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

  1. #181
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    Quote Originally Posted by Swift View Post
    How?

    First, how does the customer know how much the person preparing the homeopathic thing "believes" in the process? Is this "belief" somehow carried along in the process?

    Or are you saying that it is only the amount of belief of the people the customer actually interacts with? So, I go into a homeopathic store, the clerk is having a bad day and is annoyed at everything, and suddenly the products won't work for me? Something I've taken for years will stop working because I now have some doubts? Actually, that might be correct, but that is an awfully fragile system of treatment.

    Everyone clap real hard, or Tinkerbell will die.
    there are cases where a person who started getting better from a cancer under presumably a placebo effect and belief, was told later the "drug" was a failure and relapsed immediately. Of course such things can happen without invoking placebo but people told an expected death date tend to comply and die on time. But there is hope that we can get to understand the mechanism better and use it without tricks.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  2. #182
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    Quote Originally Posted by Swift View Post
    How?

    First, how does the customer know how much the person preparing the homeopathic thing "believes" in the process? Is this "belief" somehow carried along in the process?

    Or are you saying that it is only the amount of belief of the people the customer actually interacts with? So, I go into a homeopathic store, the clerk is having a bad day and is annoyed at everything, and suddenly the products won't work for me? Something I've taken for years will stop working because I now have some doubts? Actually, that might be correct, but that is an awfully fragile system of treatment.

    Everyone clap real hard, or Tinkerbell will die.
    It works in real medicine. Patients get larger placebo effects if the drug is administered by a doctor who is confident and relaxed than from one who is rushed, unengaged and non-commital. And we make very quick judgements about "trustworthiness" from facial expressions and body posture when we first encounter someone - a few hundred milliseconds.
    When I used to lecture about the applicability of the placebo effect to real medicine, I had a slide entitled, "Sincerity. If you can fake that you can fake anything." I would encourage the members of my audience to try not to visit patients for the first time when rushed, stressed or angry, because we know people pick up on those cues, and we know it degrades their confidence and therefore the placebo effect.
    What face-to-face con artists do well is radiate the subliminal signals that drive people towards trusting them, but most people can't do that. So believing what you're saying will generally enhance the placebo effect you're delivering.

    And I'd say that most medical practioners will have had the experience of running into some sort of confidence crisis in a patient they've been seeing for years, followed by an upsurge in symptoms, which are then controlled by transferring the patient to a new doctor they have developed more faith in.

    Grant Hutchison
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  3. #183
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    Quote Originally Posted by SkepticJ View Post
    Hmmm. How about, "Why do homeopaths only use homeopathic dilution to create medicine? Shouldn't the phenomenon, if real, be generalizable to other applications? For example, homeopathic dilutions of food would end world hunger. Homeopathic gasoline could fuel cars. The more diluted it gets, the greater the energy density."
    Well, apart from the dilution principle, there are other two principles given as underlying homeopathy:
    1) Like cures like - what a substance can cause it can also treat
    2) Disease symptoms are part of the "vital response", exhibited as the body seeks to return to normal health

    So homeopaths, by administering this special solution of a substance that can cause the patient's symptoms, assist the vital response in restoring normal health.

    It's a kind of magical thinking, arising from the "Law of Similars" in ritual magick.

    So I think a homeopath would respond that there isn't a substance that causes starvation or "empty fuel tank", any more than there's a substance causing "missing leg" in an amputee, hence there's no potential for a homeopathic cure. The cure for "no food" is food; the cure for "no petrol" is petrol.

