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Thread: homeopathy, the placebo effect, and mainstream medicine.

  1. #61
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    Quote Originally Posted by grant hutchison View Post
    ...So being told about the side effect increased the chance of experiencing it 10-fold.
    That's pretty remarkable, but it isn't nearly as surprising if the side effect were something like one's hair turning green. The psychological aspects of ED are likely fairly strong. It's not like you would tell them something like, "Dinna fash yirsel!" and they would take your advice to heart. [Did I get it right? I miss my mentor Angus McKay, I suppose.]

    So we have a couple of conflicting directives here. As physicians we must respect the autonomy of our patients, and therefore provide them with full information to make their own decisions. But we also have primum non nocere ("first do no harm"), which was part of my "Hippocratic Oath" even though Hippocrates never said it. So having respected the patient's autonomy by telling him about the danger of erectile impotence that comes with the beta blocker, do I then tell him that this information is potentially harmful, and he'd be better off not thinking about it? Or do I withhold the information on the grounds that the knowledge is itself more harmful than the drug?
    If I were your patient, I think I would enjoy learning of the above ED story, do the surgery, take a counter ED pill (placebo should work, ), and follow the advice from Angus, "You're a long time deid" ("Enjoy life while you can because once you're dead you're going to be that way for a long time!"), though probably not the best saying for hospital practice.

    Back in the days when physicians and patients were treated like grown-ups, I used to get to the end of the stuff I thought the patient really needed to know, and then I'd fix them with a level gaze and would say: "That's the end of my usual story. I can tell you more about the dangers of this surgery and anaesthesia, and I am very willing to do so. Is there anything else you want me to talk about?" Usually they'd so No, and sometimes they'd say Yes. And we'd take it from there. And a lot of how that went would depend on how well I had established a relationship of trust and honesty in the foregoing fifteen minutes or so.
    That sounds perfect and practical. Perhaps further studies will give added ballast to doctors to help "right the ship".

    To me, you can't legislate this stuff - it's about the personal relationship between two people, one of whom is putting their life and well-being into the hands of another. (But then, I'm a dinosaur.)
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    Quote Originally Posted by gzhpcu View Post
    I wonder about the influence of positive thinking and a positive attitude.
    What should we expect from millions of years of survival partly based on social interaction. Don't we think mechanisms like this would not have evolved?
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    Quote Originally Posted by gzhpcu View Post
    I wonder about the influence of positive thinking and a positive attitude.
    Studies are actually starting to show that forcing people to have a positive attitude instead of letting them actually be scared or sad or angry is bad for them.
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    Quote Originally Posted by Copernicus View Post
    What should we expect from millions of years of survival partly based on social interaction. Don't we think mechanisms like this would not have evolved?
    Sure, positive persons live longer.
    Last edited by gzhpcu; 2017-Dec-27 at 06:00 PM.

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    Quote Originally Posted by Gillianren View Post
    Studies are actually starting to show that forcing people to have a positive attitude instead of letting them actually be scared or sad or angry is bad for them.
    You can not force a person to be positive. Either you are or you are not. Just like you can not teach a sense if humor to a humorless person.

  6. #66
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    Quote Originally Posted by gzhpcu View Post
    You can not force a person to be positive.
    Agree.

    Quote Originally Posted by gzhpcu View Post
    Either you are or you are not.
    Strongly disagree. The most morose can be encouraged to be posotive. They can be shown the benefits of a positive attitude. They can be given guidance on how to attain, then maintain positivity. The disadvantages of a negative view can be demonstrated. No one is forever constrained within the mindset they have developed by maturity.

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    Gillian is correct, but it's not even as extreme as forcing anyone. Encouraging the morose to be positive, and showing them the benefits of a positive attitude, can actually be deeply undermining - now they know that a positive attitude can have health benefits, and that people want them to have a positive attitude, but they still don't have one. It's profoundly depressing, and can have adverse health outcomes.
    Looking on the bright side is also a fine way to allow your life to go to hell, if it means you avoid acknowledging problems that actually need to be addressed. There are circumstances in which an attitude of "defensive pessimism" is actually adaptive, and "cheerful optimism" is maladaptive, leading to worse outcomes in the long term.
    Evidence has been accumulating over the last decade to suggest that the benefits of a positive attitude have been rather overstated.

    A search phrase that wil turn up useful information is "Tyranny of the Positive Attitude", which I believe was coined by Heid in 2002: The tyranny of the positive attitude in America: observation and speculation.

