Category: Placebo Effect

Research:

Many ailments have specific treatments. Headaches have aspirin, nausea has Zofran, and anxiety has Xanax. These drugs work effectively to cure their various illnesses, which is not surprising, seeing as they have medical properties that help heal patients. What is surprising is the fact that a sugar pill can often produce the same results as these treatments. That’s right. A drug with no medical properties can sometimes heal a patient just as well as actual medicine. The reason for this is the placebo effect when a drug heals a patient despite it having no medical properties to do so.

Scientists are still unsure of how the placebo effect works, but most suspect it has something to do with what a patient believes will happen when they take a drug. Most of the time, a patient feels that taking medicine will cure their ailment, and simply because of that belief, they start feeling better. Because the placebo effect relies mainly on the opinions of patients, the environment in which a patient gets a drug is almost as important as the drug itself. As Harvard medicine professor Ted Kaptchuk puts it, “The placebo effect is a surrogate marker for everything that surrounds a pill. And that includes rituals, symbols, doctor-patient encounters… It’s basically the water that medicine swims in.” What this means is that traditions or rituals associated with treatment significantly impact how well a pill or placebo works. If you have a kind, caring doctor that tells you everything you need to know about your treatment gives you your medicine in front of you, and just sets you at ease, you’ll heal better than if you had a cold, remote doctor who you saw only once. With the first doctor, you feel taken care of and believe you’ll heal. With the second doctor, you feel shunned and doubt you’ll get much better. In either case, you’ll be correct. That experience you get when you go to the doctor’s office, of being taken care of and knowing that you will feel better when you leave has a profound effect on your symptoms.

Comfort levels aren’t the only things that impact how well a placebo works; research suggests that the color of a pill may impact its effects on a person as well. Pills that are warm colors, such as red, orange, and yellow, tend to give a patient a stimulating effect while those of cool colors, such as blue and green, tend to give a tranquilizing effect. All of this goes to show that the mind has quite a big effect on our bodies and that by helping patients feel comfortable and giving them positive information, doctors can make treatments more effective.

The placebo effect is mainly utilized in clinical testing. Usually, study participants are given placebos and real medicine. Neither the doctors administering the test nor the participants themselves know whether they are getting real medicine or a placebo. Such a test is called a double-blind experiment. This way, scientists can isolate the benefits the specific medicine itself provides from the effects of medicine in general. Although placebos may be used in doctors’ offices, there are concerns about being honest to patients that prevent the use from being widespread. You simply cannot lie to a patient saying that a sugar pill is a real pill that will heal them. This could lead to a whole host of problems, such as a doctor charging a patient the price of a real drug for a simple sugar pill and so on. Even if this weren’t a concern, doctors need to be honest with their patients and tell them what they’re being given. There is one exception to this, though. A doctor could tell a patient that a placebo might heal them. This is technically the truth, because of the placebo effect, and as such, this use of placebos could be considered ethical. However, this usage is uncommon.

One more possibility is being tested. Previously, it was believed that if a patient knew that a drug was a sham, the placebo effect wouldn’t work. This makes sense: after all, if the placebo effect relies so much on a patient’s belief that a drug will heal them, telling a patient that a drug is fake should reduce its effects, right? However, a study by Ted Kaptchuk shows this is simply not true. He did an open-label study on irritable bowel syndrome, a disease that has no objective symptoms. The reason he chose IBS, he says, is that placebos can’t help against physical problems. “Placebos only affect what the brain can modulate. It’s not going to shrink a tumor. It’s not going to deal with malaria. But it will deal with pain, fatigue, and nausea. Or will deal with feeling malaise. But it’s not going to deal with killing bacteria. That doesn’t happen on the level of the brain.” While it‘s true that placebos cannot cure physical ailments, they can help with psychological aspects, such as pain, nausea, headaches, and so on. So they could help a lot with a disease like IBS, where there aren’t any measurable symptoms.

Usually, in studies like this, neither study participants nor administrators know whether they got a pill or a placebo, which is slightly deceptive. This study wanted to test if the placebo effect would still work without the deception. The drugs were open-label, meaning that the study participants knew they were taking a placebo. Most scientists speculated that the placebos would not affect the patient. This would make sense if you followed the mind-cure idea, which states that if you believe something will happen or won’t happen, you’ll be correct. It has traditionally been associated with placebos and still is the main theory as to why placebos work. If you tell a patient they’re taking a placebo and they know that it’s fake, it shouldn’t heal them, right? But Ted Kaptchuk doesn’t buy it. “People think this is about mind over matter. But all my patients are people who have been to many doctors before. They don’t have positive expectations about getting better. They’ve been to 10 doctors already.” So from that standpoint, it makes sense to test this point of view.

The results did not support the hypothesis. 30% of participants healed from time alone. Testing this is significant because if a patient usually heals from a disease in a few days without a pill, pills may not be needed. Compare that to the 60% of participants who healed after taking an open-label placebo. That’s about as effective as most of the drugs in the market that treat IBS! Unfortunately, real drugs weren’t tested alongside placebos, but Kaptchuk plans on doing this in his repeated trials.

This study suggests that the placebo effect doesn’t have anything to do with the mind-cure theory. But in that case, what does cause it? As of now, scientists just don’t know. More research is required to get a grasp of the psychological/physiological effects of a placebo. This discovery was still significant, though, because it increases the use of placebos in the real world. Previously, giving patients placebos was difficult because it would require the doctor to lie about the placebo and force them to imply that it was a real drug. But now, if open-label placebos work this well in all cases, doctors can give them to patients without that deception. This would be a huge gain in medicine because of how helpful placebos can be. They are usually less effective than actual drugs because real drugs can change the body physically as well as psychologically. But with some diseases like IBS, the current treatments aren’t very effective and may hurt the patient because of their side effects. Placebos are made of relatively harmless materials, so they have no side effects. In such a situation, a placebo would work well. With this discovery, placebos will finally have practical usage in medicine rather than being waved off as “just a placebo”. No wonder the National Institutes of Health gave $2.5 million to support this project! That’s a small price to pay to learn about something that will shake the field of medicine on its foundations.

