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Quacks & Pseudoscience

elltrev said:
Question: Are some treatments known to have bigger placebo effects than others? If so, do people think it's acceptable to label such treatment as worthwhile and effective?

On the acupuncture stuff - one could argue that acupuncture does work, but not for the reasons practitioners say it does - that the sham acupuncture working doesn't represent the placebo effect, but rather that randomly sticking needles into someone is genuinely effective. Unfortunately it seems impossible to do a blind test on sticking needles into someone.
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Yes. Branded placebos have a bigger affect than non-branded. A big red placebo pill has a bigger affect than a small white one. An invasive placebo like an injection (or sticking needles in you) has a bigger affect than a non-invasive one like sugar pills.

The question around knowingly prescribing placebos is one of medical ethics. Whilst placebo effect is genuine and real, generally, you are looking for an affect beyond placebo to consider it effective.
 
milo said:
Yes. Branded placebos have a bigger affect than non-branded. A big red placebo pill has a bigger affect than a small white one. An invasive placebo like an injection (or sticking needles in you) has a bigger affect than a non-invasive one like sugar pills.

The question around knowingly prescribing placebos is one of medical ethics. Whilst placebo effect is genuine and real, generally, you are looking for an affect beyond placebo to consider it effective.
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Interesting, thanks.

Anyone strongly think knowingly prescribing placebos is unethical full stop? I'd suggest that if it has an equal or greater impact than alternatives, then it isn't necessarily unethical. Provided that there is information freely available about it, maybe even given at the time of prescription.

Any trials comparing known placebos - e.g. (for the sake of argument) acupuncture - with other treatments that are known to work e.g. a small white unbranded pill that has a greater effect than its equivalent placebo?

I guess what I'm getting at is all that matters is what has the most positive impact, regardless of the mechanism - whether placebo (presumably psychological) or directly physiological.
 
milo said:
Yes. Branded placebos have a bigger affect than non-branded. A big red placebo pill has a bigger affect than a small white one. An invasive placebo like an injection (or sticking needles in you) has a bigger affect than a non-invasive one like sugar pills.

The question around knowingly prescribing placebos is one of medical ethics. Whilst placebo effect is genuine and real, generally, you are looking for an affect beyond placebo to consider it effective.
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Yeah, those no-name copy placebos are terrible. I hardly feel any better after taking one.
 
elltrev said:
Interesting, thanks.

Anyone strongly think knowingly prescribing placebos is unethical full stop? I'd suggest that if it has an equal or greater impact than alternatives, then it isn't necessarily unethical. Provided that there is information freely available about it, maybe even given at the time of prescription.

Any trials comparing known placebos - e.g. (for the sake of argument) acupuncture - with other treatments that are known to work e.g. a small white unbranded pill that has a greater effect than its equivalent placebo?

I guess what I'm getting at is all that matters is what has the most positive impact, regardless of the mechanism - whether placebo (presumably psychological) or directly physiological.
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https://www.karger.com/Article/Abstract/320374

With regards to the ethics. Patients' responses to placebos are not uniform, so not only would you be prescribing something that has no active ingredients but something that will have little or no affect on the majority of patients.
 
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elltrev said:
Interesting, thanks.

Anyone strongly think knowingly prescribing placebos is unethical full stop? I'd suggest that if it has an equal or greater impact than alternatives, then it isn't necessarily unethical. Provided that there is information freely available about it, maybe even given at the time of prescription.
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The placebo effect only works when masked at the time of delivery. I remember reading some interesting stuff about how, once the link between action and cure is established, the effect can remain but if given as a clear placebo it won't work.

elltrev said:
Any trials comparing known placebos - e.g. (for the sake of argument) acupuncture - with other treatments that are known to work e.g. a small white unbranded pill that has a greater effect than its equivalent placebo?
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The only ones I know of were based on 3 sets of behaviour.

1) "Real" acupuncture
2) A person randomly sticking needles into a patient
3) A person studying the bedside manner and sham mysticism of a "real" acupuncturist and randomly sticking with needles but with all the flair of "real" acupuncture.

2 didn't work at all, 1 and 3 were pretty much exactly the same. What people seem to want most of all is someone to seem like they care and to spend time on them.

elltrev said:
I guess what I'm getting at is all that matters is what has the most positive impact, regardless of the mechanism - whether placebo (presumably psychological) or directly physiological.
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If there is an argument to be made for placebo prescription (not nearly reliable enough for me) then it certainly shouldn't involve handing over private or public money to charlatans.
 
I've taken some un-branded pills in the past that have made me feel absolutely on another level and taken all the pain away. Sadly, they only lasted a few hours...
 
AuroRaman said:
I've taken some un-branded pills in the past that have made me feel absolutely on another level and taken all the pain away. Sadly, they only lasted a few hours...
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There was a news story recently about a really popular, herbal cough medicine in the US that was recently banned when they found its active ingredient was morphine.
 
scaramanga said:
There was a news story recently about a really popular, herbal cough medicine in the US that was recently banned when they found its active ingredient was morphine.
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Read between the lines about the type of pills I'm talking about, Scara ;)
 
scaramanga said:
There was a news story recently about a really popular, herbal cough medicine in the US that was recently banned when they found its active ingredient was morphine.
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The lack of regulation and oversight in the herbal/supplement/alternative industry is shocking.

