How do skeptics account for the placebo effect?

[tsg]

There are countless other examples in our popular media; I wish I could remember, there was one example, in which, even after having it revealed that he was being helped by placebos, the person in question still demanded his fix.

I don't know if it's the one you were thinking of, but an episode of MASH had Hawkeye giving a placebo to Klinger to help him deal with the heat. Klinger was perfectly comfortable until Hawkeye told him it was a placebo, at which point Klinger immediately became very hot.

 

[Moochie]

Anyway, to moochie and Open-mind - the problem is, you have no understanding of what the placebo effect is, so I suggest learning a bit about how science works.

Oh come now, the term "placebo effect" has been in the public domain for a very long time, and is not "owned" by any person, group, or clique.

Regards,

 

[drkitten]

Oh come now, the term "placebo effect" has been in the public domain for a very long time, and is not "owned" by any person, group, or clique.

True, but if you expect to have a discussion with experts, you should stick to the commonly understood and used definitions of words instead of some made-up private use.

 

[Neutiquam Erro]

Oh come now, the term "placebo effect" has been in the public domain for a very long time, and is not "owned" by any person, group, or clique.

Regards,

And yet, in the context of a scientifically-rigorous medical trial, the term "placebo" has a very specific definition, which may, in fact, be slightly different from its vulgar, "public domain" usage.

Consider, for example, a frequent error in many "anti-evolution" arguments, which rely on a common vernacular that fails to adequately distinguish the terms "theory" and "conjecture." How should science proceed, if it cannot demand consistency in its terminology, within the context of its specific activities?

 

[Moochie]

And yet, in the context of a scientifically-rigorous medical trial, the term "placebo" has a very specific definition, which may, in fact, be slightly different from its vulgar, "public domain" usage.

Consider, for example, a frequent error in many "anti-evolution" arguments, which rely on a common vernacular that fails to adequately distinguish the terms "theory" and "conjecture." How should science proceed, if it cannot demand consistency in its terminology, within the context of its specific activities?

All very true, yet isn't it up to scientists to explain these fine points to the masses who aren't scientists, and who do use the 'vulgar, "public domain" usage'?

Regards,

 

[MoonDragn]

Coming from a Chinese background I have always seen acupuncture as science. The possibility that it could be a placebo effect never occured to me til I read all these articles attempting to prove it. The question is, who determins what constitutes a proof? What if all acupuncture does is send instructions to your brain for your body to correct a problem? How do we detect whether these instructions were actually sent? It could be a nerve impuse that gets triggered based on where the needle was inserted.

I read somewhere that in a clinical trial they accounted a higher recovery from treatment than a fake acupuncture treatment and that both the real and fake treatments showed an improvement over those who received no treatment at all.

 

[Neutiquam Erro]

All very true, yet isn't it up to scientists to explain these fine points to the masses who aren't scientists, and who do use the 'vulgar, "public domain" usage'?

Regards,

I agree completely! But a scientist's placebo is still a placebo, regardless whether she's explained its purpose to the public adequately or effectively. The speed of light doesn't change just because I can't do the math, does it?

edited for spelling

 

[Steve]

All very true, yet isn't it up to scientists to explain these fine points to the masses who aren't scientists, and who do use the 'vulgar, "public domain" usage'?

Regards,

I would say that it is up to each individual to ensure that they understand the meaning of the words that they use. I would also say that people in this very thread are attempting to do exactly as you suggest, only to meet with some reluctance on your part to give up your original "public domain" understanding. It is very difficult for scientists, or anyone else, to educate those who do not wish to be educated.

 

[drkitten]

Coming from a Chinese background I have always seen acupuncture as science. The possibility that it could be a placebo effect never occured to me til I read all these articles attempting to prove it. The question is, who determins what constitutes a proof?

Whether it works or not.

The "gold standard" for medical research is the randomized, placebo-controlled, double-blind clinical trial. Unpacking this collection of buzzwords, this means that

• participants are assigned randomly to treatment groups
• each (participant in a) group receives either a placebo or the experimental practice under study
• the patient does not know what group s/he is in
• the attending physician does not know what group the patient is in

If, under this framework, the patients in the experimental group do better (heal faster, experience less pain, whatever) than the patients in the placebo group, we have evidence that the treatment under study is effective. Conversely, if there's no different, then we have evidence that the treatment is "no better than placebo."

