Questions about the placebo effect.
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Dr. Walter B. Cannon of Harvard Medical School
The second describes the effect of magic bone-pointing among Australian aborigines:
The man who discovers that he is being boned by an enemy is, indeed, a pitiable sight. He stands aghast, with his eyes staring at the treacherous pointer, and with his hands lifted as though to ward off the lethal medium, which he imagines is pouring into his body. His cheeks blanch and his eyes become glassy and the expression of his face becomes horribly distorted… He attempts to shriek but usually the sound chokes in his throat, and all that one might see is froth at his mouth. His body begins to tremble and the muscles twist involuntarily. He sways backwards and falls to the ground, and after a short time appears to be in a swoon; but soon after he writhes as if in mortal agony, and, covering his face with his hands, begins to moan. After a while he becomes very composed and crawls to his wurley. From this time onwards he sickens and frets, refusing to eat and keeping aloof from the daily affairs of the tribe. Unless help is forthcoming in the shape of a counter-charm administered by the hands of the Nangarri, or medicine man, his death is only a matter of a comparatively short time. If the coming of the medicine man is opportune he might be saved.
whatever name you want to give to this 'effect', it is powerful.
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homeopathy works in some mysterious way. i am still stunned by this discovery and searching for the reason why.
it is far more than just belief. i rather like lionel milgrom's ideas.
The second describes the effect of magic bone-pointing among Australian aborigines:
The man who discovers that he is being boned by an enemy is, indeed, a pitiable sight. He stands aghast, with his eyes staring at the treacherous pointer, and with his hands lifted as though to ward off the lethal medium, which he imagines is pouring into his body. His cheeks blanch and his eyes become glassy and the expression of his face becomes horribly distorted… He attempts to shriek but usually the sound chokes in his throat, and all that one might see is froth at his mouth. His body begins to tremble and the muscles twist involuntarily. He sways backwards and falls to the ground, and after a short time appears to be in a swoon; but soon after he writhes as if in mortal agony, and, covering his face with his hands, begins to moan. After a while he becomes very composed and crawls to his wurley. From this time onwards he sickens and frets, refusing to eat and keeping aloof from the daily affairs of the tribe. Unless help is forthcoming in the shape of a counter-charm administered by the hands of the Nangarri, or medicine man, his death is only a matter of a comparatively short time. If the coming of the medicine man is opportune he might be saved.
whatever name you want to give to this 'effect', it is powerful.
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homeopathy works in some mysterious way. i am still stunned by this discovery and searching for the reason why.
it is far more than just belief. i rather like lionel milgrom's ideas.
Rolfe
Adult human female
Anybody who wants to read about Lionel Milgrom's ideas, be my guest.
Paper the first,
Paper the second,
Paper the third.
This is based very much on the "work" of Harald Walach, specifically a paper where he declares that homoeopathy is magic, and something called "weak quantum theory" of which Walach was one of the three original inventors. This startlingly entertaining fantasy is a version of quantum theory which works over large macroscopic distances, by the simple expedient of dispensing with Planck's constant. It's a pity that if you remove Planck's constant, most of real quantum theory gets eliminated as well.
But that's OK, because for all the 60-odd pages of Milgrom's outpourings, it's only presented as a "metaphor" - he isn't really suggesting this is the way things work. And the other interesting thing about the 60-odd pages is that it is pure speculation, not a single experimental result in the lot of it.
Walach seems to divide his time between publishing well-designed properly-blinded studies that demonstrate conclusively that homoeopathic remedies do precisely nothing at all, and speculative fiction trying to explain the effect he believes exists in the clinic (without blinding) as an effect of the power of the mind of the practitioner - like a magician casting a spell.
Milgrom takes the same tack. He accepts that there is nothing there in the blinded controlled studies, but can't accept that the alleged "clinical" effects are pure subjective interpretation of what was going to happen anyway. Hence the "magic" and the quantum metaphors.
