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

[Open Mind]

Originally Posted by Chris Noble

Did any of these directly compare a placebo group with a matched non-treatment group?

Both these groups arguably have similar placebo responses. I think you are perhaps reading too much into theoretical difference (in clinicians minds) than in the real world medical interaction with patients. If a patient feels 'no treatment' is the correct and proper plan of action for them, is that not also a placebo? Of course it is! Does the doc ever say 'we are not going to give you any treatment to see how much worse you do than others on treatment' ... of course they don't.

A fairer test would be to compare a placebo to nocebo (but of course it would be unethical) i.e. telling patients on one placebo they have a powerful good medicine and in the other giving the placebo telling them it isn't likely to work very well.

Ultimately, one must test doctors expectations. Which brings us back to that trial I want you to do someday Chris I would love to have you on my side of the debate one day

[David Bailey]

Originally Posted by Chris Noble

Did any of these directly compare a placebo group with a matched non-treatment group?.

I have a suspicion that this may be the heart of the problem. Splitting people into two groups and just telling one lot to go home (and not seek out any other treatment!) may be very hard. Probably if you want to test the power of the placebo effect, you really do need to compare it against clinical expectations.

My hunch might be that a lot of studies, like those I quoted, got eliminated because they simply could not deliver a comparison with no treatment.

Certainly, research into the placebo phenomenon seems to resemble parapsychology a lot - lots of observations with meta-analyses that exclude certain observations as unreliable, lots of arguments and different points of view

I would still bet that the best alternative medicine practitioners are very effective at getting the brain to do whatever it does when it thinks the body has received a powerful medicine.

David

[Open Mind]

Originally Posted by David Bailey

I have a suspicion that this may be the heart of the problem. Splitting people into two groups and just telling one lot to go home (and not seek out any other treatment!) may be very hard.

Yes. Also are they told 'do not seek any other treatment' ? If not they could be on some 'alternative' placebo I think to pacify the patient who might be concerned at receiving no treatment, the person interacting with patient is under pressure to say something like 'no treatment is actually required at the present time' and the patient thinks 'ahh, that is good news, the doc says I am doing OK without treatment, he thinks it will improve by itself ' No treatment under certain circumstances could be a good placebo too

[David Bailey]

There are anecdotal accounts of remarkable placebo effects. Since these 'anecdotes' are from doctors, perhaps they are not to be taken too lightly.

I read of a case in which a man with a tumour was offered an experimental drug which the doctor assured him was very effective. The tumour shrank away until the patient read in the newspaper that this particular drug was no longer considered effective. At this point the tumour started to grow again. The doctor then told the patient that he was injecting him with a better version of the drug and that the press report was incomplete. The tumour shrank again, until the unfortunate patient read that the drug had been withdrawn completely. His tumour then grew unchecked and killed him!

The exact details are a bit vague, but the essence of the story is as above.

There is also a joke, which I have seen mentioned in several places, that drugs seem to be most effective shortly after they have been discovered - again presumably because of the placebo effect.

David

[Topher Cooper]

Originally Posted by Chris Noble

Whine, whine, whine.

Sorry, I guess I didn't make myself clear enough -- I have seen the light, I agree completely. When a Skeptic criticizes someone who disagrees with The Truth, or when a Skeptic objects to being held to minimal standards of logic, rationality, science or classical skepticism they are not -- I repeat not -- whining and anyone who thinks otherwise is obviously on the side of Ignorance. This is because the Skeptic is a Champion of Truth, and as such, cannot be held to any such standards.

On the other had The Ignorant -- those who disagree with The Truth -- are whining if they object to whatever standards of proof are demanded, without any logical justification or even demonstration of it being expected in any other circumstance; if they ask for support for whatever the Skeptic proclaims to be True; if they require some real logic or support for the Skeptics proclamations; if they expect to be treated with respect; if they expect a fair, objective evaluation of their claims and the support they provide for them; etc.

The two circumstances are completely different -- in fact polar opposites. Th e Skeptic's position is Truth, pure and simple. There is no need for any standards in support of the Truth -- any purported statement in its support (or equivalently, against statements against it unequivocal acceptance) is unnecessary but if granted should be considered a blessing and met with applause. However weak, irrational, incomplete, unsupported or even contrary to fact such a statement is, it is beyond reproach. On the other hand, since contrary statements are opposed to The Truth, they are therefore, ipso facto, False and Ignorant. No evidence however strong is strong enough to be worth considering, no standards of evidence, however standard elsewhere or exceeding what is standard elsewhere are strong enough, no logic which might be applied to its defense is valid. They deserve only denigration.

