Please, Please, Please Go To a Real Doctor

[Belz...]

Placebo effects are very real.

That's news to me. The placebo effect is a report of improvement. Not an actual improvement. Do you have some evidence that the placebo effect is, in fact, real? And I'm talking about something not entirely psychological (blood pressure sure can be psychological; as can nausea).

 

[luchog]

That's news to me. The placebo effect is a report of improvement. Not an actual improvement. Do you have some evidence that the placebo effect is, in fact, real? And I'm talking about something not entirely psychological (blood pressure sure can be psychological; as can nausea).

To be more accurate, the "placebo effect" is not a specific effect, but a term for a range of phenomena including subjectivity of reporting, somatoform effects, hypochondria, post hoc reasoning, and any number of other confounding circumstances which affect perception without a measurable physical effect.

 

[Giordano]

That's news to me. The placebo effect is a report of improvement. Not an actual improvement. Do you have some evidence that the placebo effect is, in fact, real? And I'm talking about something not entirely psychological (blood pressure sure can be psychological; as can nausea).

I will look them up and get back with them. But no surprise, I am largely talking about physical effects that are known to be controlled, at least in part, by the brain. But my main point is that they are measurable ("real") physical effects that can represent actual improvements. Some of these almost everyone realizes are controlled by one's mental/emotional outlook (breathing and heart rate for example) but others are less well understood (part of the brain controls aspects of metabolism and even body temperature, for example) and some are not well understood at all (mental outlook, I believe, can improve one's chance of recovering from certain infections, but I will have to look that up to be certain). The placebo effects found in clinical studies are done double blind, and the doctors are measuring improvements in some symptoms that go beyond the patient telling them that they "feel" better.

If I have high blood pressure and a placebo lowers it (because it reassures me that I am being treated) then in my view that is a real effect. Beyond that, I think that even people who purely imagine effects that are not physically measurable (they are "allergic to WiFi") be recognized as having an authentic health problem even if it is not for the reason they think. If it is "real" to them and is limiting their lives, then it falls under the responsibilities of the health care system and they should be viewed sympathetically. Of course the treatment will be focus on their psychology not the WiFi, but for the patient it is a "real" illness and IMO should not be dismissed by "It's all in your head" or "Snap out of it." These reactions don't normally help anyone.

 

[luchog]

If I have high blood pressure and a placebo lowers it (because it reassures me that I am being treated) then in my view that is a real effect.

It's not a clinical effect of the placebo, it's a somatic effect of the "belief". If high-blood-pressure is stress-related, then anything that causes relaxation would lower it. The placebo pill is no more causing an actual, measurable clinical effect than would simple meditation, or petting a wombat. But it's hard to charge someone a fee to meditate (a wombat petting zoo, on the other hand...).

Beyond that, I think that even people who purely imagine effects that are not physically measurable (they are "allergic to WiFi") be recognized as having an authentic health problem even if it is not for the reason they think.

Delusions can be symptoms of a real mental illness, particularly if they are resistant to reason. On the other hand, they can also be a symptom of being profoundly ignorant and spending too much time on the Internet. In both cases, a placebo is only going to reinforce their delusions, rather than cure them; and both types of delusions are remarkably resistant to seeking remedy.

 

[Belz...]

To be more accurate, the "placebo effect" is not a specific effect, but a term for a range of phenomena including subjectivity of reporting, somatoform effects, hypochondria, post hoc reasoning, and any number of other confounding circumstances which affect perception without a measurable physical effect.

Yes, that was my understanding as well.

Giordano, thank you for the clarification. I hope you'll find some interesting stuff for us.

 

[Giordano]

It's not a clinical effect of the placebo, it's a somatic effect of the "belief". If high-blood-pressure is stress-related, then anything that causes relaxation would lower it. The placebo pill is no more causing an actual, measurable clinical effect than would simple meditation, or petting a wombat. But it's hard to charge someone a fee to meditate (a wombat petting zoo, on the other hand...).




Delusions can be symptoms of a real mental illness, particularly if they are resistant to reason. On the other hand, they can also be a symptom of being profoundly ignorant and spending too much time on the Internet. In both cases, a placebo is only going to reinforce their delusions, rather than cure them; and both types of delusions are remarkably resistant to seeking remedy.

