[log in to unmask] writes:
<< Hi. Why don't the placebo believers start an independent med school,
insurance co., in which muscle diseases and AID is "thought" away, and
stuffed arteries are meditated away! In fact why don't they travel to
Africa and try to sell the Placebo to the multitudes. >>
***They don't need to, because they are doing extremely well in the West,
where extremely effective marketing copy, expert trendy popularisations of
medical science, mass media infomercials and many other forms of
sophisticated latter day snake oil salesmanship ensure that varying levels of
placebo effect accompany a vast array of products and procedures. For some
of the techniques used, read E Aronson, "The Social Animal" and many other
texts on propaganda, marketing and mass psychology.
Anyway, before we address that point any further, here is an extract from a
website on the recent New England Journal of Medicine placebo study:
-------------------------------
THE PLACEBO EFFECT
<http://dcn.davis.ca.us/~btcarrol/skeptic/placebo.html>
"Of course, spontaneous healing or regression can also adequately explain why
homeopathic remedies might appear to be effective. Whether the placebo effect
is mainly psychological, or misunderstood spontaneous healing, or due to a
process characterized by showing care and attention, or due to some
combination of all three may not be known with complete confidence. But the
powerful effect of the placebo is not in doubt.
It should be, however, according to Danish researchers Asbjorn Hrobjartsson
and Peter C. Gotzsche. Their meta-study of 114 studies involving placebos
found "little evidence in general that placebos had powerful clinical
effects...[and]...compared with no treatment, placebo had no significant
effect on binary outcomes, regardless of whether these outcomes were
subjective or objective. For the trials with continuous outcomes, placebo had
a beneficial effect, but the effect decreased with increasing sample size,
indicating a possible bias related to the effects of small trials ("Is the
Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No
Treatment," The New England J of Medicine, May 24, 2001 (Vol. 344, No 21:
1594-602)."
According to Dr. Hrobjartsson, professor of medical philosophy and research
methodology at University of Copenhagen,"The high levels of placebo effect
which have been repeatedly reported in many articles, in our mind are the
result of flawed research methodology." This claim flies in the face of more
than fifty years of research. At the very least, we can expect to see more
and more rigorously designed research projects trying to disprove
Hrobjartsson and Gotzsche.
[If this latest research proves to be correct, then it will have huge
implications for the disciplines of Psychoneuroimmunology and hypnosis, so it
will be fascinating to see where this new work is going to do to our
understanding of healing, illness, psychology and several other fields of
study and clinical practice. Mel Siff]
------------------------------------------------------
MORE ARTICLES ON THE PLACEBO EFFECT
<http://www.md.huji.ac.il/special/cancer/19952.html>
<http://www.csicop.org/si/9701/placebo.html>
<http://dcn.davis.ca.us/~btcarrol/skeptic/placebo.html>
<http://members.loop.com/~bkrentzman/meds/placebo.html>
<http://imprint.uwaterloo.ca/issues/012398/3Science/science01.shtml>
-------------------------------------------
SURGICAL & OTHER PLACEBOS
The following very extensive article discusses, inter alia, the use of
surgery as a placebo:
<http://www.nytimes.com/library/magazine/home/20000109mag-talbot7.html>
"In the summer of 1994, a surgeon named J. Bruce Moseley found himself
engaged in an elaborate form of make-believe. Moseley had 10 patients
scheduled for an operation intended to relieve the arthritis pain in their
knees. The patients were men -- most of them middle-aged, all former military
guys -- and they weren't ready to consign themselves to the rocking chair
yet. So they had decided to take a risk and volunteer for a study that must
have sounded, when Moseley first told them about it, rather peculiar. All 10
would be wheeled into an operating room at the Houston Veterans Affairs
Medical Center, draped, examined and anesthetized. All 10 would be dispatched
to the recovery room and sent home from the hospital by the next morning
equipped with crutches and a painkiller. But there the similarities ended.
For while two of the men would undergo the standard arthroscopic surgery for
their condition -- the scraping and rinsing of the knee joint -- and three
would have the rinsing alone, five would have no recognized surgical
procedure at all. Their surgery would be a placebo, an exercise in just
pretend.
Moseley would stab the placebo patients' knees three times with a scalpel --
to make it feel and look real, there had to be incisions and later, scars --
but that was it. And he couldn't break character. If he knew in advance which
kind of surgery he was to perform, he might somehow give it away, so it
wasn't until he entered the gleaming O.R., scrubbed and in his greens, that
he opened an envelope telling him whether he was doing a real procedure or a
fake one that time. Only the anesthetist and the nurse assisting him were in
on the secret.