Analysis:

Prior to completing this research paper, I knew a bit about how the placebo works. I understood that it had to do with false treatments that healed patients despite having no medical properties, but little else. I didn’t know about the web of different psychological and medical processes involved, such as double-blind testing and the mind over matter theory. If you asked me what factors affect how well a placebo works, I would have been completely blank. I wouldn’t have been able to comprehend why so much controversy surrounds the placebo and its use. Over the last few months, all of these things have become solid facts to me and I know them like the back of my hand. However, I still understand that placebos are rather confusing to people and that their significance is not understood by most. I attempted to find what aspects about placebos were the most confusing to students so as to address them properly in my convocation presentation. I did this by distributing a ten-question survey about placebos to one-hundred eleven students and teachers in the district. My findings are listed here.

1. This question was easy to solve due to the process of elimination. Option D can be removed since theriacs are only found in myths, not scientific environments like medicine. Option B is unlikely because smell, taste, and texture are all subjective properties and would not be considered in a scientific field. Options A and C are the remaining, and option C is more reasonable, because placebo translates to “I shall please” in Latin. With good reasoning, you can arrive at the correct answer. Since the majority of people got this question correct, I wouldn’t change this question if redoing it.
2. The hint for this question makes the answer clear. If something was discovered recently, it’s unlikely that people know what causes it, making A the preferable choice. Option B is unreasonable because something pleasant to one person can be horrid to another, and happiness can only go so far when healing a patient. Option C has the same fallacy built into it. Also, having sugar daily as part of a pill will be rather unhealthy and most likely be deleterious to health. Of the remaining options, A is the best. Since 72 people chose this answer, I would keep this question the way it is if revising this survey.
3. The hint for this question removes all doubt that the correct answer is B. Also, nocebo translates to “I shall harm” in Latin, making it a clear winner over stimulants, depressants, and hallucinogens. Furthermore, all 3 incorrect options are taught in health, so every student should be able to eliminate them as viable options. From the 91 students who got this question correct, you can see that my constant barrage of hints did work. I would keep this question the way it is for any revisions of this survey.
4. What you chose for this question depended on your answer to question 1. If you chose A, B, or D on the latter, you would have selected A, B, C, and D for the former since none of the options are addictive drugs; pleasant tasting, smelling, or feeling; or remotely sweet. If you chose option C for the former, you would select A and D for this question, since only they are real treatments. The options for this question were all chosen equally, suggesting that people didn’t read the “not” in the question or that they thought they were taking too long by going back to question 1. One way to fix the first problem would be to change the question, asking for examples of placebos instead. As for the second issue, the questions could be rearranged so that 1 and 4 were next to each other, making it more convenient for participants to look at the questions together.
5. This question is one of the few difficult ones in this survey. Only option A can be eliminated because sugar concentration is on objective quantity, not subjective. The answer you choose after that point depends on what you chose for question 1. If you chose answer B, choice D would be the most reasonable for this question. If you chose C, choices B and C make the most sense. To fix this, I would change option D to something objective such as melting point.
6. This question relies largely on reasoning skills. As stated in question 5, the placebo effect is subjective and depends on the thoughts of patients. This means that color can change how effective a placebo is if a person believes something about a certain color. The only option that addresses this reasoning is choice B. Although only a few people answered this question correctly, I wouldn’t change it because there are already so few options and there is a clear path of reasoning to arrive at the answer.
7. The phrasing of this question is rather deceiving. It mentions the word subjective, which has been repeated multiple times throughout this survey in conjunction with placebos. However, after thinking through this question, the answer becomes clear. If doctors could prescribe placebos to patients, they may sell them at the same price as drugs with medical properties. It also would be difficult to stay honest with patients. From this, the answer is B. I wouldn’t change this question if revising the survey because it already has two choices and one can be reasonably eliminated.
8. The word “clinical trials” is essential to answering this question. If you don’t know what it means, you’re forced to guess between options. If you do know its meaning, though, the answer can be reasonably determined. Clinical trials test the effectiveness of a drug, but how much of a drug’s efficacy comes from medical properties can only be determined when it is compared to a placebo. Only if a drug has a significantly higher success rate compared to a placebo is it sold in the market. Hence, the answer is true. While there is a clear path to determining the answer, it may be unfair to expect students to derive this conclusion or to presume they know what “clinical trials” are. If I were redoing this question, I would add the definition for a “clinical trial” as a hint. I can’t add anything else because the question already is cut down to two options.
9. The answer to this question is fairly obvious. If a placebo is a drug that has no medical properties, it can’t help against physical problems. All it can do is make patients feel better about their illnesses and give them relief from subjective symptoms such as headaches, nausea, and so on. I wouldn’t change this question at all if revising it because, in addition to there already being only two options, the answer can be derived fairly easily. No wonder 91 people got it correct!
10. Placebos, as mentioned earlier in the survey, are rather subjective. Factors that change person to person affect them. Certain environments allow the placebo effect to work while others don’t. Hence, any given placebo will only work some of the time, making the correct answer to this question choice C. I would not edit this question in any way if revising it because the answer can be derived from information already in the survey and the fact that there are only three options to pick from. It’s a fairly easy question to answer already, so there are no additional hints needed.

The goal of this survey was to determine areas of weakness in the general public’s knowledge of placebos. It has succeeded in completing this goal. After analysis, I can see that certain points, such as what a placebo is and examples of placebos, are well known while others, like factors that contribute to the effectiveness of a placebo and the controversy that surrounds placebos in the medical field, are slightly esoteric to most people. Because of this additional research, I know what topics should be covered in greater depth in my convocation presentation and which ones should be covered more quickly. This knowledge will help keep my presentation relevant and useful for students.

As to the accuracy of the results and the dedication of the participants, I feel that most people tried their absolute best on this survey. Very few unreasonable answers were chosen and quite a few of the respondents of the survey were teachers or filled it out under the directions of teachers, making them a great deal less likely to randomly guess. All in all, I feel as though this survey went very well and will help quite a bit with my presentation in January.