1. Of course placebos can come in all forms- pills, shame operations, meditation, petting wombats (don't they bite?). Ideally one choose the safest and cheapest one that yields the desired effect for that particular condition. IMO it is an actual clinical effect in each case, but one that can be duplicated by a large number of other actions.

Interestingly the specific effects of (and response rate to) a placebo (particularly those that the patient hasn't experienced previously) can be targeted to a surprising degree by what the patient is told to expect. If given a pill placebo and the patient is strongly told it will lower their blood pressure, a significant number of patients will have lowered blood pressure when tested with a manometer. If the same pill is given but the patient is strongly informed that it will raise their blood pressure, indeed it will do so in many of the treated individuals. These pliable effects are more difficult to achieve with placebos/actions that the patient has previously experienced. If told that petting a wombat will lower their blood pressure it probably will, because this is their prior experience and/or what they have come to expect from the reputation of animal petting. Unlike a mystery placebo pill, it is harder to convince a patient that wombat petting will raise their blood pressure or cure their infection (although it probably does happen for some).

In the USA it is considered unethical to proscribe a placebo for a medical condition, but I do think that the efficacy of many real drugs is improved when the patient is told that the doctor has seen good responses in the past in reaction to this drug and it should help the current patient a lot. Conversely dwelling too much on possible side effects will likely result in the patient experiencing those side effects when they would not have if the likelihood was downplayed.

We don't fundamentally disagree except I think of placebo effects as being quite real, even those restricted to the emotional or mental state of the patient, rather than somehow not having a "true" clinical effect.

2. The people I know with delusions typically "know" the facts, at least at some level, but a larger part of their brain maintains the delusion. The anorexic knew in the logical part of their brain that they were way too skinny, but that logic was overwhelmed by their emotionally disordered part of their brain that insisted they were too fat and needed to eat even less food. So telling them that they were dangerously skinny never helped- the part of their brain that could accept this already knew it. It took a lot of treatment to allow the logical part to gain even partial control of their actions and outlook.

Sadly some studies have indicated that even mentally stable people with strong opinions (about politics or religion for example) do not change those opinions when presented with the actual facts. The facts may cause some modest uncertainty at first, by by the next day the person is back to thinking what they thought previously. If you believe that your dead rabbi was the messiah (and there are cults in Brooklyn who believe this) then being presented with contradictory facts is unlikely to change your mind.

But I don't think we disagree- only that we are emphasizing different aspects.

 

[Giordano]

Yes, that was my understanding as well.

Giordano, thank you for the clarification. I hope you'll find some interesting stuff for us.

To quote another member in another thread- I'll be back.

 

[Belz...]

To quote another member in another thread- I'll be back.

Schwarzenegger is posting here?

 

[Giordano]

Schwarzenegger is posting here?

Another movie character- Jabba! In his immortality thread.

 

[Belz...]

Don't explain the joke, man!

 

[Joey McGee]

What I said remains true, and obviously so

*********** wrong. You said "Ms. May's best chance of survival was probably avoiding the chiropractors, avoiding the real doctors equally" when you did not submit evidence that real doctors have botched cases like hers equally. Now, apologize for the grieveous mistake you have made against humanity, please.

Since certain details of the autopsy results are unclear or unknown, we don't know for sure whether or not Ms. May's initial injury prior to any chiropractic procedure required any intervention to avoid the fatal arterial rupture or other severe medical consequences, but the consensus seems to be that it probably did not. Hence, "Ms. May's best chance of survival was probably avoiding the chiropractors, avoiding the real doctors equally, and resting up until it felt better."

I'll keep a candle burning for your soul which will eventually die if you lay your brain on this wish.

 

[Blue Wode]

Updates

Apparently Katie May's estate is looking for a seven figure settlement from the chiropractor who 'treated' her...
http://www.tmz.com/2016/10/31/katie-may-death-settlement-chiropractor/

More here, including details of the alleged chiropractor:
http://edzardernst.com/2016/10/top-model-died-as-a-result-of-visiting-a-chiropractor/#comment-83219

 

[Myriad]

*********** wrong. You said "Ms. May's best chance of survival was probably avoiding the chiropractors, avoiding the real doctors equally" when you did not submit evidence that real doctors have botched cases like hers equally. Now, apologize for the grieveous mistake you have made against humanity, please.

