Homeopathy and Placebo

[blutoski]

Have any of you thought that perhaps homoeopaths do some things better than conventional medicine?

For example, the average consultation time for a GP is about 15 minutes (if you're lucky). A homoeopath will double or quadruple that.

For illnesses where tea and sympathy are all that can be offered, how someone feels while they are recovering is often just as important to them as the objective improvements they are going to have over time.

And in any case, if they're only selling sympathy, they can just say that. It would be the honest thing to do.

How bad off must their patients be to have to pay somebody to pretend to be their friend?

 

[Ivor the Engineer]

How bad must their patients be to have to pay somebody to pretend to be their friend?

Psychotherapists are to a large extent paid friends. Freudian techniques have been found to be based on nonsense, yet therapy derived from his ideas helped a lot of people feel better while they were getting better.

Homoeopathy is a talking therapy with rituals and props. It taps into peoples' need to believe, which as religion demonstrates, is a powerful motivator.

Anyone who has does any endurance sport will realise how subjective their 'state' of health is.

 

[blutoski]

Psychotherapists are to a large extent paid friends. Freudian techniques have been found to be based on nonsense, yet therapy derived from his ideas helped a lot of people feel better while they were getting better.

Homoeopathy is a talking therapy with rituals and props. It taps into peoples' need to believe, which as religion demonstrates, is a powerful motivator.

Anyone who has does any endurance sport will realise how subjective their 'state' of health is.

Ohhh... homeopathy's a talking therapy. I see. How crazy of me to have missed that aspect of the local drugstore's help-yourself-to-a-cure-and-pay-for-it-at-the-till homeopathy aisle.

So, what you're saying (let me paraphrase) is that those homeopaths who are offering nostrums (like-cures-like, dilution, percussion) are frauds, but the ones who offer nothing but talk therapy are the only legitemate homeopaths?

ie: that homeopathy has nothing to do with the principles of homeopathy?

 

[blutoski]

Psychotherapists are to a large extent paid friends. Freudian techniques have been found to be based on nonsense, yet therapy derived from his ideas helped a lot of people feel better while they were getting better.

There is no evidence that Freudian psychoanalysis helped anybody. In fact, most retrospective studies suggest that his approaches injected unnecessary trauma and stress to many patients. That's why freudian psychoanalysis is so utterly rare today, and that which there is, is very different than the original techniques.

There are modern talk therapies of course, but they require evidence of safety and efficacy before they're legalized, and practitioners are policed by a licensing system.

One aspect of talk therapy that's worth pointing out: the succesful therapist remains emotionally detached from the patient. The moment a patient and therapist develop any sort of emotional connection, a line has been crossed, success rates plummet, and danger looms. Talk therapy is work - hard work - and cannot be compared to providing empathy.

Homoeopathy is a talking therapy with rituals and props.

Because of the inherent risks to the patient, there are laws about who can and can't provide therapy. (Skeptics often expose unproven and dangerous psychotherapies.)

Are you saying that in your opinion many homeopaths are providing a service for which they have neither evidence of safety nor effectiveness, and for which they do not have a license? ie: that they are breaking the law in most states?

Where are the studies that show homeopathic 'therapy' is effective and safe? Effective and safe for what?

It taps into peoples' need to believe, which as religion demonstrates, is a powerful motivator.

I'm the one who said that homeopathy was a religion - not a science - earlier. Are you now confirming you are aligned with this characterization?

Is homeopathy the new scientology? (Technically, I think I should be asking: "Is scientology the new homeopathy?")

Are we seeing homeopathy's death throes in that it's finally resorting to the old religion gimmick, abandoning the scientific pretenses? (rhetorical question: the answer is 'yes', homeopathy is melding with the New Age and Energy Healing religions)

Anyone who has does any endurance sport will realise how subjective their 'state' of health is.

I have been a competitive open-water swimmer for thirty years, and I have no idea what you're talking about.

 

[Deetee]

To be frank, I've never seen reliable statistics about homeopathy practice turnarounds. The profession is very evasive in this regard.

However, I do have friends who are registered practicing homeopaths here in BC, and they're quite happy boasting about how many patients they can crank through in a day. I've attended some of their practice-building seminars (which for some reason qualify as continuing education credit), and the lecturer is usually promoting some family of strategies to build an assembly-line patient management system.

I seem to recall the Bristol Homeopathy hospital in the UK boasting some data that actually suggested they saw only about 6 referrals each day per clinician (once I worked out the sums). This is probably because these were "free" NHS patients. Maybe their private practices churn through many more.

