Good arcticle mel... reminds me of something that I once heard with regards
to medication: "take it while it still works." Food for thought...
Henry***
>From: [log in to unmask]
>Reply-To: - for physiotherapists in education and practice
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Placebos a Myth?
>Date: Wed, 25 Jul 2001 11:26:25 EDT
>
>[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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