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

- Rogue Medic

Placebo vs Belief vs Neither – Part II

Continuing from Part I in response to firetender’s Is it Placebo or Belief?

Consider the various flavors of plague –

Pneumonic plague is highly lethal when untreated or when antibiotic treatment is started more than 24 hours after the onset of symptoms. Untreated, the fatality rate of pneumonic plague approaches 100%.

Without prompt treatment, or if left untreated, bubonic plague has a fatality rate of 50% to 60%.

Without prompt treatment, or if left untreated, the fatality rate of septicemic plague approaches 100%.[1]

Untreated, almost all of septicemic plague and pneumonic plague patients will die.

These are the kinds of illness that do nothing for our belief in magical treatments.

Untreated, only a little over half of bubonic plague patients will die.

This is the kind of illness that leads to our belief in magical treatments.

Most Up to half * live, even when no effective treatment is given.

We could bleed these patients and most would live. Of course, they live because we bled the patients. Post hoc, ergo propter hoc.[2] We did something, therefore what happened after we did something happened because we did something.

We ignore the complexity of the human body (such as the immune system). We assume that some simple intervention is the complete explanation. Even those who claim to be using evidence-based medicine make this mistake. This is the basis for much of the mythology in EMS and much of the mythology throughout medicine.

We could use acupuncture on these patients and most would live. Of course, they live because we used acupuncture on the patients. Post hoc, ergo propter hoc.

We could have these patients eat cow dung and most would live. Of course, they live because we had the patients eat cow dung. Post hoc, ergo propter hoc.

No. No. No.

This isn’t BS.

This is genuine magic cow dung.

Eat some! It will activate your body’s hormones.

Should we use BS as the abbreviation for Brain Stimulus or the power of the human mind.

We give BS and the patient improves. It must have been very good BS, because it worked!

No. It is just conventional BS. It does not work. We just convince ourselves that any improvement we saw was because of the BS. A lack of improvement is just a sign that we did not use enough BS. If the patient gets worse, that is also a sign that we did not use enough BS.

When alternative medicine fails When the placebo of alternative medicine is not able to do anything, one excuse is to blame the patient.

The patient did not get better because the patients did not think enough positive thoughts, or activate enough unknown hormones?

With alternative medicine, it is the fault of the patient, not the inability of the placebo to do what the alternative medicine is being promoted for.

With alternative medicine we can always blame the patient for the lack of effect of the placebo.

History is strewn with cases of people who have survived, recovered or repaired themselves on thousands of therapies that have since been PROVEN NOT to work. Each of them were presented with the best identifiable options of their day and time. SOME of them responded, even if what they were administered were poisons. You cannot minimize the power of the human mind.

That would be the power of the immune system. Most illnesses are cured by the body’s immune system. The Brain Stimulus or the power of the human mind does not kill bacteria.

Could BELIEF in the Practitioner or the therapy have made the difference?

Subjectively feeling better and objectively being better are two completely different things.

If I have a pain in my foot due to an injury, I may find it too painful to move. If it starts to rain, I may decide that it is worth the pain to move to someplace dry. If someone is driving at me in a car, I may forget all about the pain and get up and run. When I stop, I can expect the pain to come back even worse.

The Brain Stimulus or the power of the human mind did not heal anything. I was distracted from the pain until the distraction was gone, or just less than the pain. If you view our ability to distract ourselves as Brain Stimulus or the power of the human mind, then you are easily impressed. We do seem to release endorphins to manage pain, there also appears to be a placebo effect on inflamation, but should we extrapolate these to other areas?

Should we use the placebo effect to distract ourselves to death?

Of course, you’ll say “In spite of” and you’re right. But you know what? I really BELIEVED that that stuff would work. I SAW it working, didn’t I? Or am I truly Certifiable? Maybe the ONLY thing that made them work was that I believed they would.

You just do not understand that the drugs you gave may not have had anything to do with the patient’s survival. You think that when you do some, that what happens after you do something is because you did something. This is an arrogance that we need to get rid of.

