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Hi Dave: I can appreciate your line of thought. When we evaluate a "cost-beneficial" treatment we should include the costs in time and resources as well as money. Another "cost" if you will is if a placebo is offered to an uninformed patient when there is evidence for treatments that are better than placebo then the cost to the patients health is probably the greatest cost of all and the most ethically troubling. I do not have an issue with treatments that have been shown to be better than placebo yet have a placebo effect. As you said this is the case with all treatments. Best Doug > Douglas > > OK however > > i. I mentioned cost-beneficial which implies that the benefits > (whatever they are) must exceed the costs (in whatever way they are > defined). How much they must do so and how > (marginally/materially/significantly etc) I'll leave to wiser heads than > mine. > > ii. I agree wholeheartedly that if placebo is no better than > treatment we have practical difficulties HOWEVER > I feel that many people look at 'placebo' as an absolute benefit that > is mutually exclusive and/ or incompatible with 'real' treatment > effect(s). Imagine, for explanatory purposes, we are dealing only with a > positive effect for a moment and have a kind of continuum with a pure > placebo effect at one extreme and a 'real' treatment effect at the > other. Surely all +ve treatments lie along this continuum i.e. they are > composed of a portion of placebo and a portion of 'real' effect and it > is only the relative amount of placebo vs 'real' effect' that varies? > > For example, suppose treatment X (which is beneficial) is composed of a > real effect and a placebo effect (which is ONLY realised on the > application of treatment X) then other than for purposes of improving > treatment even further does it matter exactly what the relative > percentage of placebo vs real is whilst utilising treatment X?[BEARING > in mind point i above]? > > cheers > > dave > **************************************** > > Dave: > > > > Yes it is another can of worms. Placebo can take many forms. PT can be > > significantly more expensive in money, time and other resources than > > many > > other types of placebo. So, shouldn't the patient or the one paying > > the > > bills be given the option of what type of placebo, or any other > > treatment > > for that matter, they want? Personally, if I was given the option of > > taking > > 2 pills or going to see a PT for several visits given the same benefit > > at a > > significantly greater cost for the PT, I would take the pills. > > > > Then there is the whole issue of informed consent. In the US we have > > an > > ethical and in many states a legal responsibility to obtain informed > > consent. If I present a treatment option as being no better than > > placebo I > > do not think many of my patients would agree to it. Nor would the > > govt. or > > insurance companies pay for it. There are many other placebos that are > > cheaper than PT. > > > > ******************************************************* > > > > Douglas M. White, PT, OCS > > Physical Therapist, Consultant > > 191 Blue Hills Parkway > > Milton, MA USA 02186 > > P: 617.696.1974 > > [log in to unmask] > > http://DouglasWhite.tripod.com > > > > > I'm a bit confused by all this (perhaps a bit stupid as well) but if > > > placebo is statistically better than no treatment and this is cost > > > beneficial(?1 - another can of worms) then shouldn't we, ceteris > > > paribus, be paid for obtaining this 'placebo healing effect'? > > > > > > dave riddell > > > > > > > > > > > > > Long live the ruling of healthcare by insurance companies and > > > > government contributions.. > > > > > > > > << If we practice in a purely philosophical environment then it > > might > > > > not > > > > matter too much what we called things. However, I dare say most of > > us > > > > practice in a socioeconomic environment where there is government > > > > regulation > > > > and third parties paying for our services. In this environment the > > > > importance of what we name things and the ability to demonstrate > > an > > > > effect > > > > superior to placebo is necessary to continue to practice. > > > > > > > > ******************************************************* > > > > > > > > Douglas M. White, PT, OCS > > > > Physical Therapist, Consultant > > > > 191 Blue Hills Parkway > > > > Milton, MA USA 02186 > > > > P: 617.696.1974 > > > > [log in to unmask] > > > > http://DouglasWhite.tripod.com > > > > > > > > > Hmm I suppose we should all give up our day jobs and start > > writing > > > > > philosophy. The human being is a strange thing. The fact remains > > > > that if > > > > > something has a positive effect on an individual then we can > > treat > > > > it as a > > > > > success. If we do not know why it had that effect then the more > > > > biomedically > > > > > minded may call it placebo. Some taking the middle ground may > > call > > > > it, > > > > like > > > > > an unknown disease process, "cryptogenic". . Others who are > > more > > > > interested > > > > > in a whollistic approach to studying the reaction of the human > > to > > > > pain etc > > > > > may go through life enjoying what they see as every week > > something > > > > totally > > > > > unexpected occurs. The biomedical modlers will then call that > > ground > > > > breaking > > > > > research.. > > > > > > > > > > regards > > > > > richard > > > > >>