In article <A0AFB0345B62D311ABD8000092966BB429FB14@EXCHANGE2>, Simon,
Steve, PhD <[log in to unmask]> writes
>M. Carmen Meerschaert writes:
>
>>My question is this: Are we right to assume that a placebo-treated group
>>is a true "control" population when studying a disease which is subject
>>to psycho-somatic exacerbations? If this patient population's response
>>to placebo is high, might this not be an unfair standard against which
>>the treatment modality is measured?
>
>I'm not a doctor, so my comments might be a bit naive. If a treatment is
>shown to be equivalent to placebo, then I would have a hard time
>understanding how a doctor or other medical specialist could justify its
>use.
When last I checked, we use placebo controls precisely because the
placebo effect is so very powerful. To put it another way, I have "real"
and "placebo" effects at my disposal, and the placebo effects are much
the most powerful. The definition of placebo we could of course dispute,
but it generally includes some form of tender loving care, a diagnosis,
and a prognosis. Those are highly effective forms of medicine. A sugar
pill may possibly help too.
> Almost every treatment has side effects and all treatments have some
>expense (time if nothing else).
When I'm giving out placebos, which I do every day, I try to ensure that
these are minimised. Truly ineffective glop tends to be cheap and
definitively harmless.
>
>Those of you who know more about medicine than I do could perhaps provide
>some examples of when a treatment that is no better placebo is justified
>from the perspective of the patient.
- try this (moisturiser) cream to rub on your back, after you do your
exercises. It'll help take the ache away
- inhale eucalyptus oil in hot steam, take some cough linctus, and
you'll be able to go back to work tomorrow instead of having another
week off
That's two from this afternoon's surgery. Though I suspect that the hot
steam may be genuinely useful, I've no trial evidence to support that.
>When is it justified from the
>perspective of the insurer?
When it gets the patient to go away, get better, and work out what to do
for themselves next time?
Arguably and cynically, the traditional surgical placebos had the
immensely beneficial effect of persuading the patient to go away and not
come back. Either because they were dead, or because they were too
terrified that the surgeon would operate again...
That said, I have no defence for ineffective, hazardous, and expensive
procedures, and I try not to use them.
>
>Steve Simon, [log in to unmask], Standard Disclaimer.
>STATS - Steve's Attempt to Teach Statistics: http://www.cmh.edu/stats
(which I recommend - thanks Steve)
--
Richard Keatinge
homepage http://www.keatinge.demon.co.uk
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|