1526: "Placebo Blocker"

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1526: "Placebo Blocker"

Postby rivulatus » Mon May 18, 2015 4:24 am UTC

Image
title text:
Spoiler:
They work even better if you take them with an experimental placebo booster, which I keep in the same bottle.


Yay, first time posting a new comic.

Edit: fixed the missing unquote in the title, now everything said in this thread is no longer being said by me.
Last edited by rivulatus on Mon May 18, 2015 5:51 am UTC, edited 1 time in total.

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Re: 1526: "Placebo Blocker

Postby jpk » Mon May 18, 2015 4:31 am UTC

Someone call Smullyan, he'll be able to sort this out.

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Re: 1526: "Placebo Blocker

Postby badmartialarts » Mon May 18, 2015 4:32 am UTC

Is there a good summary of this research that isn't behind a paywall?

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Re: 1526: "Placebo Blocker

Postby vastbluesky » Mon May 18, 2015 4:34 am UTC

rivulatus wrote:Yay, first time posting a new comic.

Yay! I came here a few minutes ago and noticed it wasn't up, but it's moot for me since I'm still a sub-5 presumed spammer.

I don't see a problem with cueball's idea, as long as no one in the test is told that it involves a placebo blocker. That would sure confuse things.

Edit to add:
badmartialarts wrote:Is there a good summary of this research that isn't behind a paywall?

I have access through my university; who has word on the legality of quoting that here? Or summarizing in my own words for that matter, although given how swamped I am I doubt that would happen on a timescale helpful to you.
Last edited by vastbluesky on Mon May 18, 2015 4:47 am UTC, edited 1 time in total.

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Re: 1526: "Placebo Blocker

Postby Envelope Generator » Mon May 18, 2015 4:38 am UTC

I got here before I checked XKCD itself and, seeing the thread title, expected a joke about placebo adblock. That's a free gag idea for you, help yourselves.

Also: the missing unquote in the thread title means everything in this thread is said by the OP. The democratic state should be abolished and all non-productive individuals exterminated!
Last edited by Envelope Generator on Mon May 18, 2015 4:41 am UTC, edited 1 time in total.
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Re: 1526: "Placebo Blocker

Postby rhomboidal » Mon May 18, 2015 4:40 am UTC

"Your head doesn't REALLY hurt. That's just a psychosomatic effect of the placebo effect."

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Re: 1526: "Placebo Blocker

Postby bondsbw » Mon May 18, 2015 5:32 am UTC

Envelope Generator wrote:Also: the missing unquote in the thread title means everything in this thread is said by the OP. The democratic state should be abolished and all non-productive individuals exterminated!


Of course, it doesn't help that every QUOTE icon has a missing end quotation mark.

Fine.

Here you go:

"

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Re: 1526: "Placebo Blocker

Postby Neil_Boekend » Mon May 18, 2015 5:44 am UTC

rhomboidal wrote:"Your head doesn't REALLY hurt. That's just a psychosomatic effect of the placebo effect."

Unless the sufferer wants the headache that is called the nocebo effect. It sucks.
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Re: 1526: "Placebo Blocker"

Postby *Wolfman* » Mon May 18, 2015 6:41 am UTC

A question:

If someone created a placebo for homeopathic medicines, would that mean it would have to have active medical ingredients in it?

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Re: 1526: "Placebo Blocker

Postby ThirdParty » Mon May 18, 2015 6:44 am UTC

badmartialarts wrote:Is there a good summary of this research that isn't behind a paywall?
http://dx.doi.org/10.1016/j.molmed.2015.02.009

In fact, the full text does not appear to be behind a paywall.

vastbluesky wrote:
badmartialarts wrote:Is there a good summary of this research that isn't behind a paywall?
I have access through my university; who has word on the legality of quoting that here? Or summarizing in my own words for that matter, although given how swamped I am I doubt that would happen on a timescale helpful to you.
I do not claim to be licensed to practice law in your jurisdiction, so this should not be construed as professional legal advice about your particular situation, but speaking in the abstract:

Summarizing an academic article in your own words and/or quoting a few sentences from its introduction and conclusion is totally, unequivocally, indisputably fair use. It's horrifying that you even feel the need to ask the question.