What if all acupuncture does is send instructions to your brain for your body to correct a problem?

Then why doesn't it give any better results than just giving the patient a sugar pill?

How do we detect whether these instructions were actually sent? It could be a nerve impuse that gets triggered based on where the needle was inserted.

It could be -- but if there's no difference in the way patients respond to nerve impulses vs. the way they respond to sugar pills, then there's not much curative effect in the nerve impulses, yes?

I read somewhere that in a clinical trial they accounted a higher recovery from treatment than a fake acupuncture treatment and that both the real and fake treatments showed an improvement over those who received no treatment at all.

Assuming that this trial really exists (which is a big assumption, and one that I don't really believe) and was properly done (an even bigger assumption), then this illustrates the points nicely.

The placebo effect ("people get better if they think they are getting treatment") explains why people in the "fake acupuncture" group did better than the "go home and die" group. The actual effectiveness of acupuncture as a medical treatment is shown in the difference between the "real" and "fake" acupuncture groups.

In practice, it seems impossible to do a "double-blind" acupuncture study, because the doctor will know which patients he gave "real" treatment to and which he just jabbed randomly with needles. Unfortunately, this means that the doctor himself knows which patients he expects to get better, which can introduce bias into the results. GIven this problem, I would actually be more inclined to attribute the difference between "real" and "fake" acupuncture to doctor bias.

 

[Rolfe]

All very true, yet isn't it up to scientists to explain these fine points to the masses who aren't scientists, and who do use the 'vulgar, "public domain" usage'?

Moochie, read what dogguy said. Then read it again, slowly, till it sinks in.

"Placebo" means "I will please". It refers to a doctor giving a patient a content-free medicine just to keep them happy, and make them feel they are being cared for. Because patients tend to expect to be given a medicine. The rest is just psychology.

What did you think it meant, anyway?

So, doing better than placebo means doing better than a content-free medicine doled out in exactly the same circumstances, so that the psychological element is kept constant between the two groups (the group getting the real thing and the group getting the placebo). If a treatment can prove that it can do this, then that is taken as proof that if has a real physiological effect, and it's not just the psychological expectation that's producing the improvement.

What's so hard about this for you to understand?

Rolfe.

 

[Rolfe]

Coming from a Chinese background I have always seen acupuncture as science. The possibility that it could be a placebo effect never occured to me til I read all these articles attempting to prove it. The question is, who determins what constitutes a proof? What if all acupuncture does is send instructions to your brain for your body to correct a problem?....

The possibility that acupuncture is a placebo only just occurred to you? Hold that thought, you're getting somewhere....

The situation is very simple. Does acupuncture actually influence healing or recovery? If it does, that is the time to start working on the mode of action. If it doesn't, then "maybe it might work in such-and-such a way" is a bit premature, don't you think?

There are a few studies that claim to have shown effects above placebo for acupuncture, but they have all been severely flawed. It's not hard to understand - organising a true placebo acupuncture group, double-blinded, is almost impossible. There are many studies where the researchers have done their level best, and found nothing. On balance, the evidence is in favour of the placebo explanation. However, the few apparently positive studies will always be there for the enthusiasts to cherry-pick and showcase.

The difficulty is that of course acupuncture actually does do something. You feel a pinprick. Your body recognises a foreign object. Inflammatory reaction is initiated. These are all tiny effects, given the very fine needles used, but they are effects. So, you can measure changes in the body with acupuncture. However, get on to whether there's anything significantly different depending on where you stick the needle, and that's a different matter. And then there's whether sticking a pin in your big toe really can cure your liver disease (or whatever the claim is). That's the real biggie.

First show that acupuncture actually does have any beneficial medical effect. And show that there is more happening in the body than we'd expect with any old needle stuck in any old place. Until you've done that, speculations about nerve stimulation or endorphins or whatever are putting the cart some few light years in front of the horse.

(Hint - if you really could trigger a nerve impulse to send a signal to heal a disease, really, it's just faintly possible that real medical science might have noticed by now.)

Rolfe.

 

[MoonDragn]

Unfortunately theres alot of mumbo jumbo that goes into an acupuncture treatment about chi and natural flow of the body etc. Since Im not an acupuncturist I can't understand it.

