The Rise and Fall of Placebo Medicine

[HuckleB]

http://theness.com/neurologicablog/index.php/the-rise-and-fall-of-placebo-medicine/

"...

Well – a couple a decades and a few billions of dollars worth of research later, and the CAM community has essentially nothing to show for it. The research is in: none of the major CAM modalities actually work. The evidence shows that homeopathy is just water, that acupuncture is no more effective than the kind attention of the practitioner, and that mystical life energies in fact do not exist.

A review of the research funded by the NCCAM, to the tune of over 2 billion dollars, found that all that research has not added one proven modality to the tools of health care. In defending this research the best the NCCAM can do is say that they have demonstrated that some popular herbs do not work, which reduced their market share a bit.

...

What we are seeing now is a transition to the next strategy. Some CAM proponents (while they have generally not given up on their claims to efficacy) are shifting to the claim that while CAM modalities may not work any better than placebo, the placebo is a powerful treatment in itself. In essence they are advocating for placebo medicine via CAM modalities.

...

In the end, placebo effects do not appear to be a sufficient justification for any particular treatment ritual. The other conclusion we can draw from the data in this study is that the magnitude of placebo effects for objective outcomes was no greater with a ritual of treatment than with no treatment at all. Further, the magnitude of placebo effects for subjective outcomes was no greater for the elaborate ritual of acupuncture than it was for a simple placebo inhaler.

..."


------------------------------------------------


An interesting write up on the issue, IMO.

:toast:

[damntexdem]

1. But placebos should be tested by the FDA for safety and effectiveness.

;-)

I remember when NCCAM would not accept xylitol studies because xylitol wasn't "alternative" enough. (Xylitol is an alcohol-based sugar, used in some gums including Trident, and claimed to suppress the growth of bacteria. It has been shown to have some benefit in reducing dental caries.)

[xchrom]

2. recommend

[HuckleB]

3. I see the closed-minded folks who are against regulation and evidence have stopped by to say hello..

Greetings, ye unrec crowd!

:hi:

[ThatPoetGuy]

4. Novella has his ax to grind, that's for certain.

What intrigues me about this man is why he draws the line where he draws it. He has his agenda to discredit acupuncture and homeopathy, and he argues that they're not proven to be effective; but neither is physical therapy or chiropractic, and yet they don't seem to earn Novella's ire. Why is that, I wonder.

He also ignores herbal medicine, probably because it would weaken his arguments. Aspirin, ephedrine, vicodin, and many other proven medicines are derived from herbal sources whose effectiveness had been singled out by herbalists. Each of those should count as a check mark in the herbalists' box, but since mainstream medicine had learned their effectiveness years ago, Novella chooses, dishonestly, to pretend that none of the herbalists' approaches have been proven.

[HuckleB]

5. It appears that you have not paid much attention to Novella.

Nevermind that he is not the issue. The lack of evidence is the issue. He definitely points out the lack of evidence for chiropractic and herbal medicine, as anyone who has read his blog (as well as the science based medicine blog) knows. (In fact, it's hard to believe that you read this piece before you wrote your response, much less any of his other work. Actually, you might have read some of it. What you're doing here, is trying to confuse the reality that today's herbalists are mostly scam artists with the fact that many of our actual treatments derive from plants. We've all seen that play before, thanks!) He may not have criticized PT, but that might have something to do with the fact that PTs actually give their patients the reality of the situation, in terms of evidence, while homeopaths (ie... faith healers), acupuncturists and chiropractors tend to avoid those discussions.

[ThatPoetGuy]

6. I've read Novella before, and with an open mind -- which you haven't.

You and I argued before. I pointed out the very first sentence in that blog entry contained a simple, plain, shame-faced distortion, and you lied through your teeth to deny it.

I recognize that you have a cognitive bias, that you really, really, really want to believe what this man is saying. You would rather lie to yourself, and lie to others, than spend ten seconds examining his words.

But there are still those of us who like to think about things. Those of us for whom truth matters more than an agenda.

[HuckleB]

7. Ah, I get it.

You didn't like being called on some BS, and now you're back to push some more of your fictions. You don't quite understand what an open mind means, nor do you understand what actual cognitive bias is. For example, your first post here shows some serious cognitive bias. Well, quite frankly, it's bad spin, as I noted already.

Unfortunately, you think far too much of yourself. You keep making claims, but you have no evidence to support them. That's the part of having an open mind that you fail to understand. An open mind actually cares about evidence, and it tries to understand the ways apparent evidence can be less than it seems.

But heck, after your spin in your first post, we both know you don't give crap about an open mind. Nice try. (BTW, as already noted, your first response makes it clear that you've either not read much of Novella's writings, or you're being dishonest about his writings. So, which is it?)

[Warpy]

8. Sticking needles into people has been shown to decrease pain perception

using fMRI studies that confirmed a concurrent change in brain activity in pain centers. What has never been demonstrated is any of the hooey about meridians and the like.

TENS units probably work about the same way, using a mild electric shock instead of needles.

[HuckleB]

9. A similar study showed that touching the spot where one senses pain did basically the same thing.

Letting mommy kiss the boo boo must be acupuncture!

:toast:

[McCamy Taylor]

10. Placebos are very effective for some things. Like migraine headache, in which

an injection of sterile saline was found to abort headaches at the same rate as traditional pain medication. Of course, the only proven CURE for migraine headaches is biofeedback, so there is a obviously a huge component of autonomic nervous system dysfunction involved.

The placebo affect has also been documented for warts. In fact, warts are caused by a virus which is cured via the body's own immune response. Imagery has been shown to cure warts as well. (I got rid of a a nasty plantar wart that had plagued me for over a year after trying imagery for three nights).

Some people do very well with modalities like biofeedback and imagery. Others seem to achieve the same effects better through the power of someone else's suggestion. That is what placebo is. Don't knock it if you haven't studied it.

[Warpy]

11. When you can both predict it and control it on an individual basis

Let us all know about it.

[HuckleB]

12. +1