firetender writes Is it Placebo or Belief? at EMS Outside Agitator in response to my post Is There a Placebo Effect – Part III.
We will find that the drugs we administer today are not much more powerful to effect healing than are the patient’s ability to mobilize their own auto-immune systems to combat what ails them; no matter how severe.
That is why the placebo is so important in assessing whether a drug works.
The drugs that work produce significantly better results than placebo, even though the patient cannot tell which is the real drug and which is the placebo.
Therefore, your suggestion that there will be little difference is not likely. Will we find some powerful unknown ability of the body to heal itself? Probably not.
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firetender describes seeing what appears to be the onset of anaphylaxis and races for help in a panic. The anaphylaxis resolves prior to treatment.
The point I have to make about this example is people are curing themselves of critical shit all the time and it’s not unlike what happened to me. Somehow, in that situation, I was able to “create” what I needed (literally!) to survive.
Or the anaphylaxis was not as bad as you thought. There certainly is not any rule that anaphylaxis has to progress to death.
Do we manufacture what we need to heal ourselves? No, but we are often able to convince ourselves that we are special and that we have magical Brain Stimulus or the power of the human mind.
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Don’t do this in the field, but do you think for your next response to anaphylaxis if you picked up your patient off the floor, swatted his butt and yelled “Run, Forrest, run or I’ll kill you!” that would work?
Because the patient is not already feeling as if death is imminent and already producing as much adrenaline as the patient can? Really.
Do you think that these patients are not already producing as much epinephrine as their panic can release?
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Even I wasn’t crazy enough to try that one! But something I learned was that given the proper circumstances (and perhaps proper training) we will likely be able to “jolt” people into the production of their own life-saving chemicals.
Jolt? Epinephrine can be quite a jolt to the body, by it isn’t the jolt that treats the patient. The jolt is a side effect that we would prefer to eliminate.
Much more likely than a self-jolt is that your allergic reaction was not going to progress to the point of killing you regardless of what you did.
The placebo effect is only one reason that people attribute medical properties to all sorts of alternative medicines.
Illnesses are naturally cured by the body’s immune system in many cases. This is most often true for illnesses that are not life-threatening, but illnesses most often resolve without intervention.
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Is there any rule that states that all allergic reactions will progress to death, except when epinephrine is given?
No.
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To be continued later in Part II.
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Required listening : http://smartem.org/smartem.org/Podcast/Entries/2011/8/10_The_Placebo_Paradox.html
WTF? I read the other blog post you were referring to and I am still trying to find the right words to describe it. The only thing I can come up is bat shit crazy, and I’m not sure that’s quite strong enough. I’m going to try and revive the brain cells that died while reading that. Later
I find it hard to believe that anyone can deny that the placebo effect exists … although I would venture a guess that said people are probably the same ones who are out there spending thousands per year on chiropractor visits and buy mail-order “all natural” herbal pills that are guaranteed to cure anything from cancer to bad breath, not to mention increase the size of their male anatomy. The placebo effect is not exactly a new discovery either … snake oil salesmen have known about it for centuries.
Out of curiosity I looked up a couple of clinical trials on drug manufacturers’ websites just now. This should be common sense, but by looking at a few of these it is easy to see that the placebo effect has much more impact on results that are completely subjective than on those that can be quantified objectively.
For example (and I am not endorsing or condemning either of these particular drugs, just using them as an example) the website for the cholesterol-lowering drug Zocor (simvastatin) includes information from a study in which 74 patients given 40 mg of the drug once daily had a median decrease in their LDL level of 28%, while the 74 patients that received placebo had a median increase of 1%. Of course, the LDL level is a completely objective parameter … it is a number on a lab result that is not open to speculation. (I realize that simply causing a change in lab results does not necessarily mean that the drug decreases mortality, but that is a whole separate study).