So, I agree completely. When you objected to being asked to support your claim, you were not whining. When you accused those who asked for it of "playing a game" you were not whining. When you turned it around and claimed that by requesting that you support your claim that the requesters were making a claim that they were required to support, you were not whining. All this was simply a Skeptic Championing the Truth and was therefore fair, rational, right and elegant. But of course, when I challenged the fairness, rationality and rightness of your statements, I was -- I now fully see -- whining. The only proper response to anything a Skeptic says is unhesitant acceptance, with, perhaps some cheers and applause thrown in.

[alextsakiris]

Originally Posted by David Bailey

There are anecdotal accounts of remarkable placebo effects. Since these 'anecdotes' are from doctors, perhaps they are not to be taken too lightly.

I read of a case in which a man with a tumour was offered an experimental drug which the doctor assured him was very effective. The tumour shrank away until the patient read in the newspaper that this particular drug was no longer considered effective. At this point the tumour started to grow again. The doctor then told the patient that he was injecting him with a better version of the drug and that the press report was incomplete. The tumour shrank again, until the unfortunate patient read that the drug had been withdrawn completely. His tumour then grew unchecked and killed him!

The exact details are a bit vague, but the essence of the story is as above.

There is also a joke, which I have seen mentioned in several places, that drugs seem to be most effective shortly after they have been discovered - again presumably because of the placebo effect.

David

My favorite story on this is from Dr. Andy Weil who would routinely asked his med students to randomly pick any major study off the library shelves and notice that the control group ALWAYS showed some cases of spontaneously healing at least as dramatic as the test group.

[Chris Noble]

Originally Posted by Topher Cooper

Sorry, I guess I didn't make myself clear enough -- I have seen the light, I agree completely. When a Skeptic criticizes someone who disagrees with The Truth, or when a Skeptic objects to being held to minimal standards of logic, rationality, science or classical skepticism they are not -- I repeat not -- whining and anyone who thinks otherwise is obviously on the side of Ignorance. This is because the Skeptic is a Champion of Truth, and as such, cannot be held to any such standards.

Have you finished building your strawman yet?

[Chris Noble]

Originally Posted by David Bailey

I have a suspicion that this may be the heart of the problem. Splitting people into two groups and just telling one lot to go home (and not seek out any other treatment!) may be very hard. Probably if you want to test the power of the placebo effect, you really do need to compare it against clinical expectations.

I don't understand. How are you going to tell if the placebo does something if you don't compare it to a matched group not taking a placebo?

[Chris Noble]

Originally Posted by David Bailey

There are anecdotal accounts of remarkable placebo effects. Since these 'anecdotes' are from doctors, perhaps they are not to be taken too lightly.

The point about anecdotes is not that the people reporting them are unreliable but that the causal connection between the events may be imaginary. The only way to tell is to do some sort of a controlled trial.

There are a huge number of anecdotes about the supposed connection between emotional attitude and cancer survival rates. It has almost become dogma that people with a positive outlook do better. However, well conducted studies find no independent effect due to emotional well-being.

Emotional well-being does not predict survival in head and neck cancer patients

[David Bailey]

Originally Posted by Chris Noble

I don't understand. How are you going to tell if the placebo does something if you don't compare it to a matched group not taking a placebo?

Well testing a real placebo effect against a fake placebo effect is bound to be challenging, isn't it

Seriously, the problem with just dismissing anecdotes, is that you can throw away too much. The collection of circumstances that lead to the account I gave you may be very hard to reproduce - particularly in the modern super-ethical context. People used to scoff at meteorites precisely for the same reason.

A perfectly reasonable man I know, who has some heart problems, told me the other day that if he feels particularly bad, in addition to his standard medicine, he takes a double dose of his homoeopathic medicine. This apparently does the trick! There are millions like him - do we ignore them all as misguided, just because medicines are supposed to operate through the molecules they contain, and homoeopathic medicine doesn't contain any!! In fact I nodded my head and said nothing.

Would my friend have benefited if I had carefully explained that after so many dilutions, his medicine was worthless - maybe even going through the calculation with him? If not, does Richard Dawkins actually help people by campaigning against such remedies? If the answer to both these questions is "No", then wouldn't it make sense to do some serious research to explore how to maximise the placebo effect (or other mind/spirit effects).

David