Destroying the placebo effect

[Junior Spaceman]

This is a question with a few different moral and scientific angles, and it's one that I need to act on, so I hope there can be some reasonable discussion.

There is a person I know who is in his mid-sixties, who is quite unwell. He has diabetes and a number of problems related to this, and recently he has had problems with his kidneys. His doctor told him that he will need to prepare for dialysis any week now.

He and his wife were at a party not long ago, and someone recommended a homeopath, who had apparently had miraculous results with different people she knew. So this man went to the homeopath, in the hope that there would be some way to stop him needing to go in for dialysis three times a week. His 'treatment' consists of the usual pills and drops in water, and so far (it's been about six weeks), he seems to be at least staying steady, and he hasn't needed dialysis.

I was talking to his wife, and commenting that I don't hold much stock in homeopaths, naturopaths, etc (I kept getting an answer something like 'oh, it's naturopaths who are the charlatans, homeopaths know what they're doing'). I'd just been reading an article linked to from this very message board about the problems with the theory behind heavily diluted medicine, so I had lots of material.

My question is, whether I should push the issue with him and his wife. I think they're wasting money, time and energy by going to a homeopath, and although they're keeping in touch with their real doctor and not throwing away other medication, I still feel scared about the effect this might have on him. On the other hand, if there is a placebo effect which is, at worst, making him feel better, am I being terrible by making them lose faith in what might help a little?

So what should I do - let ignorance reign and give him a chance to be happy for a while, or stamp out his hopes of a natural cure?

[Gatopescado]

Some studies support the placebo effect as genuine, so, ergo it is a "valid treatment". Check out "The Wonder Pill" at www.pbs.org for more info.

I figure, if it helps, why not? On the other hand, I really hate wasting money. It would be a shame for someone's condition to deteriate while pursueing "fake" treatments when they could be getting "real" treatments.

Tough call.

_______________
Fagjunk Theology: Not just for sodomite propagandists anymore.

[Apos]

I think the water coming out of my facuet "remembers" being salt water once... so shouldn't drinking it dehydrate me?

Seriously though, if all that's being wasted is time and money (not health), i can think of a lot worse things it could be spent on than something that apparently gives them a good feeling, even if nothing else.

[Bippy the Beardless]

The Placebo effect can be very effective :) so denying someone access to it would be bad. But it should never be expensive, and should be used in conjunction with actual medicines if there are any.
I used to read a lot of medical research papers on how a new treatment is tested against control groups of those receiving Placebo's and those receiving no treatment. It always seemed that the placebo group did better than the non-treatment group. So go for it with the homeopathy ( = Placebo ) but do the conventional medical stuff as well.
Cheers, Bippy

[Kalt]

Go find a PDR and look at the #'s from all the double-blind studies of each medicine (where a real pill is compared to a placibo vis a vis different symptoms/complaints from the subjects). The placebo effect is quite powerful. If someone believes that some snake oil is making them better, then as long as they're not endangering themselves I wouldn't worry about it.

[december]

However, a recent Danish study says the "placebo effect" has little effect. (http://www.angelfire.com/punk/lymedisease/Iplacebo.html)Surprising new evidence has called into question the existence of the "placebo effect," the widely accepted principle that people with various illnesses will often improve if given a dummy pill or a sham treatment.

For a half-century, doctors have been taught that this phenomenon is partly responsible for drugs' effectiveness. Researchers have taken it into account when testing new medicines. Biologists and psychologists have searched for its cause. Ethicists have even debated whether doctors could justifiably deceive patients to take advantage of it.

But in the most comprehensive effort yet to evaluate whether placebos work, Danish researchers conclude that they have little effect after all and should not be used outside research settings.HenrySpencer, I think you should encourage your friends to get real medical care and to shun the quacks.

[ProjectOmega]

Well, I had my doubts about homeopathic medicines, but my mom's really into them, who was in turn gotten into it by a friend of hers that moved from South Africa.

They work. There is no placebo effect. They honestly do everything they're touted to do. I have no friggin' clue HOW they do it, but they do. All you do is dissolve under your tongue a little sugar pill that's been soaked in an incredibly diluted natural substance.

How do I know it's not a placebo effect? Well, for one thing, they work for animals. My mom's friend from South Africa had a cat that was hit by a car. Instead of bringing it to the vet, she simply gave it the appropriate pills and it was up and about in weeks. She had a dog that developed some form of cancer. While the pills couldn't cure it, they did help suppress these digusting sores on its skin. With regular dosage, the sores would be kept to minimal size, but if she missed a dose, they would bloom and explode, creating an ungodly stench. We give them to our cat to get rid of his worms, and it works every time. That doesn't sound like a placebo to me.

