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安慰剂效应有多严重?或者说安慰剂效应有多普遍? 第1页

  

user avatar   mai-wen-xue-67 网友的相关建议: 
      

俺的盐值低迷(900+),为了挣点可怜的盐值, 俺豁出去了。俺知乎阅读总量只有 9000万,没跨出一小步(n<1亿)。才升 10 级,因此整个人有点飘。强答一番, 敬请海涵。


晚上值班碰到有些呃逆的患者, 什么胃复安也没用,护长大发娇嗔怎么办?

有经验的二线班长就会祭出穴位注射大法。

在内关打一针 B6, 即刻显神效!

后来, 大家又发现,B6 缺药时打生理盐水也有神效!


...... “To cure sometimes, to relieve often, to comfort always.”



[此处暂时省略 5000 字]


Marketing actions can modulate neural representations of experienced pleasantness - PubMed


       https://www.dana-farber.org/for-patients-and-families/becoming-a-patient/international-patients/chinese/newsroom/%E7%A0%94%E7%A9%B6%E5%8F%91%E7%8E%B0%E5%AE%89%E6%85%B0%E5%89%82%E8%83%BD%E6%94%B9%E5%96%84%E7%99%8C%E7%97%87%E5%B9%B8%E5%AD%98%E8%80%85%E5%9B%A0%E7%99%8C%E7%97%87%E5%BC%95%E8%B5%B7%E7%9A%84%E7%96%B2%E7%B4%AF%E6%84%9F%E2%80%94%E2%80%94%E5%8D%B3%E4%BD%BF%E6%82%A3%E8%80%85%E7%9F%A5%E6%99%93%E5%85%B6%E6%89%80%E7%94%A8%E8%8D%AF%E7%89%A9%E6%97%A0%E4%BB%BB%E4%BD%95%E7%96%97%E6%95%88placebo/ https://nejmqianyan.cn/article/YXQYra1907805?sg=AbW1NGsHw3NxPd6F  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784544/#:~:text='To%20cure%20sometimes%2C%20to%20relieve,I'd%20said%20that'.     


跑题了。跑题了。跑题了。

安慰劑效應(placebo effect)又名代設劑效應

安慰剂的外观与真正的药物非常相似,但是由无活性成分(如淀粉或蔗糖)组成。安慰剂效应於1955年由毕闕博士(Henry K. Beecher)提出,亦理解為“非特定效应”(non-specific effects)或受试者期望效应(subject-expectancy effect)。一个性质完全相反的效应亦同时存在, 那就是反安慰剂效应(nocebo effect):病人不相信治疗有效,可能会令病情恶化。反安慰剂效应可以使用检测安慰剂效应相同的方法检测出来。例如一组服用无效药物的对照组(control group),会出现病情恶化的现象。这个现象相信是由於接受药物的人士对於药物的效力抱有负面的态度,因而抵销了安慰剂效应,出现了反安慰剂效应。这个效应并不是由所服用的药物引起,而是基於病人心理上对康復的期望。

尽管不存在有效成分,但是一些服用安慰剂的人会觉得病情好转。其他一些人会出现“副作用”。这种现象,称作安慰剂效应,似乎因两种原因而发生。第一个原因是巧合。许多医学疾病和症状出现并在无治疗的情况下消失,因此,服用安慰剂的人可能恰巧感觉好转或变差。当这种变化出现时,人们可能会不正确地将之归功于或归咎于安慰剂。二是预期(有时也称为暗示)。患者会预期药物能够使病情好转。

安慰剂效应主要影响症状而非疾病本身。例如,安慰剂不可能促进骨骼愈合,但可减轻疼痛。一些人更容易产生安慰剂效应。对医务人员持肯定态度的患者,比那些持否定态度的患者对安慰剂更容易产生正面反应。由于每种药物都具有与本身药效无关的安慰剂效应,故在新药的研发过程中,研究者会首先对比药物与安慰剂的相对疗效。药物真正的作用必须排除安慰剂效应。通常,参与研究的受试者一半使用药物,另一半使用外观相同的安慰剂。理想情况下,受试者和研究者都不知道患者使用的到底是药物还是安慰剂(即双盲)。

研究完成后,将使用药物和使用安慰剂的受试者所发生的变化进行对比。药物与安慰剂比较必须有显著性差异,方可证明它的有效性。

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https://nejmqianyan.cn/article/YXQYra1907805?sg=AbW1NGsHw3NxPd6F


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安慰劑(placebo)最初指的是给患者应用的,通过暗示使之感觉更好的无药理活性同时无害的物质。

近年来,将假的干预措施(如在临床试验中假的电刺激或模拟的手术程序)也被作为安慰剂考虑。该术语有时也用作一些使用时对疾病无作用仅起着安慰剂效应的有活性的药物(如抗生素用于病毒疾病的患者)。

安慰剂尽管无生理学活性,但可能有实质性的作用――好的和坏的。这些作用似乎与期待的产品将发挥的作用有关。对不良作用的期待有时称为反安慰剂的(nocebo)作用。安慰剂作用常常发生于主观性的反应(如疼痛、恶心)而非客观的反应(如腿部溃疡的愈合率,烧伤伤口的感染率)。

影响安慰剂反应大小的因素有许多,包括:

临床医生表达的自信(“这会使你感到好许多”相对于“这是一个机会,可能有帮助”)

患者的相信程度(当患者确信他们得到的是活性药物时比当他们得知他们有获得安慰剂的机会时,作用更大)

安慰剂的类型(如可以注射的药物比口服的安慰剂效应更大)


并不是每个患者都会对安慰剂有反应,也不可能预测谁会有反应,已有理论阐述个人特征与对安慰剂反应的相关性,但并未被确认。然而,有依赖性格以及要取悦他们的临床医生的患者更可能报告好的作用,而那些有表演性格的患者更可能什么作用都报告,不论是好是坏。


安慰剂在临床试验中的应用

许多临床试验将活性药物与安慰剂作比较。为了鉴别真正的治疗作用,将安慰剂表现的作用从活性治疗表现出的作用中减去;是否有意义,对临床以及统计学差异的显著性都有要求。在有些研究中,安慰剂减轻患者疾患的百分比很高,从而更难体现出活性药物的功效。【说得通俗一点就是“新药/神药” 连安慰剂都打不败】

~~~~~~~~~~~~~~~~临床试验设计中对照组设置原则

安慰剂在临床实践中的应用

现今临床医生判定患者有轻微的自限性疾病,又没有活性药物或者不符合药物适应证时(如非特异性的不适或疲劳),有可能会在处方上开安慰剂。理由是安慰剂满足了患者治疗的要求,又免使他们出现可能不良反应,通常使患者感到好转。出于安慰剂效应或者自发好转。


伦理的考虑

在临床研究中,伦理学要考虑究竟用安慰剂是否恰当。

当存在有效治疗(如阿片类镇痛药治疗严重疼痛)时,给研究受试者安慰剂,剥夺其治疗,一般都考虑为违背伦理。在这种情况下,对照组也给活性药物。因为参试者事前知道他们有可能得到的是安慰剂,这不涉及欺骗。然而,在医疗中给安慰剂,不告知患者他们接受的是无活性的治疗,这种欺骗是有争议的。一些医生认为违背伦理明白无疑,如被发现,可能损害医患关系。而其他医生认为不给患者一些可使其感觉好转的东西,更不伦理。只是为了安慰剂的作用而给予活性治疗,可能进一步考虑也是违背伦理,因为将患者暴露于真实的不良反应之中(与反安慰剂的不良作用相反)。


       Quotes from Hippocrates:  “Make a habit of two things: to help; or at least to do no harm.”  “Cure sometimes, treat often, comfort always.”  “Wherever the art of medicine is loved, there is also a love of humanity.”  “Many admire, few know.”  “Science is the father of knowledge, but opinion breeds ignorance.”  “There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.”  “To do nothing is also a good remedy.”     





【未完待续】


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user avatar   sme-98 网友的相关建议: 
      

你知道吗?你给狗治病,安慰剂效应会出现在你身上,这对狗的伤害是巨大的。

不是有一类关于“己所欲施于人”的吐槽吗?你妈觉得你冷非逼你穿秋裤、你奶奶觉得你饿把你喂成胖子……对宠物来说,发生在主人身上的安慰剂效应就是:你主人觉得你病好了。

这种奇葩的安慰剂效应安抚的是人,痛苦的是狗。


2003年,一个由美国几所大学研究人员组成的研究小组进行了一项小型临床试验,试验结果有些意外。试验组中,即服用了真药(一种减少癫痫发作的抗惊厥药物)的患者中,有86%认为癫痫发作频率下降了,而另外那些服用安慰剂(不含任何有效成分)的患者中癫痫发作频率下降的竟然也有79%。

这听起来似乎是一个关于安慰剂效应的经典案例,但不同的是,上述临床试验的所有患者都是狗。在进行试验的数据评估时,结果似乎显示参与试验的这些狗在安慰剂的作用下也有好转,这种情况是以前不曾报告过的。