I find it very amusing the way the dimmer homoeopathy proponents (like Xanta) eagerly embrace Milgrom's outpourings, without apparently understanding either that the quantum part is only intended as a metaphor, there is no great quantum theory there, or that the whole basis of the thesis is the acceptance of the fact that homoeopathic remedies have no effect when those concerned don't know whether they're taking the remedy or not.
Of course the perfectly simple explanation that they don't have an effect at all (beyond the subject of this thread) just isn't one they'll contemplate.
Rolfe.
Paper the first,
Paper the second,
Paper the third.
This is based very much on the "work" of Harald Walach, specifically a paper where he declares that homoeopathy is magic, and something called "weak quantum theory" of which Walach was one of the three original inventors. This startlingly entertaining fantasy is a version of quantum theory which works over large macroscopic distances, by the simple expedient of dispensing with Planck's constant. It's a pity that if you remove Planck's constant, most of real quantum theory gets eliminated as well.
But that's OK, because for all the 60-odd pages of Milgrom's outpourings, it's only presented as a "metaphor" - he isn't really suggesting this is the way things work. And the other interesting thing about the 60-odd pages is that it is pure speculation, not a single experimental result in the lot of it.
Walach seems to divide his time between publishing well-designed properly-blinded studies that demonstrate conclusively that homoeopathic remedies do precisely nothing at all, and speculative fiction trying to explain the effect he believes exists in the clinic (without blinding) as an effect of the power of the mind of the practitioner - like a magician casting a spell.
Milgrom takes the same tack. He accepts that there is nothing there in the blinded controlled studies, but can't accept that the alleged "clinical" effects are pure subjective interpretation of what was going to happen anyway. Hence the "magic" and the quantum metaphors.
I find it very amusing the way the dimmer homoeopathy proponents (like Xanta) eagerly embrace Milgrom's outpourings, without apparently understanding either that the quantum part is only intended as a metaphor, there is no great quantum theory there, or that the whole basis of the thesis is the acceptance of the fact that homoeopathic remedies have no effect when those concerned don't know whether they're taking the remedy or not.
Of course the perfectly simple explanation that they don't have an effect at all (beyond the subject of this thread) just isn't one they'll contemplate.
Rolfe.
Rolfe-
...homoeopathic remedies have no effect when those concerned don't know whether they're taking the remedy or not.
I had to work through the negatives with a pencil. (Cheap white wine- I had to drink it, I'm defrosting the fridge).
I think it cancels to-
"...homoeopathic remedies have no effect... "
I wonder how anyone could tell whether they were taking the remedy or not - and what difference it would make anyway?
...homoeopathic remedies have no effect when those concerned don't know whether they're taking the remedy or not.
I had to work through the negatives with a pencil. (Cheap white wine- I had to drink it, I'm defrosting the fridge).
I think it cancels to-
"...homoeopathic remedies have no effect... "
I wonder how anyone could tell whether they were taking the remedy or not - and what difference it would make anyway?
Rolfe
Adult human female
mmm, sorry.Soapy Sam said:
By the way, don't go away, I'm sending you a PM in a minute. I think my Mum is trying to phone your Mum for an auld lang syne chin-wag!
The system the homoeopaths have worked out is that no matter what happens, this is explained in terms of the remedy having had an effect. So if the patient improves, this is proof of how great it is. If the patient gets worse, this is an aggravation and proves that you've got the right remedy but sometimes it has to get worse before it gets better. And there are other wrinkles.
The point that Xanta can't quite grasp is that repeated studies have shown that when a properly blinded controlled trial is done, where one group of people get their remedy as prescribed, and the other comparable group only think they're getting their remedy (i.e. a non-potentised placebo is given instead), there is no difference between the groups. Whatever happens after taking the remedy seems just as likely to happen if you don't get the remedy.
The homoeopaths who have grasped this are trying to explain it as a "quantum" effect, otherwise explicitly admitted to be magic. The mind of the practitioner is part of the "entangled" system, and if this isn't engaged then the effect disappears.