Bibliography:

1. Harvard Health Publishing. “The Power of the Placebo Effect.” Harvard Health, www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect.
2. Jacobs, Tom. “Placebo Effect Produces Higher Test Scores.” Pacific Standard, 24 Mar. 2013, psmag.com/economics/placebo-effect-produces-higher-test-scores-54276.
3. Mados, et al. “The Mastermind Effect – Psychologists Boost Students’ General Knowledge Using Priming Placebo.” Research Digest, 30 July 2016, digest.bps.org.uk/2013/03/07/the-mastermind-effect-psychologists-boost-students-general-knowledge-using-priming-placebo.
4. Newman, Tim. “Placebos: The Power of the Placebo Effect.” Medical News Today, MediLexicon International, 7 Sept. 2017, www.medicalnewstoday.com/articles/306437.php.
5. “Placebo Effect to Better Grades.” Brainscape Blog, 22 Feb. 2017, www.brainscape.com/blog/2013/05/placebo-effect-better-grades/.
6. “Placebo Effect.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 24 Sept. 2017, nccih.nih.gov/health/placebo.
7. “The Placebo Effect: What Is It?” WebMD, WebMD, www.webmd.com/pain-management/what-is-the-placebo-effect#1.
8. “The Self Fulfilling Prophecy ‘ Dr. Madeline Daniels.” Dr. Madeline Daniels, www.drmadelinedaniels.com/2007/02/07/the-self-fulfilling-prophecy/.
9. Shmerling, Robert H. “The Placebo Effect: Amazing and Real.” Harvard Health Blog, 2 Nov. 2015, www.health.harvard.edu/blog/the-placebo-effect-amazing-and-real-201511028544.
10. TED-Ed. “The Power of the Placebo Effect – Emma Bryce.” YouTube, YouTube, 4 Apr. 2016, www.youtube.com/watch?v=z03FQGlGgo0.
11. Resnick, Brian. “A Radical New Hypothesis in Medicine: Give Patients Drugs They Know Don’t Work.” Vox, Vox, 2 June 2017, www.vox.com/science-and-health/2017/6/1/15711814/open-label-placebo-kaptchuk.

Task 1

The Health Belief Model (HBM) -The health behaviour model is classified as a psychological model which has been developed in order to provide a prediction and an explanation of the various behaviours which are health-related. In the year 1966, both Stanislav Kasl and Sidney Cobb specified that there are three main types when it comes to health-related behaviours. Firstly, that health behaviour meant a behaviour which seeks to prevent diseases – for example, maintaining a healthy diet in order to reduce the risk of developing diabetes. Secondly, that health behaviour was a behaviour which aimed to seek for remedy – for example, booking a GP appointment and seeing a doctor when feeling unwell. Thirdly that the sick role behaviour means any activity which has the intention of making the individual getting well – for example being given a medical prescription or being told by the doctor to take time off of work in order to gain some rest. Later on in 1984 Joseph for ‘behavioural pathogens’ which have a negative effect to health behaviours such as consuming high amounts of alcohol, smoking excessively on a daily basis and consuming high cholesterol diets regularly too. Behaviours with positive effects may include attending to check-ups on a regular basis and making sure that every night you have the right amount of sleep on a daily basis. Overall health behaviours are usually referred to as behaviours which will have a relation to the overall status of a human being.

A physician called Thomas Mckeown wrote a book called ‘The Role of Medicine’ which studies the effect of medicine within health ever since the beginning of the seventeenth century. Mckeown provided explanations on the many suggestions and assumptions which revolved around the benefits of medicine and its role when it came to reducing the chances of many individuals developing highly infectious diseases (e.g. measles, pneumonia, whooping cough and more). The physician also displayed how there was a decrease in illnesses before any type of medical development. Once he displayed this he claimed that the reduction of the development in infectious diseases which has been viewed over the last three centuries would be understood clearly in the role of behaviour and behaviour mortality. For example in the role of behaviour, Thomas Mckeown studied both illness and health during the twentieth century. He strongly believed that illness which is contemporary is usually determined by the many choices an individual decides to make (such as eating habits, exercise, and alcohol consumption). In conclusion, the physician looked at the causes of death within society and results showed that the majority of deaths were actually caused by illnesses that are dominant such as coronary heart disease and lung cancer.

Theories of Placebo Effects (TBE) – There are many different types of explanations and summaries of the definition of placebo. The most common definition would be a substance that is consumed and will cause some sort of relief towards the symptoms. A good example would be if I was given a sugar pill and said ‘due to the fact that I have taken this sugar pill, my headache has now disappeared’. As there are many types of definitions of placebos, this has caused some misunderstanding with what the word actually means. Non-active theories are theories which study one’s characteristics, health professionals’ characteristics and characteristics of treatment too.

Firstly we have the characteristics of the health professional. This is when there are professionals who work in the health industry (e.g. a doctor) provide treatment of the placebo which can control the extent of the placebo effect. Studies have shown that the higher the status of the professional then the higher the worry – the reason for this is because of the increase within the placebo effect.

Secondly, there are the characteristics of an individual. Every individual carries many different types of traits which make them easily vulnerable to experiencing the effects of the placebo. Different types of characteristics have been classified as neurosis or emotional dependency- those who are seen as introverts have also shown a reaction toward the placebo effect. There is limited evidence which can provide support that traits which are consistent are predicted when responding to the placebo effect.

Lastly, there are the characteristics of treatment. Research in the past have solely focused on the characteristics of treatment and have provided suggestions that these characteristics of the placebo treatment may have a relation to how effective the placebo effect really is. A good example would be that if a treatment is viewed by one who takes it seriously, meaning that the effect of the placebo being high such as receiving an injection. Studies have also shown that the greater the pill (within size) then the greater the effect of the placebo in comparison to a smaller pill.

Within health psychology placebos have different types of factors such as pain, stress, health beliefs from health professionals, health beliefs, illness cognitions and health-related behaviours. The ‘health beliefs’ portray that in order for a placebo to be effective, a human being must have a strong belief for the mediation to have an effect. If I was given a placebo which is in a pill-like structure will have an impact if one applies to the model of medical illnesses and health and the tradition of medical beliefs when looking at alternative medicine.

Task 1 ii

There are a variety of factors which can have an impact on the way we behave and our beliefs in which we will have a response of illness and health, such as gender, socioeconomic class, culture, education, ethnicity and location geographically. The two factors which I’ll be focusing on is gender and culture.