The truth of my statement clearly does not depend on the real doctors botching any cases like hers, let alone equally. Only that in the probable case that her specific malady required no clinical treatment, visiting a doctor presented a higher risk of mortality than resting at home. Which is clearly true, based on the travel risk alone. Will you apologize for your grievous mistreatment of logic?

I'll keep a candle burning for your soul which will eventually die if you lay your brain on this wish.

I'll throw waffles at chipmunks anticipating the day when that statement will make any sense.

 

[luchog]

1. Of course placebos can come in all forms- pills, shame operations, meditation, petting wombats (don't they bite?). Ideally one choose the safest and cheapest one that yields the desired effect for that particular condition. IMO it is an actual clinical effect in each case, but one that can be duplicated by a large number of other actions.

Erm, no, that's not what a placebo is. A placebo is a sham or ineffective medical treatment presented to a patient as if it is a real medical treatment. If you're prescribing relaxation exercises such as meditation for a patient with stress-induced hypertension, or stretching exercises for a patient with muscle spasms, those aren't placebo, because they're legitimate medical treatment. If you prescribe magic water for people with those issues, that is a placebo, because it has no clinical effect whatsoever.

Now, prescribing stretching exercises or meditation to treat rheumatoid arthritis or schizophrenia would be placebo, since they have no effect on those conditions.

 

[Giordano]

Erm, no, that's not what a placebo is. A placebo is a sham or ineffective medical treatment presented to a patient as if it is a real medical treatment. If you're prescribing relaxation exercises such as meditation for a patient with stress-induced hypertension, or stretching exercises for a patient with muscle spasms, those aren't placebo, because they're legitimate medical treatment. If you prescribe magic water for people with those issues, that is a placebo, because it has no clinical effect whatsoever.

Now, prescribing stretching exercises or meditation to treat rheumatoid arthritis or schizophrenia would be placebo, since they have no effect on those conditions.

I guess we do disagree. My point is exactly that a placebo (defined as a substance, procedure, etc. without a known direct action) can be effective by causing a clinically measurable effect in a patient. Placebos used in clinical trials are NOT ineffective- they have clear, measurable effects on patient's mental states and in several reproducibly measurable clinical tests (again, blood pressure, heart rate, etc.). That is why they are used in these trials to compare the effectiveness of a new drug to the placebo effect. The placebo effect is not magical- the emotions invoked by a placebo treatment are themselves real, and like emotions invoked by other events, can have real physical effects. The is separate from whether prescribing a placebo should be considered medically ethical or not.

Again, a placebo need not be a pill. It could be a shame operation, or (as I see it) a trip to the petting zoo (if prescribed by a doctor to treat a medical condition). I don't see why you view meditation to treat hypertension as not a placebo- the idea is the same- prescribing a treatment that works through the mental state of the patient. Versus stretching for muscle spasms- this is not a placebo because it is a treatment that has a direct action on the tissue involved in the disorder.

If you wish to define a placebo as only those treatments that have no effect, you are going to have a big problem, because through the emotional effects of the powers of suggestion almost any treatment can have a psychological/physiological effect. Are you certain that lactose pills (or even meditation or stretching exercises) have no effect on rheumatoid arthritis or schizophrenia? I will look to see if I can find a clinical study using lactose pills as placebos in these diseases- I am nearly certain that they do have effects, at least on how the patient perceives their health. If so would you then still consider them placebos as you define it?

 

[Belz...]

I guess we do disagree. My point is exactly that a placebo (defined as a substance, procedure, etc. without a known direct action) can be effective by causing a clinically measurable effect in a patient.

Well, you're wrong.

...unless you can find the evidence we're waiting for, that is.

 

[Blue Wode]

through the emotional effects of the powers of suggestion almost any treatment can have a psychological/physiological effect.

Unfortunately, the placebo effect is unpredictable when used in clinical practice. As a consequence, it calls ethics into question:
http://web.archive.org/web/20100103080345/http://www.arc.org.uk/news/arthritistoday/131_1.asp

 

[luchog]

I guess we do disagree. My point is exactly that a placebo (defined as a substance, procedure, etc. without a known direct action) can be effective by causing a clinically measurable effect in a patient.

Except that then you're stepping outside the definition of "placebo"; what is known as a redefinition fallacy.

Placebos used in clinical trials are NOT ineffective- they have clear, measurable effects on patient's mental states and in several reproducibly measurable clinical tests (again, blood pressure, heart rate, etc.).