The placebo worked. Six months after surgery, the 10 patients still didn't
know whether they had been faked out or not. But all of them reported much
less pain. None were unhappy with the outcome of the operation. This was a
pilot study -- far too small to offer any definitive conclusions about the
efficacy of arthroscopic surgery for osteoarthritis. But it was suggestive
enough to set Moseley and Wray on an expanded version of the same research
design -- this time with 180 patients -- for which they expect to have the
results next October.....
Last year, the pharmaceutical company Merck announced that it was halting
development of MK-869, a new antidepressant it had been promoting for months
as a blockbuster drug on the scale of Prozac. Alas, the dummy pills worked
just as well. And in a recent study on VEGF, a genetically engineered heart
drug announced with much fanfare by its manufacturer, Genentech, the placebo
actually performed better. Two months after their treatments, patients who
had gotten low doses of VEGF could walk 26 seconds longer on a treadmill,
those who had gotten high doses could walk 32 seconds longer and those who
had gotten a placebo could walk -- go figure -- 42 seconds longer....."
-----------------------------------------
This article discusses "Sham Surgery":
<http://www.nytimes.com/library/review/042599surgery-ethics-review.html>
"In 1939, long before high-tech drugs came along to treat the chest pain
known as angina, an Italian surgeon named Fieschi devised a simple technique.
Reasoning that increased blood flow to the heart would ease his patients'
pain, he made tiny incisions in their chests and tied knots in two arteries.
The results were spectacular. Three quarters of all patients improved." One
third were cured.
Two decades later, the National Institutes of Health paid a young
cardiologist in Seattle, Dr. Leonard A. Cobb, to conduct a novel test of the
Fieschi technique. Cobb operated on 17 patients. Eight had their arteries
tied; the other nine got incisions, nothing more. In 1959, the New England
Journal of Medicine published his findings: The phony operations worked just
as well as the real thing.
That was beginning of the end of the procedure, known as internal mammary
artery ligation; within two years, it became a footnote in the medical
history texts. It was also the beginning and the end, apparently, for sham
surgery in this country. By the early 1970s, an ethics revolution had
transformed human experiments, and the idea of surgery as placebo was
unthinkable.....
--------------------------------------------------------
PLACEBO EFFECT & ANTIDEPRESSANTS
<http://www.shpm.com/articles/depress/antidprs.html>
Placebo Effect Accounts for Fifty Percent Of Improvement in Depressed
Patients
The debate about treating depression with drugs, psychotherapy, or a
combination of both drugs and psychotherapy has raged on over the years. But
a recent analysis of 39 studies of 3,252 depressed patients, presented at the
American Psychological Association's (APA) 104th annual convention, found
that 50 percent of the drug effect is due to the placebo response. In other
words, a patient taking antidepressant medication with a self-reported
improvement rate of 10 points, can attribute half of that improvement to the
placebo effect.
To determine the placebo effect of antidepressant medications, psychologist
Guy Sapirstein, Ph.D., at the University of Connecticut, analyzed 39 studies
of depressed patients from 1974 to 1995. The studies included patients with a
primary diagnosis of depression, were randomized, and controlled for
patients who received no treatment. Studies that measured the effects of
antidepressant medications such as fluoxetine (Prozac), sertaline (Zoloft)
and paroxetine (Paxil) were included in the analysis.
Dr. Sapirstein concluded that the pharmacologic and nonpharmacologic effects
of antidepressants indicates that while only 27 percent of the response to
medication is due to the medication alone (a true pharmacologic effect), 50
percent is due to the psychological impact of administering the medication
(placebo effect) and 23 percent is due to other "nonspecific factors."
"People benefitting from drugs are benefitting because they think that taking
the antidepressant medicine is working," Dr. Sapirstein said. "If we take
these results and say that improvement is due to what the patients think,
then how people think and its effect on how they feel are more powerful than
the chemical substance," he added.......
-----------------------------------------
NON-PHYSICAL PROCESSES MAY STILL OPERATE
We do know that all ailments and human performance characteristically exhibit
ongoing ups and downs, so that spontaneous healing or regression can also
adequately explain why any given intervention or method might appear to be
effective. This is the core explanation offered by Hrobjartsson & Gotzsch in
that New England Journal study and it is certainly a most valid issue to
consider. However, even if it is proved that this phenomenon better explains
the "placebo effect", it still has to contend with the possibility that these
natural fluctuations in physiological state may also implicate psychological
processes. In other words, we might be trapped in a circular argument which
will necessitate the design of some ingenious new experiments to identify
the fundamental origins spontaneous remission or placebo-like healing.
Dr Mel C Siff
Denver, USA
http://groups.yahoo.com/group/Supertraining/
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