Prof. John F. Kihlstrom

Office: Tolman Hall 3333

Telephone: 643-3928

http://courses.berkeley.edu:7000/public/psy24jk2/index.html

Course Description

Is that a real pill you’re taking, or is it just a sugar pill? When people get sick, receive some form of treatment, and then get better, we usually say that the recovery was a result of the treatment they received. Of course, that can be true. But what if the "treatment" were merely a sugar pill, a saline injection, or just a visit with someone wearing a white labcoat? Such treatments are known as placebos. Do they produce "real" effects as well? If so, how much of recovery can be attributed to the biochemical effects of a pill and how much can be attributed to the patient’s (and physician’s) beliefs that the pill is effective?

Placebo effects are of special concern in the drug treatment of "subjective" symptoms such as pain, depression, and anxiety, but they also occur in the treatment of "physical" illnesses, and in psychotherapy, and in the current enthusiasm for herbal remedies. The Food and Drug Administration and the pharmaceutical industry consider placebos to be "nuisance effects" to be ruled out, but placebos are also active psychosocial treatments, effective in their own right. As such, placebo effects offer new insights into the "mind-body" problem and psychosomatic effects, and behavioral, complementary, and alternative medicine. Placebos also raise serious policy issues concerning the circumstances under which, if ever, health-care providers may knowingly prescribe placebos to their patients.

In this seminar, we will examine the full range of issues surrounding placebo effects: how they are evaluated in clinical trials, their underlying psychosocial mechanisms, their role in medicine and psychotherapy, and the ethics of their use. Seminar discussions will be based The Placebo Effect: An Interdisciplinary Investigation, edited by Anne Harrington (Harvard University Press, 1997), as well as selected other general-interest readings. Students will be expected to post comments and questions on class readings to the course website, as a basis for class discussions.

Harrington, A. (Ed.). (1997). The placebo effect: An interdisciplinary investigation. Cambridge, Ma.: Harvard University Press.

Also, a selection of articles posted to the course website.

Optional Background Reading

 

Shapiro, A.K., & Shapiro, E. (1997). The powerful placebo: From ancient priest to modern physician. Baltimore, Md.: Johns Hopkins University Press. The chapter by Shapiro and Shapiro in the Harrington book is essentially a precis of this book.

The course should be taken for a letter grade.

During the semester, students will be required to submit one (1) question or comment on the assigned reading each week, as a potential springboard for class discussion. These questions or comments should be posted to the bulletin board on the course Website by 2:00 PM the Sunday before each class. No postings are required on weeks when there are no assigned readings.

Students should be prepared to participate actively in class discussions. Unfortunately, time will not permit us to address each and every posting in class, but the instructor will attempt to respond on the course bulletin board, and other students in the class are invited to do the same.

Postings should (a) be thoughtful and relate directly to the day’s reading assignment; (b) not just be definitional in nature; (c) go beyond the assignment to indicate that the student has read and thought about the material. These don’t have to be, and shouldn’t be, long essays. Just a paragraph or two, with your comment setting the stage for your question, will suffice. Grades in Psychology 24:2 are based on class participation, and also on the timeliness and quality of assigned postings to the bulletin board on the course Website.

The Instructor:

John F. Kihlstrom is Professor in the Department of Psychology and a member of both the Institute for Cognitive and Brain Studies and the Institute for Personality and Social Research. He received his PhD in Personality and Experimental Psychopathology from the University of Pennsylvania, and completed a clinical psychology internship at Temple University Health Sciences Center. His research interests focus on cognition in a personal and social context; most of this work involves memory in some way. Before coming to UCB, Kihlstrom held positions in psychology departments at Harvard University (Personality and Developmental Studies), the University of Wisconsin (Social Psychology and Personality), the University of Arizona (Cognitive Psychology and Cognitive Science), and Yale University (Cognitive Psychology).

Gaining Access to the Course Website

 

This course has a website, which provides a copy of the syllabus, information (including feedback, as it becomes available) about exams, copies of overheads displayed during lectures, and various supplemental materials.

There is also a bulletin board for students and the instructor to exchange information during the semester. Students whose comments and questions are not addressed during class or discussion sections can post them to the bulletin board, and the instructor will try to respond (other students may feel free to chime in, too!).

Students should point their web browsers to the following URL:

This will take you to the course "Welcome Page". Scroll down to the bottom of the page, and follow the instructions for creating an account:

click on the "Create Account" button;

enter your first and last name;

enter a LogIn ID (which may be your regular Internet ID);

enter a password (which can be anything you want).

Keep a record of your password, as you will need it to gain access to certain course records, such as your entries in the course gradebook.

