42. Chris Carter, Parapsychology, Skepticism and Ideology (Podcast)

[David Bailey]

Originally Posted by Chris Noble

Are there any CAM modalities that you think are bullshit?

Acupuncture?
Homeopathy?
Therapeutic touch?
Reiki?
Kinesiology?
Chiropractic?

I fully expect that people will continue to pay lots of money for these treatments but this has little to do with results from well controlled studies.

Well at least you are clarifying your true-believer status.

As I pointed out a while back - these therapies presumably tap into the placebo effect more effectively than orthodox medicine. We know the placebo effect is very real in most medical contexts, though the conventional 'explanation' as to how it works is just a guess.

I suspect part of the problem here is how do you set up double blind trials if the whole essence of the therapy is to use the placebo effect as efficiently as possible.

I don't know which of the above are most effective, but I would be rather surprised if none of them are useful.

David

[Topher Cooper]

Originally Posted by David Bailey

As I pointed out a while back - these therapies presumably tap into the placebo effect more effectively than orthodox medicine.

Well, I certainly am not in any position to question your statement that you presume that. There are certainly a lot of people out there who not only assume it, put vehemently defend that assumption as the only possibility to be allowed in public discourse. Personally, I think that is likely to be true. However, ...

there is a large gap from being more effective at tapping into the placebo effect to operating only through the placebo effect. I wouldn't be surprised, for example, to discover that injecting a drug better taps into the placebo effect than taking the same drug in pill form, but that shouldn't imply that the injections only work (or are only more effective than the pills) because of the placebo effect.

The truth is, it is sometimes difficult to design double-blind studies for complementary medical treatments. When this is nevertheless done, even when they show positive results, the meaningfulness of the results are often argued against by the practitioners because the necessity of isolation required by the tests are in conflict with the system from which the treatment was derived.

[Paul C. Anagnostopoulos]

Originally Posted by Chris

Homeopathy?

The poster child for bullshit. Homeopathy is so completely ridiculous from every angle. The only way we can think it works is to imagine a completely magical world. Yet I suspect its placebo effectiveness is quite high.

~~ Paul

[David Bailey]

Topher,

I think you took what I wrote the wrong way. What I mean is that the existence of the placebo effect is probably an indication of a wholly different form of healing - essentially mentally based - and seen in a watered down form in orthodox medicine.

In other words, I am not trying to denigrate alternative treatments by associating them with the placebo effect - quite the opposite - I am saying that the placebo effect is well established scientifically, but usually considered as an irritation, not as an indication that the mind can heal the body.

David

[Topher Cooper]

Originally Posted by David Bailey

Topher,

I think you took what I wrote the wrong way. What I mean is that the existence of the placebo effect is probably an indication of a wholly different form of healing - essentially mentally based - and seen in a watered down form in orthodox medicine.

In other words, I am not trying to denigrate alternative treatments by associating them with the placebo effect - quite the opposite - I am saying that the placebo effect is well established scientifically, but usually considered as an irritation, not as an indication that the mind can heal the body.

David

No, that's what I thought you meant -- but I think that it does undervalue (not denigrate, but undervalue) possible modes of action. The placebo effect is too often treated as the same as "no real effect at all". It is, instead, the marshaling of the minds own ability to heal, which is clearly powerful medicine.

To presume, though, that these techniques work only or principally via the placebo effect -- that they are, in effect, effective showmanship that convinces the patient to get done what needs doing -- means that any effect that they might have on the body itself will be ignored. Acupuncture for peripheral pain relief, for example, has been pretty conclusively demonstrated to not be a placebo effect. Both acupuncture and hypnosis were effective means of pain relief, for example (hypnosis only in a selected subset, however). The comparison, however, has been done when both were accompanied by either an opiate antagonist or a placebo. The effectiveness of hypnosis was unaffected, but most of the effectiveness of acupuncture disappeared with the real opiate antagonist but not the placebo opiate antagonist. This was a strong indication that acupuncture pain relief operated by directly stimulating the endogenous opioid system.