    Grant Hutchison
    Last edited by grant hutchison; 2017-Dec-27 at 08:01 PM.
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    Quote Originally Posted by grant hutchison View Post
    Gillian is correct, but it's not even as extreme as forcing anyone. Encouraging the morose to be positive, and showing them the benefits of a positive attitude, can actually be deeply undermining - now they know that a positive attitude can have health benefits, and that people want them to have a positive attitude, but they still don't have one. It's profoundly depressing, and can have adverse health outcomes.
    As someone who is not a particularly positive person (I wouldn't go as far as morose), I can completely believe it.

    An interesting TED talk about how stress and thinking about stress affects your health.


    But while stress has been made into a public health enemy, new research suggests that stress may only be bad for you if you believe that to be the case. Psychologist Kelly McGonigal urges us to see stress as a positive, and introduces us to an unsung mechanism for stress reduction: reaching out to others.
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    Quote Originally Posted by grant hutchison View Post
    Gillian is correct, but it's not even as extreme as forcing anyone. Encouraging the morose to be positive, and showing them the benefits of a positive attitude, can actually be deeply undermining - now they know that a positive attitude can have health benefits, and that people want them to have a positive attitude, but they still don't have one. It's profoundly depressing, and can have adverse health outcomes.
    "You should be happy! Look at all you've got and accomplished!".
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    I do wonder if there isn't a confounding variable connecting "positive attitude" and "health benefits", in the form of social support, which we know is a significant reducer of stress and its associated "inflammageing".
    Many of the studies connecting positivity with health outcomes were conducted in the USA, where an unrelentingly positive attitude is perhaps more strongly rewarded with social support than it is in, say, my part of the world. (I have vivid memories of a young Californian medical student who found herself socially isolated for the first time in her life when she spent a few months attached to my medical school, back in the 1970s. Her endlessly enthusiastic positive approach to everything around her made her extremely unpopular with her new Scottish and English colleagues, to the extent that people avoided her at mealtimes and during lab work, and stopped inviting her to social occasions. I'm afraid I've only understood the problem with the benefit of long hindsight - sadly, I think the poor woman had a pretty miserable experience and, IIRC, went home early from her attachment.)

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    some people, like me, have had a negative attitude as just a habit, so in some cases levering someone out of such a habit can be a positive thing, but it wouldn't work with people who were genuinely down.
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    2008 Nobel prize winner Prof Luc Montagnier will address next year the House of Lords and the Royal Society of Medicine on new evidence that Homeopathy is clinically effective for scientific reasons, and that it is not a placebo: "Undoubtedly the most significant scientific discovery in sub-molecular dilutions since Dr Hahnemann".
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    Quote Originally Posted by wd40 View Post
    2008 Nobel prize winner Prof Luc Montagnier will address next year the House of Lords and the Royal Society of Medicine on new evidence that Homeopathy is clinically effective for scientific reasons, and that it is not a placebo: "Undoubtedly the most significant scientific discovery in sub-molecular dilutions since Dr Hahnemann".
    "Sub-molecular dilutions"=dilutions until no molecules are present. Of course this is absurd, it's a lot of work to do that much dilution and no doubt essentially no one ever actually does it. And for good reason: they know it's pointless effort, the patient will never know and the outcomes will never be affected. What's more, in some cases the molecule in question will already be present in the water used, so dilution beyond some point is clearly a fool's errand. I'm afraid some Nobel prizewinners have a tendency to go off the deep end in their later years, but this is not one to wait for.

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    The main "aha" for me in this thread is Grant's point that we are not necessarily choosing between real medicine versus placebo medicine, but rather, real medicine with a placebo effect versus just placebo effect without real medicine. So there's actually nothing "alternative" in alternative medicine, except that they don't use any real medicine, and they have fewer constraints that could limit their ability to apply placebo medicine to its full effect. Removing those limitations allow them to deceive their patients (in the way homeopathic remedies deceive people about how they are actually prepared, which I'm pretty sure amounts to filling them out of a spigot), so that unfetters their placebo effectiveness, but also ushers in the tragedies of patients receiving false information that leads them to make poor decisions about their health. "It works if you think it will work" is not necessarily true, rather, "it works better if you think it will work, but there might be other treatments that work better anyway." What's more, mainstream medicine has access to placebo effects that alternative practitioners can only dream of, if the mainstream personnel would only learn to use them to their full efficacy (large staff, serious clothing, big buildings, fancy equipment, etc.).
    Last edited by Ken G; 2017-Dec-28 at 04:09 PM.

