ahem…. haha… of course not… how silly of us

If anything sidetracked the conversation it was SA/DS storming in angrily, then changing tone to a poor me/concern troll to annoy people with his melodramatic crap. Sonic got the conversation back on track. Besides after 5 days and 119 comments a little deviation is allowed.

I would also add that the blogger didn’t really add much to the discussion. Ben Goldacre has already discussed the notions that there are some inherent and odd differences to placebos including the fact that a red placebo has more of an effect than a blue one.

It still doesn’t really change the discussion – namely that active deception is unethical and that maximal placebo response can only at best ameliorate subjective complaints, but not effect objective change. The problem with opening up non-deceptive placebo use is that we still don’t know if it would work, and even if it did who would really use it? I mean seriously – would you go to a doctor and be happy to hear him/her say, “So I’m going to give you this sugar pill. It has worked as placebo in other people and helped them feel better, so maybe it will with you too. Thanks for coming in, don’t forget to pay your bill on the way out!” Man, I would feel downright gypped! My doctor just basically said that (s)he didn’t really have anything to help me, gave me a random sugar pill (which apparently was optimized to induce the placebo response by being big and red and requiring it be taken 3 times a day), and then CHARGED me for that??

But we haven’t even gotten that far. It was a pilot study. Pandering to a specific population that is likely more credulous to such things. With myriad confounders that haven’t been adequately addressed.

To put it very simply, people who are being conscientious to take a pill at specified times are also likely to be more conscientious about all their other health activities. Never mind the fact that just being in a trial would likely heighten that as well. And don’t forget it was a 21 day (very short!) trial with a subjective outcome reporting.

What I am getting at is that yeah, maybe some more research could be handy, but really I see nothing there to suspect that such non-deceptive placebo use rolled out at large would be effective at anything. It would be nice if it did, but I see nothing convincing yet.

And of course that distracts from the main topic here which is that CAM is entirely placebo AND deceptive.

http://scienceblogs.com/insolence/2010/12/more_dubious_statements_about_placebo_ef.php

http://www.sciencebasedmedicine.org/index.php/placebo-effects-without-deception-well-not-exactly/

Namely his objection to the way that placebos were discussed with patients. First the researchers put out an ad asking for participants in a mind-body connection study, then told them that placebos had demonstrated efficacy in the medical literature, including the pills they were taking.

That might not be much of a problem except the idea was to test how patients would respond if placebos didn’t come with expectations. The researchers selecting patients more likely to believe in mind-body healing and telling them that the sugar pills they were taking promoted mind-body healing undermines the purposes of the experiment. These concerns were brushed aside.

Disgruntled PhD also said Gorski treated the study as having guilt by association with NCCAM. Quite the opposite:

NCCAM funded the study. Why am I not surprised? Actually, come to think of it, this is one of the better studies that NCCAM has funded. Even so, it’s only just an OK study. It has a somewhat intriguing finding that could well be due to differences between the experimental groups, reporting bias, and/or recruiting bias. But ground-breaking or somehow demonstrating that the placebo effect can be activated without deceiving patients.

Not quite, but nice try.

http://disgruntledphd.blogspot.com/2010/12/placebos-now-with-added-ethics.html

In other words, I can cure a bacterial infection with antibiotics regardless of whether the patient knew he was getting any drugs at all.

I can heighten the effect of narcotics by talking them up.

I can give saline, call it a narcotic, and still achieve some effect.

I cannot give saline to a patient and tell them it is an antibiotic and expect it to do diddly squat.

So in the subjective arenas where placebo would work, you would still have to lie to the patient to achieve the effect (somehow, I don’t think saying “I am going to inject you with saline which has no pharmaceutical action, but if you believe it does, your pain will go away” would work) and that is unethical

No matter how you slice it, use of placebos is simply an untenable option for the medical profession.

Dr. Gorksi dissected a recent article (can’t find the link at the moment) where it was stated that you could induce the placebo effect without lying to the patients. Turns out it was a poorly designed study.