Just because we call something medicine doesn’t mean that it will make a difference.

Just because we do something doesn’t mean that it will make a difference.

We look for explanations, but they may be much more complex than what we imagine, or there may be no relationship between what we see as the cause and what we see as the effect.
 


 

We can be taught to be superstitious in a variety of way based on intermittent conditioning. Lucky charms, potent omens, alternative medicine, and other superstitious behaviors are based on intermittent reinforcement, not on any cause and effect relationship. Looking for meaning to random occurrences is the source of superstition.

The way to find out if something really does make a difference is to test it, while trying to minimize the effects of all other variables.

If the effect is not there under those circumstances, the alternative medicine promoter will make excuses about some intangibles not being just so. Then the answer is to make the intangibles just so and test it again. Then it still doesn’t work and the excuse is that it doesn’t work in a controlled environment.

That answer is correct, but it is unnecessarily long.

Then it still doesn’t work and the excuse is that it is based on some magic (quantum, spiritual, or other BS), that does not work in a controlled environment.

If magic doesn’t work in a controlled environment, is there any good reason to believe that it works in an uncontrolled environment.

No.

This is just one way that we convince ourselves to believe in magic.

* Correction – The example given is one where most may not live, even when no effective treatment is given. What is cited states that Up to half (50% – 60%) live, even when no effective treatment is given. Characterizing 40% to 50% as Most is not accurate.
 

Without prompt treatment, or if left untreated, bubonic plague has a fatality rate of 50% to 60%. [1]

 

Footnotes:

[1] Clinical Presentation of Plague
Yersinia pestis (Plague)
(Updated October 8, 2007)
Center for Biosecurity of UPMC
Article

[2] Post hoc ergo propter hoc
Wikipedia
Article

.

Comments

  1. All fair enough, and I agree with you completely, however my immediate ‘devil’s advocate’ thought on this (and after too many too long shifts with not enough sleep and I really need to go to bed now…)

    Mental stress can make illness worse or prolong recovery – isn’t that an accepted case?

    and

    People who have car vs car accidents, isn’t there some research about how their whiplash/neck pain gets better quicker if the other driver is insured?
    (I think it may have been a study involving Lithuainian drivers – I cannot recall).

    Which might lead one to believe that a patient’s state of mind can have an effect on their health and healing.

    (Of course I may have completely misread your post – my brain is a bit like porridge at the moment)

  2. The point I’d like to focus on that you made is (paraphrased) it is not the mind that does the healing, it’s the immune system.

    Our body produces the chemicals we use to “adjust” us to one state of health or illness or another. Many of the chemicals injected into us stimulate us to PRODUCE the chemicals that will alter our state of health. SOMETIMES we simply don’t have those chemicals but over all, at this stage of our TRUE medical knowledge (again, we are in our infancy) we don’t quite know what chemicals we can produce ourselves and how.

    Right now, our dominantt paradigm tells us to keep pumping external drugs into the system. Maybe we can do better.

    My best example would be the people who, by their attitudes often begun by moments of trauma, weaken themselves by thier thoughts, their immune systems slowly shut down and there we are, bringing them back and forth to hospital for no damn reason other then THEY compromised their own immune systems; a sort of chemical self-alteration.

    In some cases psychological/emotional counseling can, by shifting the attitude of the person, allow the body to pick back up and begin producing the chemicals necessary to support their stability.

    My only point is that we’re just learning to work with the power of our minds. Maybe right now we’re learning most from just how efficiently we can break down our own bodies with our thoughts.

    The pharmaceutical companies claim that they can identify chemicals lacking in the brain and then pin certain depressive symptoms on that lack. Then, they manufacture those chemicals and get them tried out on thousands of people who are praying that “something out there” will take care of what’s bothering them “in here”.

    Sometimes, they work, and just as often, years later we find out that what they do often is to compromise another system with dire consequences. The side effects ARE clinical; perhaps the only true effect they have is on the negative side. Perhaps the good effects were precisely manufactured by the person’s mobilization of his/her own immune system based on belief in the drug, therapy or Administer.