 

[blutoski]

I seem to recall the Bristol Homeopathy hospital in the UK boasting some data that actually suggested they saw only about 6 referrals each day per clinician (once I worked out the sums). This is probably because these were "free" NHS patients. Maybe their private practices churn through many more.

That still doesn't tell you how much time the spend with them. My wife sees 10 patients a day on Monday and Friday. Eight of them are dosage visits - about five minutes apiece - and two are one-on-one cogbeh therapy, for about an hour each. Wednesdays she sees no patients, as she's usually in court testifying. The rest of the time is administration and research.

That doesn't account for the occasional emergency (she's on call to the police for jumpers, hostage-takers, and the 'armed and barricaded').

On Tuesday and Thursday, she sees about 60 patients, as she does six group sessions with ten patients each for an hourlong session.

It's unreliable to estimate minutes per patient as an inverse of patients per day.

 

[Zep]

Perhaps the thing with the placebo effect can be summed up thus:

The patient feels better in their mind about their illness, but don't actually get better as a result. It's a way of separating a fool from his money while making him feel happy about it.

 

[Ivor the Engineer]

There is no evidence that Freudian psychoanalysis helped anybody. In fact, most retrospective studies suggest that his approaches injected unnecessary trauma and stress to many patients. That's why freudian psychoanalysis is so utterly rare today, and that which there is, is very different than the original techniques.

There are modern talk therapies of course, but they require evidence of safety and efficacy before they're legalized, and practitioners are policed by a licensing system.

One aspect of talk therapy that's worth pointing out: the succesful therapist remains emotionally detached from the patient. The moment a patient and therapist develop any sort of emotional connection, a line has been crossed, success rates plummet, and danger looms. Talk therapy is work - hard work - and cannot be compared to providing empathy.

Yet when the effectiveness of different types of therapy are compared, there is often little difference between them. IIRC, only Cog. Behav. has consistently been shown to be slightly better than other forms of therapy. A large proportion of the success of any type of therapy is attributed to the 'therapist effect'.

Because of the inherent risks to the patient, there are laws about who can and can't provide therapy. (Skeptics often expose unproven and dangerous psychotherapies.)

Are you saying that in your opinion many homeopaths are providing a service for which they have neither evidence of safety nor effectiveness, and for which they do not have a license? ie: that they are breaking the law in most states?

No, I'm saying the benefit people get from a homoeopathic consultation is due to the social interaction with the homoeopath, reinforced with rituals and props.

Where are the studies that show homeopathic 'therapy' is effective and safe? Effective and safe for what?

I think we can be pretty sure homoeopathy is no worse than the illness it is being used to treat. A lot of people believe they benefit from it, just as a lot of people believe they benefit from a belief in God. The benefits are largely subjective.

I'm the one who said that homeopathy was a religion - not a science - earlier. Are you now confirming you are aligned with this characterization?

I said that earlier too and as so often seems to happen to me nowadays, a "True Sceptic"(TM) told me off for saying it.

Is homeopathy the new scientology? (Technically, I think I should be asking: "Is scientology the new homeopathy?")

Are we seeing homeopathy's death throes in that it's finally resorting to the old religion gimmick, abandoning the scientific pretenses? (rhetorical question: the answer is 'yes', homeopathy is melding with the New Age and Energy Healing religions)

I think the methods of action are very similar. I don't believe homoeopath is in its death throes.

I have been a competitive open-water swimmer for thirty years, and I have no idea what you're talking about.

Are you generally faster in competition than in training?

 

[drkitten]

Perhaps the thing with the placebo effect can be summed up thus:

The patient feels better in their mind about their illness, but don't actually get better as a result. It's a way of separating a fool from his money while making him feel happy about it.

Actually, the placebo effect is a lot simpler (and a lot more complicated than that) and it has little to do with making people feel better "in their minds."

Most case are self-limiting. If I have a toothache, it will not put me in a constant amount of discomfort. Sometimes it will be a mild annoyance, and sometimes it will be the agonies of Prometheus. I will probably not seek treatment until it gets Real Bad.

But precisely for this reason, if it's Real Bad on Tuesday (when I see the dentist as an emergency appointment), it will probably feel better on Wednesday even if he didn't do anything for me at all, just from "regression" to a merely average level of pain.

If my heartburn is really bad today, it will probably be better tomorrow even if I don't take anything for it. And if it's really good today, it will probably be worse tomorrow even if I don't do anything in that direction.

And if it's just an infection that I've got -- well, most infections clear up by themselves eventually. If I have a cold today, chances are I will be fine in a week via natural healing.

