, created to patent and sell for higher prices because opium (morphine/codeine) couldn’t be patented. Hydrocodone/oxycodone/morphine/codeine etc. all more or less target the same receptors and have the same risk of dependency and side effects but could be sold for higher prices for a time because they were under patent. And when they first came out pharmaceutical reps could mislead doctors about how these drugs somehow were safer and less likely to lead to patients abusing them. Tramadol was touted as a miracle drug that patients could never become addicted to, until they did.
Yeah that's what I'm saying. We had morphine 150 years ago and today's opioids aren't safer nor more effective.
Yes but there are mild analgesics in acetylsalicylic acid, paracetamol/acetaminophen, ibuprofen, and naproxen.
Those are decent are reducing inflammatory response or taking the edge off. But if you’ve just had your impacted wisdom teeth removed, your finger cut off, or any kind of severe pain etc. they don’t hold a candle to opiates. Because opiates mimic our bodies natural response to pain, as endorphins (which actually stands for endogenous morphine) bind to our opioid receptors. The sad reality is they’re still needed for bouts of severe acute pain, and dependency can be developed rather quick. When I took codeine for two weeks after surgery my first week or two off the drugs was very uncomfortable as I’d developed a minor physical dependency already.
Not sure where you heard this, but studies have shown that opioids are not more effective than mild analgesics at reducing physical pain. https://jamanetwork.com/journals/jama/fullarticle/2661581 https://www.nsc.org/getmedia/8ecdc0e5-ae58-43e8-b98b-46c205e1c2b2/evidence-efficacy-pain-medications.pdf
I’m curious, do you believe doctors and medical professionals prescribe extremely risky controlled substances like opioids with high risk profiles because they’re all just ignorant of their lack of efficacy? The first article you linked describes a very specific scenario, and makes no commentary on opioids overall ability to reduce pain for other injuries. I’m not a specialist on this. Just a former student with a background taking some biomed classes. The idea that opioids are useless and needlessly prescribed and that all pain can be easily managed with OTC options is far from the consensus established by the greater medical field to my knowledge. There’s a reason ambulances keep Fentanyl and Ketamine on hand, and why these drugs are still prescribed despite the huge risks. My examples of severe pain that necessitate opioids were probably not great. But surely in cases where inflammation isn’t the primary cause of pain doctors can’t rely on NSAIDs alone? My medical info is all dated at this point, but you have me curious and I’m gonna see if I can find some PubMed articles comparing the two in a more broad way.
Wow, thanks, those were very interesting!
It is hard to improve on vast amounts of opiates and cocaine (for dental pain).
its also ridiculous they seemingly let any joe shmo publish a "research paper" (and actually encourage publishing for the sake of publishing) yet those research papers are locked behind a paywall/license wall, and, somehow even more ridiculous, this blog post - yes, blog post - that is written based on the authors interpretation of the "research paper" has itself been cited a couple times. no wonder our medical "industry" in the us is a \[REDACTED\] joke
that does sound ridiculous
it is, but it is also unfortunately the reality. [this article](https://news.stanford.edu/stories/2015/11/fraud-science-papers-111615) was actually published the same year as the OP, appropriately enough. its not a new problem, but it does seem like it started to be [taken much more seriously](https://undark.org/2020/07/23/cracking-down-on-research-fraud/) around 2020 for reasons i can only imagine
There’s a fascinating bit from Nerdstock a few years ago where [Dr. Ben Goldacre](https://youtu.be/O1Q3jZw4FGs?si=ohkI5sitnN2pqQN3) talked about nocebo and placebo weirdness. You may have to slow the video down. He talks like he’s late for a bus.
Too many popups on my phone, but why wouldn’t placebo be a major factor? It’s very well documented the effects of placebo, and this isn’t some new study done by big Pharmaceutical, we are very well aware of how ridiculously heavily placebo effects things
They are over-crediting the placebo factor is the issue. It’s beyond mad that the USA would be so extraneous in studies.
Sounds about right for an article in Nature.
placebo the number one painkiller
Also number one human killer. Drug abuse is real, kids
I've been fiending for placebo all day, man
Just dying for a little pure morning, huh?