No big surprise it's attracted the attention of "big pharma" - great place to make money.
 
Publications and resources
thumb.php

Response to suggestions that placenta pills stop postnatal depression
Today, newspapers are reporting claims that mothers can stop postnatal depression by taking pills made from dehydrated placenta.

"A growing list of celebrity mums including Kim Kardashian believe taking the pills can stop postnatal depression, boost energy and balance hormones." From The Daily Mirror, Wednesday 27 January 2016

"It has been claimed that eating the placenta can improve energy levels, help with the production of breast milk, boost iron levels and make it easier for new mothers to shed their baby weight." From The Daily Mail, Wednesday 27 January 2016

Catherine Collins, spokesperson for the British Dietetic Association, says:

“Fresh placenta contains nutrients, enzymes and hormones essential for life- but it also contains environmental toxins filtered out from reaching the baby, but which remain in the placenta - substances we have no need to add back to our diet. Placenta enzymes and hormones are proteins and so will possibly be destroyed in the preparation process, and also by our own digestive processes. There is a real lack of evidence to support most of the health claims made. Some research cited dates back to 1918 – a period of time at the end of the First World War when diets were nutritionally inadequate for the masses and so placenta may well have helped improve a meagre protein and iron deplete diet. As a dietitian today I’d place placenta-phagy as wacky and whimsical that offers only unproven benefits to the new mum.

"What concerns me the most is the suggestion new mums can avoid or reduce the risk of postnatal depression by taking placenta pills. There is no robust evidence to support this, and as both a dietitian and a mum of two, I’d recommend that new mums who feel down or depressed should talk to their midwife or health visitor, healthcare professionals able to help new mums cope with their feelings and the stress of a new baby.”

http://www.senseaboutscience.org/re...hat-placenta-pills-stop-post-natal-depression
 
milo said:
Publications and resources
thumb.php

Response to suggestions that placenta pills stop postnatal depression
Today, newspapers are reporting claims that mothers can stop postnatal depression by taking pills made from dehydrated placenta.

"A growing list of celebrity mums including Kim Kardashian believe taking the pills can stop postnatal depression, boost energy and balance hormones." From The Daily Mirror, Wednesday 27 January 2016

"It has been claimed that eating the placenta can improve energy levels, help with the production of breast milk, boost iron levels and make it easier for new mothers to shed their baby weight." From The Daily Mail, Wednesday 27 January 2016

Catherine Collins, spokesperson for the British Dietetic Association, says:

“Fresh placenta contains nutrients, enzymes and hormones essential for life- but it also contains environmental toxins filtered out from reaching the baby, but which remain in the placenta - substances we have no need to add back to our diet. Placenta enzymes and hormones are proteins and so will possibly be destroyed in the preparation process, and also by our own digestive processes. There is a real lack of evidence to support most of the health claims made. Some research cited dates back to 1918 – a period of time at the end of the First World War when diets were nutritionally inadequate for the masses and so placenta may well have helped improve a meagre protein and iron deplete diet. As a dietitian today I’d place placenta-phagy as wacky and whimsical that offers only unproven benefits to the new mum.

"What concerns me the most is the suggestion new mums can avoid or reduce the risk of postnatal depression by taking placenta pills. There is no robust evidence to support this, and as both a dietitian and a mum of two, I’d recommend that new mums who feel down or depressed should talk to their midwife or health visitor, healthcare professionals able to help new mums cope with their feelings and the stress of a new baby.”

http://www.senseaboutscience.org/re...hat-placenta-pills-stop-post-natal-depression
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Really well written!

Anyone who can read that and ask "what's the harm?" need to stop eating fudging placenta pills, they're obviously getting toxins into the part of their brain that's supposed to logic.
 
milo said:
@scaramanga @braineclipse - I stumbled across this recent Ernst blog post on some acupuncture research on its effectiveness treating hot flushes during the menopause. It is a lot more in line with the other research on acupuncture and what we would expect to see

http://edzardernst.com/2016/01/acup...hot-flushes-no-its-just-a-theatrical-placebo/
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Cheers.

I suppose the benefit of acupuncture a a placebo is that it is very theatrical. Plenty of needles, some real discomfort, human touch, some clothes off. Perhaps makes it a rather effective placebo...

I sometimes have difficulties with what I perceive as effective placebo treatments. A lot of real suffering that can be alleviated through belief and placebo treatments, I wouldn't really want to see that taken away from people who benefit from it and have a better quality of life because of it. I know for sure if someone I cared about got their life improved by a cheap-ish harmless placebo and that there aren't good medical options available (for whatever reasons) it's a bit of a ethical dilemma, but I don't usually come down on the "argue against it" side.

At the same time I do think there are plenty of downsides. And it's certainly possible that the net effect in terms of human suffering/well being is negative.

The worst part is there often are evidence based options from psychology for example that could be beneficial. But the health care system isn't able to deliver those services to the right people, or at the right quantity, for it to be able to fill the gap currently filled by effective placebo treatments. Even then from a socioeconomic viewpoint educating a sham-acupuncturist is going to be a hell of a lot cheaper than educating a psychologist or cognitive therapist. But accepting this as a solution based on economic reasoning obviously means accepting a significant class divide in terms of evidence based treatments for various ailments. Something I know Scara is just going to lose sleep over for weeks... ;)
 
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