Needless to say, homeopathics work on humans too. I haven't been bed-ridden with illness for two years. I've had cuts and bruises disappear with astonishing speed. When I was in high school, my mom gave them to me to perk me up and shake off some of my normally sombre mood. While that last one may scream "placebo", I'd give it the benefit of the doubt since there are so many visible effects of the various pills.

There are a couple downsides to homeopathy. First, it's expensive. A vial of those little white balls will cost you quite a few bucks. Second, it's not exactly as easy as taking a Tylenol. You have to figure out what your chemical disposition is and then crossreference that to whatever you're trying to do. In other words, pills that do something for one person may have no effect, or an entirely different effect on someone else. It's a complex system and you'll probably need someone well-learned in the mechanics of it to get you started.

[RexDart]

As a faithful reader of Skeptical Inquirer, allow me to just inform that poster of the conventions in discussing something like this...

ProjectOmega, around here you probably need to provide several links to scientific studies if you want to argue that a form of alternative medicine works. While I doubt that cats could benefit from a placebo effect, there could by any number of reasons the cat recovered, so one isolated incident isn't very good proof. Considering that the general opinion of those in the know is that all these alternative medicines are naught but quackery, you have a higher burden of proof than merely anecdotal evidence can provide.

[scr4]

Originally posted by ProjectOmega
How do I know it's not a placebo effect? Well, for one thing, they work for animals.
That's not a valid proof. Placebo effect can work on animal owners.

[ProjectOmega]

Originally posted by RexDart
ProjectOmega, around here you probably need to provide several links to scientific studies if you want to argue that a form of alternative medicine works. While I doubt that cats could benefit from a placebo effect, there could by any number of reasons the cat recovered, so one isolated incident isn't very good proof. Considering that the general opinion of those in the know is that all these alternative medicines are naught but quackery, you have a higher burden of proof than merely anecdotal evidence can provide.

Well, I honestly don't want to bother with all the trouble of sifting through hundreds of wacky communing-with-the-animal-spirit websites, so you can take my experiences with homeopathy as you like. Trust me, I'm as skeptical as you get when it comes to "alternative" medicine. I made fun of my mom and refused to take her crazy "hippy pills" at first, but I couldn't deny the effects. Even more astonishing was the fact that animals benefitted greatly from it.

And curing my cat of worms isn't an isolated event; he gets worms, we fail to treat him, it can go on for months and months; if we start treating him, the worms are gone and his coat is silky in less than two weeks--this happens absolutely every time. The dog and his putrid skin blemishes weren't isolated either.

[ProjectOmega]

Originally posted by scr4
That's not a valid proof. Placebo effect can work on animal owners.

I'd have to dispute that. When a cat has "worms", there is a very visible clue to this: namely the white, maggot-ish worms crawling out of its rear end. As above, homeopathic treatment eliminates them in under two weeks in most cases, while going untreated usually means my cat can go months with these worms falling out of his ass. Unless these pills give off a high amount of radioactive hallucinogens that turn the worms invisible to my eyes, there is something very real about homeopathy.

[even sven]

I knew a woman with terrible bone cancer. The doctors gave her less than a year to live. She did every quack fad in the book, from shark oil to homegrown fungus. She lived for ten more years, until the day after her daughter graduated from high school. I doubt the fungus did anything for her body, but it did just enough for her soul.

I'd argue that as long as the quackery isn't keeping them from seeking neccesary conventional medicine, it is actually unethical to try to tear down their beliefs.

[lekatt]

Think about it. Placebos have to do with faith. It is faith that changes things.

Now that thought should get a lot of negative responses on this board.

[Tristan]

leakatt- "can... opened.... worms... everywhere..."



ahem.

Back when I was a CNA in Montana, we had a lady who every night got a "sleeping pill" which was comprised of sugar free Jell-O powder in a gel-cap.

She would holler if we didn't give it to her, and she wouldn't be able to sleep. Give her the pill, and she'd be out in 15 minutes.

Placebo's do work, although I'm not about to hazard a reason why.

[Revtim]

Originally posted by Apos
I think the water coming out of my facuet "remembers" being salt water once... so shouldn't drinking it dehydrate me?If I understand homeopathic theory, the water should actually provide the opposite effect than what it has a "memory" of, so the water whould actually hydrate you.