However I know that the doctors claim that each person must be treated differently, so there goes the consistancy thing. You can't just read a chart and say, here is the right spot to poke you. Its like a chiropractic session, the doctor finds out whats wrong through some tests and then determines just where to adjust you. I know alot of acupuncturists also know about human physiology and are often times also practiced in western medicine.

Another thing is, these points are not fixed, they move around your body. There is a method for determining where they move to. But a fake accupuncture treatment might accidentally hit the right spot.

I do know the Chinese philosophy is to treat the entire body, not just the location. That kind of philosophy just doesn't fit into large clinical trials.

All in all, accupuncture is a bad example because its not like other holistic medicines. This one has been practiced for thousands of years with literally billions of satisfied customers. In the case of western medicine, not every treatment always work on everyone either.

 

[Moochie]

I would say that it is up to each individual to ensure that they understand the meaning of the words that they use. I would also say that people in this very thread are attempting to do exactly as you suggest, only to meet with some reluctance on your part to give up your original "public domain" understanding. It is very difficult for scientists, or anyone else, to educate those who do not wish to be educated.

Oh those poor scientists, having to put up with inquisitive hoi polloi!

Yet some manage to do this quite well -- as shown by Richard Dawkins and Jerry Coyne in their lucid explanation of the difference between ID (creationism) and evolution published in The Guardian recently.

Regards,

 

[MoonDragn]

Oh those poor scientists, having to put up with inquisitive hoi polloi!

Yet some manage to do this quite well -- as shown by Richard Dawkins and Jerry Coyne in their lucid explanation of the difference between ID (creationism) and evolution published in The Guardian recently.

Regards,

Frankly Im a little skeptical if psychology works at all, how can you pigeon hole human behavior into a few definate states when its is obvious that everyone is different from everyone else and they psychology differs as well?

Didn't freud say somewhere that he made the whole thing up?

 

[Steve]

Oh those poor scientists, having to put up with inquisitive hoi polloi!

This has some relevance to my comment? I think that most scientists would welcome "inquisitive hoi polloi" with open arms. For many, having the general public take an interest in their work would be a dream come true.

Yet some manage to do this quite well -- as shown by Richard Dawkins and Jerry Coyne in their lucid explanation of the difference between ID (creationism) and evolution published in The Guardian recently.

Regards,

Agreed. Many scientists, and others, can provide excellent explanations. Getting the general public to read and take an interest in the information is another matter entirely. You cannot (unfortunately?) force an education on anyone.

 

[Mojo]

All very true, yet isn't it up to scientists to explain these fine points to the masses who aren't scientists, and who do use the 'vulgar, "public domain" usage'?

Well, yes, but you have to do a little work yourself. It's no argument at all to just say "I don't understand," is it?

 

[Rolfe]

Another thing is, these points are not fixed, they move around your body. There is a method for determining where they move to. But a fake accupuncture treatment might accidentally hit the right spot.

I do know the Chinese philosophy is to treat the entire body, not just the location. That kind of philosophy just doesn't fit into large clinical trials.

This is just the usual double-speak excuse offered by homoeopaths and so on. In fact by every one of these quack "narrative" treatments. What's really going on is the there is a syspem of excuses which is formulated to cover anything at all that might happen following the treatment. So, everyone is different and there is a neat explanation for all the different things that can happen. The method can never fail! And since nothing can be predicted in advance (you know, because everybody is different), then it's quite difficult to prove it wrong.

There have been thousands and indeed millions of satisfied customers for every single quack nonsense method ever used in the history of mankind. So what?

And the "holistic" thing is just another trendy buzzword. Doesn't mean a thing. Alt-med treatments tend on the whole to be less interested in treating the whole patient than real medicine. But doesn't it sound good?

And after all these centuries of alleged successful Chinese practice of acupuncture (I say alleged, because if you look into the history of it all you might find it's somewhat less than claimed), and all the perfectly serious attention given to the method in the 1970s by medical researchers who thought that perhaps there might be something useful there, still nobody has ever managed to prove that an acupuncture needle in the hands of an acupuncturist does anything different from any old needle stuck in any old place.

Rolfe.

 

[steenkh]

I do know the Chinese philosophy is to treat the entire body, not just the location. That kind of philosophy just doesn't fit into large clinical trials.

All in all, accupuncture is a bad example because its not like other holistic medicines. This one has been practiced for thousands of years with literally billions of satisfied customers. In the case of western medicine, not every treatment always work on everyone either.