Well, no, you're not understanding drug trials. If they had a measurable clinical effect, then they'd confound the results, and possibly create a synergistic effect with the drug being tested. Placebos are chosen for their lack of clinical effect.

Again, a placebo need not be a pill. It could be a shame operation, or (as I see it) a trip to the petting zoo (if prescribed by a doctor to treat a medical condition). I don't see why you view meditation to treat hypertension as not a placebo- the idea is the same- prescribing a treatment that works through the mental state of the patient. Versus stretching for muscle spasms- this is not a placebo because it is a treatment that has a direct action on the tissue involved in the disorder.

You're really stretching your definitions beyond the point they actually make sense here.

If you wish to define a placebo as only those treatments that have no effect, you are going to have a big problem, because through the emotional effects of the powers of suggestion almost any treatment can have a psychological/physiological effect.

And well beyond the point of making sense. The "power of suggestion", like any other idiosyncratic subjective response, is not a clinical effect, and is one of the very things that placebo-controlled randomized trials exist to eliminate from results. That's the entire point of such trials. Eliminating subjectivity and error.

Not even going to bother responding to the rest of the gibberish.

 

[Dave Rogers]

What I said remains true, and obviously so, regardless of what rank in the list of causes of death medical error achieves. Quite simply, if one has a minor injury that does not require medical treatment by another person, then the lowest risk option is to not seek such medical treatment. Because seeking and receiving treatment, however competent and professional, obviously carries risks, including not only the risks of medical error but other hazards such as travel to and from a medical facility, infections acquired at the medical facility, and (here in the U.S.) very high costs that can contribute to the many other known health risks associated with poverty.

While that's true a posteriori, one of the main reasons as far as I'm aware for the initial consultation with a GP is to determine, within a reasonable margin of error, whether the illness, injury or condition does or doesn't require medical treatment, because this isn't something a lay person always gets right. A priori, I think the best course of action would have been to phone a doctor, describe the symptoms and ask whether it was worth bothering to get the injury treated. That would be the normal practice in the UK, and we have a specific phone service to do so (which I availed myself of last Friday in fact). Is that done in the US?

Dave

 

[Giordano]

Here is a down payment on my promise for documentation/definition of placebo-
https://en.wikipedia.org/wiki/Placebo

I am not using this Wikipedia article as evidence so much as a quick source for some initial citations that lead to more established sources of support for my position. I will find primary medical publications when I have more time, hopefully in the next hour or so.

My point at this stage is that a proper and correct current view of a placebo is not something that has no "real" effect but is instead a stimulated treatment for a disease of other medical condition intended to deceive the patient. Not infrequently, this deception can result in actual improvements both in the patients perception of their health and in actual measures of their physiology. A placebo (as the term is now used in clinical trials) may indeed have no effect at all, only an effect on the patients perception (which, given that perception is the result of chemistry of the brain, is a still a real effect), or an effect on their physiological state that can be medically detected clinically. This can work on its own or to improve the response to a direct-acting drug. I will quote just one short part of the Wikipedia article right now:

"Brain imaging techniques done by Emeran Mayer, Johanna Jarco and Matt Lieberman showed that placebo can have real, measurable effects on physiological changes in the brain.[11] Placebos can produce some objective physiological changes, such as changes in heart rate, blood pressure, and chemical activity in the brain, in cases involving pain, depression, anxiety, fatigue, and some symptoms of Parkinson’s. "
I will back this up. But I am even getting confused as to what we are arguing here because I thought my statement, that placebo treatments have documented effects, is nearly universally accepted.

Is our argument in this thread that the effects of placebo treatments on the mental state and viewpoint of a patient aren't "real?" Wouldn't that make any mental or emotional disorder not real? Are the effects of psycho-active drugs (say SSRIs) not real because they effect mood and not something independently measurable, such as blood pressure?

Or is the current argument that although we all accept that placebo treatments can affect a patient's mental state and viewpoint as to how they "feel" , a placebo cannot effect any physiologically measurable, "somatic" aspect of a patient?

Or are we even only arguing that the placebo itself (i.e. a sugar pill) is not having an effect, but that the show and drama associated with its administration (the placebo treatment) is what is having the effect? If os then we are arguing the fine points of a definition and I would be only to happy to agree that the placebo effect is not from the sugar pill but from the patient's awareness of the sugar pill (thought by the patient to be a true drug) is being administered.