@Grant Ritchey
For some reason the first post I wrote in reply to your request for more information on the placebo effect a) never made it out of moderation and b) seems to have been deleted. Anyway, my suggestions were to look at the articles on Benedetti here on sciencebasedmedicine (plug “Benedetti” into the search box and you’ll see Dr. Hall’s two discussions of him and 3 other articles that mention them) and to search for Dr. Ben Goldacre’s “Bad Science” site, which has a “placebo” category with articles discussing the placebo effect. In addition, above you can see my reply containing a link to an amazon page with a book about the placebo effect that was recommended by Dr. Goldacre.

These are just expectations based on a crude intuition of NO effects. NO effects are much more complicated and idiosyncratic. You can have high NO and low NO simultaneously in tissue compartments separated by a few microns.

Ischemia first causes low NO as superoxide is generated, then causes high NO as the nitrite reductases are disinhibited by the lack of O2.

http://www.ncbi.nlm.nih.gov/pubmed/17484949

Which I find quite interesting.

Yes, I misremembered the paper and perhaps conflated some other stuff.

Nausea is largely mediated by NO, because the smooth muscle of the gut is relaxed by NO, and conditions where you want the gut to empty itself (bad bacteria in the gut) are also conditions of high NO. Early pregnancy is also a high NO state and where high nausea correlates with better outcomes.

There are few adverse symptoms characterized by high NO, so there are few things that placebos (an inert substance said to make stuff better) actually make worse. Some sickness behaviors are mediated through high NO. Low blood pressure might be another one. I will see if I can find data to that effect.

Let’s see. The latter study came first and its findings contradict itself as well as some of the findings of the second study. Quote—

“No significant differences were observed among expectation groups for retrospective reports of motion sickness (NP); however, significant differences in EGG responses to drum rotation were obtained. The unexpected results of a univariate analysis of variance (ANOVA) revealed significantly greater gastric tachyarrhythmia and less normal activity, an indication of motion sickness, in the low expectation for sickness conditions.
CONCLUSION:
These results suggest that inducing a high expectation for sickness in healthy individuals about to be exposed to provocative motion results in a protective effect from motion sickness following exposure to the stimulus,”

So there was no statistically significant effect of expectation on symptoms under the conditions of this study, but they say their findings “suggest” this. Why? Because of the EGC findings. However the findings could equally be interpreted also as meaning that EGC findings are not well correlated with motion sickness ( just as some other researchers are saying) and the association with expectancies is due to chance or other artefact.

The second study is a later one by the same authors and on this occasion (surprise, surprise?) the results now support the favored hypothesis.

Now, it is possible that when told they are going to get terrible motion sickness, subjects will report very favorably if it turns out not to be so bad after all. I am prepared to accept that as real finding under the conditions that applied in this study although concerned that the researchers are after “interesting” results and have a special interest in this group. It certainly needs confirmation by other authors before being accepted as fact.

But you also said, and this is what I found counterintuitive and “contradicting a great deal of other research”, ” — yet the same substance potentiates the symptoms of nausea (objective and subjective) when subjects are told it will relieve the symptoms of nausea”.

The authors are not claiming that and neither can you, because there is no truly non-intervention control group. The groups given placebos may have fared better than would a group with entirely neutral expectations (assuming one could be devised) or perhaps placebo “effects” were simply dampened altogether under the conditions fo the study..

How is the research coming along?

https://www.ncbi.nlm.nih.gov/pubmed/16738082

https://www.ncbi.nlm.nih.gov/pubmed/15193970

The problem is not with these studies, the problem is with your conceptualization of what placebo and nocebo effects are such that you consider these effects to be counter-intuitive.

D2, those results run counter to plausibility, general experience, and the results of many clinical studies on the placebo and nocebo.

Where did you get them? If true, there has to have been a very powerful additional psychological input, not yet revealed.

“Placebo effects are not manifestations of arcane principles of physics or biology, they are understandable by anyone of reasonable intelligence and education.”

and you know this how?