On the other hand, consider the drug Lyrica (pregabalin) which is used to treat fibromyalgia, as well as other things. There is absolutely no objective way to quantify the severity of fibromyalgia. In a study listed on the drug website, Lyrica was shown to be more effective for treatment of fibromyalgia than a placebo, with 68.1% of patients receiving 300 mg/day reporting some degree of improvement. However, in the placebo group, nearly half — 47.6% — of patient also reported improvement in their symptoms!
If you still don’t believe me, I’ve heard that certain chiropractors are now doing state of the art adjustments that can cure stupidity!
“Bat shit crazy”; I like that!
Rogue will tell you there’s no clinical evidence that bat shit is a causative factor of insanity.
At some point — and if you look at other blogs I’ve done with the possible exception of that Flying Saucer thing — you may figure out that everything we’re doing in EMS today is the result of “out-of-the-box” thinking. Some many people stepped outside of the paradigm “you can’t beat death” and started doing it. That whole game started in the 1950’s.
We are infants in our understanding of the power of the mind.
I agree with Rogue that my number wasn’t up, but do you think for a second my sitting waiting for an ambulance to show would have produced a “favorable outcome”? I ran like a bastard and you can’t convince me it didn’t save my ragged butt!
To date, all we’re doing is employing outside agents to effect healing. Could there be more? Could there be other avenues we haven’t quite seen but have gotten glimpses of? I’m just reporting some glimpses.
You can call me a crank but where I’m coming from may be useful to you. My 12 years experience in EMS at its very beginning exposed me to such off-the-wall stuff as I never could have imagined. It also tipped me off to how little we know and how arrogant we are about being sure. I administered every Drug-du-joir available to me fully convinced that the best of my day’s science was guiding me and I was offering my patients things “proven” to work.
Read through Rogue’s blogs and you will find almost EVERYTHING I used to (supposedly) save lives has since been disproven. As arrogant as it seems, I’m saying that in 25 years — especially with the kinds of leaps in genetics and whatnot — most everything you use today will be in the trash heap as well.
(And if you take a look at Dr. Bledsoe’s latest, as reported by Rogue, you’ll see I am an idiot; He’s saying by 2015!)
EMS has been around long enough so we can begin to get perspective on what it is we’re really doing; we’re TRYING to beat death. So far, the only thing that really seems to be making a dent is defibrillation. Maybe what I’m trying to do here is prepare you by asking you to stretch your understanding of what you do and put it into a much broader context. EMS is one extremely tiny part of a much larger continuum that has to do with humankind’s search for immortality.
What if, instead of being Ricky Rescues, we started to look at EMS and ourselves within the context of that of which we are a part; the Healing Arts? What if we were to seek a better understanding of our role in healing, as (duck and cover!) Healers?
I left the field around 1985 with a trunkfull of questions. It led to an ongoing exploration into all the things that we are told just can’t happen. You know what? A lot of them DO!
Personally, I’ve gotten a whole lot of satisfaction out of the exploring. I’ve come back into EMS through the blog world to reach those who can enjoy that kind of trip as well. I really don’t care what you think, but I’m advocating that medics of all stripes take a good look at what they are in the midst of, no matter how bat-shit crazy it seems.
I’m glad you liked the bat shit crazy bit. I came into EMS at roughly the same time as you were leaving it, so it’s safe to say that I’ve seen a lot of meds, procedures, and various other “life saving” techniques go by the wayside (most of them thanfully so).
All of that time, and all of those patients that I’ve interacted, with have also made me aware that tincture of time is one of the best cures out there. Now does this mean that everything we, as well as the doctors, do is moot? No, there is no doubt that medicines and the medical arts as a whole reduce morbidity and mortality (do I really have to cite this or can we accept it as fact? Vaccines, penicillin, etc ). To be completely honest I don’t think our overall opinions or positions are that far apart from each other in regards to the bodies ability to heal its self and our underwhelming knowledge of the brain. I do still think that bat shit crazy is an appropriate summation of the blog post though. Remember, there is a razor thin line between genius and whacko. Bat shit crazy is somewhere betwixt the two 🙂 Cheers