And what do you know, the water from the tap DOES hydrate me! Maybe I was wrong being skeptical about this thing.... ;)

[Revtim]

Re: the OP

It's hard to weigh the placebo benefit vs. the cost, especially since we don't know how much they are spending or their financial situation. Unless it's causing real financial distress, maybe the benefit outways the cost, even if it's just hope.

[bullfighter]

Looking through the Danish article cited by December, there are clearly different types of placebo effect, some of which certainly exist and some of which almost certainly don't. There is the reporting effect, where a patient or subject tells the doctor that he/she feels better to please the doctor, although they don't feel better. One might also sincerely believe that a treatment has relieved pain even though it doesn't because you believe that the pain would have been worse without the treatment. Both of these seem to me very likely to exist.

There is the possibility that pain actually is reduced by believing in the treatment. Similarly a person might sleep better given a placebo just because they are less worried about getting to sleep. I'm not sure these effects are real, but they are pretty plausible.

What I doubt would be real, would be a placebo actually curing a disease with physical causes, like kidney disease. I suppose a false belief in its effectiveness might reduce stress slightly resulting in the body fighting the problem a little better, but I doubt this would help much, and it could be very bad if it resulted in putting off a real effective treatment.

As far as homeopathy is concerned, the theory behind it is so utterly illogical it would have to pass numerous very rigorous controlled tests and be thoroughly replicated before I would find it at all plausible. From what I have seen of casual observations of alternative medicine effectiveness, there are usually ways to find excuses when the treatment fails, but always assign credit when the condition improves, even if there is a significant time delay after giving the treatment. I would guess this sort of thing, together with a bit of coincidence, would explain the cat success better than treatment with water.

[Patty O'Furniture]

Just FYI, feline tapeworms will go away eventually, once the life cycle of fleas (the carrier) is broken. Anyway, why apply a (probably) costly placebo when a 49¢ pill will do the job in a single dose?

[EasyPhil]

Homeopathy isn't placebo, that's not its mode of action. The diluted effects of the active ingredient do work. I would also say that the power of thought or faith, call it what you will, does have effects which is why your reaction to stress can ultimately harm you.

Here are some studies of homeopathy vs placebo (http://www.nib.unicamp.br/recursos/homeopatia/medline.htm)

[nogginhead]

The case studies cited by Project Omega have no value here.

I agree with those who say not to interfere. Call it a placebo effect or what you will, the patient's state of mind affects their health.

On the other hand if we were talking about 'supplements', AKA unregulated drugs (like ephedrine) I would encourage the perosn to consult with their MD. Some supplements actually have physiological activity, meaning that they can have interfere with medical treatment or have interactions with prescription drugs. But homeopathic stuff is usually administered in such small quantities that this is not a concern.

RE: Danish study. It's not a great idea to trust the press to interprect medical papers correctly-- even excellent papers like the Washington Post. I'll try to post an assessment of the paper this weekend.

[Hentor the Barbarian]

Originally posted by nogginhead
RE: Danish study. It's not a great idea to trust the press to interprect medical papers correctly-- even excellent papers like the Washington Post. I'll try to post an assessment of the paper this weekend. nogginhead, I agree with your post, and look forward to your assessment of the paper. I may do the same, if I can find the time. It is also premature to report on the death of the placebo effect based on one study. The placebo effect may be best understood in the context of response expectancy theory (http://www.apa.org/books/431730As.html), which is fairly well established.

[Revtim]

Originally posted by EasyPhil
Homeopathy isn't placebo, that's not its mode of action. The diluted effects of the active ingredient do work.That is very debatable. Skeptics, like myself, do in fact think that the only effect from homeopathy is placebo.

I was unable to go to your link for some reason, so I cannot comment on it. But the idea that water has "memory" and can generate some kind of immunization-like response to what it has memory of is quite hard to believe and has tremendous flaws. For example, how do they erase the "memory" of what the water has come into contact with during the last thousand or million years, before they make a new "memory" for the treatment they are creating? What if it had come into contact with stuff that has the opposite characteristics of what they want it to "remember"? Do they create the water from scratch, combining Hydrogen and Oxygen?

[nogginhead]

Originally posted by EasyPhil
Homeopathy isn't placebo, that's not its mode of action. The diluted effects of the active ingredient do work. I would also say that the power of thought or faith, call it what you will, does have effects which is why your reaction to stress can ultimately harm you.

Here are some studies of homeopathy vs placebo (http://www.nib.unicamp.br/recursos/homeopatia/medline.htm)

The claim in the first paragraph is not suppoerted by any of the first 10 or so abstracts in the link you provided. I quick look showed only one marginally interesting result, about skin relief.