Reposting the full text of such an article would normally not be okay, though the situation is a bit murkier in cases like this one where the article was produced using a government grant and so is at least arguably in the public domain.

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Re: 1526: "Placebo Blocker"

Postby keithl » Mon May 18, 2015 7:15 am UTC

Two years ago, a friend graduated from medical school. As a graduation gift, I prepared a website for him, sidfx.com. Sidfx is a pharmaceutical far worse than placebo, to be fed to the control group in clinical trials. Compared to Sidfx, any trial drug will have better statistics. Imagine pill dispensers resembling nuclear waste storage casks.

The hope was that the website would encourage dishonest pharmaceutical companies with dodgy new meds to attempt to buy Sidfx for their trials, stringing them along until enough documentation was accumulated to prosecute. Never finished the site, too much like work, joining moneytoilet.com, typeandtalkjesus.com, and rapturefutures.com in the dustbin of halfbaked web business ideas.

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Re: 1526: "Placebo Blocker"

Postby madaco » Mon May 18, 2015 3:13 pm UTC

Maybe you could replace one of the placebos with the placebo blocker?

It sounds to me(though I am ignorant) like that would work, but that there might be ethical questions about what one tells the participants.
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Re: 1526: "Placebo Blocker"

Postby MrScience » Mon May 18, 2015 3:49 pm UTC

I have to say, I haven't literally laughed out loud for the last few weeks, but this comic broke the streak. Thank you Randall!

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Re: 1526: "Placebo Blocker"

Postby RAGBRAIvet » Mon May 18, 2015 4:00 pm UTC

This comic more than makes up for the massive fail of the prior one ("Emojic 8 Ball").

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Re: 1526: "Placebo Blocker"

Postby orthogon » Mon May 18, 2015 4:37 pm UTC

I reckon the researchers started with the word placebome and worked back from there.
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Re: 1526: "Placebo Blocker"

Postby rkyeun » Mon May 18, 2015 5:17 pm UTC

No, it works.
You give both groups a placebo, and then you give one group a placebo blocker, and the other a second placebo.
If the placebo blocker blocks the placebo effect of the first pill better than the placebo effect of the second pill does, you have efficacy.

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Re: 1526: "Placebo Blocker"

Postby JeffR23 » Mon May 18, 2015 8:34 pm UTC

You know, it occurs to me that sugar isn't exactly a biochemical nullity (like salt, if it were invented today it would never come need to being approved as a food additive by anyone...) and thus that sugar pills are likely a poor choice for placebos rather than something like chalk or cellulose. How much of what we're calling the placebo effect is actually the effects of low-dose sugar?

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Re: 1526: "Placebo Blocker"

Postby Knee Jerk » Mon May 18, 2015 9:53 pm UTC

JeffR23 wrote:How much of what we're calling the placebo effect is actually the effects of low-dose sugar?
Good point. I've wondered about this.

How much of the placebo effect is having people care about your well-being? (The mental affecting the physical.) It never ends. If only we were robots that could run only one routine independently.

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Re: 1526: "Placebo Blocker"

Postby JohnTheWysard » Mon May 18, 2015 9:58 pm UTC

One pill makes you larger
And the other makes you small;
and the ones the researcher gives you
Don't do anything at all....

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Re: 1526: "Placebo Blocker"

Postby da Doctah » Mon May 18, 2015 11:16 pm UTC

JeffR23 wrote:You know, it occurs to me that sugar isn't exactly a biochemical nullity (like salt, if it were invented today it would never come need to being approved as a food additive by anyone...) and thus that sugar pills are likely a poor choice for placebos rather than something like chalk or cellulose. How much of what we're calling the placebo effect is actually the effects of low-dose sugar?