I've always found asprin, ibuprofen, and paracetamol (Americans call it acetaminophen). It never feels like it's doing anything. I'm sure it does do something, but because there's no noticeable effect of my mood or brain, it feels like nothing is happening. Opiates on the other hand, feel like God's gift to mankind until you do them too much, and you realise only Satan could invent something like this. (I don't mean literally, of course, as I'm not religious).
Funnily, I was given some opiates for severe stomach pain back in March and have used three or so since. They honestly don't feel like they work at all. Maybe because I wait until the pain is unbearable to take them but it doesn't do shit for me, I still feel like I'm dying. Advil does seem to have some slight effect though.
I was given opiates after a surgery. I stopped taking them and just stuck to Tylenol as they made me feel so nauseous and it didn't feel as though they actually helped at all. Good for me I guess, 0 chance of every getting addicted, but better pain relief would have been appreciated
I had an accident resulting in the partial amputation of a finger and a bone fusion. During my recovery, I found that waiting for high levels of pain to take opiates led to much less effectiveness and higher dosing levels. What worked better was a kind of pre-emptive dosing right away in the morning, even though I generally woke up with minimal pain. If I waited until my pain got acute (usually by late morning), I'd end up taking 2-3 doses before dinner and then one before bedtime. If I took one in the morning, I often wouldn't need another dose until after dinner whch would last until the morning. I think with pain there's some kind of cumulative effect that takes much higher doses to manage, but if you take a pre-emptive painkiller it inhibits it from getting to acute levels and you end up taking less total medication. What seemed odd about it all was how weird both my surgeon and her PA were when I asked questions about dosing strategy and physical dependence. They both got kind of weird and their only response was "well, we don't have to prescribe any". I would think that a *hand surgeon* would have extensive experience in pain management and might have both academic and clinical experience knowledge on effective dosing strategies. Instead it was just medication with a "use as needed" kind of instructions. I suspect there are some basic usage strategies that physicians could teach patients which would be more effective at pain reduction and result in less total pain medication consumption. And I'm not talking (mostly ineffective) advice like "get more exercise". But doctors either don't know them or just don't want to talk about them with patients for kind of weird reasons, like they're worried about encouraging use or afraid that their liability is somehow increased.
Opiates aren't really for stomach pain, depending on the actual issue there are probably far more appropriate remedies, some that aren't even 'painkillers'.
Exactly. I can take Tylenol, and then 1 hr later notice my pain’s gone, OK. But with opioids, I’ll feel the high and don’t care if the pains gone
Yeah Tylenol ibuprofen and aspirin I usually pick two and take them together. Works about as well as any opiates I've had and I can still do my job.
Naproxen Sodium (Aleve) is the only OTC pain killer that I've found actually works for me. The rest do absolutely nothing. Codeine is the good stuff though, that shit works a treat
I wish I could take nsaids like that all the time as they really do work but they mess up my stomach before the kidney problems even start. So they just give me endless codeine. I would prefer morphine for when codeine can't cut it but over long term usage codeine seems to work better, I theorise it's because the morphine your liver does create from it is more effective with opiate receptors flooded with codeine and the lesser metabolites.
Same with over the counter pain meds, even morphine doesnt feel like its doing anything, it wasn't until they put me on hydromorphone that I started to feel it.
I live in a state where kratom is legal. I know the plural of anecdote is not data. However it helps my chronic pain, and supplements my monthly tramadol prescription. Kratom also helped blunt the cravings for alcohol when I stopped drinking. (I'm a recovering alcoholic, nearly two years sober)
I live in a state where kratom is legal. I know the plural of anecdote is not data. However it helps my chronic pain, and supplements my monthly tramadol prescription. Kratom also helped blunt the cravings for alcohol when I stopped drinking. (I'm a recovering alcoholic, nearly two years sober)
If you use placebo long enough all the pain and troubles will go away
They need to be sure. They screwed the pooch with Oxy.
Oxy is far more effective than a placebo..
is it though? in this [pediatric study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428788/), oxycodone was not more effective than ibuprofen for fracture pain Adult study, [Not better than weaker Acetaminophen + Codeine](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786200) Adult study, [back pain, opioids not better than ibuprofen + acetaminophen](https://www.aafp.org/pubs/afp/issues/2018/0301/p348.html)
Ibuprofen and acetaminophen are extremely effective painkillers. They are the exact opposite of a placebo, they're well studied and efficacious drugs.