Why does an inert agent (lactose) relieve the symptoms of nausea (objective and subjective) when subjects are told it will potentiate the symptoms of nausea, yet the same substance potentiates the symptoms of nausea (objective and subjective) when subjects are told it will relieve the symptoms of nausea?

How does the placebo effect mediate such effects on nausea? If there are no arcane principles of biology involved, there should be a simple explanation.

The only explanation I know is fairly complicated, and is not the generally accepted mechanism behind placebo effects. That it is not the generally accepted explanation makes it arcane (in my opinion). Do you have a non-arcane explanation?

See, this is where you start to sound like a new age guru.

Ah, but are you merely shooting one of the messengers, CC?

Actually, knowing that beneficial placebo and non-specific responses have contributed to the evolution of the extraordinary variety of different medical cultures seriously undermines the whole idea of cultural relativism. It helps explain the very observations upon which that is based.

We can then look at medicine as having always consisting of a sea of this basic, generic medical activity, onto which scientific medicine is now grafting itself. This in its turn helps explain CAM and the persistence of cultural medicine. This is another area where the placebo can be enlightening, as a good hypothesis should.

(This post is in moderation for some unknown reason so I will try posting it again….)

Steven Novella is not exactly a novice at this game but, you never know, an amateur like you might just be able to influence him sufficiently to change his style…I’m sorry…strategy. On the other hand, have you read Orac’s article linked to at the end of Steven Novella’s post? Good luck trying to change his style.

Jokes aside, I think the preamble/background/scene setting these authors use can be very useful. But, I have to admit, when confronted with some of Orac’s extraordinarily long articles, I sometimes scan the first few paragraphs to get to the meat of the article, especially when I’m pretty familiar with the background issues already.

ps I haven’t patented that strategy yet, so you are free to use it if you wish.

(This post is on moderation so some unknown reason so I will try it again….)

Steven Novella is not exactly a novice at this game but, you never know, an amateur like you might just be able to influence him sufficiently to change his style…I’m sorry…strategy. On the other hand, have you read Orac’s article linked to at the end of Steven Novella’s post? Good luck trying to change his style.

Jokes aside, I think the preamble/background/scene setting these authors use can be very useful. But, I have to admit, when confronted with some of Orac’s extraordinarily long articles, I sometimes scan the first few paragraphs to get to the meat of the article, especially when I’m pretty familiar with the background issues already.

ps I haven’t patented that strategy yet, so you are free to use it if you wish.

Steven Novella is not exactly a novice at this game but, you never know, an amateur like you might just be able to influence him sufficiently to change his style…I’m sorry…strategy. On the other hand, have you read Orac’s article linked to at the end of Steven Novella’s post? Good luck trying to change his style.

Jokes aside, I think the preamble/background/scene setting these authors use can be very useful. But, I have to admit, when confronted with some of Orac’s extraordinarily long articles, I sometimes scan the first few paragraphs to get to the meat of the article, especially when I’m pretty familiar with the background issues already.

ps I haven’t patented that strategy yet, so you are free to use it if you wish.

You put a piece (article, form, web site) in front of a focus group and they give you their impressions. They are supposed to be a representation of the average viewer. You are trying to get an idea of how the average viewer saw the piece, whether they got the information they needed or were confused, whether they were convinced by your arguments or unimpressed. The idea is, if I had those impressions, there is a good chance that other readers who do not comment and do not read comments, had the same impressions. Same goes for windriven’s concerns.

Whether you can convince me or yourself that my impression was wrong or mistaken, doesn’t really change whether 10% (whatever) of the readers of this article will had the same impression.

But it’s just a focus group, often a variety of responses from ‘eh, I think that’s an anomaly. I’m not doing anything’, to ‘well, I’ll consider that the next time I write on the topic’ to ‘Panic! It didn’t occur to me that the logo looked like a swastika!’** can be correct.

I’m not trying tell SN what he should do with his focus group responses. I will say, if he want to convince folks of his arguments, I hope he responses strategically rather than stylistically.

*with all the drawbacks of a focus group, too, I’m sure.

** luckily not the case here.