    Grant Hutchison
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  4. #184
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    one very interesting aspect is the conditioned response. Various trials have used an active drug then switched to a placebo pill after getting a change. Remarkably the patient continues to benefit and produces the hormones or proteins that the drug caused. In that case placebo is a learning experience within the body chemistry.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  5. #185
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    Quote Originally Posted by profloater View Post
    one very interesting aspect is the conditioned response. Various trials have used an active drug then switched to a placebo pill after getting a change. Remarkably the patient continues to benefit and produces the hormones or proteins that the drug caused. In that case placebo is a learning experience within the body chemistry.
    I've never heard of such a thing. Do you have a reference?
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  6. #186
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    Quote Originally Posted by grant hutchison View Post
    It works in real medicine. Patients get larger placebo effects if the drug is administered by a doctor who is confident and relaxed than from one who is rushed, unengaged and non-commital.
    Just to add one comment about that: this is why the "gold standard" for clinical trials is so-called "double blind trials," where neither the patient nor the administrating doctor knows whether the patient is receiving real medicine or placebo.
    As above, so below

  7. #187
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    Quote Originally Posted by Swift View Post
    I've never heard of such a thing. Do you have a reference?
    I gave one earlier in this thread. Neuropharmacological dissection of placebo analgesia: expectation-activated opioid systems versus conditioning-activated specific subsystems.
    We investigated the mechanisms underlying the activation of endogenous opioids in placebo analgesia by using the model of human experimental ischemic arm pain. Different types of placebo analgesic responses were evoked by means of cognitive expectation cues, drug conditioning, or a combination of both. Drug conditioning was performed by means of either the opioid agonist morphine hydrochloride or the nonopioid ketorolac tromethamine. Expectation cues produced placebo responses that were completely blocked by the opioid antagonist naloxone. Expectation cues together with morphine conditioning produced placebo responses that were completely antagonized by naloxone. Morphine conditioning alone (without expectation cues) induced a naloxone-reversible placebo effect. By contrast, ketorolac conditioning together with expectation cues elicited a placebo effect that was blocked by naloxone only partially. Ketorolac conditioning alone produced placebo responses that were naloxone-insensitive. Therefore, we evoked different types of placebo responses that were either naloxone-reversible or partially naloxone-reversible or, otherwise, naloxone-insensitive, depending on the procedure used to evoke the placebo response. These findings show that cognitive factors and conditioning are balanced in different ways in placebo analgesia, and this balance is crucial for the activation of opioid or nonopioid systems. Expectation triggers endogenous opioids, whereas conditioning activates specific subsystems. In fact, if conditioning is performed with opioids, placebo analgesia is mediated via opioid receptors, if conditioning is performed with nonopioid drugs, other nonopioid mechanisms result to be involved.
    Just giving someone a placebo analgesia triggers the usual endogenous opioid system that mediates the placebo analagesic response (demonstrated by the fact it's reversible with naloxone).
    Conditioning someone with real opioid analgesic and then replacing with placebo also produces an endogenous opioid response (demonstrated by the fact it's reversible with naloxone).
    Conditioning with a non-opioid analgesic and then replacing with placebo produces a non-opioid placebo response (which can't be reversed by nalaxone).
    Benedetti provides other examples in his books The Patient's Brain and Placebo Effects - modulation of specific components of the immune system is the most striking example.

    Grant Hutchison
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  8. #188
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    Quote Originally Posted by grant hutchison View Post
    "Sincerity. If you can fake that you can fake anything."
    I'll bet that got some laughs!
    What face-to-face con artists do well is radiate the subliminal signals that drive people towards trusting them, but most people can't do that. So believing what you're saying will generally enhance the placebo effect you're delivering.
    Not just con artists, also everyday salespeople (if you think there is a difference). A commonly taught principle of salesmanship is to believe in your own product. You start by intentionally deceiving yourself, so that you can then sell to (and sometimes, deceive) your potential customer. This would also seem to be a central principle in alternative medicine, and like you say, doctors have something to learn from it as well.

  9. #189
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    Quote Originally Posted by WaxRubiks View Post
    I would think that if the people preparing and selling the homeopathic water believe in the process, that should lead to a greater placebo effect.
    But I'm talking about over-the-shelf homeopathic remedies, which are, of course, expensive water. The people selling them don't know anything about them, it's a checkout person. Yet those products are found in almost any grocery store pharmacy, without prescription. So someone is making a buck by bottling water and cashing in on the good karma produced by actual placebo pracitioners on the ground in alternative medicine clinics. None of that good karma is produced by the homeopathic remedy makers-- they contribute nothing but the bottle it's in, and do not strengthen anyone's faith in placebos, they are kind of like placebo parasites. It would make more sense for placebo practitioners to say wave your arms over your head and say "humuhumunukunukuapuaa" to get the curative benefits, at least that's free.