That's most of the placebo effect right there. People get better all by themselves. And they'll get better all by themselves regardless of what you tell them.

And, getting back to the OP, is why homeopathy should be discouraged. Because no one should pay for the privilege of getting better by themselves.

 

[Ivor the Engineer]

<snip>

Because no one should pay for the privilege of getting better by themselves.

Well that should slash the number of payments for all forms of health care by about 80%, if patients only pay when the treatment they receive does more than make them feel better while they're getting better by themselves.

 

[fls]

In order to continue my shameless self-promotion (either that or I'm too lazy to restate this stuff), I also wrote a bit about how just the taking of a placebo serves as a marker for success (to follow-up on what drkitten wrote).

"It's a matter of attention and anchoring.

Consider what happens when trying to recall these things. It's very difficult to get an accurate account of the course of symptoms/disease when taking a history. The heart attack that happened "two years ago" really happened ten years ago. The symptoms that have been "present for three months" were already complained about a year ago. This isn't done deliberately. We have difficulty estimating these things unless we can anchor them to something where the timing is known. If the heart attack happened at your daughter's wedding, there is no difficulty in recalling the date. But most of the time we don't really have the opportunity or inclination to track these things.

Add to that our tendency to notice only those things that are unusual in the first place. Regression almost guarantees that next time you ask, things will be better. It's just that most of the time we don't ask.

We have thousands of opportunities for success, but we squander most of them by not paying attention and by not providing a way to anchor the timing to a known event. Taking a homeopathic preparation solves both these problems. Now attention will be paid to that we would have ignored previously (the waxing and waning of eczema), and we have a specific event (the taking of a therapy) by which to time the course of events.

It doesn't require cherry-picking to find examples of success. Success is almost inevitable. It requires cherry-picking to find examples of failure. The error that Procida and the homeopaths make is not cherry-picking. It is that they falsely attribute homeopathy as the cause of the success when in reality it merely serves as the marker. Arguing that they are cherry-picking is unpersuasive to them because they can see that they are not cherry-picking.

The real cherry-picking occurs before the homeopath (or Procida) even becomes involved. Nobody goes to visit a homeopath because they are doing well. Procida doesn't choose to treat herself or a friend when the symptoms have waned. It's just that that part of the process is almost invisible.

The process of attention and anchoring should lead to success almost all of the time, so you should not express any surprise at Procida's success rate. The problem with comparing that to the homeopath's casebook is that you considered all events, not just those events that would have been marked by the process. The process of marking an event is cherry-picking, but once the event is marked, it doesn't require cherry-picking to find success."

Linda

 

[drkitten]

Well that should slash the number of payments for all forms of health care by about 80%, if patients only pay when the treatment they receive does more than make them feel better while they're getting better by themselves.

Placebos don't even make people feel better while they're getting better by themselves.
Placebos simply let people get better by themselves, expensively.

Aspirin, measurably, makes people feel better. It reduces pain.

Placebos typically do not even reduce pain; they simply cause the patient to wait around until the pain reduces away by itself.

 

[Ivor the Engineer]

Placebos don't even make people feel better while they're getting better by themselves.

<snip>

If the above statement is true, they why waste money on giving out fake pills during clinical drug trials? Just having a treatment and no-treatment group would be sufficient, would it not?

http://skepdic.com/placebo.html

Some believe the placebo effect is psychological, due to a belief in the treatment or to a subjective feeling of improvement. Irving Kirsch, a psychologist at the University of Connecticut, believes that the effectiveness of Prozac and similar drugs may be attributed almost entirely to the placebo effect. He and Guy Sapirstein analyzed 19 clinical trials of antidepressants and concluded that the expectation of improvement, not adjustments in brain chemistry, accounted for 75 percent of the drugs' effectiveness (Kirsch 1998). "The critical factor," says Kirsch, "is our beliefs about what's going to happen to us. You don't have to rely on drugs to see profound transformation." In an earlier study, Sapirstein analyzed 39 studies, done between 1974 and 1995, of depressed patients treated with drugs, psychotherapy, or a combination of both. He found that 50 percent of the drug effect is due to the placebo response.

 

[blutoski]

Yet when the effectiveness of different types of therapy are compared, there is often little difference between them. IIRC, only Cog. Behav. has consistently been shown to be slightly better than other forms of therapy. A large proportion of the success of any type of therapy is attributed to the 'therapist effect'.

Untrue. I have no idea what the 'therapist effect' is. I have two psychology degrees and my wife is a psychiatrist. Neither of us have heard of this term.

