NB I am not (at all) discussing the misuse of placebo as associated with ”sugar pills”-pharmacological ”prof” inspired medical reductionists and pharmacologists including short comings associated with the ”sugar pill people” methodology – see elsewhere at my websites.
Now to the very limited elaborated concept of real placebo-nocebo, and its potentials as I see it from my paradigm (see also elsewhere at my websites)
When placebo (Placebo is Latin for ’I will please’) and nocebo (The term ”nocebo” was originally coined to give a name to the negative equivalent of the placebo phenomenon, https://pmc.ncbi.nlm.nih.gov/articles/PMC3401955/) are really observed/discussed it usually is associated with biopsychocial medicine changes which is not understood why they emerge. This means also that it must be enough substantial to be observed and not very smal changes over a longer time (”approaching mean” is something sometimes used).
I will propose that placebo and nocebo include also very smal dynamic changes (see picture below), and that it might be associated with changes in the autonomic nervous systems (ANS) oscillatory changes patterns and main neurotransmitter (excitatory and inhibitory) dynamic interplay (the latter harder to measure). I will later return to the above proposal after some experiment (single case design moving up to normative design)
Now back to introduction discussion
The assumed forces which placebo and nocebo represent may be based on the process of evolution directly or a not “intended” consequence of synergy effect of interplay between evolved systems/functions … As we assume that the processes are mainly not conscious (in humans´ our Limbic-spatial part of our brain – see more at https://www.boaim2.se/innovativm2/evolutional-perspective-on-placebo-nocebo/dynamic-placebo-nocebo-varying-between-and-within-individuals-over-time-and-situation/ – although we attribute placebo/nocebo to expectation of an organism (later about how early such a process may be emerged), preferably in humans, which is what we need to not only try to explore but also exploit, while, if we can reveal how to construe a placebo behavioral toolbox (to be promoted before any external interventions of e.g. pills) as well as a nocebo tool (to be demoted), we would probably develop an “all winner” beyond what we today in our best desires can think of! I mean tools which can be tailored according to each individual´s wherewithal/preferences/conditions … Impossible? Maybe, but it is not impossible to vastly invest in focused om evolutionary biopsychosocial systems integrating efforts!
Thus, placebo and nocebo, regarded as multifaceted and therefore not even regarded as options of such forces (and not subjected to such at all and therefore not of placebo interests), could also to some part be thought of as placebo as a down regelation of nocebo ”expressions” and vide verse. Out f such a perspective we can assume that such dynamic synergies are always at ”finetuned” work in the extremely complex biopsychosocial medicine symphony orchestra performing at the individual´s life stage.
Methodology to discuss
Placebo is mostly used in studies, especially pharmacological ones.
Dubbel-blind means here no one knows what is the active studied substance and what is called “sugar pills” (meaning placebo study – which is to offend the concept and existence of placebo as a possible individual tailored intervention strategy without pills.
All kind of studies have a lot of short comings as well as in hopefully few planed sophisticated cheating.
One of the problems is e.g. side effects of the studied substance, while this vary within and between individuals over time and circumstances
Another is how the individual is experienced experiment situation, which can influence an individual´s tendency of placebo or nocebo reactions in general, hard to find out
Also, reaction time vary as well as reaction on reaction further complicate data interpretation.
To avoid low or no validity with amount if subjects is one way to try but the problem with normative studies is always (?) that the individual is (most) not identify and few of us is a “mean” or part of statistical elaboration.
One way which can be of clinician´s interest for a particular patient is to use a careful planned single case design where measurements is following an a priori predicted intervention, something which is more effective using dynamic psychophysiological parameters, where ANS (also oscillatory behavior pattern) and neurotransmitters are of general interest in most dysfunctions. As mitochondria is often involved in very many dysfunctions dynamic Oxicapnometry measurements are of interests together with the subjects´ reports.
More – A relevant thorough questionnaire including attitudes – health care and the use if pharmacological substances in general and also careful selection of participants prior to randomization to the study as well as the same environment including asking each participant how representative they consider themselves to be before the test.
Before they arrive, they have also got a text about the purpose with the study.
Much of the above is considered what many investigators always do, but I mention this if someone will add or criticize.
More is coming …
Below I will move on in line with the above …
But first some somewhat old, but still provoking I hope, own links:
Placebo R&D | Biopsychosocial Medicine
The biopsychosocial medicine placebo toolbox will be published 2019 | Biopsychosocial Medicine
Alternative to Yuval Noah Harari´s Homo Deus -> 2.0 beta-version of Homo Deus? | Cultural Medicine
Confirmation bias and … | Cultural Medicine
Two perspectives on evolution and production of species | Skills before pills
Are psychiatric diagnoses meaningless, at best? | Skills before pills
More coming