You could have a separate forum section here for bearing witness.

Yes, he certainly seems to. But as I said above, the evidence is rather inconclusive.

Squander Two: “If it’s true that the placebo effect is equal to no effect, tell me, how would you go about distinguishing between those two results?”

What I’m saying is that plenty of research shows that once you have accounted for background noise (regression to the mean, fluctuation of symptoms, other treatments taken at the same time, experimental design flaws, errors, observer, recall and selection bias, habituation etc.), it often turns out that the placebo effect is actually equivalent to no effect, i.e. they can’t be distinguished.

The placebo effect has become such an ingrained concept both in science and popular culture that it takes a while to get your head round to the idea that it might actually be nothing at all. It’s an intriguing notion, and as I say, there is some quite compelling research out there that casts doubt on the whole “placebo effect” idea.

IMSoP: “The idea of trial design is to fix all the possible variables except the one you’re testing; so the purpose of placebo treatments is to fix any possible variables arising from psychological effects of simply being treated, etc, which would obviously confuse the data you actually want – such as the effectiveness of a drug.”

Placebos aren’t necessarily there to screen out psychological effects that might confuse the data but are an attempt to screen out any kind of bias that can’t be due to the intervention under study.

It is of course a bit academic with regard to most drug trials these days though, as ethical considerations demand that new drugs are tested against the best existing drug.

However, I think it is worth considering that placebo may be nothing when we are evaluating CAM, most of which is probably nothing more than placebo…

It is often claimed, for example, that even if CAM is only placebo, it at least has some benefit and therefore some use but if placebo really does turn out to be nothing at all, then what does that say about those making a living from such practices?

These are what I meant to quote:

> There is, after all, a very strong body of evidence that placebos don’t work.

> This is why placebo is the gold standard for double-blind controlled trials.

But I would like to pick you up on one logical flaw, best summed up here, but mentionned or implied a couple of times:

>

In fact, more-or-less the opposite is true – the placebo is the gold standard in controlled trials precisely because it *might* have an effect, at some level. If it was guaranteed to have absolutely no effect, researchers could save a lot of effort by not doing anything at all with the control group.

The idea of trial design is to fix all the possible variables except the one you’re testing; so the purpose of placebo treatments is to fix any possible variables arising from psychological effects of simply being treated, etc, which would obviously confuse the data you actually want – such as the effectiveness of a drug.

Now, at what level those effects take place, and even if there are any, is obviously open to debate – or, rather, research. Which brings me back to the position of considering that a potentially very interesting area of study.

[PS: IANAS (I Am Not A Scientist), although I did do a part-Psychology degree; so feel free to correct me if I've got something fundamentally wrong here.]

Fair enough. So let me rephrase.

Surely the placebo effect describes effects which are not caused by any sort of direct biomechanical reaction between the treatment and the outcome.

> There is, after all, a very strong body of evidence that placebos don’t work.

I’m hardly any sort of expert in this area, but doesn’t Ben often refer to the strong body of evidence that they do work? Would I be right in guessing that what we have here is two contradictory strong bodies of evidence, or — looked at another way — one inconclusive strong body of evidence?

> this is why genuine medical interventions need to be proven to have an effect over and above placebo

Well, that’s kind of the point, isn’t it? Showing that medicine merely has an effect over and above no effect is not good enough, but showing that is has an effect over and above the placebo effect is considered conclusive. If it’s true that the placebo effect is equal to no effect, tell me, how would you go about distinguishing between those two results?

I see where you’re coming from but “placebo effect” really describes “non-specific effects” – how these can be explained is rather controversial; a psychological explanation is just one of many. Personally, I favour the “no effect” explanation.

There is, after all, a very strong body of evidence that placebos don’t work.

This is why placebo is the gold standard for double-blind controlled trials.

When the control group are given a placebo, they are being given a blank, i.e. a pill with no active ingredients (just like homeopathy).

The effects that some people then perceive from receiving the fake pill are in fact just background noise, and this is why genuine medical interventions need to be proven to have an effect over and above placebo, i.e. placebo = no effect.

And it bears emphasising that the original quantitative claim that placebo is real (Beecher, H. K. 1955. The powerful placebo. Journal of the American Medical Association, 159:1602-1606) was subsequently thoroughly dismissed (Kienle GS, Kiene H. 1997. The powerful placebo effect: fact or fiction? J Clin Epidemiol. 50:1311-8).

And this is of interest:

“Hrobjartsson and Gotzsche published a study in 2001 and a follow-up study in 2004 questioning the nature of the placebo effect. (Hrobjartsson 2001, Hrobjartsson 2004) They performed two meta-analyses involving 156 clinical trials in which an experimental drug or treatment protocol was compared to a placebo group and an untreated group, and specifically asked whether the placebo group improved compared to the untreated group. Hrobjartsson and Gotzsche found that in studies with a binary outcome, meaning patients were classified as improved or not improved, the placebo group had no statistically significant improvement over the no-treatment group. Similarly, there was no significant placebo effect in studies in which objective outcomes (such as blood pressure) were measured by an independent observer. The placebo effect could only be documented in studies in which the outcomes (improvement or failure to improve) were reported by the subjects themselves. The authors concluded that the placebo effect does not have “powerful clinical effects,” (objective effects) and that patient-reported improvements (subjective effects) in pain were small and could not be clearly distinguished from bias.

These results suggest that the placebo effect is largely subjective. This would help explain why the placebo effect is easiest to demonstrate in conditions where subjective factors are very prominent or significant parts of the problem. Some of these conditions are headache, stomach ache, asthma, allergy, tension, and the experience of pain, which is often a significant part of many mild and serious illnesses.”
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=11372012&cmd=showdetailview&indexed=google

If dreams of flying are part of your reality…then…haven’t you already done it?

I read a press relese of European Committee for Homeopathy today. I thought it was good. Open, clear and certainly not biased.

most importantly, while life stories are vitally important for deciding on qualitative issues (eg “is this a pleasant clinic to attend?”) or deciding on one person’s medical treatment (eg respecting and working with your own idiosyncratic personal preferences) they are absolutely not useful for deciding on quantitative issues like whether a treatment works.

http://www.badscience.net/the-rules/

would that be okay? i dont like to be too dictatorial about things like this.

I don’t think that’s true. Surely the placebo effect describes effects which are caused by psychological factors and not any sort of direct biomechanical reaction between the treatment and the outcome. Your statement only follows from the assumption that “placebo effect” means “no effect”, so may not be used in turn as backup for that assumption.

> Denying my own personal (repeated) experience, would be denying my very own existence…

I have a recurring dream that I can fly. I deny its truth. I have yet to deny my own existence.

And this is from where I enter the quest…that is why it is not IF but HOW, because I want to know…

And that is why it is not for me either/or…I want both…
Modern medicine – we can explain, great, CAM way of working – not quite yet, that does not mean that it is not explicable…
Our brain/heart work is not that refined yet. Let’s face it, look at world around you…we are…pretty crude…

Denying my own personal (repeated) experience, would be denying my very own existence…

Errr…

No.

The flow of energy through an ecosystem does not mean “energy” has a direction. There is a difference between a flow of energy (e.g. heat energy moving from a hot environment to a colder one), and the direction of “energy” of our ‘inner processes’.
The difference is, of course, one of these is actually a real thing.

But placebo effect no effect. So… perhaps most of us just have an everyday deficit of placebo? What can be done about that? Not homeopathy – not for people here – we unfortunately have a resistance to it.