#81: Placebos, nocebos, and the doctor as a placebo
Published February 5, 2018
52 min
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    Boost treatment efficacy and amplify the “doctor as a placebo” phenomenon with tips from placebo expert (and ex-cartoonist), Mark W. Green, MD, Director of Headache/Pain Medicine and Professor of Neurology, Anesthesiology, and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. Topics include: What’s that pesky sugar pill actually doing to us? Why do we get a boost from taking medicines that have no active compounds within them? How does placebo work? How can it be leveraged? What does it mean for study design/blinding? And what’s with its pesky dark twin--the nocebo effect? “Enjoy this, our only placebo-controlled episode”  (Thanks, Stuart!).

    Written and produced by: Molly Heublein, MD and Nora Taranto MS3; Edited by: Matthew Watto, MD

    Full show notes available at http://thecurbsiders.com/podcast

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    Time Stamps

    • 00:00 Disclaimer
    • 00:37 Intro banter
    • 01:30 Picks of the week
    • 08:02 Getting to know our guest
    • 14:00 Clinical case of pain
    • 15:08 Placebo hierarchy
    • 17:19 Non-inferiority studies
    • 18:20 Clinical trials, placebo, eligibility creep and regression to the mean
    • 22:04 Nocebo response
    • 27:05 Physiologic response to placebo
    • 29:13 Placebo amplification
    • 30:18 Caffeine experient
    • Dr Green reports no relevant financial disclosures
    • 32:47 How to counsel patients interested in alternative or ineffective therapy
    • 34:22 Surgery and placebo; sham surgery
    • 37:15 Open-label placebo and genetic response to placebo
    • 42:04 Blinding in placebo controlled trials may be ineffective
    • 43:53 Script for counseling patients on alternative therapy
    • 45:51 Take home points
    • 47:56 The Curbsiders recap and lessons learned
    • 52:52 Outro 

    Tags: placebo, nocebo, study design, dopamine, opioids, COMT, pain relief, therapeutic relationship, research protocol, randomized controlled study, non-inferiority, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student


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