Socioeconomic

Socioeconomic classes can also have an influence the way we behave and our beliefs in which we will have a response of illness and health. I strongly believe this because it can affect their life expectancy, health physically, the ability to gain the appropriate and the right care for nutrition and medicine. Studies in the United States display that an individual’s social and economic status can affect ones health. An individual who has a low socioeconomic level is more likely to experience a wide range of issues related to health whereas someone with a high socioeconomic level is less likely to have health problems. Having a low socioeconomic level this means that one will struggle to afford and use healthcare, if they’re able to use the healthcare with a low socioeconomic level then it’s more likely to have low quality. Many researchers think this maybe because of the different hazards of the environment. For example, if one lives in a poor and low-class neighbourhood then this means they’re not exposed to many grocery stores, healthy restaurants and are instead exposed to a variety of fast-food chains. This shall increase an issue in nutrition and the different health conditions related to nutrition (e.g. eating disorder).

By having a lower socioeconomic class this will result to lower chances of buying health insurance – leaving those in the lower socioeconomic class to be prone to getting many injuries and not receiving compensation for any injuries or illnesses. This can be easily explained due to the likelihood that those who are in the middle and higher class have an employer who will provide them with health insurance as a benefit for the employees – on the other hand, those who are in lower socioeconomic classes are less likely to work in jobs where they’re provided with health insurance and other health related benefits. Without having health insurance it can be incredibly expensive, due to the high expense this means that those who are uninsured are more likely to have poor quality treatment. Lower socioeconomic class people are more likely to be exposed to physical injuries which can lead them to being disabled, cancer and deaths within infants.

Gender

1. Males – Research shows that health risks which occur within male can be linked to behaviour. Overall men are known to take part in different types of activities and behaviours which can cause them to have more illnesses and injuries in comparison to women – these activities and behaviour can include rugby and fighting. Men are also known to consume diets which are considered as unhealthy – such as eating diets filled with high cholesterol on a daily basis e.g. KFC, McDonalds and more. The way the body works, genes and also hormones can have an impact on the high risk of the diseases which men develop such as cardiovascular disease. Cardiovascular disease is when the blood vessels are narrowed which can lead to a heart attack, various pains within the chest and strokes too. When studying males who are aged over 60, over 40% will be diagnosed with heart disease in comparison to females who are also aged over 60 as only 27% will be diagnosed. Researchers believe that the reason for this is because females are often known to have a slim figure in comparison to men who have a more heavy build – when a female gains weight, the weight will usually be transferred to their thighs or hips. Pamela Strauss (a doctor who specialises in medicine) has claimed that men are often put on weight ‘in the middle’ (referring to their bellies and stomach) –by having this type of body fat it makes men more prone to developing a heart disease called visceral which is a heart disease where fat is kept deep down in the abdomen, women don’t have this as they don’t share the same problem.
2. Females – Many doctors believe that the causes of the different types of health risks within women is due to their hormones and the way their body works too. Research displays that every year in the United States of America, roughly around 50,000 more women were more likely to have a stroke in comparison to men. The reason for this is because of oestrogen – which is a sex hormone primarily found in females. Mahtab Sohrevardi who is a doctor in medicine has stated that females may be unaware of the impact oestrogen can have in the development of a stroke, by taking pills such birth control can raise the chances of them being fertile however it can also change the levels of oestrogen too. Once the levels of oestrogen have changed this can have an impact on the substances within the bloodstream which will lead to blood clots being produced. The more blood clots that are produced the higher the risk of developing a stroke. In the United States, almost 80% of females out 10 million male and females are more likely to have osteoporosis. Osteoporosis is the weakening of bones which makes them incredibly fragile – one can get osteoporosis if they’ve had a sudden fall. This happens because females have bones which are both thinner and don’t have a lot of bone tissue in comparison to males. Oestrogen protect the bones of women however this can stop a substance which can instantly kill the cells within the bones. Once a woman begins menopause a lot of oestrogen will be lost which results to bone mass being lost. Almost 50% of women who are over the age of fifty are most likely to break a bone due to osteoporosis.

Task 2: Researching own case study

Task 2 (1)

In case study 1 the health implication that Paul consumes high amounts of alcohol. I can infer this because in the case study is states that he drinks a bottle of red wine after work, every single evening, has high levels of cholesterol and doesn’t take part in any forms of exercise. Another health implication is that Paul’s wife Anne is overweight and binge eats. There are a variety of symptoms when studying Paul’s different health problems.

Paul’s health implications (CASE STUDY 1)

Firstly alcoholism is a dangerous form of alcohol abuse which means when someone is unable to manage and control how much alcohol they drink. In males, it’s highly recommended that nothing more than four drinks should be consumed a day and no more than fourteen drinks should be consumed within a week. The symptoms of alcoholism is that it can raise ones blood pressure which can damage the heart and often cause heart attacks too – even by drinking around two average-sized drinks every single day can increase the chances of having bowel and stomach cancer. Mentally and emotionally it can have an impact on your daily moods (you could feel happy one minute and switch to angry the next) and that by drinking excessive amounts of alcohol can increase the chances of developing dementia. Fertility-wise, consuming high amounts of alcohol can have an affect and lower the males levels in their testosterone and lower their sperm count too.

Secondly, there’s high cholesterol which is when one has an excessive amount of cholesterol (a substance which consists of fat) in your bloodstream. You can gain high cholesterol by eating ‘fatty foods on a daily basis whilst not doing enough exercise, consuming lots of alcohol and smoking too. The main symptoms of high cholesterol are heart disease, high blood pressure, stroke, sudden chest pains (which is caused by heart disease), extra growth in the screen which is usually yellow/green. For men in particular with high cholesterol, they’re more likely to develop impotence which is caused by the arteries, this can cause an impact on high amounts of cholesterol within the blood.

Lastly, by doing no exercise this means that decline of movement in the body which requires energy. Examples of different types of exercise/physical activity would be walking, playing football, swimming, climbing up the stairs, dancing and more – exercise can have high vigorous-intensity or they can be moderate. There are a range of symptoms when an individual barely does any exercise such as sharp pains in the lower back, constantly hungry, high levels of fatigue and a higher chance of developing cardiovascular disease.