No, it doesn't fly, but then we're not talking about the brightest crayons in the box here.
Rolfe.
Soapy Sam said:
That's the whole point, its all about what the patient believes to be true, not the actuality. The really interesting thing is, even if they are told the medicine is a fake, if they believe it works, they still will get the placebo effect.
geni
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Soapy Sam said:
Rolfe is talking about double blind studies. If you tell one group of people that they are getting a placebo and tell another group they are getting a homeopathic remedy I predict there would be a difference between the two groups. Don't tell either group what they are getting I predict such differences will dissapear. When we do the test this is what we find.
Rolfe
Adult human female
But rather than allow the obvious conclusion, Lionel Milgrom and Harald Walach are trying to maintain that "it's quantum, man". Even though Milgrom admits this is just a metaphor, and Walach openly uses the word "magic" to describe the effect he still believes is there in the clinic, despite the null-effect double-blind trials - which he himself is churning out at quite a rate, actually.geni said:
Rolfe.
Geni- yes, I understand. There is (it seems to me) a subtle difference here from normal drug tests. In a normal test, one pill actually has a real dose of an active ingredient. The alternative is a placebo- chalk & sugar or whatever.
When testing a homoeopathic preparation in the same way, neither pill contains a real dose. How can this be a double blind test? This is ,as Gestahl says, the whole point. My creeping unease is that there is something logically questionable about a test where all the pills are placebos. In that context, how can you correct for placebo effect?
Let me stress that I am not supporting homoeopathy here. I start from the assumption that the pills have no active ingredient and should have no effect. I am simply leery about what it proves. - What would it prove if all the pills in a test contained the actual drug in a real dose?
When testing a homoeopathic preparation in the same way, neither pill contains a real dose. How can this be a double blind test? This is ,as Gestahl says, the whole point. My creeping unease is that there is something logically questionable about a test where all the pills are placebos. In that context, how can you correct for placebo effect?
Let me stress that I am not supporting homoeopathy here. I start from the assumption that the pills have no active ingredient and should have no effect. I am simply leery about what it proves. - What would it prove if all the pills in a test contained the actual drug in a real dose?
geni
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Soapy Sam said:
Homeopths claim there pill are not placebos so the problem does not arise (remeber that one group of pills will have had contact with water that had contact with water that had contact with water that had contact with water that had contact with water ....that had contact with water that had contact with the orginal substance. The other pills will not have. homeopaths ay this makes a difference.
sincve we have no control group very little. See above for why the anology does not hold.
Rolfe
Adult human female
But the point is that the homoeopaths declare that there is some sort of "active" ingredient in the potentised remedy. All the magic rituals of diluting and succussing are supposed to impart some sort of mystical unmeasurable properties to the remedy, which they claim has a therapeutic effect.Soapy Sam said:
Crazy though this is, it is what is being tested for by the controlled trials.
If you scour the homoeopathy vanity press you'll find all sorts of wondrous claims made, and some of the papers even look at first sight as if they've been properly carried out. But in fact this lot is demonstrably unblinded and subject to bias.
There are about three published studies in real journals that looked at the available literature and said, well the evidence isn't good, and this really needs more work, but possibly there might be something there at the borders of statistical significance. Yes, this the the best they can do, away go the miracle cures and the self-evident powerful healing method, all this entire system of medicine had going for it up to about 1997 was just possibly something might be happening, but there's no clear evidence what. As someone said at the time, if this is the best they can do, why bother.
However, more and better studies have been done since, and the earlier studies scrutinised in more detail, and the conclusion is clear. Walach and Milgrom fully accept it, but Xanta, although she quite likes the word "quantum", can't.
I did link to the studies in question in the thread discussing "Oaf"'s spamming thread.
Rolfe.
Rolfe
Adult human female
That's the point. This was all pointed out to Xanta patiently and repeatedly at H'pathy. With links and references and rational arguments, the lot. She didn't even seem to read the information she was given, just went on spamming the same three old, discredited studies (with very selective quotes and in one case a frankly fabricated quote), and remarks about [enter invented number here] doctors in Schleswig-Holstein.geni said:
Then they banned the sceptics because it was getting all too embarrassing for most of them (BSM in particular had them reeling on the ropes), and Xanta is so lonely she has simply copied all the original spam from H'pathy and reposted it here. Several times over.
She didn't want to hear the answers then, and she doesn't want to hear them now. She just seems to get some sort of twisted kick out of reposting the same stuff again and again to see if the sceptics might say anything different. Which she doesn't read, and if she does, she won't understand it anyway.
So I can well understand Geni not wanting to do it all again. Neither do I.
Ignore lists are a great invention.
Rolfe.
Rolfe said:
over 100,000 Medical Doctors!!!!!!!!!!
and
Kleijnen 1991
British Medical Journal. 107 trials. Criteria-based meta-analysis.
77% are positive
The higher the scientific merit of the study, the more likely it is to show homoeopathy as superior to placebo.
The evidence presented in this review would probably be sufficient for establishing homoeopathy as a regular treatment for certain conditions.
Boissel 1996
Report for European Commission. 15 trials. Very strict inclusion criteria. Meta-analysis; data synthesis by combining the significance levels (p-values) for the primary outcomes from each trial.
Combined p value for the 15 trials was highly significant p=0.0002.
' There is evidence that homeopathic medicine is more effective than placebo' .
Little evidence of publication bias.
Further high quality studies are needed.
Linde 1997
Lancet. 89 trials. Meta-analysis; data synthesis by combining the odds ratios.
Combined odds ratio 2.45 (95% CI 2.05, 2.93) in favour of homeopathy.
Odds ratio for 26 best quality studies was 1.66.
No evidence of significant publication bias.
The results are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo.
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"the borders of significance"??????????????????/
simply unbelievable how a person can hide from something that is so very clear.
fascinating how you are able to delude yourself rolfe
geni
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olaf said:
And flawed
Nice try. I've read the study. It says that oposite
CONCLUSIONS--At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1825800
The further trails have been done xanta. Didn't work out for you did it
I'm not interetsed in politcal reports. Anyway Rolfe as debunked this to the moon and back
Another meta analysis of flawed trial. Garbage in garbage out as the programers say.
From the study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9310601
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You haven't even got that far in a well controlled trial
I'm sorry but I'm forced to use this smiley
I'm sorry but again I have no choice
Rolfe, Geni-
I hear what you are saying about homoeopathy, but I'm not really concerned here about what homoeopaths claim.
The fact is that there is no active agent in any of the pills, so all the pills in the test are placebos, regardless of claims to the contrary.
This thread is not specifically about H'pathy, but about the placebo effect. If placebo effect itself can be tested for,- if we can learn anything about how it operates- then the results of such a double-transparent test may have something (I have no idea what) to say about the psychology of belief, or possibly about the amount of sugar in the placebos, but I still can't see what it can tell us about the effect of H. preparations. There is nothing to test.
Anyway I'm for some non homoeopathic hot chocolate and bed. Night all.
I hear what you are saying about homoeopathy, but I'm not really concerned here about what homoeopaths claim.
The fact is that there is no active agent in any of the pills, so all the pills in the test are placebos, regardless of claims to the contrary.
This thread is not specifically about H'pathy, but about the placebo effect. If placebo effect itself can be tested for,- if we can learn anything about how it operates- then the results of such a double-transparent test may have something (I have no idea what) to say about the psychology of belief, or possibly about the amount of sugar in the placebos, but I still can't see what it can tell us about the effect of H. preparations. There is nothing to test.
Anyway I'm for some non homoeopathic hot chocolate and bed. Night all.
geni
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Soapy Sam said:
It tell us that they are no different from placebos wgich is what we claim. The area of reasearch into the placebo effcet is an interesting one that apears to only recently got off the ground. Ask me again in 10 years.
Rolfe
Adult human female
OK, just once. This is what Xanta's three favourite studies really say. (And note I include links so you can read them for yourselves.)
Kleijnen J, Knipschild P, ter Riet G.
Clinical trials of homoeopathy.
BMJ. 1991 Feb 9;302(6772):316-23.
Cucherat M, Haugh MC, Gooch M, Boissel JP.
Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group.
Eur J Clin Pharmacol. 2000 Apr;56(1):27-33.
(The published version of the Boissel study - the work was done in 1996 actually.)
Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB.
Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.
Lancet. 1997 Sep 20;350(9081):834-43.
All three papers say maybe there's something but we can't really pin it down for sure. More better-quality studies are needed.
Of course this has been done, the trouble is Xanta doesn't want to and won't look at them. I'm grateful to Geni for this lot:
There have been three more meta-analyses since then, including a re-evaluation by Linde of his original work, where he acknowledged that he'd been mistaken in the 1997 conclusions in even suggesting that there might be something in it.
Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB.
Impact of study quality on outcome in placebo-controlled trials of homeopathy.
J Clin Epidemiol. 1999 Jul;52(7):631-6.
A systematic review of systematic reviews of homeopathy.
(Citation not available because site is temporarily down.)
A critical review of the possible benefits associated with homeopathic medicine.
Rev Hosp Clin Fac Med Sao Paulo. 2003 Nov-Dec;58(6):324-31.
Lionel Milgrom and Harald Walach now understand that if anything's happening it must be supernatural. Xanta clearly doesn't.
Rolfe.
Kleijnen J, Knipschild P, ter Riet G.
Clinical trials of homoeopathy.
BMJ. 1991 Feb 9;302(6772):316-23.
Note the date. 13 years ago.
Cucherat M, Haugh MC, Gooch M, Boissel JP.
Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group.
Eur J Clin Pharmacol. 2000 Apr;56(1):27-33.
(The published version of the Boissel study - the work was done in 1996 actually.)
8 years ago.
Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB.
Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.
Lancet. 1997 Sep 20;350(9081):834-43.
7 years ago.
All three papers say maybe there's something but we can't really pin it down for sure. More better-quality studies are needed.
Of course this has been done, the trouble is Xanta doesn't want to and won't look at them. I'm grateful to Geni for this lot:
This isn't all of them, I know of at least three more, but it's getting late.
There have been three more meta-analyses since then, including a re-evaluation by Linde of his original work, where he acknowledged that he'd been mistaken in the 1997 conclusions in even suggesting that there might be something in it.
Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB.
Impact of study quality on outcome in placebo-controlled trials of homeopathy.
J Clin Epidemiol. 1999 Jul;52(7):631-6.
Ernst, E.
A systematic review of systematic reviews of homeopathy.
(Citation not available because site is temporarily down.)
Almeida RM.
A critical review of the possible benefits associated with homeopathic medicine.
Rev Hosp Clin Fac Med Sao Paulo. 2003 Nov-Dec;58(6):324-31.
Wouldn't it be nice if published papers which have failed replication and been repudiated by their authors could be shunted into some sort of limbo. Unfortunately they stay there, for closed-minded morons like Xanta to post and re-post, and there seems to be no way on earth to make her even look at the newer studies and the evidence they show.
Lionel Milgrom and Harald Walach now understand that if anything's happening it must be supernatural. Xanta clearly doesn't.
Rolfe.
Rolfe
Adult human female
Mmm, sorry again. Whenever you start to talk about the placebo effect, which is just a way of saying that the very act of being prescribed and taking medicine seems to cause many patients to report feeling better, at least in conditions with at least some subjective component to them, homoeopathy tends to come up. We were discussing it in context, but then Xanta barrelled in and said she thought Milgrom's lunatic fantasies about homoeopathic mode of action (it's quantum, man) were in some way valid, and this rather had to be responded to.Soapy Sam said:
I believe homoeopathy has been shown to be very effective in cases of hypochondria!
Rolfe.