Consistent Differences in Individual Reactions to Drugs and Dummies

Joyce, C. R. B.

doi:10.1111/j.1476-5381.1959.tb00958.x

Cited by 21 publications

(7 citation statements)

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“…Joyce (1959) and Knowles and Lucas (1960). Their publications, together with the review of the literature by Trouton (1957), provide a useful background to placebo studies.…”

Section: Discussionmentioning

confidence: 99%

Placebo Responses in an Arthritis Trial

Morison¹,

Woodmansey²,

Young³

1961

Annals of the Rheumatic Diseases

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Since the publication in this Journal of a description of the effects of placebos in rheumatoid conditions (Traut and Passerelli, 1957), there has been a growing literature on the subject of placebo responses, but little has appeared in print regarding such effects in arthritis.During a recent intra-articular injection trial in which two steroid preparations and a placebo were compared, it became apparent that responses to the latter were frequent and well marked. It was decided, therefore, to make a parallel study of the whole question of placebo responses as these occurred during the trial.The results of injection of the two steroids have already been reported; one paper dealt with the effects on rheumatoid arthritics (Chandler, Wright, and Hartfall, 1958) and the other with the effects on osteo-arthritics (Wright, Chandler, Morison, and Hartfall, 1960).The present paper is concerned chiefly with a detailed examination of the responses to the placebo injections in the same trial. It also reports the results of a subsequent dummy tablet trial on the same group of patients. Finally, some of the implications of these findings as they apply to clinical trials are discussed.Material 49 patients were included in the original trial, and of these, 10 dropped out for various reasons during the 18 months that the trial was in progress. The remaining 39 patients from whom results were complete, comprised 34 females and 5 males; 21 were osteo-arthritics, and the remaining eighteen rheumatoid arthritics, the knees being involved in every case. The age range was 29 to 76 years (mean 58 6). The two steroids used were hydrocortisone acetate, and hydrocortisone tertiary butyl acetate. The placebo consisted of the inert aqueous vehicle. Design of Injection TrialEvery patient received three courses of injections into the affected knee, each course comprising four injections with an interval of 2 weeks between injections. There was a resting period of 2 months between courses, and the order in which courses were given was arranged so that every patient eventually received a course of each steroid and a course of the placebo.Assessments for local pain and tenderness, range of joint movement, and walking time, were carried out at each visit. After careful consideration it was felt that walking-times would give the most useful single objective measurement by which clinical improvement or deterioration could be assessed. Patients were asked to walk a distance of 75 yards as quickly as possible while being timed by a stopwatch. The value taken was the mean of the four walking times which were measured fortnightly during the 2-month resting period following each complete injection course. These values were then expressed as percentages of the original walking time.Alterations of less than ±10 per cent. were classified as "unchanged", while decreases or increases of more than 10 per cent. were classified as "improvement" or "deterioration" respectively. Throughout this article the values of these walking times are referred to as "find...

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“…Joyce (1959) and Knowles and Lucas (1960). Their publications, together with the review of the literature by Trouton (1957), provide a useful background to placebo studies.…”

Section: Discussionmentioning

confidence: 99%

Placebo Responses in an Arthritis Trial

Morison¹,

Woodmansey²,

Young³

1961

Annals of the Rheumatic Diseases

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“…64 A heightened awareness of autonomic sen-sation has also been associated with increased symptom reporting following placebo administration. 65,66 Situational and Contextual Influences. Nonspecific side effect reporting is influenced by the context and environment in which the medication is given, and by the physical and symbolic characteristics of the medication itself.…”

Section: Factors Associated With Nonspecific Side Effectsmentioning

confidence: 99%

Nonspecific Medication Side Effects and the Nocebo Phenomenon

Barsky

Saintfort

Rogers

et al. 2002

JAMA

671

549

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Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors. Physicians and other health care personnel can attempt to ameliorate nonspecific side effects to active medications by identifying in advance those patients most at risk for developing them and by using a collaborative relationship with the patient to explain and help the patient to understand and tolerate these bothersome but nonharmful symptoms.

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“…However, to this field perhaps more than to any other applies. Delisle Burns's dictum that people working on the central nervous system should declare their bias in advance (Burns, 1958): so, perhaps because we expected to find a greater degree of patterning in the responses than chance would lead one to predict, we indeed found this to be so (Joyce, 1959). It turned out that predictions about the category to which a given healthy subject would belong when he was tested with the crucial administration of a dummy could be made with an accuracy of between 60 and 80 per cent., depending upon the kind of antecedent test used to make the prediction.…”

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confidence: 58%