Anne’s health implications (CASE STUDY 1)

Being overweight means when one has more body fat than what is usually seen as healthy on a human being. A body which is healthy needs the minimum amount of fat in order for the body to gain energy, thermal uses and so that the body can function properly including the reproductive system, our hormones and immune system. If the body has too much storage of body fat then this can cause an impact on how quickly the body moves, its flexibility and it will also alter the body’s appearance. The symptoms of being overweight include being breathless quite often, high levels of sweating, often feeling isolated and depressed, high fatigue and many more.

Patient’s health implication (CASE STUDY 2)

The patient in case study 2 is a heroin addict, which means that he has a physical addiction to the drug heroin. Heroin is a drug made from morphine, a substance which is extracted from the seeds of poppy plants. Consuming heroin can have both its short-term and long-term effects. Short term is you may often have the feeling of a dry mouth, vomiting and nausea, experience a warm flush within the skin and mentally you may feel hazy or unclear thinking. On the other hand, the long-term effects is that you can get insomnia, the tissues that are located in the nose will become severely damaged (as they use their noses to snort and sniff the drug), can have lung and kidney disease, can experience complications within the lungs and more.

Task 2 (2)

There are a range of demographic, genetic, psychological, social and medical factors which can have an impact on Paul’s problem behaviour. The three main factors which are linked to Paul’s drinking problem are genetics, social and psychological.

There are many genetic factors which can impact one’s drinking behaviour. For example, case study one states how Paul’s mother is an alcoholic and died from chronic liver disease. Chronic liver disease is when there’s a scar within the tissue which replaces the healthy liver tissue. The scarred tissue will stop the healthy liver from functioning properly. It’s a long-term disease which can cause damage to the lungs over a long period of time. Chronic liver disease is a genetic cause which can be inherited, it’s known that fifteen out of 100 newborns can inherit the disease – as they grow older the more the disease will develop. Although in the case study it hasn’t stated whether Paul inherited the disease from his mother, we can infer that there’s a chance he may have which has led him to drink excessively and be at a high risk of having the disease.

Paul’s drinking problem can have its social factors. For example, it states how in the weekend both Anne and Paul go out with friends and family which is when Paul will always go past the limit of the advised levels of drinking. Social often means an informal gathering which has been organised by an individual or a group of people. Going out with friends and family is a social event and in many cultures it is normal to have a drink when in the company of others. Although it doesn’t specify whether it’s every weekend or if it’s once every few weekends – we know that he exceeds the recommended drinking levels which has an impact on Paul’s drinking behaviour.

Lastly, there’s psychological factor which can affect Paul’s drinking behaviour. In the case study it says ‘But Paul says that unlike her, he can stop drinking anytime.’ This means that mentally Paul strongly believes that he can restrict himself from consuming the same habits which is mother had. However, in reality, it seems like he can’t as he’s constantly drinking high amounts of alcohol on a regular basis. This has an impact on Paul’s drinking behaviour as he is in denial of how he isn’t following his mother’s footsteps and that he hasn’t got an addiction.

Task 2 (3)

There are any different types of psychological and social interventions which can address Paul’s drinking problem. The first idea would be for Paul to attend cognitive behavioural therapy which is considered as both a psychological and social intervention. Its therapy where the individual (who has the addiction or ‘problem’ where one will focus on their many thoughts, beliefs and attitudes to different aspects of their lives, their feelings and how they behave – during this treatment an individual will be taught on the different coping mechanisms which they can apply to when having to deal with difficult problems throughout their lives. If Paul was to attend a cognitive behavioural therapy then I strongly believe that this would benefit him because he will be able to talk freely about any issues he may have and may find that it’s easier to talk about these issues in front of a group of strangers rather than those who are closer to him. Paul can also be taught the coping mechanism when it comes to how much alcohol he consumes.

An example of a social intervention would be family therapy. Family therapy is when an individual gains emotional support from family members towards the member who is trying to restrain themselves from consuming alcohol. when studying the health behaviour model.

Annotated Bibliography

Bishop, Felicity L, et al. “When and Why Placebo-Prescribing Is Acceptable and Unacceptable: a Focus Group Study of Patients’ Views.” PloS One, Public Library of Science, 9 July 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4089920/.

This source is reliable because it is the National center for biotechnology information. This is a government databank that published medical studies along with other scholarly information.

This study found that the more someone believes in a placebo, the better an outcome could be and vice versa. Bishop talks about how prescribing a placebo would be unethical because it is considered deception. The placebo teeters on the line of what is ethical because a placebo can make a patient or a patient’s family feel like they are being lied too or that they are not getting the right kind or best care. Bishop also found that the more a placebo was talked about the better the view on it would be.

I would use this article because it talks about the ethics of the placebo and how people’s perception on it can get better. I think it peers into the patients perspective and informs what a patient may feel like when prescribed a placebo.

Harvard Health Publishing. “Putting the Placebo Effect to Work.” Harvard Health, Harvard Health Publishing, www.health.harvard.edu/mind-and-mood/putting-the-placebo-effect-to-work.

This is a reliable source because it was published by a renowned school, and was published six years ago, so it is still relevant to today. Harvard has also published studies relating to the placebo effect.

The article starts with mentioning that the placebo effect was not used as widely as it is today and our perception of the placebo is changing. The author says it is changing because we are finding proof that the placebo effect has an impact on neurotransmitters which affects our brain. They also mention how powerful our belief in the treatment is. The more we believe in it, them more we get out of it. Their study was another informative resource, it stated, of those who received the placebo in the study 44% saw an improvement in their symptoms. Placebos can also have a psychologically positive effect while having no physical effect on the body. One study found that albuterol was much more effective in the treatment of asthma, those receiving the placebo and real treatment both reported symptom relief. Placebos have been found to release endorphins, which are a natural painkiller.

I would use this information because it has statistics that are useful and mentions possible reasons for why the placebo effect is, in some cases, very useful and not in others. It also mentions the importance of belief in the treatment and how it can be useful. This article will be helpful for anyone in further understanding the placebo effect.

Munnangi, Swapna. “Placebo Effect.” StatPearls [Internet]., U.S. National Library of Medicine, 27 Oct. 2018, www.ncbi.nlm.nih.gov/books/NBK513296/.

This source is reliable because it is the National center for biotechnology information. This is a government databank that published medical studies along with other scholarly information.

