The Placebo Delusion

[porker]

OM,

A couple of things then.

Dr Novella is simply stating that although the placebo effect exists to the extent that subjective patient experience may be improved, it has no effect on objective clinical outcomes. (I appreciate that you are not suggesting that patients don't take advantage of medical treatment that does have objective effect).

O'Yeah's assertion was that stress caused ulcers. I am yet to be at all persuaded that this is the case. In and of itself this statement is nonsense.

Your essays cited from Dr Moerman are far better addressed by here Science-Based Medicine Dummy Medicines, Dummy Doctors, and a Dummy Degree, Part 1: a Curious Editorial Choice for the New England Journal of Medicine in particular, it's entirely reasonable that the healing results from the Cimetidine meta analysis are exactly what you'd expect on a comparison of treatment versus no treatment.

I also think that it's worthy of recognistion that Dr Moerman is not a clinical practitioner but an anthropologist.

While that may not invalidate his arguments, I know who I would prefer to have treat my asthma.

Your mice study is interesting indeed although it illustrates at least a few problems; one, how do you define "stress", can you extrapolate the "stress" of a mouse to a human and can you extrapolate the physiological effects of "stress" on mice to humans (the last are two different things).

[qetzal]

Originally Posted by O' Yeah

Depends how you choose to see it. Because what you quote also happens to people who had real surgeries. So isn't surprising that people who were told they would need a surgery to improve their condition felt an improvement of the same quality as those who were operated, even if nothing was changed in their knee..?

Excuse my butting in to an ongoing discussion. Came here based on the trackback from porker's link above.

Anyway, I just wanted to comment about the placebo knee surgery discussion from a few pages back. Anyone trying to interpret those results needs to understand that there was more than just real or sham surgery involved. Quoting from the scientific publication:

Postoperative care was delivered according to a protocol specifying that all patients should receive the same walking aids, graduated exercise program, and analgesics.

IOW, the observed improvements in the placebo group could have been entirely due to the post-surgical regimen of walking aids and graduated exercise. The placebo surgery itself may have made no contribution whatsoever.

[O' Yeah]

I'm teaching guitar. I recently dealt with 2 engineers who were taking lessons with me. They were both very stressed by their job. They both had frequent pain in the head, in the stomach and both had panic attack. They both had to stop working and had to take pills (anti-depressor) so they could relax.

Now, if I listen to some of you, you really think that no way the mind can affect the body?
It is one thing to believe that consciousness is exclusively a brain product, but to think that this brain product wouldn't be able to interact with the body is something I wouldn't think you would argue...

It is silly to think that the mind can influence the body Paul? Silly??

[really]

Originally Posted by O' Yeah

I'm teaching guitar. I recently dealt with 2 engineers who were taking lessons with me. They were both very stressed by their job. They both had frequent pain in the head, in the stomach and both had panic attack. They both had to stop working and had to take pills (anti-depressor) so they could relax.

Now, if I listen to some of you, you really think that no way the mind can affect the body?
It is one thing to believe that consciousness is exclusively a brain product, but to think that this brain product wouldn't be able to interact with the body is something I wouldn't think you would argue...

It is silly to think that the mind can influence the body Paul? Silly??

Don't change the argument. You're talking point was stress causes ulcers not stress can have bad affects upon the body.

[Open Mind]

Originally Posted by porker

Dr Novella is simply stating that although the placebo effect exists to the extent that subjective patient experience may be improved, it has no effect on objective clinical outcomes.

Yes I know that ..... I think he is wrong ... even in this study the placebo, sham accupunture and no treatment had small objective improvements that if combined are probably significant, Novella has dismissed this as noise ....

If I recall correctly, there was a prior paper on asthma where the authors claimed a placebo had an objectively measured effect, not just a subjective one ... if I find time I will track it down.

(I appreciate that you are not suggesting that patients don't take advantage of medical treatment that does have objective effect).

Yes patients should do what works best, in the short and long term.

O'Yeah's assertion was that stress caused ulcers. I am yet to be at all persuaded that this is the case. In and of itself this statement is nonsense.

In isolation, yes, but if you are viewing H. Pylori as the sole factor in developing ulcers, that is too simplistic too because swallowing H.Pylori doesn't always cause ulcers.

In an attempt to prove that the bacteria caused an ulcer Barry Marshall swallowed Helicobacter Pylori culture in 1985 but did not develop an ulcer and only developed a severe case of gastritis – inflammation of the stomach. However the inflammation vanished without treatment.

Helicobacter pylori

Health is a combination of various factors, leading to disease seldom a single isolated cause ... in the case of stomach ulcers, once developed, of course people should take the drugs that kill H. Pylori .... no change of opinion from me on that ... but people should also prevent disease by healthier diet, exercise, avoiding negative stress, etc.

[Interesting Ian]

Originally Posted by porker

OM,

A couple of things then.

Dr Novella is simply stating that although the placebo effect exists to the extent that subjective patient experience may be improved, it has no effect on objective clinical outcomes.

I don't understand what this means. Do placebos have an actually physical influence on the body or not??

[Open Mind]

Originally Posted by Interesting Ian

I don't understand what this means. Do placebos have an actually physical influence on the body or not??

Ian, the materialists do not wish to believe so .... for it weakens their belief body creates mind as one directional process and things like property dualism or interactive dualism which suggest bi-directional processes (i.e. mind changes body too) become more plausible.

So Novella and co. - the political materialists - want to return to the notion a placebo is an imaginary improvement - just like materialism has reduced consciousness to puppet with no causal role, that evolved for no reason

[porker]

Originally Posted by Interesting Ian

I don't understand what this means. Do placebos have an actually physical influence on the body or not??

Well. A true placebo should be pharmalogically inert. So, no, placebos themselves have no physical influence on the body.

If I took one that was invisble, odourless and tasteless when dissolved in water and and spiked your drink with it, you would not notice anything.

Otherwise, it's not a placebo.

However. The placebo effect occurs when I don my white coat and stethescope, and give it to you. I can even tell you it's just a placebo and you may, for a while, feel a little better.

What the paper under discussion says is that as an asthmatic you may even feel it has relieved your symptoms. Sadly (especially for asthmatics, and I am one) it has not relieved anything and another difficult to repair insult has been made to my lungs.

I don't understand why OM is insisting that materialists don't believe this nor how he can use it to bolster his arguments.

[Interesting Ian]

Originally Posted by porker

Well. A true placebo should be pharmalogically inert. So, no, placebos themselves have no physical influence on the body.

If I took one that was invisble, odourless and tasteless when dissolved in water and and spiked your drink with it, you would not notice anything.

Otherwise, it's not a placebo.

However. The placebo effect occurs when I don my white coat and stethescope, and give it to you. I can even tell you it's just a placebo and you may, for a while, feel a little better.

What the paper under discussion says is that as an asthmatic you may even feel it has relieved your symptoms. Sadly (especially for asthmatics, and I am one) it has not relieved anything and another difficult to repair insult has been made to my lungs.

I don't understand why OM is insisting that materialists don't believe this nor how he can use it to bolster his arguments.

If they make you feel better, and if mental states are always correlated with physical states of the brain, then necessarily placebos have a physical influence too.

[porker]

Originally Posted by Interesting Ian

If they make you feel better, and if mental states are always correlated with physical states of the brain, then necessarily placebos have a physical influence too.

You are missing the point.