And they aren't highly addictive opiates. That's the fucking point
Acetaminophen will fuck up your liver and ibuprofen will give you ulcers
If you take 20 a day every day… yes. But we’re not talking about opiates.
If you have liver disease, on a blood thinner, or are just stupid, you can very easily run into issues. And as an American RN, I see it often enough but probably have a bit of confirmation bias
Surely your confirmation bias would put the relative dangers of ibuprofen and acetaminophen in perspective with *opiates*
You'd be surprised how often a doctor will prescribe 5mg of oxy when a patient has pain but also liver disease and hx of ulcers.
I know plenty of people who take about 20 tylenol a day because they no longer get prescribed effective pain meds. there's gonna be a shitload of liver failures in America's near future.
Neither of those drugs are contributing to the current drug issue as far as significant facts are concerned.
Ibuprofen also messes up your kidneys.
Oxy will fuck up your brothers life.
If misused.
No the point of that comment was in response to whether Oxy is more effective than a placebo. Chill out lol If it is as effective as acetaminophen or ibuprofen, then it’s obviously more than just placebo.
This is true, but you are massively underestimating how well placebos work.
They are anti-inflammatory. They are not more effective than a placebo effect where a person thinks they received opioids. They are more effective than someone who does not get the placebo effect when they are made to think they're getting opioids. They are still anti-inflammatory, and they also attack your liver and stomach lining by the way. Aspirin does not attack the liver however.
What? Acetaminophen and Codeine or Ibuprofen and Acetaminophen are FAR superior to a placebo? You’re comparing drugs to drugs, not to a placebo
For the two adult studies... >identical capsules containing ibuprofen (400 mg) plus acetaminophen (1,000 mg); oxycodone (5 mg) plus acetaminophen (325 mg); hydrocodone (5 mg) plus acetaminophen (300 mg); or codeine (30 mg) plus acetaminophen (300 mg). Wouldn't a fairer comparison be: Ibuprofen 400mg + paracetamol 1000mg versus oxycodone 10mg + paracetamol 1000mg? 5mg is a very low dose, as is 300/325mg of paracetamol. Hell, 30mg of codeine isn't what I consider to be a "normal" post-op dose (60mg) either.
Questions whether a painkiller is better than a placebo. Provided evidence: other painkillers are more effective. I don't think this supports your argument very well.
Ibuprofen and acetaminophen are not placebos…
Yeah but you care alot less about the fracture while on oxy on account of being high
I took oxy after a surgery and I was too busy talking my family’s ears off to think about the pain.
I haven't had oxy but I've had Dilaudid. It works, but also makes me feel terrible.
It's easy to cherry pick studies with off kilter results, particular in an over studied discipline like that. I find it insane that MDs are trying to push that paracetamol is as good a painkiller as a moderate opiate. A lot of people being sent home from surgery in extreme uncontrolled pain due to these dodgy studies.
wtf, you're compaing it to actual pain killers though and saying they're the same... so it IS a painkiller by your own admission?
Are you claiming that ibuprofen isn't better than a placebo?
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They are the same drug. Oxycontin is extended release oxycodone.
I’ll say this for me. Pain killers do not actually “kill” the pain but what they do is improve your mood so much that the pain signals become background and are no longer as pronounced. If I have significant pain APAP/NSAIDs will not touch the pain. A little swelling, tight muscle? Sure those work great. Opioids/opiates most certainly do a fantastic job in dulling moderate to severe pain.
Doctor gave me a non addictive opiate after my knee replacement. I asked for oxy or dilauded. I was in so much pain after they took me off the morphine drip and sent me home with that garbage I ended up back in the emergency room for uncontrollable pain. The reason these pain pills don’t get approved is because they don’t fucking work. Drug companies need new patents to charge top dollar when we already have generic drugs that work great. Then bribe the doctors to give you the new less effective drugs so they can both line their pockets at the expense of the patient.
There have been some very well-conducted studies that have shown that this isn't the case.
It was one dude that pushed that through the FDA and got a job with Purdue afterwards.
I'd love to be able to take placebos, but the side-effects are a killer....
I'm addicted to placebos. I could quit, but it wouldn't do anything
Dude, just go to a PA meeting (Placebo Anonymous).