Few of the papers speak to comparing placebo to homeopathy; the one's I saw so far show no difference, which should be taken as a lack of proof of difference. ( As opposed to a proof of sameness.)

[Apos]

I still can't get over the people who were trying to sell "healing sugars" to my diabetic aunt. They were selling her a sugar pill. And they were TELLING her that it was a sugar pill: full of "seven essential sugars." Now, maybe there's something to that, but when I raised the concept here, some dopers pointed out how ridiculous it probably was. Still, glyconutrients are a huge industry, apparently....
http://www.amazon.com/exec/obidos/tg/detail/-/0345441079/qid=1045847869/sr=8-1/ref=sr_8_1/002-6131907-3579210?v=glance&s=books&n=507846

I think prime suspects for people selling placebos are the claimed effects. If it involves curing a condition that often goes away naturally, or symptoms cycling in and out, that's bad. If it promises diffuse results like "fight off colds, lower your blood pressure, or simply have more energy" that's bad.

So, if ex-salt water would hydrate me, would highly diluted gatorade dehydrate me? :)

[Hentor the Barbarian]

Originally posted by Apos
I still can't get over the people who were trying to sell "healing sugars" to my diabetic aunt. They were selling her a sugar pill. And they were TELLING her that it was a sugar pill: full of "seven essential sugars." When my son was first diagnosed with diabetes at age 3, my pain over the matter was pretty raw. When my wife told me that a customer at the bank at which she worked told her that he was a chiropractor and could treat his diabetes with chiropractology (or whatever the hell you'd call it) I was so furious I wanted to seek him out and beat him until he couldn't spout such nonsense. My wife, being more level headed and less prone to fits of violence, simply asked him for literature supporting such a claim. He subsequently produced some in the form of a pamphlet, which from the brief references themselves were clearly inadequate. The primary one seemed to be a single case study from 1975. Charlatans come in all shapes and sizes, yet they should all be strung up by the gonads.

[BMalion]

All homeopathic solutions should taste like my urine because I pee'd in the ocean once when on a vacation to the beach.

[EasyPhil]

Originally posted by nogginhead
The claim in the first paragraph is not suppoerted by any of the first 10 or so abstracts in the link you provided. I quick look showed only one marginally interesting result, about skin relief.

Few of the papers speak to comparing placebo to homeopathy; the one's I saw so far show no difference, which should be taken as a lack of proof of difference. ( As opposed to a proof of sameness.)

Here's two abstracts from peer review journals that you might have missed:

Twenty-three patients with rheumatoid arthritis on orthodox first-line anti-inflammatory treatment plus homeopathy were compared wtih a similar group of twenty-three patients on orthodox first-line treatment plus an inert preparation. There was a significant improvement in subjective pain, articular index, stiffness and grip strength in those patients receiving homoeopathic remedies whereas there was no significant change in the patients who received placebo. Two physicians were involved in prescribing for the patients and there were no significant differences in the results which they obtained. No side effects were observed with the homoeopathic remedies.


The hypothesis that homoeopathic potencies are placebos was tested in a randomised, double-blind, placebo-controlled trial. The study model chosen compared the effects of a homoeopathic preparation of mixed grass pollens with placebo in 144 patients with active hayfever. The homoeopathically treated patients showed a significant reduction in patient and doctor assessed symptom scores. The significance of this response was increased when results were corrected for pollen count and the response was associated with a halving of the need for antihistamines. An initial aggravation of symptoms was noted more often in patients receiving the potency and was followed by an improvement in that group. No evidence emerged to support the idea that placebo action fully explains the clinical responses to homoeopathic drugs.

[EasyPhil]

Originally posted by BMalion
All homeopathic solutions should taste like my urine because I pee'd in the ocean once when on a vacation to the beach.

Urine has been used therapeutically: Premarin (http://premarin.org/)

[Apos]

I don't doubt that it could turn out that small doses of allergens things could help with allergies (that's what eating local pollenated honey is all about). But cancer isn't an allergy.

[BMalion]

What happens to a homeopathic solution that cures alzhiemer's and it forgets what it's diluted with?

[Ludovic]

Originally posted by lekatt
Think about it. Placebos have to do with faith. It is faith that changes things.

Now that thought should get a lot of negative responses on this board.

Looking at the responses so far, you thought wrong. What makes you so quick to judge us?

[nogginhead]

Originally posted by EasyPhil
Here's two abstracts from peer review journals that you might have missed:

I did say that I only looked at the top ten or so... those are pretty far down the list.

