Revisiting placebo (what it is, what it isn't, what are the ethics)

[HuckleB]

http://scientopia.org/blogs/whitecoatunderground/2010/08/16/revisiting-placebo/

"The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is. A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.

First, we must review what “placebo” is. There are basically two primary uses of the word. The first is technical. In randomized controlled trials, making sense of an intervention requires some sort of control group. If I give Fabulostatin to one group, any changes I see in the group may be due to chance alone or to bias. I can minimize this effect by subjecting a similar group to an identical-appearing sugar pill, one which we call a “placebo”. If the only significant difference between the two groups is Fabulostatin or placebo then significant differences between the two groups can be more readily attributed to Fabulostatin.

This doesn’t mean that the placebo group will be unchanged. If there is a third arm of the study, one in which no pill was given, we can often measure a difference between this group and the placebo group. This difference is usually called the “placebo effect”, that is, the group that is treated with a sugar pill improves despite being given no active drug.The second use of the word is in a therapeutic sense. A doctor may give a patient a pill or treatment they know to be essentially inert, but then give the patient the explicit expectation that it will help them. The patient may indeed feel better. This is a tricky concept, one that is difficult to measure. It is also ethically problematic.

...

Ethical problems aside, placebo isn’t a therapy in the same sense as surgery or medication. It is the sum of many otherwise-intangible effects, such as being listened to, touched, and cared for. There is no need to add needles, back-cracking, or sugar pills. It’s time to give up the idea that we can ethically prescribe placebo treatments. Prescribing therapies that are “as good as placebo” simply creates deception, cost, and possible harm through the application of physical interventions that cannot improve upon holding a patient’s hand and listening to them."

http://scientopia.org/blogs/whitecoatunderground/2010/08/16/revisiting-placebo/



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Just a touch of basic health care knowledge that gets twisted and turned by far too many on the Internet.

:hi:

[Dr.Phool]

1. I have the same back problems described in the article.

Severe degenerative joint disease, and an MRI a couple of weeks ago revealed a herniated disk. I've had the symptoms for almost 10 years. Periods of excruciating pain down the right leg, etc. But, it always goes away.

However, the last two episodes were worse, and lasted longer than previous attacks. Hence the MRI.

I couldn't even lift my right leg, enough to put on a change of underwear. But, by the time I got to see doctor, the pain was gone, and the strength returned to my leg. Just for the record, I'm a former martial artist, and have very strong legs. One specialist, after reviewing the x-rays wanted to perform surgery, and fuse my vertebrae. The second one, after the MRI said that the rest of my spine was stable, and I could opt for a variety of treatment. But some physical therapy might do some good.

But, the way I look at it. Physical Therapy would be a waste, since I'm not having any pain now. In fact, he cleared me to return to the gym, saying just don't push it. And I feel fine.

I think the best treatment is, when I have an attack, I have some oxycodone to help with the pain, taken only when absolutely necessary. It works, and a 60 pill prescription lasts me over a year.

[SPedigrees]

2. Try muscle relaxants rather than pain meds

right away at the first sign of symptoms. It may not work for everyone, but it does for me. I have the same sciatic pinched nerve lower back disc problems described above.

Another thing that helps is spinal decompression. I installed a bar near the ceiling, and hanging from it, even for a few minutes at a time (I don't have sufficient upper body strength to go longer) really helps. Before installing the bar I used to hold on to the top of a door and suspend myself that way. Your body weight pulls down and allows more space for a slipped disc to slide back into place, provided the inflammation and swelling are not too severe.

Good luck; I feel your pain.

[KittyWampus]

3. Placebos have an actual, measurable effect that goes beyond chance something Materialists

try to gloss over.

And Acupuncture has proven quite effective for certain things.

Oh, and taking prescription drugs AS PRESCRIBED is a leading cause of death. Then there are the adverse reactions with lasting, life-long effects.

[HuckleB]

4. So you didn't read the article, and don't understand placebo.

Further, you offered up baseless cliches and red herrings as a response.

Why?

No one is glossing over anything, by the way.

The Placebo Effect
http://www.sciencebasedmedicine.org/?p=24

Placebo is not what you think it is
http://www.sciencebasedmedicine.org/?p=1248

Placebo Effects Revisited
http://www.sciencebasedmedicine.org/?p=4304


Dig in. Challenge yourself. It's ok! Really!

[HuckleB]

5. kick.

[johnaries]

6. I disagree. My doctor prescribed placebo for my hypochondria.

It works great!

[HuckleB]

7. Yeah, and you're keeping it all for yourself, too!

Sheesh!

:hi:

[HuckleB]

8. Give me a P!

[Donald Ian Rankin]

9. The placebo effect is really quite potent.

One of my favourite facts about it is that it is possible to treat stomach ulcers really quite effectively with placebo pills. This in itself isn't terribly surprising, but what amazes and delights me is that you get better results if you get the sufferer to take four entirely empty pills per day than if you get them to take two.

The problem with prescribing placebos, though, is that for them to work well you probably have to lie to the person you're prescribing them to, though, which clearly isn't ethical.

I have wondered if I could learn to self-medicate with placebos, though, by convincing myself that they were going to do me good.