Interestingly the placebo effect is real in that a person tricks their body into releasing the endogenous drugs. A study gave painkillers and to the placebo group they administered naloxone the opioid antagonist, without their knowledge, either the administrator or the patient as double-blind is, and it reversed the effects. A couple other interesting points, they found different color pills work better for different Placebo effects. Some people experiencing the placebo effect are made to know it is a placebo and it still works. I will believe somebody has achieved true enlightenment like Buddha if they can induce their body to release endogenous drugs at their will. I am sorry this is paywalled, there are ways around it but I have trouble finding them myself. But here is the source: https://www.newyorker.com/magazine/2011/12/12/the-power-of-nothing
This is the whole premise behind the Bene Gesserit in Dune.
To be fair, Naloxone gives me more pain from baseline so even if I only thought that the placebo was working, Naloxone would appear to reverse the effect. I do believe it, just pointing out a flaw
My doctor stopped filling my placebo prescription. I gotta buy it on the street now. The Healthcare system is a mess.
Pharma is allowed to advertise, thus we’ve been conditioned to believing there’s a pill for everything.
I think this knowledge and exposure might also have an unintended consequence where it amplifies the response from placebo further. It’s known that placebo induces a response regardless of whether you are even aware you’re taking it for treatment. But research has found that the *expectation* a placebo will work paradoxically increases the response effect severalfold. This actually still holds even if you are aware of the placebo effect and know that what you’re taking is only placebo. It’s a really fascinating phenomenon, and its effects become more robust if you study it for pain relief in particular
Hol’ up. Placebo works even if you don’t know you’re taking it for treatment? Can you please elaborate?
I think that it’s an ethical gray area which would involve a doctor using a patient as a test subject without their knowledge, so there’s not much in the way of robust studies to document it in humans. Even if it’s technically harmless from a chemical standpoint. But the corollary to the placebo effect is that a negative counterpoint exists called the nocebo effect. Where if a patient is told a pill is harmful in some way, it can have outsize undesirable side effects in an otherwise inert substance. And it can severely burden the patient with physical side effects
im drink, high, and tired and this placebo stuff just blows my balls. Like how does it work? Why do we do this? We’re crazy machines
>im drink, high Who asked
Actually you're totally sober—I swapped out your drugs for placebo right before you took them! Placebo effect in action!
Only in the US and New Zealand. Everywhere else knows that's stupid.
New Zealand allows it but you will rarely see actual ads on TV. Here is a saved comment that explains why: We have it in new zealand too but for a very good reason. In the late 1980's our government set up a department called Pharmac. Think of it as a bulk buying club with 5 million members. Each year, pharmac puts out tenders for the drugs that cover whatever 99% of newzealanders would need in their lifetime. Things like paracetamol, insulin, cancerdrug and antihistamine etc. They say "Hey all you drug companies, New Zealand wants to buy 10 million hayfever tablets of these specifications for this upcoming summer. Who wants to give us the best price?" While canadians and americans pay $140 for a medication, we pay $5. As a drug company, you either win the pharmac contract, or you completely miss out on any sales within new zealand of your product. So they drop their prices real low. When a doctor writes a prescription on his computer and looks up antihistamine, anything pharmac funded appears highlighted in the list. Drug companies were somewhat unhappy about this - initially there were more cases challenging it going through the courts than pharmac had staff on its payroll. So the government decided to let the drug companies advertise on tv. But in reality, when you go to your doctor and say "The TV told me to ask about Cialis because my dick doesnt work" the doctor is going to say "Well sure, here is a prescription - it will cost you probably $50 at the pharmacy. Or i can prescribe you Genericdrug which has the same ingredient but only costs you $5 at the pharmacy since it won the pharmac tender". And its no surprise, major brand drug companies will repackage their drugs into whitelabel brands and then bid on the supply tenders with the exact same product. International brand Lopressor is whitelabelled by its manufacturer and my doctor prescribes "Betaloc CR" which won the pharmac tender for a type of beta blocker tablet so that the Lopressor brand retains the more expensive image and price point on the pharmacy retail shelf. A buyer in the USA cant say "your selling Lopressor to New Zealanders for $3, why should we pay $90" because its a different 'product'. None of the drug companies really bother advertising on tv, knowing that the doctors are just going to prescribe a cheaper option.
That's very interesting. Thanks for the info!
Don't blame it all on pharma. The unregulated supplements market is equally as much to blame. People believe just about every snake oil scam that's brought to market. All the supplement company has to say is "These claims have not been evaluated by the FDA" My parents are elderly, and they and all their friends have tried CBD for just about everything you can use it for. I told them that it basically does jack shit for anything besides a specific type of epilepsy and about a few hundred bucks and a year later they finally told me it didn't help them for anything.
Which makes it so heartbreaking when you're diagnosed with a disease and told that there may not be any medicine that works for you
We're basically 40k Orcs over here.
I am starting an experiment. When I get a headache...I take an aspirin. Headache goes away but stomach is upset. Now, I take an aspirin and sniff a lavender thing. Soon, I will take a placebo and sniff the lavender thing. If all goes as planned, headache is gone and no side effects. I expect this to take several weeks.
The placebo must be taken without your knowledge otherwise it would not be a placebo. Just in case you didn’t know that…
Not true. https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926
I used to think that was true but several studies say the placebo effect works even when you know it's a placebo. Weird. My experiment will be to see if this is true for me.
Fake it till you make it baby!
I placeboed myself into having covid. \*Everyone around me is getting covid at work\* \*Panic and think I might get covid\* \*Start coughing, burning up, feel like I’m going to die\* \*Take a 30 minute power nap\* \*Wake up fine with literally no symptoms\* \*Get covid test, clean\*
So do you have 'Placebo Long Covid' now?
Nah but if I had a false covid positive test I probably would.
Richard Nixon and Rupert Murdoch are both to blame
The placebo effect is wild!! I heard a radiolab podcast back in the day that blew my mind. Thank you radiolab!
The USA is the leader in self delusion
We’re… number… one?
USA! USA! USA!
If nothing else, this suggests delusions may be beneficial to our well-being. Sometimes if you believe something seemingly stupid steadfastly enough, it happens. That's kind of America.
We’re Orks. RED GO FAST
I mean… country was founded by the Puritans. People so zealously religious, Europe didn’t like them.
not really, the puritans stopped really being relevant a couple decades before the revolutionary war even started and most of the founding fathers were Episcopal, Presbyterian, Anglican, or deist
Jesus fucking Christ… Reddit… it was a half-joking, tongue-in-cheek dig at the weirdness of the Puritans and the fact that the United States remains an outlier in religiosity in the developed world.
If any comments are “JFC Reddit”, they’re yours bud.
The American Dream!
What are you, Canadian? Apparently Canadians believe any old pseudo science they read about on Reddit
Well it a link to a Nature article with footnotes. So clearly your projecting a little bit there, eh!
I don't think you know what that word means. But your statement "The US is the leader of self-delusion" is insinuating that the placebo effect is a result of delusion? What a crock of shit.
Add sugar to every food from the time we're born, then act shocked when sugar pills make us feel better?? /S
For bonus points even being aware of the placebo does not diminish the effects of the placebo! Source: https://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo
Where do we get these placebos?
Maybe there's some in this truck!
The researchers should implement a double blind study. Give placebos and drugs to people who don't even know they are even being drugged and then after a few months ask them how they feel. Simple.
Your brain is insane, you can be given a placebo, TOLD it's a placebo and it can still help you.
Its our fault the studies take so long and cost so much. Just say it.
Here I was waiting for someone to somehow blame the FDA for doing their job. But honestly in recent years the FDA hasn't really done that either. A part of me wonders what horror stories will come out in the next few decades and the anti-science movements that will spin off of it.
Back in the heyday of the FDA, the FDA actually ran drug trials and the taxpayer paid for it. It was expensive but the agency was independent. The FDA prevented widespread use of the anti nausea morning sickness drug which caused birth defects. It was a system that worked. Later congress mandated that drug companies had to pay for the drug studies instead of the FDA, so it meant all the people doing the regulations and safety were financially dependent on drug companies to submit drugs for testing. And then people started to really screw the pooch.
You make it seem like the process doesn't work anymore, when the opposite is true. There's a reason most new pharmaceutical treatments come out of the US.