I got high praise indeed the last time we had a comic involving placebos, when I suggested a double-blind study in which one group of hypoglycemia sufferers be given a sugar pill, and the control group a placebo.

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Re: 1526: "Placebo Blocker"

Postby sotanaht » Tue May 19, 2015 12:34 am UTC

I figure if you want to test an actual placebo-effect blocker, you give one group placebos, the other gets the blocker, and you tell both groups they got a real medicine for whatever condition you want to measure.

Of course the blocker could have the effect of making the tested condition worse, therefor countering the placebo effect the wrong way. In order to eliminate that problem as a possibility, you can sneak the blocker to a few control subjects who think they are getting nothing at all. Telling them they are getting a placebo could cause a nocebo effect. Then of course you control THAT against people who really got nothing at all.

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Re: 1526: "Placebo Blocker"

Postby Chizumatic » Tue May 19, 2015 1:12 am UTC

Oddly enough, this experiment has been done. The "placebo blocker" is the drug naloxone. Naloxone is an opiate antagonist, used in emergency rooms to treat heroin overdose. When someone suffering an overdose gets an injection of naloxone, within a minute they're right back on the ground, showing no effects from heroin, and if they're addicted they will be suffering withdrawal symptoms.

The experimenters were working with the hypothesis that placebo pain relief is caused by release of endorphins. If so, naloxone should block it. So they used (volunteer) dental patients who had just had wisdom teeth extracted, each of whom got two injections at intervals. Each patient was asked to estimate their pain level by making a mark on a line. For the first injection, some patients got morphine but most got saline. After a while they were asked to make another mark. Then they got a second injection. Some patients got morphine, some got saline, but a lot of them got naloxone. After a while they were asked fir a third time to make a mark on the paper.

There were a lot of patients who indicated pain relief from saline in the first round. Among those, if they got naloxone for the second one they reported the pain had returned!

This was strong evidence for the hypothesis that their pain relief had been due to release of endorphins (i.e. natural opiates; the naturally occurring substance that morphine and heroin simulate).

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Re: 1526: "Placebo Blocker"

Postby RealGrouchy » Tue May 19, 2015 1:39 am UTC

sotanaht wrote:I figure if you want to test an actual placebo-effect blocker, you give one group placebos, the other gets the blocker, and you tell both groups they got a real medicine for whatever condition you want to measure.

More specifically, you tell them that the first pill (the placebo) sometimes results in a side-effect (like itching), and that the second pill is a drug that aims to prevent the effect of the first pill.

Not only that, but when you say you are testing to see if the second pill successfully blocks the effect of the first pill, you aren't even lying. (Which, if you're given to ethics—as some are—you might consider to be a bonus)

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Re: 1526: "Placebo Blocker"

Postby serutan » Tue May 19, 2015 3:25 am UTC

JohnTheWysard wrote:One pill makes you larger
And the other makes you small;
and the ones the researcher gives you
Don't do anything at all....


Why didn't you just ask Alice about it?
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Re: 1526: "Placebo Blocker"

Postby Pfhorrest » Tue May 19, 2015 3:45 am UTC

serutan wrote:
JohnTheWysard wrote:One pill makes you larger
And the other makes you small;
and the ones the researcher gives you
Don't do anything at all....


Why didn't you just ask Alice about it?


Pfft. You think she'll know? When logic and proportion have fallen sloppy dead?
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Re: 1526: "Placebo Blocker"

Postby ijuin » Tue May 19, 2015 4:11 am UTC

JeffR23 wrote:You know, it occurs to me that sugar isn't exactly a biochemical nullity (like salt, if it were invented today it would never come need to being approved as a food additive by anyone...) and thus that sugar pills are likely a poor choice for placebos rather than something like chalk or cellulose. How much of what we're calling the placebo effect is actually the effects of low-dose sugar?


