If you don’t think placebos effects exist or are not based off of mental perceptions and belief, i’m open to hear your theory.

I don’t see where I denied any placebo effect. As for it requiring belief, all I wrote is That is also unclear. There may be something other than belief involved. I was not clear enough. I should have written, there may be more than just belief involved in the placebo effect.

You’re never going to extinguish magical thinking completely- it’s the brain’s basal state(remember kids start off with magical thinking). I think you’re fighting an uphill battle.

I agree.

I think that we need to work to improve the understanding of science. Uphill battle, or not, educating people about science is a good thing.

I would much rather have people complaining that I am spending too much time trying to explain science, than not enough.

Even a lot of doctors have been misinterpreting research. My reply to Sharon MD, about the study she referred to, is just one case of this. Sharon MD is not the only MD to misinterpret the results. Medscape reported the results as mininterpreted by the authors.

We should be encouraging a better understanding of science. That does not include encouraging magical thinking. Or, I should say, that does not include discouraging children from outgrowing magical thinking.

I think the main difference between you and me is that you want to convert patients to your way of thinking, while i’m resigned to the fact that certain patients don’t think scienfically (Jenny McCarthy and other random people), and i’m willing to work with that.

Don’t get me wrong, I would love all patients to think more scientifically- but it’s not happening in the near or distant future. The brain’s natural state is to recognize patterns(think skinner box experiments)- this is where the emergence of magical thinking occurs. You’re never going to extinguish magical thinking completely- it’s the brain’s basal state(remember kids start off with magical thinking). I think you’re fighting an uphill battle.

As i stated in my first post, placebo effects are still effects- they work better than doing nothing at all.

I agree. There would not be a difference in outcomes otherwise.

I don’t know how placebos manage thier effects

There are still people claiming that the placebo effect is a myth, so explaining how it works is far from clear.

but placebos are effective, they just happen to be as effective as every other placebo.

I think there have been studies that show that the type of placebo influences the effect. A pill has less of a placebo effect than something more involved, or one involving more manipulation of the body.

The funny thing about placebos is they have to make patients believe in them to work. They wouldn’t work on me cause i don’t believe in most alternative medicines.

That is also unclear. There may be something other than belief involved.

If a specific placebo is harmful, i’ll fight it, but otherwise i’ll accept the placebo effect- anything to make the patients feel better.

I think that there is harm in telling people that magic works. We need people to understand science to deal with many problems in our future. Alternative medicine has a lot to do with the person believing that they have something special about them, or there is something special about natural treatments, or some other exemption from the real consequences of the real world. This is not at all healthy.

Just look at Jenny McCarthy and Dr. Jay Gordon and others telling people to not vaccinate their children because a mother knows. This is the kind of illogical destructive thinking that come from belief in magic.

Alternative medicine is belief in magic. A belief that although science keeps demonstrating that the treatment is no more effective than placebo, because the person taking it is a good person, with good karma, they will be healed by the magic. This is dangerous.

I don’t know how placebos manage thier effects- if it’s a matter of “self fullfilling” prophesy, a trick of the mind mediated through internal opiods, self hypnosis or some other random thing- but placebos are effective, they just happen to be as effective as every other placebo.

The funny thing about placebos is they have to make patients believe in them to work. They wouldn’t work on me cause i don’t believe in most alternative medicines. But for some people, alternative medicine provides them with that belief that they’ll get better. Listen, i’m not going to explain or endorse specific placebos, but i’m not going to fight patients over them as well. Placebos obviuosly put many patient in a state of mind that makes them feel better- it would be silly to take that away from them. Hope is a powerful mediator in health that doctors often ignore. A hopeful patient often tries harder, is less discouraged and is generally healthier.

If a specific placebo is harmful, i’ll fight it, but otherwise i’ll accept the placebo effect- anything to make the patients feel better.

Acupuncture has lots of evidence behind it (although most of the rigorous studies show no difference between sham acupuncture and “real” acupuncture, both methods are clearly superior to no treatment.)

I wrote about this misrepresentation of the research in Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone.

Maybe this discussion of should be whether there is a place for placebos in medicine. Or whether there is a place for treatments with no evidence to support them. Aside from the conditions where research is very difficult due to small numbers of patients with the condition and other legitimate restraints on research.

I don’t know of anyone who would object to using an alternative treatment that can demonstrate effectiveness, but the research has not been showing any more effectiveness than placebo and sometimes alternative medicine is less effective than placebo.

Conventional medicine has a bit of the same problem. There are many treatments that do not have good evidence to support them. I do not think that we should encourage the use of wishful thinking medicine just because it is conventional, either.

If Sen. Tom Harkin gets his way, we will be paying billions of dollars for all sorts of alternative treatments, just because he thinks it is a fairness issue. We should not be paying for ineffective treatments. If competent adults want to pay out of their own pockets, that is their choice. I see no reason to indicate, in any way, that alternative medicine is a good choice.

Instead of digging trenches and fighting patients over thier choice of care, I think a more effective way of treatment is to work with what patients want. I’m chinese and i know tons of people who prefer eastern medicine. Instead of denouncing thier beliefs- you’re more likely to get better patient cooperation if you accept that they will use eastern medicine and try to convince them to use evidense based medicine in conjunction with whatever alternative treatments they use. Do i think it’s the best treatment possible- probably not. But i do think it’s better than not using evidense based medicine at all.

Alternative medicine is “replacement medicine” only if you make it an either/or proposition. don’t fall into that trap.

As long as the placebo is safe, affordable, and not used to replace evidence based medicine – the harm is minimal.

The problem is that alternative medicine is often used to replace evidence based medicine. That is the basis for the name alternative. Some use complementary as a way of seeming to avoid that conflict. Still, when there is a good outcome, the credit is given to the alternative medicine. When there is a bad outcome, the blame is placed on the evidence based medicine.

Why should we be treating patients with treatments that have no evidence to support them? Other than the rare, difficult to study, disease?

Look at the case of Daniel Hauser. A mother takes her son and runs away to avoid a treatment that is over 90% successful. A treatment that has significant side effects, but is extremely successful. He is taking a treatment from the founder of an on-line religion. This healer is in between jail terms (I do not expect him to avoid further fraud, do you?). When they return, they continue with the alternative medicine and give all of the credit for the patient’s improvement to the alternative medicine.

I do not see alternative treatments, which have no evidence to show that they are anything other than glorified placebos, as harmless. They will continue to be promoted as alternatives to evidence based medicine.

We also need to require that conventional medicine be much more evidence based.

On the other hand, the good thing about the placebo effect for infertility is its unique property, that while the temporary placebo effect may go away after time, the positive consequences stick around. In other words, let’s say a couple have been childless for five years and they try aromatherapy and voodoo to try and boost their fertility. If the placebo effect results in a temporary boost in their monthly chance to conceive and they end up getting pregnant and having a baby, even if those effects fade away, guess what — they still have their baby.