Placebo is an effect that has been known to humans for a very long time. It is an effect of healing that is achieved through psychological, rather than physical means. In other words, if a person believes they are getting better, it helps activate hidden resources of the organism, which makes recovery easier. Tribal shamans, medieval doctors, warlocks, and many other healers used this method throughout the history of humankind, due to the absence of knowledge and medicine. In the 21st century, placebo remains one of the most controversial subjects to discuss. While modern medicine does not deny the existence of placebo, it has also given root to many pseudo-medical sciences like homeopathy, osteopathy, faith healing, crystal healing, and others. Researchers were investigating the potential of utilizing some placebo-based techniques, such as Reiki, acupuncture, meditation, and others, in treating a variety of diseases, reducing pain, and improving the general wellness of patients.
The article written by Meissner et al. (2013) provides a review of available literature and statistical analysis of the results from randomized controlled trials used in testing out the effects of placebo in various settings. The main purpose of this research is to investigate different types of placebo techniques in the context of treating migraines (Meissner et al., 2013). As it is a systematic review, there is no implicit hypothesis in place. The authors utilize information from qualitative sources to form a basis for the review, while quantitative sources provide the data for subsequent statistical analysis. The purpose of this paper is to analyze the article, its methods, sample, data evaluation, and conclusions, in order to determine its validity and significance.
The Problem: Variable Responses to Placebo Treatments
The problem is clearly stated at the beginning of the article – the knowledge base regarding placebo is relatively weak, meaning that the results of interventions may cause different placebo effects (Meissner et al., 2013). This issue is important and relevant to today’s existing health issues for several reasons. First, expanding the knowledge about placebo would enable making accurate predictions on the effectiveness of certain interventions. In addition, it would serve as a basis for introducing alternative medicine into hospitals, as many alternative treatments heavily rely on placebo.
As stated in the article, its purpose and research questions revolve around investigating different types of placebo treatments for migraine prophylaxis (Meissner et al., 2013). The hypothesis, although not directly stated in the article, is implied in the aims and purposes section of the study. The researchers suspect that placebo treatments have varied effects on migraine patients based on the nature of the treatment and personal predispositions of the patients. Although key terms are not explicitly defined in the article, the researchers state that the keywords utilized in the research were related to migraine and placebo controls combined with filters for randomized controlled trials.
Review of Literature
As the article is presented as a systematic review of literature pertaining to the use of placebo controls in migraine prophylaxis, it utilizes a wide variety of sources in order to conduct research and analysis. Overall, the article cites 102 sources, out of which 79 articles were used in the meta-analysis (Meissner et al., 2013). The remaining 23 had insufficient data to be included in the pool or were used to set up the background information section. The articles analyzed were chosen within the time frame from inception and to 2012, which provided a broad array of material published within a large timeframe (Meissner et al., 2013). Considering the design of the research, the number of sources analyzed was neither too broad nor too narrow. The sample size is deemed appropriate.
Not all of the references were recent. Although the majority of sources were published between 1995 and 2012, some sources went back to the year 1978 (Meissner et al., 2013). However, the information from these sources was used sparingly, either to enhance the narrative or provide a historical context. There is no evidence of bias, as the number of publications minimizes the potential of misrepresenting or misinterpreting the results of numerous studies analyzed in the scope of the article.
Design and Procedures
The article is a quantitative study that utilizes various quantitative and qualitative sources as a base for its research. It provides a statistical analysis of 79 randomized control trials that investigated the use of placebo in migraine prophylaxis (Meissner et al., 2013). Thus, it used a quantitative methodology. No mentions of replica studies were found, so it is safe to assume that the design of the study was original.
Due to the nature of the study, no measurement tools were necessary, as the purpose was to assess and analyze the data already extracted from various experiments rather than perform an experiment of their own. The variables investigated in the scope of this paper included demographics, levels of migraine reduction, and placebo methods (pharmacological or non-pharmacological) (Meissner et al., 2013). Several other variables were included in the multivariate analysis, although they were less pronounced. The article has no dedicated section for that.
The sampling process involved a database search, which included several largest information depositories, such as MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and PsychINFO (Meissner et al., 2013). Out of 5886 articles screened during initial evaluation for eligibility, 420 were manually analyzed by two researchers separately one from another (Meissner et al., 2013). As a result, 102 were chosen for the final meta-analysis. The double-blind article selection was utilized to ensure a lack of bias. No pilot study was performed.
Data Analysis and Presentation
The data for the proportions of patients receiving placebo and active treatments as well as the confidence intervals for each were calculated and pooled together with a random-effects model (Meissner et al., 2013). Stratified analyses were performed in order to evaluate and differentiate the effects of different placebo treatments. Meta-regression analyses and inverse variance analyses were performed for the same reason. In addition, an explorative analysis was performed, which investigated 15 covariates separately and collectively (Meissner et al., 2013). Two additional multivariable analyses were utilized in order to investigate the overlap between the type of placebo treatment and type of binding. Logistic regression analysis was used to analyze independent variables, such as demographic factors and responder data. Lastly, secondary analyses were utilized in order to evaluate various continuous outcomes (Meissner et al., 2013).
The findings provided answers to the implicit questions of the study. The data supported the effectiveness of all interventions in inducing a placebo effect in patients. However, that effect varied from one study to another, depending on various factors as well as the method of intervention. One of the greatest limitations of the study included the heterogeneity of treatments, setting, and patient modalities, which prevented the researchers from connecting network meta-analyses to one another.
Conclusions and Implications
The article concludes that some methods of placebo treatment, namely acupuncture, fake surgery, and medications are associated with greater improvements when compared to other types of treatments (Meissner et al., 2013). Because of this, it can be extrapolated that these placebo treatments warrant further clinical examination, as they seem to trigger relevant responses. These conclusions answer the purpose of the study and are related to its original purpose.
In addition, researchers provide several important implications in regards to placebo control groups and systematic variation. As it was stated, the knowledge base on the subject is weak, which affected the results of this meta-analysis (Meissner et al., 2013). The rate of dispersal and the variety of conditions, as well as the abundance of various placebo treatments and their modalities, making comparisons difficult. The researchers imply that until a more solid base is acquired, systematic reviews will have to rely on making indirect comparisons, which would affect the quality of the results.
The results of this research provide a much-needed addition to the existing amount of knowledge and can be served as a basis for further studies. The authors recommend dedicating additional resources and efforts to exploring the effects of placebo by conducting more randomized control trials using similar interventions and modalities. My overall assessment of the article is positive. Although the structure of the article warrants several improvements to make reviews and a general understanding of the issue simpler, the amount of work put into the paper is enormous. I believe that the article highlights several important gaps in existing research and provides guidelines for further research into the subject. The research design is simple and straight-forward, meaning that it can be used as a framework for new systematic reviews and meta-analyses of similar nature.
Meissner, K., Fassler, M., Rucker, G., Kleijnen, G., Hrobjartsson, A., Schneider, A., …
Linde, K. (2013). Differential effectiveness of placebo treatments: A systematic review of Migraine prophylaxis. JAMA Internal Medicine, 173(21), 1941-1951.