当时,在兽医学领域,双盲安慰剂对照试验是很罕见的,但是如果没有进行这次双盲试验,那当时就很有可能会误判这种治疗癫痫的成分左乙拉西坦的药效。

虽说安慰剂效应在人类患者中是普遍存在的,但很少人会关注兽医学中的是否存在安慰剂效应。因此,安慰剂效应的存在成为了一处兽医盲区,它会破坏我们在兽医护理中的努力。

早前就有医生注意到一些虚假的医学疗法,比如服用糖丸或注射生理盐水,真的可以让很多病人感觉更好。当人真正相信治疗一定会减轻病症,实际上就真的很可能会真的有效,即便治疗是虚假的。

尽管我们对动物的意识和思维还并不足够了解,但宠物们肯定不会抱着一定会被治好的心态进入兽医诊所,以它们的认知水平不会对疾病有了解,更别说懂得治疗的含义。然而,临床上对猫、狗和马的大量研究表明,安慰剂似乎真的对宠物有效。

研究指出了一种所谓的“看护者安慰剂效应”或“代理安慰剂效应”。在兽医学中,接受治疗的患者本身并不能与医生交流,它们无法主动告知症状和不适之处,而在实际中,这些交流通常依靠宠物主人的观察的推断。

在很多犬类癫痫的研究中,研究人员通常依赖于狗主人来跟踪狗的癫痫发作情况。大多数情况下,癫痫发作是非常确定,但也存在一些模棱两可的情况。有些狗在癫痫发作时会无法控制地流口水,当主人发现地板上有唾液的痕迹,就需要决定是否记录为一次发作。那些坚信自己的狗正在接受有效治疗的主人就会更倾向于忽视这种模棱两可的情况。

所以,安慰剂效应欺骗的不是宠物,而是人类。当我们自己或宠物正在接受治疗,都会期望它有所帮助,这就带来了一种自我暗示。“看护者安慰剂效应”在儿童的研究中也提及,即便只是旁观者,潜意识里的期望也会欺骗你。这就是为什么宠物主人报告的状况可能与客观事实不符的原因。

在一项FDA批准的犬类关节炎消炎药的试验中,研究人员同时使用了主观和客观的方式来评估它们的肢体功能,除了让狗主人和兽医在治疗过程中定期评估狗的关节情况外,他们还使用了测力平台来确定狗的关节承受重量,承重变大则表明狗的疼痛有所减轻。

最终安慰剂对照组的主观评估和客观评估存在差异,主人和兽医经常报告狗的情况有好转,但客观的步态分析表明并非如此。

有时候这种渴望治疗有效的强烈欲望甚至让人们对动物的真实情况视而不见。某位兽医回忆起一个案例,一只患有某种骨癌的罗威纳犬在兽医眼中非常痛苦,然而狗的主人却拒绝了给狗开止痛药的建议。这只狗的主人正在采用“顺势疗法”给狗治疗,并且确信治疗有效。

这就是“看护者安慰剂效应”要比传统的安慰剂效应更有害的原因。传统的安慰剂效应至少的确能让没有接受有效治疗的患者减轻痛苦,但看护者安慰剂效应只消除了我们自己的焦虑感,但那些需要治疗的宠物仍然在遭受痛苦。

看护者安慰剂效应的确带来了一些负面的影响,不过这也是基于人类的正常心理,从某种意义上说,这种现象证明了人类对宠物的关心,以及希望改善它们生活质量的巨大决心,但另一方面,你越爱你的宠物就越可能受到看护者安慰剂效应的影响,也就越可能让你的宠物更痛苦。

以上为翻译内容,原文链接:theatlantic.com/science


user avatar   xiexing233 网友的相关建议: 
      

本人50岁,丈夫03年意外过世,自己带儿子至今。事业单位工作,业务优秀,职称也评下来了,目前做行政。在帝都,工资不高,再带个儿子,压力还是蛮大的。曾经数年,周末在外面兼职,直到儿子工作。目前一大一小两套房,大房子和车都给儿子,自己去住上班更远小房子。总之,做了一个母亲能做的一切。

工作上并不开心,我应该是个业务型,不适合行政,每天各种瞎忙,也没什么成就感。

至于想什么,感觉自己只有眼前的苟且,攒钱给儿子结婚,自己熬到退休,那时经济压力就小了。

我的诗和原方,就是退休后能去四处走走,好好锻炼身体,拥有好的生命质量。至于再婚,已经不抱希望,过往的经历让我清醒了,有的男人一听说你是儿子,连面都不想见。交往过的,有的对我各种算计。好容易遇到不算计的,却出轨……呵呵,而我偏偏眼里不揉沙子,即使有时候一个人很孤独,也不想将就。

原本不信命的我,现在信了,任凭命运安排吧!


user avatar   wu-pei-70-19 网友的相关建议: 
      

关键是是否合乎逻辑,是否合乎情理

《亮剑》这片子就没多少人喷吧,因为这个 片子里没有把日本人贬低得一塌糊涂

亮剑原著中也是有裤裆藏雷的,而且非常详细,可是就没有几个人吐槽亮剑。




  

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