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    Quote Originally Posted by wd40 View Post
    2008 Nobel prize winner Prof Luc Montagnier will address next year the House of Lords and the Royal Society of Medicine on new evidence that Homeopathy is clinically effective for scientific reasons, and that it is not a placebo: "Undoubtedly the most significant scientific discovery in sub-molecular dilutions since Dr Hahnemann".
    Well, it's stated that he'll have dinner at the House of Lords, which is a thing you can do without anyone at the House of Lords knowing you exist, let alone listening to what you have to say.
    And this "Montagnier Seminar" is curiously absent from the RSM's official list of events. In any case, talking at a meeting held using the facilities of the RSM is not the same thing as "addressing the RSM" - you stand in a room on the Royal Society of Medicine's premises and address anyone who's prepared to pay to come and hear you talk. And the RSM is not to be confused with the Royal Society. They are unrelated, and you can buy a fellowship of the RSM for a few hundred pounds a year.
    (I get the feeling Lord Aaron Ward-Atherton (a registered nurse who seems to have bought his listed lordships for a few thousand pounds) is trying to make the event seem rather more impressive than it actually is.)

    Grant Hutchison
    Last edited by grant hutchison; 2017-Dec-28 at 06:02 PM. Reason: bracketed
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    Quote Originally Posted by Mudskipper View Post
    some people, like me, have had a negative attitude as just a habit, so in some cases levering someone out of such a habit can be a positive thing, but it wouldn't work with people who were genuinely down.
    In 1989, Steven Tyler was on an '80s retrospective on MTV. He said, and I remember this vividly, "Saying 'Just Say No' to a heroin addict is like saying 'Just cheer up' to a manic depressive." I've wondered ever since if he's aware just how often people do that.
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    Quote Originally Posted by grant hutchison View Post
    W(I get the feeling Lord Aaron Ward-Atherton ... is trying to make the event seem rather more impressive than it actually is.)
    Apparently if you dilute the facts down enough the story becomes much more effective.

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    I should probably support my statement about Lord Ward-Atherton:
    His CV
    A list of titles offered for sale by Strutt & Parker in 2002 (see post by Sean J. Murphy)
    The "Fake Titles" website concerning Strutt & Parker's sales

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    Quote Originally Posted by grant hutchison View Post
    I should probably support my statement about Lord Ward-Atherton:
    His CV
    A list of titles offered for sale by Strutt & Parker in 2002 (see post by Sean J. Murphy)
    The "Fake Titles" website concerning Strutt & Parker's sales
    From your second link, regarding a certain purchase of Lordship title, I enjoyed the subsequent post stating,

    "There is not one scrap of land which can be said to
    offer any "rights" to a feudal lord of the manor and quite frankly if
    you mentioned to the vast majority of the residents of this estate
    that you were their feudal lord, you would be told in no uncertain
    terms where to go!! 8000 for that !"

    For the buyers, I would suspect, nevertheless, that there are both an analogous placebo (acquired title) and a nocebo (if the Lordship visits his/her subjects) effect here. Perhaps there are stars named after some of the titles. Ug.
    Last edited by George; 2017-Dec-28 at 08:54 PM.
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    So where does the placebo effect place with biofeedback and cerebral plasticity?
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    (John, not the other one.)

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    Quote Originally Posted by Ken G View Post
    mainstream medicine has access to placebo effects that alternative practitioners can only dream of, if the mainstream personnel would only learn to use them to their full efficacy (large staff, serious clothing, big buildings, fancy equipment, etc.).
    Funnily enough, perhaps part of the actual placebo effect in mainstream medicine is its denial of the placebo effect.
    By taking a mechanistic approach to healing, understood as physical chemical reactions and operations, with no soul involved, modern medicine gives the comforting message that its approaches are based on evidence rather than faith.
    To patients acculturated to value reason, the exclusion of placebos validates medical methods by excluding quackery.
    But the implicit idea that health has causality like a game of billiards ignores some key lessons of psychology, that our minds and bodies are intimately entwined.

