Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Is There a Placebo Effect – Part I

ResearchBlogging.org

This is about a JournalWatch podcast[1] discussing the editorial[2] by Daniel Moerman, PhD. I have alrready pointed out many of the problems with the idea that the subjective appraisal of the patient is all that matters.[3] That only is true with self-limiting, or minor illnesses.

For someone who is taking such an unusual approach to medicine, he presumes that all roads to medical school are the same and that all physicians approach medicine the same way.

There is the statement that a placebo is an inert agent, therefore a placebo cannot do anything. He concludes that there is no placebo effect.

This does not make sense.

The effect of giving an inert treatment is not an effect?

The problem is that Daniel Moerman appears to be trying to reconcile some post-modernist ideas with research on placebos. He spends time describing all of the things, from the parking attendant, to the lab coats, to everything else that creates an atmosphere of medicine. There is one big problem with claiming that the effect comes from these, rather than from the placebo. In the study that Daniel Moerman wrote the editorial about, when the patient does not receive the placebo, there is no effect.[4] All of these atmospheric accouterments have zero effect, when not followed by a placebo or by an active treatment.

The problem with the statement that there is no placebo effect is that the placebo does something by the effect it has on what the patient is thinking, not by the effect of any active drug in the body.

Daniel Moerman gives the example of chronic back pain. The problem is that there is no good medical treatment for back pain. He suggests that some studies of chronic back pain treated with conventional treatment, acupuncture, and sham acupuncture show some effect of acupuncture that is not pure placebo. He misunderstands the same way many others have misunderstood these studies.

What Daniel Moerman claims that these show is that acupuncture works. However, there is no difference between real acupuncture and sham acupuncture. Acupuncture is just a placebo. If a placebo is inert, then the only way it can work is by the placebo effect. The only effect of acupuncture, other than the occasional infection and rare perforation of vital organs, is placebo.[5],[6]

To be continued in Is There a Placebo Effect – Part II.

Footnotes:

[1] Podcast 126: Placebos and Medical ‘Meaning’
Joe Elia
July 16th, 2011
JournalWatch
Page with links to podcast player and download

[2] Meaningful placebos–controlling the uncontrollable.
Moerman DE.
N Engl J Med. 2011 Jul 14;365(2):171-2. No abstract available.
PMID: 21751911 [PubMed – indexed for MEDLINE]

Preview from NEJM

[3] Subjective Improvement vs Objective Improvement
Rogue Medic
Article

[4] 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]

Preview from NEJM

[5] Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone
Rogue Medic
Article

[6] Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone – comment from RavenBlack
Rogue Medic
Article

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

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Comments

  1. Rogue Medic – Thanks for your posts on placebos and to Pyroknight for commenting.

    This is interesting to me since I’m working on combining the placebo effect with self-hypnosis. The Virtual Healing Machine consists of a series of free videos available on the internet. The videos provide a healing ritual to enhance the placebo effect, plus provide healing hypnotic suggestions. https://sites.google.com/site/thevirtualhealingmachine/

    You and your colleagues might also be interested in my VHM blog, http://thevirtualhealingmachine.blogspot.com/ . There are some articles referenced relating to using hypnosis in emergency medicine written by paramedics – See Tuesday, July 19 posting on “resources”. Also, there is lots on placebos, even the NIH has a grant going to enhance placebo effect!

    I’d be interested in your comments or feedback. Please pass this along to others you think might be interested.

    P.S. I’m not a Doctor. I’m a rogue retired scientist/engineer trying to help myself and others with health care.

    Thanks and keep up the great work!

    Tom

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