Individuals who do not have Internet access from their homes may reach the course website from any computer that has Internet access, including the various workstations in campus libraries and other sites.

Individuals who use an Internet Service Provider other than UCB, such as AOL or Hotmail, may experience some difficulty in accessing the course website. Make sure that Java is enabled on your browser. Make sure that you include the phrase "/index.html" in the URL. Check whether your browser adds a final "/" after the "index.html" phrase (this isn’t strictly necessary, but sometimes this helps). Try reaching the course website through the Psychology Department’s website (click on "Classes and Syllabi"). When you’ve reached the course Welcome Page, make a bookmark.

If you still have problems reaching the course website from home, create an account from a machine on the campus network. Then contact the course instructor, and we’ll do our best to help you solve the problem.

No Readings

Zivin, J.A. (2000, April). Understanding clinical trials. Scientific American, 282, 69-75 (posted on the course website).

Hall, S.S. (2001, March 11). The Claritin effect: Prescription for profit. New York Times Magazine (posted on the course website).

Strictly for background, you may want to read the articles from the New York Times series, "Medicine Merchants", which are posted to the course website:

"Birth of a Blockbuster: Drug Makers Rep profits on Tax-Backed Research" by J. Gerth & S.G. Stolberg (04/23/00);

"Drug Makers and 3^rd World: Study in Neglect" by D.G. McNeil (05/21/00);

"Patents and Patients: As Devastating Epidemics Increase, Nations Take On Drug Companies" by D. G. McNeil (07/09/00);

"Keeping Down the Competition: How Companies Stall Generics and Keep Themselves Healthy" by S.G. Stolberg & J. Gerth (07/23/00);

"Cultivating Alliances: With Quiet, Unseen Ties, Drug Makers Sway Debate" by J. Gerth & S.G. Stolberg (10/05/00);

"High-Tech Stealth Being Used to Sway Doctor Prescriptions" by S.G. Stolberg & J. Gerth (11/16/00);

"Selling Cheap ‘Generic’ Drugs, India’s Copycats Irk Industry" by D.G. McNeil (12/01/00);

"Another Part of the Battle: Keeping a Drug on the Shelves of Stores" by J. Gerth & S.G. Stolberg (12/13/00);

"Drug Makers Design Studies with Eye to Competitive Edge" by S.G. Stolberg & J. Gerth (12/23/00);

"Sales of Painkiller Grew Rapidly, but Success Brought a High Cost" by B. Meier & M. Petersen (03/05/01).

 

 

Harrington, A. (1997). Introduction. In A. Harrington (Ed.), The placebo: An interedisciplinary investigation. (pp. 1-11). Cambridge, Ma. : Harvard University Press.

Shapiro, A.K., & Shapiro, E. (1997). The placebo: Is it much ado about nothing? In Harrington (pp. 12-36).

Spiro, H. (1997). Clinical reflections on the placebo phenomenon. In Harrington (pp. 37-55).

Hahn, R.A. (1997). The nocebo phenomenon: Scope and foundations. In Harrington (pp. 56-76).

Brody, H. (1997). The doctor as therapeutic agent: A placebo effect research agenda. In Harrington (pp. 77-92).

Fields, H.L., & Price, D.D. (1997). Toward a neurobiology of placebo analgesia. In Harrington (pp. 93-116).

Price, D.D., & Fields, H.L. (1997). The contribution of desire and expectation to placebo analgesia: Implications for new research strategies. In Harrington (pp. 117-137).

Ader, R. (1997). The role of conditioning in pharmacotherapy. In Harrington (pp. 138-165).

Kirsch, I. (1997). Specifying nonspecifics Psychological mechanisms of placebo effects. In Harrington (pp. 166-186).

For your interest, browse through the exchange over the controversial article, "Listening to Prozac but Hearing Placebo", by I. Kirsch & G. Sapirstein, which was published in the on-line journal Prevention & Treatment in 1998 (links posted on course website).

Morris, D.B. (1997). Placebo, pain, and belief: A biocultural model. In Harrington (pp. 187-207).

Harrington, A. (Ed.). (1997). Placebo: Conversations at the disciplinary borders. In Harrington (pp. 208-250).

Hrobjartsson, A., & Gotzcsche, P.C. (2001). Is the placebo powerless? An anaysis of clinical trials comparing placebo with no treatment. New England Journal of Medicine, 344, 1594-1602 (posted on course website).

Strictly for background, browse through the Emotion and Disease website, documenting an exhibition at the National Library of Medicine, 11/13/96 - 05/01/97. There is an entire section devoted to the placebo effect, self-healing, and other aspects of "psychosomatic medicine". There’s a link from the course website: