Questions about the placebo effect.

[rockoon]

Clarinex (which provides nondrowsy 24-hour relief from allergy symptoms caused by seasonal allergens such as ragweed, grass, and tree pollens and year-round allergens such as dust mite, animal dander, and mold spores. ) has this great television ad which states:


"Side effects are similar to placebo..

..and may include sore throat, dry mouth and fatigue"

 

[Soapy Sam]

"I believe homoeopathy has been shown to be very effective in cases of hypochondria!

Rolfe."

- Hoo! You've done it now! "Well Known Veterinary Sceptic Accepts Effects of Homoeopathy! Shock! Horror"

 

[Benguin]

Placebo or not

I recall reading a news article a couple of years back on research into anti-depression medication (or the efficacy of it).

Someone had a theory that the patients in the control group actually were aware they were receiving placebos, thus meaning the placebo effect was not being properly generated.

The reasoning was that the patients had to have the ailment being treated in order for their to be anything to be tested for (eg depression). The vast majority had a history of medication for their condition and were familiar with the side effects.

When the sugar pill control group was supplemented with a group taking nausea, insomnia inducing pills the results showed three of the leading medications had little efficacy beyond the second control group.

I wish I could find a damned link or something!

 

[Rolfe]

This was discussed in another thread a few months ago I think. It's an interesting point - do you dream up something that only gives the side-effects, and would this be ethical even if you could identify such a substance?

I think the consensus was that it probably only applies to a few specific situations such as the one you mention, but it's an interesting wrinkle that seems suitable for further investigation.

In the dog arthritis study I mentioned earlier in this thread, it turned out that the snake-oil made quite a high proportion of dogs in the treated group smelly, with a distinctive smell. This is how the treating veterinary surgeons became unblinded as to which dogs were actually getting the stuff. But it was assumed that the owners, only coming in contact with their own dog, might not have cottoned on to the significance of the smell (though who knows, some of them might have). Of course if all concerned had been familiar with the smell thing before they'd started, they'd have had to find a placebo preparation that also produced the smell, which seems like a tall order to me!

Rolfe.

 

[Kumar]

It means you agree ' it effects'. It is a placebo effect, faith healing, belief effect or otherwise--is a secondary issue.

 

[Rolfe]

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.

I've been thinking about this, and I don't think it's really a meaningful point. Whether the molecular composition of the test substance and the sham are identical or not isn't the point. The point is that claims are made that the test substance has some sort of "energy" (or quantum effect or magic) that will cause a clinical effect. This is what is being tested for.

The fact that we have our own opinions on the molecular content of the stuff is really sophistry. It's not meaningfully different from saying, here, have these pills which may or may not contain extract of pampas grass, which I claim is effective for boils on the backside. Whether the threapeutic claim relates to an identifiable physical substance or some weird "energy" is irrelevant - you're still doing the same thing, testing to see if there really is an effect.

Rolfe.

 

[Rolfe]

It means you agree ' it effects'. It is a placebo effect, faith healing, belief effect or otherwise--is a secondary issue.

No. This is the main issue. We are talking about whether the substance has, of its own properties, any physiological effect on the body, as distinct from the non-specific effect of pill-taking.

Don't you think it's important to know whether a drug has a real physiological effect, or whether people are only experiencing a psychological boost from the pill-taking, and you'd get just as much effect from a handful of (cheap) sugar or starch pills?

We know that a handful of sugar or starch pills will often cause people to report feeling better. What we are interested in is whether a drug has an effect of its own making, apart from this. Most people agree that this is quite important!

Rolfe.

 

[Kumar]

Don't you think it's important to know whether a drug has a real physiological effect, or whether people are only experiencing a psychological boost from the pill-taking, and you'd get just as much effect from a handful of (cheap) sugar or starch pills?

Rolfe.

My priority is that ' Best effects with least adverse effects' & 'Cheap and the best'. It may depend upon the type of problem. Sometime it can be best just by thoughts & othertime it may be best by CMS medications.

 

[Benguin]

Believing you're cured

Are we not looking at this slightly the wrong way round? When a drug is trialed we want to see that there is a statistically identifiable difference in the recovery (or pain experienced, or whatever) between people taking the substance and those who aren't.

As some have pointed out ... people taking pills without the active ingredient report that they feel better with greater frequency than those who do not believe they are receiving treatment.

I think the original questioner was specifically interested in why that is .... maybe one could apply all the answers given in support of homeopathy after yet another double-blind trial has failed.

Maybe it would be interesting to distinguish between people experience the placebo effect through participating in a ritual of taking sugar pills, and those who do not take pills but "believe" they are receiving treatment ... that could be through massage, prayer, remote healing etc. The sugar pills are, after all, only a means by which to rule out self-induced factors.

 

[Rolfe]

My priority is that ' Best effects with least adverse effects' & 'Cheap and the best'. It may depend upon the type of problem. Sometime it can be best just by thoughts & othertime it may be best by CMS medications.

Sure, if you don't need to take medicine, you shouldn't take medicine. I think we can all agree on that. However, there are many people with real illnesses who are very much in need of effective treatment. We need to know that the drugs we're giving them actually are doing them real good. This is what we're talking about.

Rolfe.

 

[Rolfe]

Re: Believing you're cured

Maybe it would be interesting to distinguish between people experience the placebo effect through participating in a ritual of taking sugar pills, and those who do not take pills but "believe" they are receiving treatment ... that could be through massage, prayer, remote healing etc. The sugar pills are, after all, only a means by which to rule out self-induced factors.

Yes, of course you're right. The point is to treat both the test group and the treatment group in an identical manner, so that nobody knows who is getting the real treatment and who isn't. So sugar pills are only relevant to situations in which the preparation under test is in pill form.

If the treatment under test is something else, then you have to devise a "sham" of that as convincingly as possible. Even if it's just telling people they're being "prayed for" when they aren't. The effect of believing that you are the subject of a therapeutic intervention is what counts, no matter what form the intervention takes.

Placebo surgery isn't something which tends to happen on purpose. Not ethical. But it's amazing how often someone is taken to hospital for exploratory surgery, not intended to be curative, and insists afterwards how much better they are since they "had their operation".

Placebo acupuncture is a difficult thing to organise - they have tried fake needles that retract into the handles, though it's debatable whether the patients really think they've been punctured with those. They have also tried "needling" points of the body which aren't the recognised acupoints for the condition - this is tricky too though, because acupuncturists don't agree so's you'd notice on what is the right approach for any particular complaint. And finding a point which isn't labelled as an acupoint on some acupuncture chart somewhere is almost impossible. However, opinion seems to be that sticking needles into people is a pretty persuasive thing to do, and wherever you stick them or even if they've just been convinced they've been stuck, they tend quite often to report an improvement. (Having said that, of people of my own acquaintance who've tried it, I can't think of one such example - all I seem to hear about are the people announcing how much they paid for it and how it didn't do a blind bit of good. So make of that what you will.)

Rolfe.

 

[Benguin]

I know one person who swears by acupuncture, maybe I should probe deeper. (pun intended ... )

I'm not too familiar with the research on acupuncture, is that stuff on endorphine release a proven fact or just an assertion? I know it's actual claims are all about qi and energy flows and that.

What you're getting at, I think, is it is difficult to convince people they've had acupuncture without actually performing something that might be described by someone as acupuncture. It wouldn't be possible to get a group of the needle stickers to agree that certain locations will NOT help with, say, a headache?

 

[Rolfe]

1. I'm not too familiar with the research on acupuncture, is that stuff on endorphine release a proven fact or just an assertion?

2. It wouldn't be possible to get a group of the needle stickers to agree that certain locations will NOT help with, say, a headache?

1. Assertion. It was suggested that if it worked, that might be how. However, first prove the first part of that sentence. There's no doubt the body does tend to notice if you stick pins in it. However, whether this has any therapeutic benefit in the vast majority of situations where the acupuncturists claim such benefits is fast moving out of the realms of speculation and into the category of "no, it doesn't".

2. You can try! There is a tendency to retroactive "No True Scotsman" on the part of most altmedders, though. Get them to agree a protocol in advance, and then when they don't like the result, suddenly there is a reason for this which doesn't involve them re-evaluating their world-view.

You may be interested in this thread here. It comes in two parts. A reasoned discussion, which incidentally included a mention that "Xanta" at H'pathy was making disparaging remarks about my sceptical opinion of acupuncture, on a H'pathy thread. At that point Xanta was in the middle of spamming H'pathy with "It works", "100,000 medical doctors!", "THE QUEEN OF ENGLAND!" and "Kliejnen, Boissel and Linde!", and the sceptics on the board were presenting the counter-arguments. Then that board decided to ban all dissent, and the sceptics vanished. Xana apparently missed what she saw as her brilliant sceptic-baiting and came over here to continue, as perhaps you have noticed. In fact the poster "Olaf" who bumps the acupuncture thread after three weeks dormancy is Xanta herself, come to where the action is.

It's all most amusing.

Rolfe.

 

[Benguin]

lol, yes.

I'd read that thread, I'd been tempted to post and ask how she felt reasserting her challenged figures made them any more credible.

Hell, the figures might even be correct, but we saw them all on the first page and don't need to them repeating as it adds no weight.

Can I try coining Argumentum ad troll or has someone done that?

Oh s0d it, I'll get my pig costume on and join the wrestling.

 

[qII]

Rolfe,

To date I have received 4 private emails from long time members here who have backed acupuncture. All you are doing is losing credibility with people when you unfairly attack it.

Just because you are an angry spinster does not mean that you can unleash your rage on anything you see fit.

 

[geni]

Xanata the problem is that you haved lied so often that no one is going to belive you (unless the names behind the emails are things like steven G.

 

[Benguin]

Piercing attack

Olaf, I appreciate you have some history with Rolf but simply flinging an ad hominem like that does not do you or your cause any credit.

I'm open-minded about it acupuncture (I know little about it and have heard good and indifferent reports).

How about you and/or rolf start a new thread and try and convince me one way or the other.

A couple of ground rules;
Attacking someone's character will not sway me in any direction.
Repeating the same information ad nauseam will not increase it's potency.

 

[Rolfe]

Can I try coining Argumentum ad troll or has someone done that?

I think you may as well take the credit. I like it!

I don't see much point in discussing the numbers unless
(a) some evidence for their veracity is presented
(b) they can be expressed as a meaningful percentage of the total number of medical practitioners from which the population is derived
(c) someone can expain why the fact that a small percentage of doctors is either gullible or prepared to practise fraud for the money actually endorses the method in any way.

If anyone here has good (or even indifferent) contrary evidence regarding the efficacy of acupuncture, the usual drill would be to post in the thread for all to see. I don't believe in those PMs.

However, Xanta might be interested in the genuine PMs being exchanged by Soapy Sam and myself, delighted to realise we come from the same town, had a nodding acquaintance as children and possibly as students, and my mother and her family are old friends of his parents and their families. Phone numbers are just now being exchanged to allow our mothers to renew their very old acquaintance. Meetings for coffee or even lunch seem to be on the agenda.

It's a small world, as they say, and I just threw this in to contrast the reality with Xanta's paranoid attempts to foment strife between Soapy and myself.

I've answered Xanta's spamming posts as often as I care to. Actually there's no real history there at all. On the other acupuncture thread Xanta tried ploy #37 (or whatever) and asserted that it worked on animals, so it must be a real effect. Zep or someone suggested she might like to take that one up with me, but in fact I didn't respond as the thread was in GS&P, so I wasn't following it at the time. Xanta decided on the spot that I was lying, carrying this on from her earlier rantings on the H'pathy forum, all before we'd interacted at all (if you don't count the posts she made when she was "Gold") and began a somewhat frenzied attack. She has continued to assert this despite never once being able to quote any statement I've made which she can demonstrate to be false.

It's all getting a bit tedious.

Rolfe.

 

[qII]

I


(c) someone can expain why the fact that a small percentage of doctors is eith gullible or prepared to practise fraud for the money actually endorses the method in any way.

Rolfe.

because they see that it works. if it did not work there would not be so many who practice it or use it.

 

[geni]

because they see that it works. if it did not work there would not be so many who practice it or use it.

All those aztecs can't have been wrong can they?