[David Bailey]

Topher,

OK, I don't really want to argue this point strongly because that was not the point of my original post - which was to point out that there is an elephant in the room that the materialists are trying to ignore.

Even so, I find discussions about the mechanism of effects like this extremely slippery. For example, it could be that the brain responds to acupuncture with a placebo effect that creates an opiate that then gets blocked if you add the opiate blocker! Hypnotism seems a little different anyway, because it creates an altered state of consciousness. This is analogous to discussions about the mechanism involved in various Ψ experiments - are you looking at ESP or precognition of a future time when the subject gets to know his results, etc.

David

[Topher Cooper]

Originally Posted by David Bailey

Even so, I find discussions about the mechanism of effects like this extremely slippery. For example, it could be that the brain responds to acupuncture with a placebo effect that creates an opiate that then gets blocked if you add the opiate blocker! Hypnotism seems a little different anyway, because it creates an altered state of consciousness. This is analogous to discussions about the mechanism involved in various Ψ experiments - are you looking at ESP or precognition of a future time when the subject gets to know his results, etc.

David

A reasonable question. However, the ineffectiveness of opiate antagonists to combat placebo induced pain relief is a very well established result, quite outside the study of complementary medicine. For example, opioids + opioid antagonist = placebo in effectiveness in pain relief. Furthermore, the same "acupuncture works, acupuncture + opioid antagonist doesn't" pattern occurs in animal studies. We would need to hypothesize that there is not one but multiple different placebo effects, triggered distinctly and independently by different kinds of manipulations, also distinguishing real from sham manipulations and with the same effects in animals.

Ultimately you could argue that we cannot know that any medical procedure -- even bone setting and organ transplants -- don't operate a placebo effect, but by that time the concept has gotten stretched so far it is completely meaningless.

[Chris Noble]

Originally Posted by David Bailey

Topher,

I think you took what I wrote the wrong way. What I mean is that the existence of the placebo effect is probably an indication of a wholly different form of healing - essentially mentally based - and seen in a watered down form in orthodox medicine.

In other words, I am not trying to denigrate alternative treatments by associating them with the placebo effect - quite the opposite - I am saying that the placebo effect is well established scientifically, but usually considered as an irritation, not as an indication that the mind can heal the body.

David

The placebo effect is almost completely limited to subjective measures. As soon as you start looking at objective measures like survival the placebo effect shrinks to barely significant or disappears completely. This is why CAM proponents focus on chronic illnesses and psychosomatic complaints. These are exactly the complaints where a large placebo effect is seen.

Scientists do know how to use the placebo effect. Simply tell the patients they are taking some really expensive medicine and they'll report improvements on a variety of subjective measures. You aren't going to cure their cancer but they might report less pain while they die.

[David Bailey]

Originally Posted by Chris Noble

The placebo effect is almost completely limited to subjective measures. As soon as you start looking at objective measures like survival the placebo effect shrinks to barely significant or disappears completely. This is why CAM proponents focus on chronic illnesses and psychosomatic complaints. These are exactly the complaints where a large placebo effect is seen.

Scientists do know how to use the placebo effect. Simply tell the patients they are taking some really expensive medicine and they'll report improvements on a variety of subjective measures. You aren't going to cure their cancer but they might report less pain while they die.

OK - this is more a plea for some facts/explanation - so please treat it seriously.

Why is it that just about every medical trial uses controls? Why can't you just say cancer X has 58% fatality with current best treatment, so lets try new compound Y and determine if we can do better. There have been huge rows in the USA particularly because potential AIDS drugs are not just tried on people, they go through double blind trials, so some people don't get treated - again, if the placebo effect is relatively unimportant, why is research on fatal diseases done that way?

Do you have some actual numbers or references?

Maybe it would be worth having a separate thread just to discuss placebo effects, because to me they are central - they offer copious evidence that there are 'alternative' ways to cure, and make alternative therapies far more plausible.

David

[Larry Boy]

Originally Posted by David Bailey

if the placebo effect is relatively unimportant, why is research on fatal diseases done that way?

I don't think anybody here has said the placebo effect is "relatively unimportant", they have just distinguished between potential real effects of CAM and the placebo effect.