I thought the reason most new drugs come out of the US because our lack of pricing controls, IP laws, and the fact the pharmaceutical companies can directly market their nonsense to the consumer by getting a Kardashian or Lady Gaga to shill for them?
Formerly robust and steadily dwindling investment in public research combined with shoveling so much money into the pockets of the pharmaceutical industry that the fraction that doesn't get diverted to advertising and shareholders is still enough to fund the rest?
Its what happens when a certain political party starves federal agencies.
They called it Placebo! I think it's made by PuhFizer.
It's all mental. That's probably what I'll say until the day I die of some preventable disease.
Plain old opium is so much more calming and pain-relieving compared to all the garbage derivative drugs they've "invented" by studying opium. Just give people opium.
We are becoming Orks from WH40K
Holy shit. Makes sense, though. So many people walking around in this country refuse to believe the sky is blue simply because somebody told them it wasn't.
Could be the propaganda programming is so strong and effective. It has successfully made people more susceptible to influence.
Or it could be the methodology in the studies. Too many junk studies these days.
and it could be the methodology. Why would the methodology be worse in the US?
Lack of oversight and the extreme monetization of publishing journals
If you genuinely think Americans see more propaganda than other countries then you're deep in it yourself.
The US isn’t the only place with effective propaganda. It has to be caused by something very unique to the US… possibly related to the countless billions that Big Pharma spends on ads
"possibly related to the countless billions that Big Pharma spends on ads" So....propaganda
Much more likely it correlates with religious belief. Last I checked something like 80% of Americans believe in literal angels. Belief is a powerful thing - if the mind really believes something it can have observable physiological effects. Kinda whacky, but that's my take.
The most reasonable explanation is that we've always been susceptible to the placebo effect.
I think the study is pretty flawed but this was my first thought as well. Basically of course the most effectively propagandized country on the planet has this issue.
Americans are just Orks and our pills need more dakka
This is easily explained when you realize most of these clinical trials in USA are paid and the people who take them will lie for money. Even if you don’t feel anything it worked bc you want your money.
lol for those studies that do involve monetary compensation, the compensation is not at all attached to the outcome. You get paid whether something works or not lol. What kind of smooth brain shit is this?
Yeah, especially with something subjective like pain. I get mind-bending migraines, but I’ve learned to focus the pain to a pinpoint and then just kind of squeeze it out of existence. It takes a lot of focus, but it works.
I’ve had cluster headaches. The right pain definitely recalibrates one’s pain scale.
Oh, hell yeah. When people talk about being at a 7 from 1-10, I’m like, you wouldn’t be taking to me coherently and normally if you were at a 7. I think a real line we can draw is involuntary vocalizations from pain. Like, when I’m at that level that I literally can’t stop myself from either saying something profane or groaning, that’s when it’s pretty bad.
That's an actionable detail to base a pain scale.
Hey, I have to be on these FOR THE REST OF MY LIFE!
There are clinical trials that iii don’t even know who’s getting a placebo treatment or not due to skewed results.
Correct. It’s called a double blind trial when neither participant nor administrator know who is receiving what dose. It’s part of what makes gold standard research.
A reason longer trials could be a factor is one of the placebo effects (there are really several, it's not just "mind over matter") is natural remission/tolerance. More time may allow more opportunities for those effects.
These are gazebos and they’re bullshit
i wonder if the value of the medication contributes to this. like would the placebo effect be higher if you think a pill is worth $400 compared to $1 because we've been conditioned to think more expensive = better?
Yes. At least a branded pain killers can be more effective than non-branded as far as I remember.
One major difference cited in the trials is nursing care - dedicated nurses vs. those having other responsibilities. So the patients may be responding to lower stress associated with better nursing care, not just placebo effect.
I was addicted to a painkiller called "Placebo" once. Thankfully, my doctor got me off the stuff with a regimen of Sucrose tablets.
I wonder if it's because of how expensive medical treatment is. Similar to how hotels raise their prices and people think the room is more luxurious.
I live in a state where kratom is legal. I know the plural of anecdote is not data. However it helps my chronic pain, and supplements my monthly tramadol prescription. Kratom also helped blunt the cravings for alcohol when I stopped drinking. (I'm a recovering alcoholic, nearly two years sober)
Americans fucking love drugs
I used to do placebos. I still do, but I used to too.
In other words Americans are potent psychic healers