Disclosure: I'm a statistician and methodologist, and I review papers for medical and psychiatric journals. I don't expect or want anyone to believe me for this reason, but also know that I'm also not just making stuff up.

The latter is from Lancet 1986, p 881. I don't believe I have access to Lancets that old, and the abstract is not complete enough to evaluate the quality of the study or the accuracy of the abstract. The Lancet is usually a trustworthy journal, though.

The former is from Br J Clin Pharm 1980 p 453. It's apparently not a blinded study, though. And there's no suggestion of who the subjects were.

Let's suppose, though, that the methods of both of the above are perfect. Even so, it doesn't prove anything. The way statistics works, loosely, is that it gives some sense of how likely the observed results are to have been seen if there was in fact no association. That means you can get a spurious result: in this case, one that supports the non-placebo-ness of homeopathy, even when homeopathy is really a placebo. (Especially) When counter-intuitive or unexpected results appear, you should rely on one or preferably more replications of the work. I saw one paper on the referenced pubmed search that talked about replication but haven't read it yet.

If anyone wants to start a thread about homeopathy, I'd be willing to comment on the scientific validity of any article the full text of which can be e-mailed to me.

[ProjectOmega]

I have a question for the skeptics in here, just on a final note:

Let's say homeopathy IS just a fancy placebo. Say there are no legitimate medicinal effects whatsoever. If that's true, the human mind and body are a lot more powerful than we think. The woman from South Africa that I've mentioned has never used any anesthetic while at a dentist. Instead, she goes on a regular dosage of the pills a few days before and she doesn't feel a thing while on the chair, even when she has to get cavities drilled or a root canal. That's a pretty powerful placebo.

So if the human mind is so easily tricked into these things, why all the scoffing? A person above me told a story of a woman that lived NINE years longer than expected, largely in part, he believed, because her spirit believed alternate medicine worked. Why is that so laughable? Why do you guys laugh and shake your head at a chance of a better standard of living? So you can die after a lifetime of trips to the doctor and medlys of illnesses proud that you lived in firmly in the realm of science and logic, while these fruity alternative medicine hippies continue to live well into their 90s, never having bought over-the-counter drugs and been to the doctor maybe twice? Unless you can willingly force your brain to perform these miracles on itself, what's so bad about dissolving a sugar pill under your tongue once in awhile if it makes you healthier than you've ever been? Is it more the princepal of the thing?

[Revtim]

Because actual medicine is even stronger. The sugar pills may have worked as a good anasthetic on that woman, it might not work on everybody. Novacaine does.

[nogginhead]

Who's laughing? Most of the posters seem to respect the power of the placebo or mind or whatever you want to call it. I'm all for doing whatever works for you.

The problem is when you eschew scientifically proven treatment for something that isn't working for you. And when you try to convince someone else that a particular non-scientific remedy is what they should use, instead of what a responsible MD recommends.

My wife's aunt died of essentially untreated cancer, because she believed some particular brand of quackery would cure her. I'm all in favor of letting her do that. I also favor legal suicide. But if your goal is to live, you've got to listen to all the information. Many MDs now are alternative-medicine friendly, and I think that's progress. But you've also got to respect science, or chances are you won't make it to 90.

You've also got to be careful about how results are attributed. A person who exceeds their expected life span can claim it's due to all the cigarettes they smoke, to frequent spakings, red wine enemas, homeopathic remedies, or to the magical sky fairies. That doesn't mean it's true. And it also doesn't mean it was the power of their minds. The body is a funny place, and tumors can go into remission for reasons that no one understands.

[ProjectOmega]

Originally posted by Revtim
Because actual medicine is even stronger. The sugar pills may have worked as a good anasthetic on that woman, it might not work on everybody. Novacaine does.

Ah, yeah, there's that, but actual medicine is often terrible for you as well. Even novacaine has side effects and can cause allergic reactions in some people, and many common medicines, like Tylenol, can build up in your body with ill effects over the long run. Sugar pills are harmless. The point of homeopathy is that it offers a safer, healthier alternative to mainstream medicine. If mainstream medicine was harmless and did only what it was supposed to do, there would be no need for alternatives.

And yeah, I'm not touting that people avoid much-needed cancer surgery in favour of seaweed, but homeopathy can drastically improve their everyday quality of life, whether it's the chemical or psychological effects of homeopathy.

[eburacum45]

Some of the supposedly effective dilutions of 'active ingredients' are so dilute that there is less than one molecule of 'active ingredient' dissolved in the equivalent of all the water in the solar system.