No, I'm saying the benefit people get from a homoeopathic consultation is due to the social interaction with the homoeopath, reinforced with rituals and props.

What benefit?

I think we can be pretty sure homoeopathy is no worse than the illness it is being used to treat. A lot of people believe they benefit from it, just as a lot of people believe they benefit from a belief in God. The benefits are largely subjective.

There are different responses to this assumption.

1. The nocebo effect is the creation of negative outcomes from placebo. It is possible for the placebo group to be worse off than the non-experimental and treatment groups.

2. The expense of money for no result means the patient is clearly worse off. They go from being sick to being sick and poorer.

3. Part of the advocacy of homeopathy is medically disproven advice such as avoidance of conventional treatments and avoidance of prevention. The patient may not even be receiving an homeopathic remedy to be harmed by homeopathy.

4. Adulteration. Many of the worst cases of adulterated naturopathic remedies have been homeopathic. eg: the deceptive addition of significant quantities of viagra to homeopathic remedies. Because they are not monitored by the production controls of prescription medications (such as spot-checking by the FDA for ingredients) homeopathy is disproportionately overrepresented in this problem.

I said that earlier too and as so often seems to happen to me nowadays, a "True Sceptic"(TM) told me off for saying it.

I wasn't in the conversation, so I'm not sure what to say. Homeopathy seems to shift the claim, depending on what sells. If the customer is looking for spiritual guidance; then it's a New Age faith healing modality. If the customer is looking for scientifically proven remedies; then it's scientific.

I think the methods of action are very similar. I don't believe homoeopath is in its death throes.

I rewind a bit and ask: method of action for what? What outcomes are we 'explaining'?

As I said: I'm unaware of studies that show homeopathy is better than non-treatment.

Are you generally faster in competition than in training?

Of course not. I go much longer distances in competition than in training, and don't get interval breaks, so I intentionally go slower. It's called 'strategic pacing', or sometimes just 'pacing'. Same when I did ironman. I don't train 40k runs, but I run 10ks a few times a week. My average speed is certainly faster doing 10ks in training than when running 40k.

 

[Ivor the Engineer]

Untrue. I have no idea what the 'therapist effect' is. I have two psychology degrees and my wife is a psychiatrist. Neither of us have heard of this term.

<snip>

I'll answer this one now (because the information is in a book):

From Psychology: A Student's Handbook by Michael W. Eysenck p.723:

Wampold et al. (1997, p.211) carried out a meta-analysis on studies in which two or more forms of therapy had been compared directly, and in which the same outcome measures had been applied to patients receiving different forms of therapy. Their findings suggested that the beneficial effects of all forms of therapy are essentially the same. They concluded as follows:

Why is it that researchers persist in attempts to find treatment differences, when they know that these effects are small in comparison to other effects, such as therapists' effects ... or effects of treatment versus no-treatment comparisons?

"therapist effect" in Google brings up quite a few pages too.

(For a moment there you had me doubting myself.)

I'll reply to the rest of your post tomorrow.

 

[BenBurch]

Personally, I believe "The Placebo Effect" itself is largely experimental error. But this can never be proven for any non-trivial illness because the experiment would be unethical.

 

[fls]

Personally, I believe "The Placebo Effect" itself is largely experimental error. But this can never be proven for any non-trivial illness because the experiment would be unethical.

Can you elaborate on this? What kind of experiment are you thinking of?

Linda

 

[BenBurch]

Can you elaborate on this? What kind of experiment are you thinking of?

Linda

Two cohorts each with a non-trivial non-self-limiting condition.

One cohort you treat, but only with a placebo.

The other cohort you deny all treatment to.

Monitor for years, and see if there is a statistical difference between the groups.

In other words, another Tuskegee experiment. Absolutely unethical.

 

[fls]

Two cohorts each with a non-trivial non-self-limiting condition.

One cohort you treat, but only with a placebo.

The other cohort you deny all treatment to.

Monitor for years, and see if there is a statistical difference between the groups.

In other words, another Tuskegee experiment. Absolutely unethical.

Earlier I referred to meta-analysis of 114 studies comparing placebo to no treatment. Considering that it showed no real difference, what additional information do you think the above experiment would give us?

Linda

 

[BenBurch]

Earlier I referred to meta-analysis of 114 studies comparing placebo to no treatment. Considering that it showed no real difference, what additional information do you think the above experiment would give us?

Linda

I get a rash when I consider a meta-analysis to be more than an indicator.

There are too many variables to consider when you look at studies that are not precisely the same.

An experiment would settle matters so we don't even have to talk about a placebo as anything other than a control in testing of other treatments.