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    Quote Originally Posted by Robert Tulip View Post
    Funnily enough, perhaps part of the actual placebo effect in mainstream medicine is its denial of the placebo effect.
    Yes you have a point-- perhaps people who don't believe in the placebo effect get a stronger placebo effect from evidence based medicine, an ironic flip side of the coin of people who are not impressed by evidence receiving more benefits from alternative medicine. Maybe that's why alternative medicine practitioners are never the ones doing the clinical studies that show that in some situations alternative medicine is better than no treatment-- their patients are the ones who don't care about studies anyway! While for the others, perhaps a good strategy for doctors is to actually produce a stack of papers and say "here are the studies that show the treatment I'm giving you is effective." Would it kill them to think of that?
    Last edited by Ken G; 2017-Dec-29 at 05:00 AM.

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    yes, one of the points I was going to make was that by including homeopathy within NHS treatment options might weaken the confidence some people had in the NHS, and so weaken the placebo effect, for mainstream treatment, for some.
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    Quote Originally Posted by Robert Tulip View Post
    Funnily enough, perhaps part of the actual placebo effect in mainstream medicine is its denial of the placebo effect.
    I didn't think that mainstream medicine denies it. I think that Grant's posts show that it accepts it. And when you do clinical studies, you have to do things like double blinds to try to account for or minimize the placebo effect.

    Quote Originally Posted by Robert Tulip View Post
    But the implicit idea that health has causality like a game of billiards ignores some key lessons of psychology, that our minds and bodies are intimately entwined.
    I don't think that it is anti-mainstream to say that our minds and bodies are intimately entwined. In a lot of places, I think that mainstream medicine is empirical rather than based on theories. If something works, you use it, and scientists try to figure out why but it's not the key. There are many treatments that work but nobody knows why they work, and people are still trying to figure out. I don't think that anesthesia is really understood. I read an interesting paper earlier this year arguing that electron spins might be key to anesthesia, but that's somebody's theory. In general we use it because it works.
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    Quote Originally Posted by Jens View Post
    I didn't think that mainstream medicine denies it. I think that Grant's posts show that it accepts it. And when you do clinical studies, you have to do things like double blinds to try to account for or minimize the placebo effect.


    I thought he meant denial by the patient. The patient believes so strongly in the ordinary effects of the treatment, that a placebo effect is stronger.
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    There is a difference between believing in the placebo effect as an hypothesis and believing in your doctor, homeopath or indeed trusted friend. Witch doctors were effective long before the word placebo was coined. It can also be called expectancy effect, and the way it was downplayed in earlier times hid the rather amazing strength of the effect. It does not mean it is the only way we react of course.
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    I suppose it is also like the power of suggestion.
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    Quote Originally Posted by Mudskipper View Post
    I suppose it is also like the power of suggestion.
    I have seen pain removed by suggestion so I guess believing a pill can do the same is related. But placebo can go further than controlling pain into the immune system for example and into those telomeres too. Placebo goes beyond individual treatments into wellbeing ideas. For example true relaxation is good for you! How much is due to something related to placebo and how much to mechanistic physiology?
    sicut vis videre esto
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    someone once told me something about plants. Has it ever been tested where someone is told that one bottle of water contains a fertiliser, and another is just water, and they water two plants, and the one with the supposed fertiliser grows larger?
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    placebo effects seem to be apparent in dog:

    The placebo effect is a well-recognized phenomenon in human medicine; in contrast, little information exists on the effect of placebo administration in veterinary patients.
    HYPOTHESIS:

    Nonpharmacologic therapeutic effects play a role in response rates identified in canine epilepsy trials.
    ANIMALS:

    Thirty-four dogs with epilepsy.
    METHODS:

    Meta-analysis of the 3 known prospective, placebo-controlled canine epilepsy trials. The number of seizures per week was compiled for each dog throughout their participation in the trial. Log-linear models were developed to evaluate seizure frequency during treatment and placebo relative to baseline.
    RESULTS:

    Twenty-two of 28 (79%) dogs in the study that received placebo demonstrated a decrease in seizure frequency compared with baseline, and 8 (29%) could be considered responders, with a 50% or greater reduction in seizures. For the 3 trials evaluated, the average reduction in seizures during placebo administration relative to baseline was 26% (P = .0018), 29% (P = .17), and 46% (P = .01).
    CONCLUSIONS AND CLINICAL IMPORTANCE:

    A positive response to placebo administration, manifesting as a decrease in seizure frequency, can be observed in epileptic dogs. This is of importance when evaluating open label studies in dogs that aim to assess efficacy of antiepileptic drugs, as the reported results might be overstated. Findings from this study highlight the need for more placebo-controlled trials in veterinary medicine.
    https://www.ncbi.nlm.nih.gov/pubmed/19912522
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