This article first mentions Dr. Henry Beecher who brought light to the placebo effect along with how and why it should be used. It also mentions that a placebo can have a damaging effect. It also talks about how a placebo works; a condensed version would be the belief that the treatment will work and the expectations of the treatment. Another point in the article would be, how and when placebos would be used. The article also mentions the downsides of placebos from a clinical standpoint; the placebo can be damaging because when used alongside another treatment, that may be experimental, it becomes difficult to separate what treatment has caused what. It also mentions that the placebo effect can be considered deceptive and unethical because other treatments can be withheld.

I would use this source because it mentions the negatives of the placebo effect, how it works, and how it was popularized. Overall this source was informative and allowed a differing view than other sources I have found.

Silberman, Steve. ‘Doctors Can and Should Regularly Use Ethically Prescribed Placebo Treatments.’ Alternative Medicine, edited by Lynn M. Zott, Greenhaven Press, 2012. Opposing Viewpoints. Opposing Viewpoints in Context, http://link.galegroup.com/apps/doc/EJ3010501245/OVIC?u=scschools&sid=OVIC&xid=81dee5c4. Accessed 26 Mar. 2019. Originally published as ‘Meet the Ethical Placebo: A Story That Heals,’ NeuroTribes, 22 Dec. 2010.

This is a reliable source because it was found on opposing viewpoints, Steve Silberman also runs a blog called neuro blog and has contributed to magazines such as Time, the New Yorker, and wired.

Silberman talks about how important a patient’s belief in treatment is when taking a placebo, if they do not believe in it, the placebo will not work. He also finds that placebos have been found to alleviate symptoms from medical conditions such as IBS or Parkinsons’. He also mentioned a study that found their was minimal difference in real acupuncture versus sham acupuncture, this could mean acupuncture is a form of a very believable placebo. He also mentions the importance of the relationship between the patient and practitioner, it is important because it can help strengthen a placebos effect if given. It also mentions the dilemma many doctors face when giving a placebo which is deception. He mentions a study where a group of people with IBS knew they were getting a placebo, but still took a pill for it twice a day. The study found that those who were on the placebo still had clinical improvement.

I would use this source because it gives a loophole to figuring out how to ethically prescribe a placebo which was supported by a study that has been published by the British Medical Journal. This source also mentions standard of care when providing placebos which is an important factor in patient treatment and symptom relief.

Sobel, Eliezer. ‘Placebo Treatment Can Have Harmful as Well as Beneficial Effects.’ Alternative Medicine, edited by Lynn M. Zott, Greenhaven Press, 2012. Opposing Viewpoints. Opposing Viewpoints in Context, http://link.galegroup.com/apps/doc/EJ3010501246/OVIC?u=scschools&sid=OVIC&xid=05380117. Accessed 28 Feb. 2019. Originally published as ‘The Placebo Effect Can Kill You,’ The 99th Monkey: A Psychology Today Blog, 10 Apr. 2010.

This is a good source because it is on discus and it was published by Eliezer Sobel who is a journalist who has contributed to Tikkun, Yoga Journal, Village Voice, Mudfish, and Quest Magazine.

In this article, we find that the negatives a placebo can produce, the belief in the placebo, and the subject’s attitude towards the randomized control trial can impact how the placebo works. Although the patient or caregiver do not know who gets the actual medicine or placebo, the impact is the same. The placebo can produce withdrawal symptoms because the brain perceives the placebo as a harmful substance; when this happens, it is often referred to as a “nocebo effect.” The placebo can also produce physiological symptoms that are dependent on the patient’s belief in the drug, sometimes these effects can be harmful, such as heart rhythm lowering or quickening dependent on what the caregiver says it will do. The placebo has also been associated with deception and a lower standard of care because as some patients improve with the real drug, those with the placebo will continue to decline.

I would use all this information because it explains the possible disadvantages a placebo can produce. The information in the article was relevant to my research project because it allowed me to understand the full scope of my topic better and was very effective in relaying information to the readers.

The question I asked myself before doing my research:

Would having an Athlete in a specific mindset affect his/her overall performance.

What I’m trying to test:

I’m trying to see if having an athlete in a specific mindset will affect their performance either positively or negatively. I plan to do this by making my 12 athletes run 200 meters, I will then split them in half randomly, and give one group the positive feedback and the other group the negative feedback. I will record their times and compare them to the original trial.

Hypothesis:

I believe that athletes that are given a positive feedback will do better in their second trial.

Introduction

Being a good athlete requires good skills attained by training as well as a good physical and mental body. Training can help an athlete reach peak performance, in terms of physical fitness, and refine his/her technique so it’s the best it can be. However, to further enhance their performance an athlete requires a mental edge. Mind Coaches can help an athlete gain a mental edge in their sport by training the athlete to calm the mind and focus on the correct thing to do in their sport. This will ultimately help an athlete gain a mental edge thus improving their performance. To summarize an athlete’s performance, it is determined with what’s happening inside their head or something scientists like to call the placebo effect. So, what is a placebo? Well, the dictionary definition for a Placebo is medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect. From this project, I would like to see if having an athlete in a negative mindset by giving him/her negative feedback will have a positive effect or negative effect on his/her performance. An Athlete’s mindset is determined by self-esteem, recent events, Positive reinforcement (from family, Friends, Yourself, etc.), and the belief that you have what it takes to win.

Summary/abstract:

I chose this topic because I play a lot of sports and have also got used to getting negative and positive feedback from my couch. I carried out an experiment with 12 second-year students and made them all run 200 meters. I then gave them a 15-minute break to get there breathe back and I randomly split them in half I gave one group the positive feedback and the other group the negative feedback, I then compared their results and got my conclusion. From this project, I would like to see if couches giving us negative feedback is actually motivating us to keep going or making our self-esteem drop hence having a dramatic effect on our performance.

Background research:

How does having an athlete in a specific mindset affect his/her performance:

An Athlete’s mindset is determined by self-esteem, recent events, Positive reinforcement (from family, friends, yourself, etc.), and the belief that you have what it takes to win. I have identified two mindsets that people can have about their talents and abilities. Those with a fixed mindset believe that their talents and abilities are simply fixed. They have a certain amount and that’s that. In this mindset, athletes may become so concerned with being and looking talented that they never fulfill their potential they also might take constructive criticism too personally, compare themselves to others, etc., and hence that will have an immediate effect on their performance. The other mindset is known as a growth mindset. Individuals with this mindset think of their abilities and talents as things they’re able to grow and develop. They realize that with practice, instruction, and effort, they can realize their full potential. The growth mindset recognizes talent, but it focuses on developing and building on talent instead of displaying talent and trying to simply coast along to success.