This is plainly absurd, and any 'active ingredient' that is there is more likely to be there by chance, and to have the same likelyhood of being present as any other possible 'active ingredient'
so any homeopathic remedy should be as effective against a particular ailment as it is against any other, and to be exactly as effective as plain water.
We are not talking dilute solutions, we are talking complete and utter absence of anything effective.
One molecule in a solar system.

[BMalion]

Originally posted by ProjectOmega
but homeopathy can drastically improve their everyday quality of life, whether it's the chemical or psychological effects of homeopathy.

This has not been proven. "The improvement of the everyday quality of life" is a vague statement. How does one measure "quality of everyday life" ?

If 75 out of 100 homeopaths show decrease in measurable cancer, viruses or something. Random chance/placebos showed only 10 out of 100 then we'd be looking into it. But, every study I've read shows that random chance and homeopathic cures are about equal in occurance. To have faith in something that relies on anecdotal evidence is to be superstitious. "My aunt got better" does not qualify to get a study in the New England Journal of Medicine.

Ah, yeah, there's that, but actual medicine is often terrible for you as well. Even novacaine has side effects and can cause allergic reactions in some people

actual medicine is not often terrible for you. Those risks and side-effects are quite rare and most medicines do the most good for the most people.

[Patty O'Furniture]

...while these fruity alternative medicine hippies continue to live well into their 90s, never having bought over-the-counter drugs and been to the doctor maybe twice?

They just never got sick in the first place. What about all those hippies that relied on alternative medicine and died anyway? We never hear about them for some reason.

It should not be hard to accept the idea that some people will live for a very long time and not get sick enough to need medical intervention. Of course, those are the ones that make it onto the Today Show. Naturopathy is no more responsible for keeping people alive in their 90's than conventional medicine is responsible for killing people in their 50's.

Katie Couric: So what's your secret?
112 year-old woman: I'm at the high end of the bell curve.

[Junior Spaceman]

Somehow I knew that this was going to get into a debate about whether homeopathy works or not (which is why I put it in GD, I guess). Originally posted by even sven
I knew a woman with terrible bone cancer. The doctors gave her less than a year to live. She did every quack fad in the book, from shark oil to homegrown fungus. She lived for ten more years, until the day after her daughter graduated from high school[my bolding]. I doubt the fungus did anything for her body, but it did just enough for her soul.I would credit the part I bolded as being a far stronger force than any fungus - I have had three family members hold on to life until a precious relative could arrive, and then very quickly passing away.

Also, situations of people living longer than expected are actually not uncommon - I know of a person (if you don't mind a round of trading anecdotes), who was actually quite negative, and seemed to be full of hate and despair, living for around twenty years, after being given one year to live. They didn't use any alternative medicines, they just happened to not die as quickly as the doctors thought they would, based on statistics (after all, doctors aren't prophets).

Maybe hating the world is the best way to extend your life? Either way, in these stories, the ending is almost always the same, with the cancer taking its toll eventually.

originally posted by lekatt
Think about it. Placebos have to do with faith. It is faith that changes things. A very interesting point. Why are people seemingly hardwired to have faith in what is illogical, rather than what is tested and proven? I suppose this is a question that's been asked a thousand times on these boards.

[eburacum45]

Here's a thought-
many modern drugs have uncomfortable side effects, while placebos have none.
In at least one test on anti-depressants recently, the drug was less sucessful than the placebo
mainly because the placebo had no side effects.
(sorry, no cite ATM- just trust me, sorry)

So, the placebo group were eventually informed that they had recieved no real active treatment-
and they promptly were plunged into worse depression than before.
It is all a confidence trick.

[FranticMad]

Back to the OP

"I think they're wasting money, time and energy by going to a homeopath, and although they're keeping in touch with their real doctor and not throwing away other medication, I still feel scared"

I'm going to give the Ann Landers advice.
It's their money. It's their time. It's their energy. They're seeing a doctor. Keep your nose out of their business.

The issue isn't homeopathy, it's that you're scared. What's that about? Are you afraid of death, or suffering, or losing your dearest friend? Or are you the type of person that just wants everybody to live their personal lives according to your idea of what's right? You'll get more meaningful answers if you talk about you, instead of all this other baloney.
[ Ann Landers hat off ]

[Primaflora]

Henry, dialysis is not a cure. It's an unpleasant process to undergo. If the homeopathics mean he avoids dialysis while he takes them, that's a good outcome even if they only have a placebo effect.

As long as he is being monitored closely so that he gets effective allopathic treatment when it becomes essential, where's the problem? Are any of his conditions curable? Are they more curable now than they would be in 6 months time? If someone has a brain tumour which is removable and curable with surgery now, it's probably not such a fab idea to treat the tumour with unproven science.