I once read a history of Japan written by a Japanese, and in the description of the 1780'es he wrote that a "Dutch" school of young doctors appeared who were so impressed with the Dutch medical system where surgeons actually tried to find out what organs were doing what, and where medication was based on observation and tests. The Chinese medical system the Japanese had been using until then, simply did not have the same beneficial effect as the Dutch. The Dutch school only lasted a few decades before the Shogun clamped down on foreign influences and demanded a return to traditional medicine, but the ground was laid, and when Japan was opened up in the 1860'es, the doctors were prompt to adopt western medicine.

It is funny how "wise" some people can find an ineffective system just because it is old, whereas the Japanese who knew everything about the Chinese system, scrapped it as soon as they could! As for the billions of satisfied customer for the Chinese system, we notice that in China it is only popular for those things that western medicine cannot cope with anyway, and for which there is a wide margin for interpretation of effects. Since Chinese medicine is based on magic, it shares its efficiency with other quack magical healing systems like homoeopathy that also has "billions" of satisfied customers.

As for treating the "whole body", nobody knows what it means. It is just words. I know for certain that in homoeopathy that is also claimed to be a holistic healing system, homoeopaths freely give advice about medication after having read only a two-word description of a patient's problems.

And the theory that acupuncture points move around the body, but can be found by a skilled acupuncturist is definitely not what is generally practised. All accounts of acupuncture that I have listened to have described how the acupuncturist simply sticks the needles in without probing around for anything.

 

[MoonDragn]

I once read a history of Japan written by a Japanese, and in the description of the 1780'es he wrote that a "Dutch" school of young doctors appeared who were so impressed with the Dutch medical system where surgeons actually tried to find out what organs were doing what, and where medication was based on observation and tests. The Chinese medical system the Japanese had been using until then, simply did not have the same beneficial effect as the Dutch. The Dutch school only lasted a few decades before the Shogun clamped down on foreign influences and demanded a return to traditional medicine, but the ground was laid, and when Japan was opened up in the 1860'es, the doctors were prompt to adopt western medicine.

It is funny how "wise" some people can find an ineffective system just because it is old, whereas the Japanese who knew everything about the Chinese system, scrapped it as soon as they could! As for the billions of satisfied customer for the Chinese system, we notice that in China it is only popular for those things that western medicine cannot cope with anyway, and for which there is a wide margin for interpretation of effects. Since Chinese medicine is based on magic, it shares its efficiency with other quack magical healing systems like homoeopathy that also has "billions" of satisfied customers.

As for treating the "whole body", nobody knows what it means. It is just words. I know for certain that in homoeopathy that is also claimed to be a holistic healing system, homoeopaths freely give advice about medication after having read only a two-word description of a patient's problems.

And the theory that acupuncture points move around the body, but can be found by a skilled acupuncturist is definitely not what is generally practised. All accounts of acupuncture that I have listened to have described how the acupuncturist simply sticks the needles in without probing around for anything.

Acupuncture is still practiced widely in japan as well. They didn't abandoned it, they simply adopted to western medicine because Acupuncture was only really effective as an alternative to treating pain and nerve related problems like carpal tunnel. I know plenty of people who's pain cannot be controled by western medicine but accupuncture can.

As I said I am not sure how it works, but I definately read somewhere that those points move. Accupuncture is really just a refined form of accupressure. The various pressure points around the body are all related to some nerve there. The most likely explaination for accupunture is that it somehow transmits a signal to the nerve near by to trigger an event in the body.

 

[steenkh]

Of all the woo practices, I regard acupuncture as the least woo. At least there is a clear physical action, and a number of possible explanations (but none involving "meridians").

Acupuncturists have also willingly cooperated in trials with the best possible controls (but real double-blind trials have so far not been possible) and they have not claimed that the embarassing results have been caused by too high controls. Fortunately for them the results have not been too embarassing.

My own position is that IF it works, it does not matter exactly where the needle is inserted, because that has been tested and proven to be of no consequence. But the needle CAN be placed wrongly: my wife once got a needle in a nerve, and apart from the immense pain, it also left half of the leg numb for almost a month!

I note that in the West there is myth that acupuncture is used instead of anaesthetics in China, but as far as I know, major operations have only seldom been practised with acupuncture, and never with results that outsiders would believe had been painless!