Unless you are diabetic, the effect of a thousand milligrams or so of sugar would be swamped by the effects of almost any non-zero-calorie food or beverage that you had taken in the past couple of hours. You would get more sugar-based effect on your body from one bite of any sweet-tasting food.

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Re: 1526: "Placebo Blocker"

Postby krogoth » Tue May 19, 2015 6:01 am UTC

The other effect is from water if the pill is taken with, most headaches if I recall correctly are caused by dehydration, and the glass of water sometimes helps more than the painkiller. So do you need a control group for taking the pill with water/not water as well? Maybe we just need more ad campaigns telling people of all the positives of water, then everyone gets the placebo effect from it and you have to have control groups for "watches tv".
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Re: 1526: "Placebo Blocker"

Postby FOARP » Tue May 19, 2015 7:20 am UTC

Pfhorrest wrote:
serutan wrote:
JohnTheWysard wrote:One pill makes you larger
And the other makes you small;
and the ones the researcher gives you
Don't do anything at all....


Why didn't you just ask Alice about it?


Pfft. You think she'll know? When logic and proportion have fallen sloppy dead?


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Re: 1526: "Placebo Blocker"

Postby Neil_Boekend » Tue May 19, 2015 8:11 am UTC

FOARP wrote:
Pfhorrest wrote:
serutan wrote:
JohnTheWysard wrote:One pill makes you larger
And the other makes you small;
and the ones the researcher gives you
Don't do anything at all....


Why didn't you just ask Alice about it?


Pfft. You think she'll know? When logic and proportion have fallen sloppy dead?


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Re: 1526: "Placebo Blocker"

Postby LtBrenton » Tue May 19, 2015 11:03 am UTC

You know I just figured something, it must really suck to be on a trial for an experimental drug to cure your terminal autoimmune problem or something, only to find you've wound up in the placebo group :|

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Re: 1526: "Placebo Blocker"

Postby HES » Tue May 19, 2015 11:51 am UTC

One group gets the actual medicine and the actual placebo blocker
One group gets the actual medicine and a placebo placebo blocker
One group gets a placebo and the actual placebo blocker
One group gets a placebo and a placebo placebo blocker
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Re: 1526: "Placebo Blocker"

Postby FOARP » Tue May 19, 2015 12:02 pm UTC

LtBrenton wrote:You know I just figured something, it must really suck to be on a trial for an experimental drug to cure your terminal autoimmune problem or something, only to find you've wound up in the placebo group :|


My mother-in-law does human trials for pharmaceuticals companies, and yes, something like this can happen, but they have very strict ethical rules about how this is done. Firstly people have to be told if it is possible that they may receive a placebo, and there will be no placebo if there is already a treatment that will cure the disease (e.g., Chemotherapy) unless the placebo can be taken at the same time as receiving the treatment. Many clinical trials allow the placebo group to cross over into the treatment group. There's a lot of interesting papers out there on his which you can check out via Google.

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Re: 1526: "Placebo Blocker"

Postby Angelastic » Tue May 19, 2015 12:09 pm UTC

HES wrote:One group gets the actual medicine and the actual placebo blocker
One group gets the actual medicine and a placebo placebo blocker
One group gets a placebo and the actual placebo blocker
One group gets a placebo and a placebo placebo blocker

Does the placebo blocker also block placebo placebo blockers? Or should we research a placebo placebo blocker blocker, taking care to ensure that one group gets a placebo placebo placebo blocker blocker. Is there a blocker of all placebo blockers that don't block themselves?

Placebo placebo placebo placebo placebo placebo placebo placebo buffalo Buffalo buffalo buffalo buffalo Buffalo buffalo blocker blocker blocker blocker blocker blocker blocker blocker. :?
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Re: 1526: "Placebo Blocker"

Postby Whizbang » Tue May 19, 2015 12:27 pm UTC

HES wrote:One group gets the actual medicine and the actual placebo blocker
One group gets the actual medicine and a placebo placebo blocker
One group gets a placebo and the actual placebo blocker
One group gets a placebo and a placebo placebo blocker


Make sure the medicine is one with well known/studied effects. Otherwise it'd be difficult to separate out what caused what.