What is negative feedback:

Negative feedback is the opposite of constructive criticism, it is when your coach is straight Forward with you and tells you exactly what you’re doing wrong.

What is positive feedback:

Positive feedback can be from teacher to student or peer to peer, it is positive and motivational feedback that pushes you farther and gives you belief to push yourself.

What is a placebo:

The dictionary definition for Placebo= is A medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect. The definition of the placebo in sports terms: The Placebo Effect is a measurable, observable, and felt improvement of ability and health when it comes to athletes. To simplify that, when a coach or someone close to an athlete tells them a supplement is going to enhance their performance (Ability) it generally improves their performance. So, a Placebo in sports is essentially a substance that seems to provide the athlete with maximum performance. The Placebo Effect isn’t mind-body training, it is a term for a drastic positive or negative change in an athlete’s performance. At the beginning of the section, I mentioned that an athlete requires a mental edge when it comes to sports. This can mean setting goals, teaching themselves to calm down and concentrate when their playing. All these will ultimately affect the magnitude of the Placebo Effect. In this project, the feedback I give the athletes is my Placebo, since the feedback I give them after their first trial isn’t true. But they think that it is and that will either make them try harder on their second trial or they might do worse. Nocebo is sometimes referred to as “placebo’s evil twin,” or the “negative placebo effect.” It’s also sometimes described as “the other side of placebo.” The nocebo effect can be defined as a negative effect that occurs after receiving treatment.

Why does an athlete let their nerves take over their mind before or in a game?

An athlete, like many people, gets nervous before they play a game. There’s a lot to think about, plays, what to do, what to do if they get in trouble etc… point being that they just think too much sometimes and that’s what affects their performance. The best athletes only visualize what they must do and as I mention in my second question this is a great example of the Placebo Effect. When it comes to actual game play, I believe that athletes only mess up either because the person that they’re playing against is better or they think they’re better. So, this is going back to Psychology. When an athlete thinks a team or an individual is better than they are, they generally stop trying (This is only when an athlete does not have a mental edge). An athlete with a mental edge, even though they know they’re better they keep trying and train so that one day they’ll be better. According to a British Blog, The Guardian, an athlete that doesn’t have a mental edge or think negatively before an event are not going to do as well as an athlete that is confident and focused. Sean Ingle, Reporter wrote (this was written in 2012) “Last year at the World Triathlon Championships I was chatting to an elite British athlete. ‘The swim is going to kill me,’ she said. ‘I’m not looking forward to it. I’m going to get beat up.’ Her language was very negative.’ Since this athlete wasn’t thinking positively, I’m guessing she didn’t do so well. When the brain is set on a specific mind set it’s generally hard to change your mind set. For example, if you go into an exam thinking “I’m going to fail”, your setting yourself up for failure. It’s the exact same in sports, if athletes just had confidence in their training and thought “I’ve done all I can do, let’s see if I win or lose”, then they’re going to set themselves up for success because their thinking positively. If I was to say one thing to the athletes of the world, it would be thinking positive because that means you setting yourself up for success.

Experimental methodology

Hypothesis:

I believe that athletes that are given a positive feedback will do better in their second trial.

Justification behind hypothesis:

I believe that the athletes that are given the positive feedback will do better in their second trial because, whenever I get negative feedback from my coach, I notice that I don’t perform as well. I also have background research to back up my theory. But I have to acknowledge the other side of the argument, and the group that get the negative feedback might perform better because they want to beat the other group or just to prove that they have what it takes to win.

Controls:

• Same athletes (I made sure they were all the same age)
• Same distance
• Same track
• Same warmup
• Same timer in this case I used a stopwatch on my phone (same people timing)

Independent variable:

• Positive and negative feedback (placebo)

Dependent variable:

• How good the athlete’s running time (Performance) is

Materials:

• 12 athletes all being the same age
• Running track
• Trundle wheel
• Cones
• Timer
• Pen and paper for recording the results
• Whistle

Factors i had to consider to make sure my experiment was as fair:

• I made sure my athletes were all the same age
• I made sure they were all wearing appropriate running gear
• I made sure everyone’s legs were behind the cone before I blew the whistle for them to start running.

Safety considerations:

• I had to make sure the grass wasn’t wet, and I made sure it was safe to run the experiment.
• I made the athletes do a warm up so their muscles wouldn’t tighten while running.
• I made sure they all wore the appropriate running gear.
• I also reminded them to check if their laces were tied.

Procedure:

Before I conducted my Experiment, I had to make sure:

• it was safe to do my experiment (I had to get approval from my Pe teacher)
• I had to make sure the field wasn’t wet and was safe for running
• I asked my athletes if they were all feeling well and if they all wanted to still do the run

After I was ensured that it was safe to conduct my experiment, I gathered all my athletes and told them the following:

• I told them that they are going to be running 200 meters twice
• I told them that I was testing how fast an average second year could run, and I was testing different schools in Killester. I told them this because some of the athletes questioned why I was doing this run, and I wanted them to give their full performance, so I told them that I was testing different schools, so they think they have competition.

1. 1. After I gave them all the necessary information, I measured out 200 meters using a trundle wheel. The length being 80m and the Width being 20m, I put down cones in the four corners so the athletes would know where to run.
2. 2. They all did a 10-minute warmup which included a slow jog and stretches.
3. 3. When the athletes were finished their warmup, I gave them all a random number, and told them that they should give their 100% while running and they shouldn’t make any mean remarks of the other athletes running. I ensured that they all started behind the cone and nobody had their leg in front of the cone.
4. 4. Hannah and I used my phone to get how long it took the athletes to run the 200m and wrote them down on my data sheet.
5. 5. After all the athletes ran their 200m I gave them a 15-minute break so their breathing would go back to normal.
6. 6. I split them up randomly and gave 6 athletes positive feedback I told them the following:

• I told them that they were chosen to be in this group because they had the best 1st trail and they were the fastest group compared to other schools.
• I told them that they have so much potential, and they can definitely beat there first score, and that they are doing an amazing job.

