Continuing from Part I.
If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then we should ignore this chart, because this chart demonstrates objective improvement.t Objective improvement is what is real.
If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then we should pay attention to the following chart of subjective improvement. Subjective improvement is what the patient thinks is real, even if reality does not agree.
When we go to a magic show and see a woman being cut in half, we are experiencing subjective reality. The objective reality is that the woman was never really cut in half, even though our subjective experience is that she has been cut in half.
We have been tricked.
If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then would it be better to give asthma patients a sedative, rather than a placebo?
Looking at that graph of subjective improvement, I suspect that with the right titration of a sedative I could produce much better subjective reports of improvement by giving an active sedative, rather than by giving albuterol, placebo albuterol, acupuncture, sham acupuncture, or any other alternative medicine treatment or the sham version of an alternative medicine treatment (as if the sham version of a sham treatment makes any difference).
Roughly 50% improvement in subjective assessment?
That’s nothing. I can probably get the improvement to 80% with a sedative alone.
Or I could use morphine.
Morphine would probably the same effect, even though it might produce a worsening of objective air flow.
But that would be unethical, wouldn’t it?
If I give a treatment that will produce a subjective improvement, but objective worsening, then I am harming the patient.
Similarly, the old practice of bleeding patients to the point where they stop complaining was abandoned. Should we bring it back? Get rid of those annoying patients by bleeding them to the point of submission or to the point where they never recover from that subjective improvement.
We just need to ignore objectivity and we can do whatever makes the patient feel better.
 Active albuterol or placebo, sham acupuncture, or no intervention in asthma.
Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, Kirsch I, Israel E, Kaptchuk TJ.
N Engl J Med. 2011 Jul 14;365(2):119-26.
PMID: 21751905 [PubMed - indexed for MEDLINE]
Wechsler, M., Kelley, J., Boyd, I., Dutile, S., Marigowda, G., Kirsch, I., Israel, E., & Kaptchuk, T. (2011). Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma New England Journal of Medicine, 365 (2), 119-126 DOI: 10.1056/NEJMoa1103319
Moerman, D. (2011). Meaningful Placebos — Controlling the Uncontrollable New England Journal of Medicine, 365 (2), 171-172 DOI: 10.1056/NEJMe1104010