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Re: 1526: "Placebo Blocker"

Postby squall_line » Tue May 19, 2015 1:42 pm UTC

krogoth wrote:The other effect is from water if the pill is taken with, most headaches if I recall correctly are caused by dehydration, and the glass of water sometimes helps more than the painkiller. So do you need a control group for taking the pill with water/not water as well? Maybe we just need more ad campaigns telling people of all the positives of water, then everyone gets the placebo effect from it and you have to have control groups for "watches tv".


The problem with ad campaigns touting the benefits of water (which already exist, by the way), is that you're fighting against the many, many issues with that toxic, deadly substance known as dihydrogen monoxide. It's a never-ending battle, really.

LtBrenton wrote:You know I just figured something, it must really suck to be on a trial for an experimental drug to cure your terminal autoimmune problem or something, only to find you've wound up in the placebo group :|


Yes, quite. And it makes for rather interesting conversation vis a vis television plotlines, such as one in season 2 of Boston Legal, although that dealt with a trial for a cancer drug rather than an auto-immune problem.

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Re: 1526: "Placebo Blocker"

Postby MrT2 » Tue May 19, 2015 3:04 pm UTC

LtBrenton wrote:You know I just figured something, it must really suck to be on a trial for an experimental drug to cure your terminal autoimmune problem or something, only to find you've wound up in the placebo group :|

If the test group taking the drug has noticeable beneficial effects, on ethical grounds the trial is often stopped early in order to give the control group the drug as well.

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Re: 1526: "Placebo Blocker"

Postby rmsgrey » Tue May 19, 2015 4:46 pm UTC

MrT2 wrote:
LtBrenton wrote:You know I just figured something, it must really suck to be on a trial for an experimental drug to cure your terminal autoimmune problem or something, only to find you've wound up in the placebo group :|

If the test group taking the drug has noticeable beneficial effects, on ethical grounds the trial is often stopped early in order to give the control group the drug as well.


And, really, "does better than placebo" isn't the right test anyway - you should be looking for "does at least as well as existing treatments" - makes it harder to sell the latest generation of drugs, but does separate genuinely useful treatments from ones which are only better than nothing...

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Re: 1526: "Placebo Blocker"

Postby orthogon » Tue May 19, 2015 5:02 pm UTC

Also, it's not unheard of for the drug under test to be worse than placebo, either in the sense of having unacceptable side effects our even of having a detrimental effect on the very condition it's intended to treat. One of the early AIDS treatments was like this. Tragically, many people died more quickly than if they'd gone untreated. (I'll try to find a reference). In that case you'd be glad you were in the placebo group.

EDIT: The trial I was thinking of was mentioned in the 2011 film We were here, and was apparently of Suramin. The Wikipedia page supports the idea portrayed in the movie that the drug had a detrimental effect. I don't get that impression from the abstract of the study findings, but I'm not experienced in reading such things. Certainly several test subjects died, but it's not clear whether this was a significantly greater number than in the control group.
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Re: 1526: "Placebo Blocker"

Postby Knee Jerk » Tue May 19, 2015 6:39 pm UTC

krogoth wrote:The other effect is from water if the pill is taken with, most headaches if I recall correctly are caused by dehydration, and the glass of water sometimes helps more than the painkiller.
I noticed the instructions with most medicine I've taken is "drink plenty of water". There I am thinking, "Why wasn't I prescribed water instead?" I know I don't drink enough water. If I did then I could just stop seeing doctors, right? ha-ha!

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Re: 1526: "Placebo Blocker"

Postby x7eggert » Tue May 19, 2015 7:05 pm UTC

serutan wrote:
JohnTheWysard wrote:One pill makes you larger
And the other makes you small;
and the ones the researcher gives you
Don't do anything at all....


Why didn't you just ask Alice about it?

Alice only talks to Bob, and only using encryption.


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