1. 7. I made them run their second lap and recorded their times.
2. 8. I then gave the other 6 athletes the negative feedback I told them the following:

• I told the athletes that they were chosen to be in this group because they did the worst first trial.
• I told them that the positive placebo group was so much better than them.
• I finally Reminded them that I haven’t seen anyone do this bad before. I told them that I would be very disappointed if they aren’t able to beat their original score.

1. 9. I made them run their second lap and recorded their times
2. 10. I brought the athletes back inside and told them what my project was about, and I also apologized in case I hurt anyone’s feelings.

Results/data anaylsis:

• From my results I can see that the group that I gave my positive feedback to did better compared to the negative feedback group. I graphed my results and I will explain them thoroughly.

Table 1 – Analysis of data

Time taken in seconds

Participants No placebo Positive Negative Difference

1. 1 56 58 -2
2. 2 54 53 1
3. 3 57 53 4
4. 4 57 49 8
5. 5 57 58 -1
6. 6 56 59 -2
7. 7 54 60 -6
8. 8 53 59 -6
9. 9 54 59 -5
10. 10 54 37 17
11. 11 56 43 13
12. 12 53 35 18

This data table shows how long it took the athletes to run their first trail, and how long it took them to run while under the influence of the placebo effect.

• On the last column on the right-hand side, you can see I have written down the difference from the time it took them to run the first trail and their time for the second trail.
• If there is a minus sign in front of the number that means they were slower compared to their original trial.

Mean performance analysis

Groups Mean score – Seconds

1. No placebo 55
2. Positive placebo 45
3. Negative placebo 56

• This table shows how long it took each group on average to run the first trial and the second trial.
• The average time it took the athletes to run the first trial with no placebo was 55 seconds.
• It took the Negative group 56 seconds on average, that might not look like a drastic increase only because the distance wasn’t as long as I wanted it to be, If the distance was longer it would level off and it would be easier to see the difference.
• It took the positive placebo group 45 seconds on average to run their second trial. They were able to beat their original score by 10 seconds. Therefore, my hypothesis was right the group that got the positive feedback did better on their second trail.
• I have graphed all this data on bar graphs to make it easier to understand.
• This graph shows how the athletes performed individually
• The blue bar represents how long it took the athletes to run their first trail
• The grey bar represents how long it took the athletes that were given the negative feedback to run the 200 meters
• The dark orange bar shows you how long it took the athletes who were given the positive feedback to run the 200 meters
• The light orange bar shows you the difference between their trials individually. If the bar goes under and has a minus sign beside the number that means they ran slower than their original trail.
• This graph shows the average times it took the athletes to run the trials.

Conclusion/ further reasearch

Based on the results of my experiment, I can comfortably say that athletic performance can be affected by having an athlete in a specific mindset. To summarize my results, all athletes are affected by the Placebo Effect either positively or negatively. The average time it took to run lap one was 55 seconds, and on average it took the negative group 56 seconds on average to run their second lap. This might not seem like a drastic increase since the distance they ran wasn’t as long. The positive placebo group was able to beat their scores by 10 seconds on AVERAGE. This experiment shows that not only that the placebo effect manipulates athletic performance, but it also shows that athletes that think they’re not good enough won’t do as good in sports as athletes that have that mental edge. So, based on this I can assume that athletes all over the globe are allowing themselves to totally be manipulated by an effect that has no power what so ever, instead of trusting their training and themselves. We can’t allow athletes to do this, so when a big competition is coming up you have to positively reinforce them, so they play better when their competition comes. The Placebo effect, for the longest time, has been used to trick people into thinking that something has special powers that can either make them better or lessen the pain of an injury. We can use this knowledge to trick athletes into reaching peak performance every single time they play a game Even if it means using a Placebo. Further research can be done to see what specific feedback can be used to help athletes reach their peak performance.

Errors with my project:

There were some errors with my experiment they are as follows:

1. I had a small trial group.
2. I used a small distance, we were able to see the clear difference between the no placebo and Positive placebo group, it was hard to see the difference between the negative and the no placebo groups.
3. If I was to do this experiment again, I would use a bigger trail group and a bigger distance. I would also have more people helping me with the timer so It would be easier to get the times of which the athletes crossed the last cone.

References:

1. This is a list of websites, research articles, and videos I used to help understand my topic in depth and helped get some information from.
2. These websites were reliable because people aren’t allowed to edit them and put up random false information. All the information I have gotten are all from established institutions, I also stayed away from news articles because they might have been biased or have used some propaganda, In my background research I used quotes that were written in a news article but the quotes were actually said and weren’t edited.
3. https://www.funderstanding.com/brain/brain-biology-a-negative-feedback-loop-system/
4. https://www.iedp.com/articles/how-the-brain-responds-to-feedback/
5. https://www.dictionary.com/browse/placebo
6. https://www.reference.com/sports-active-lifestyle/feedback-important-sports-d4750644777b2c5a
7. https://www.youtube.com/watch?v=z03FQGlGgo0
8. https://www.youtube.com/watch?v=DmxAIrr1LZc
9. https://www.youtube.com/watch?v=DMqe2SbQMT0
10. https://journals.sagepub.com/doi/abs/10.1177/03635465030310021901
11. https://www.youtube.com/watch?v=rtPe5lsoHXY
12. https://fs.blog/2017/09/open-closed-minded/
13. https://www.academia.edu/38409909/Effects_of_energy_drinks_on_economy_and_cardiovascular_measures?email_work_card=view-paper
14. http://www.mindsetonline.com/howmindsetaffects/sports/
15. https://www.youtube.com/watch?v=udJ31KKXBKk
16. https://www.youtube.com/watch?v=UTJX1uirL9Y
17. https://www.youtube.com/watch?v=gcai0i2tJt0
18. https://www.youtube.com/watch?v=ps4pRPYJWOo
19. https://www.youtube.com/watch?v=PDYqvMuIFKg
20. https://www.youtube.com/watch?v=yG7v4y_xwzQ
21. https://www.youtube.com/watch?v=TupaYScUUHM