    The charlatan is the person who accepts money for something that can be obtained elsewhere for free. That's why we should always ask ourselves, whenever we are being paid for anything, could the client receive this exact same service for free? If they could, we are charlatans too, so we must endeavor to be sure we are providing something more.
    Last edited by Ken G; 2018-Jan-25 at 02:29 AM.

  10. #190
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    Quote Originally Posted by Ken G View Post
    Not just con artists, also everyday salespeople (if you think there is a difference). A commonly taught principle of salesmanship is to believe in your own product. You start by intentionally deceiving yourself, so that you can then sell to (and sometimes, deceive) your potential customer. This would also seem to be a central principle in alternative medicine, and like you say, doctors have something to learn from it as well.
    I recently bought a new car. I browsed around various manufacturers, and ended up coming back to a showroom I'd visited a month previously.
    The salesman on duty was the one I'd spoken to before. As soon as he saw me, he came over confidently, smiled, greeted me by name, and named the vehicle I'd been interested in. I was so struck by the placebo effect he was using (appear in control, remember the patient's name, remember the medical history) that I shook his hand and said, "Well done!"
    At which point he blew the whole effect by looking completely panicked and weirdly murmuring, "Well done ..." in return.
    Still a long way to go, there.

    Grant Hutchison
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  11. #191
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    It is often said that a sale always occurs, it is just not always done by the salesman.

  12. #192
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    maybe it is a side issue, but I read something about sales on the wiki page on cognitive dissonance, whereby people who were paid nothing to sell something fake(I think it was, or not very good) had dissonance about trying to sell it, and so they counteracted this by trying to believe they were doing a decent thing, whereas the people who were paid to sell the same product, didn't have so much dissonance as they were being paid, so they could pass the dissonance/blame onto the people who were paying them, and so didn't have to believe in the product, and so didn't do such a good job of sales people....

    Something like that anyway. It was a few years ago I read the page.
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  13. #193
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    Quote Originally Posted by Ken G View Post
    It is often said that a sale always occurs, it is just not always done by the salesman.
    Wow. I've never heard that. I love it and will likely use it often.

    cheers,

  14. #194
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    At night the stars put on a show for free (Carole King)

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  15. #195
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    Of course, we do actually have placebo blockers, and we have actually done that study.

    Grant Hutchison
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  16. #196
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    I'd say it all boils down to the fact that if we claim no knowledge of the mechanism by which a medicine acts, then medicines are defined entirely by their testable effects. In short, everything becomes a medicine, some are just more effective than others. Furthermore, the situation in which the medicine is administered is also part of the medicine. Then there's no such thing as a "placebo," there are just cheaper and more expensive medicines to manufacture, more and less effective medicines, and more and less effective modes of applying them. What emerges as the only important thing is the testing. If we claim no understanding of the mechanisms, we have only the trials to go on. And that's pretty much all we do have to go on, because we are so often stymied in our attempts to understand the mechanisms!

    One wonders if the mechanisms often described for medicines might themselves be a kind of placebo effect, where a mechanism only seems to explain what is happening if you believe it explains what is happening. Perhaps medicine needs a "shut up and test" school, akin to the "shut up and calculate" school in physics. Of course, not shutting up is the basis of the placebo effect, so we are back where we started! (That's OK, there isn't really a "shut up and calculate" school in physics either...)
    Last edited by Ken G; 2018-Feb-13 at 02:29 AM.

  17. #197
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    Hippocrates: “Let food be thy medicine and medicine be thy food.”
    Formerly Frog march.

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  18. #198
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    This video sums it up nicely: https://youtu.be/8HslUzw35mc

  19. #199
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    Quote Originally Posted by gzhpcu View Post
    This video sums it up nicely: https://youtu.be/8HslUzw35mc
    yes agreed, I watched it. It's a cartoon presentation originating from Germany, supports the idea of placebo
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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