[scr4]

Originally posted by ProjectOmega
...but actual medicine is often terrible for you as well..... The point of homeopathy is that it offers a safer, healthier alternative to mainstream medicine.
Homeopathy does have a negative side effect: because people believe in them, they see it as an alternative to conventional drugs even when there are effective and safe ones available. And some people think (consciously or not) that it can compensate for a less healthy lifestyle. My mother tends to buy "supplements" which is probably harmless, but when she buys supplement that claim to protect the liver and use that as an excuse to drink more, than I have no choice but to try to destroy that placebo effect.

There is an even greater damage that is done by alternative medicine: they often suggest that conventional treatments are ineffective. The result is that patients stop believing in modern medicine and don't get the benefit from placebo effect when they receive conventional drugs. That's the main reason I'm opposed to alternative medicine in general.

[Alien2022]

The human mind is a perpetual enigma. An enigma wrapped in an enigma, wrapped in an enigma. We may never know what goes on in it.

I think it would be wise for us not to discredit the power of the mind over the body. We are only now discovering the powers of the mind that are observable, muchless the power of human spirit. I think that there is a lot of truth to the saying, "Mind over matter."

Homeopathics, are like Miss Cleo. They are such a blatant liers, that it would be well advised to stay away from them. However, the placebo effect is a curious effect, and i wouldn't bother trying to tell your friend to stop going to the homeopath. As long as he evades dialysis, nothing can be really bad for him. How he wants to spend his money is his decisison really...

[ProjectOmega]

Originally posted by HenrySpencer
A very interesting point. Why are people seemingly hardwired to have faith in what is illogical, rather than what is tested and proven? I suppose this is a question that's been asked a thousand times on these boards.

That's the definition of faith, isn't it? I don't have faith that if I push a plate off a table, it will fall to the floor, I *know* that's going to happen. If there's something you don't *know* but believe it anyway, that's faith.

Which brings up another interesting point: Many religious people are so devouted to their religion that they have absolutely zero room for any doubt. Can it actually be considered "faith" then? Or is having "faith" believing God exists, but never knowing he does?

[Apos]

---In at least one test on anti-depressants recently, the drug was less sucessful than the placebo mainly because the placebo had no side effects.---

Though I also have no hard cite, I can confirm that a read this same thing here:

http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A42930-2002May6&notFound=true

[MonkeyMensch]

The water I drink has picked up infinitesimal influences of the good things that have passed through its essence in the past ages of the Earth.

Which is why I have all the bad shit happen to me...

[Junior Spaceman]

Originally posted by FranticMad
Back to the OP

"I think they're wasting money, time and energy by going to a homeopath, and although they're keeping in touch with their real doctor and not throwing away other medication, I still feel scared"

I'm going to give the Ann Landers advice.
It's their money. It's their time. It's their energy. They're seeing a doctor. Keep your nose out of their business.Maybe always good advice :(The issue isn't homeopathy, it's that you're scared. What's that about? Are you afraid of death, or suffering, or losing your dearest friend? Or are you the type of person that just wants everybody to live their personal lives according to your idea of what's right?I don't really understand what you mean by this - I don't have some vague fear about the meaning of the universe, and I'm not doing this out of some desire to control everyone around me. I have a specific fear that someone with limited money and energy is using that money and energy on something that isn't really helping him, and, indeed, may have been better spent on things that are actually pleasurable or enjoyable in their own right.

I'm also scared of how supporters of homeopathy spread postive results and ignore negative ones. I've had a very close family member say that their homeopath or naturopath couldn't help them when what they had was serious, but they still plan on going, and want me to go too (just for the heck of it). You'll get more meaningful answers if you talk about you, instead of all this other baloney.
[ Ann Landers hat off ]Huh? I could talk about myself all day, but I don't think that's going to be too interesting or helpful.

[Junior Spaceman]

As so often happens in this world, I found out I had a false dilemma. I ended up telling them what I think of the treatment, and they ignored it, so there ya go. The reason I did it was because they were pushing me to go to cure my own ills, and when I said I'm not interested, they pushed me into saying why I'm not. So I did - I told them that the treatment is plain water, with a bit of pixie dust in it. They weren't too impressed with me and they're not going to change their behaviour.

C'est La Vie.

[FranticMad]

I'm glad you cleared the air with your friends. At least you got closer to the truth of what's going on.