    Am I wrong in saying, Rogue, you seek absolutes? Personally, especially in emergency medicine, those are the rarest things out there. Sure, there are a couple, but most everything else is just part of a big ongoing experiment wherein our role is as Distributors.

    • firetender,

      The point I’d like to focus on that you made is (paraphrased) it is not the mind that does the healing, it’s the immune system.

      In the case of an infection, yes.

      Our body produces the chemicals we use to “adjust” us to one state of health or illness or another. Many of the chemicals injected into us stimulate us to PRODUCE the chemicals that will alter our state of health. SOMETIMES we simply don’t have those chemicals but over all, at this stage of our TRUE medical knowledge (again, we are in our infancy) we don’t quite know what chemicals we can produce ourselves and how.

      There are things that the mind is capable of that we are not yet aware of. However, there is no good reason to believe that these unknown abilities will include the ability to heal ourselves. There is no reason to believe that our current knowledge of the brain includes such abilities.

      Right now, our dominant paradigm tells us to keep pumping external drugs into the system. Maybe we can do better.

      I am all for doing better with lower doses. Please provide some good evidence that this is practical.

      My best example would be the people who, by their attitudes often begun by moments of trauma, weaken themselves by their thoughts, their immune systems slowly shut down and there we are, bringing them back and forth to hospital for no damn reason other then THEY compromised their own immune systems; a sort of chemical self-alteration.

      If you know of a way to make them improve on their own, please provide the cure.

      How do we know that the mind is shutting down the immune system and that the same thing that is shutting down the immune system is not also shutting down the mind?

      In some cases psychological/emotional counseling can, by shifting the attitude of the person, allow the body to pick back up and begin producing the chemicals necessary to support their stability.

      That may be the case, or it may be something else.

      My only point is that we’re just learning to work with the power of our minds. Maybe right now we’re learning most from just how efficiently we can break down our own bodies with our thoughts.

      Are we breaking down our bodies with our thoughts?

      We are also just learning to work with the idea of the flying car. This is something that has been on the horizon for half a century, but never seems to get closer – like a mirage. Maybe someday we will have flying cars. I would expect that long before we have a good enough understanding of any magic healing powers of the mind.

      Maybe we don’t have much ability to heal with our minds. The more we learn about our minds, the more we learn that the greatest powers are observation and analysis. We learn to use tools to make up for the inadequacies of our bodies (including our minds).

      When we have problems due to the misuse of tools, that does not mean that the tools are bad.

      The pharmaceutical companies claim that they can identify chemicals lacking in the brain and then pin certain depressive symptoms on that lack. Then, they manufacture those chemicals and get them tried out on thousands of people who are praying that “something out there” will take care of what’s bothering them “in here”.

      Sometimes, they work, and just as often, years later we find out that what they do often is to compromise another system with dire consequences. The side effects ARE clinical; perhaps the only true effect they have is on the negative side. Perhaps the good effects were precisely manufactured by the person’s mobilization of his/her own immune system based on belief in the drug, therapy or Administer.

      I have not examined the research on psychiatric drugs, so I do not know if anything you claim is true.

      Am I wrong in saying, Rogue, you seek absolutes?

      That depends on what you mean by seeking absolutes.

      If you mean that I think that the truth, however gray and uncertain, is much better than a pleasing and pure lie.

      Absolutely.

      The reality is that we live in a world that we do not understand well. We learn about it by experimentation, not revelation.

      The way things work is determined by probability, not by any kind of certainty.

      Magic and superstition are attempts to come up with absolutely true answers to things that do not have absolutely true answers.

      Absolutes are rare. Absolutes are an insignificant part of what we know.

      Personally, especially in emergency medicine, those are the rarest things out there. Sure, there are a couple, but most everything else is just part of a big ongoing experiment wherein our role is as Distributors.

      We agree that absolutes are rare, but we disagree on the reason for coming to this conclusion.

      .

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