Hey, wait a minute! You said "I told them that the treatment is plain water, with a bit of pixie dust in it." They've got pixie dust? REAL pixie dust? We were talking about placebos, when all that time you knew someone who has dust from pixies? For goodness' sake man, THAT is news. You're sitting on a goldmine! Maybe a Nobel Prize!

[nogginhead]

Originally posted by december
However, a recent Danish study says the "placebo effect" has little effect. (http://www.angelfire.com/punk/lymedisease/Iplacebo.html)

The above link is to a Washington Post story covering an article published in the New England Journal of Medicine in 2001.

I don't know if anyone is still reading the thread, but I did read the article and thought I'd post some thoughts about it.

First of all, there were about a dozen letters to the editors published in response to the article... that's a lot. Many of the letters pointed out methodological issues, most of which I won't summarize here. There was at least one important issue not commented on, as far as I noticed in a somewhat hurried read-through.

There are also loads of articles that reference the piece, which is a lot for only 2 years or so.

To summarize, the article is a meta-analysis-- that means it summarizes the results of many studies in an attempt to synthesize all knowledge on a topic. In this case, the authors summarized across all studies they could find which had a placebo arm and a 'no-treatment' arm (and met other reasonable criteria). About 10,000 people from 114 studies published between 1948 (approx) and 1998 were included. One advantage of meta-analysis is that it allows the pooling of information and subjects across many small and large studies. A disadvantage is that to the extent that the studies are measuring different things, collapsing them together doesn't make a lot of sense.

I think that is the major problem here. The researchers summarize over trials of smoking cessation, hypertension, (extremes of differentness, possibly) and 38 other medical conditions. The unspoken hypothesis of the study, therefore, is that placebos have the same effect regardless of the medical objective being considered. I don't think this makes sense, and several letters commented on it. The point not specifically addressed in the letters is that the medical treatments in the included studies may also not have worked. I doubt that a proponent of placebos would argue that they should generally work even when nothing else works, but that they may sometimes work almost as well as real treatment. Other issues pointed out by the letters include the fact that many of the no-treatment arms had plenty of patient-doctor contact, and that this may be the mechanism of placebo, so that the comparison is tainted.

In addition to the methodological isues skimmed over above, the authors, IMO, biased they way their results were perceived by making dichotomous endpoints the primary discussing point of the paper. (Dichotomous in this case means yes/no.) They thus focussed their attention on whether the smoking cessation was successful in more placebo or untreated patients, rather than the number of cigarettes smoked, which is the continuous version of that outcome. (If you're new to this stuff, continuous means measured, loosely, or counted. Another example could be hypertension. Dichotomous: do you have high blood pressure? Continuous: What is your systolic blood pressure? The smoking and hypertension example also show that you can change people for the better (lower BP, fewer cigarettes) without making that dichotomous measure switch.)

I can't see why they did this except that it supported their preconceived notion that the placebo effect doesn't exist. (Or, even more cynically, that they would get more attention for shooting it down than supporting it.) For example, more people were involved in studies they were unable to generate continuous results for than for the studies with continuous outcomes. Each of the continuous results (except one) showed a clear advantage for the placebo, while the dichotomous did not, generally. So their results actually show that the placebo works!

As a final point, the authors in many places discuss the fact that the power of some tests that failed to show what they wanted was small. (Statistical power is, loosely, the probability you reject the null hypothesis, given a particular alternative is true.) However, they fail to address the fact that the 'main' result about the dichotomous outcomes were in fact close to being statistically significant, suggesting that the power for their main outcome was lacking, and that more subjects could in fact prove that the placebo effect exists, even in the dichotomous case!

The Washington Post actually did a decent job: they reported the results of the study as the NEJM allowed them to be published. On the other hand, the NEJM got totally hoodwinked, (or more cynically, got desired coverage even though the science was mediocre), and the peer-review process once again showed its frailty.

The placebo effect is alive and well, and the authors of the article go on the list of 'scientists' whose credibility is highly suspect.

[Hentor the Barbarian]

Nogginhead, thank you very much for taking the time to provide such a cogent and thorough review of the paper in question. Clearly, again, news of the death of the placebo effect is premature. I am also disappointed that this paper would receive such a bright and apparently positive turn in the limelight, given its significant methodological deficiencies. Perhaps it is news that the audience for that journal wants to hear, regardless of its empirical support?

[davidm]

Originally posted by december
However, a recent Danish study says the "placebo effect" has little effect. (http://www.angelfire.com/punk/lymedisease/Iplacebo.html)Yes, but was this a double-blind study? :D

[FranticMad]

Yes, thank you nogginhead. Well done.