> Do you think optimism and hope should be outlawed?
Irrelevant. But do I think selling (nothing but) hope and optimism should be outlawed? Hell, yes!
For anything else, you couldn't get away with this argument. You can't sell a brick as a loaf of bread, knowing that it isn't nutritious, then claim that what you really sold was "hope and optimism" for nutrition. It's fraud, no matter what you call it.
> If a placebo "works" for some people - doesn't harm them, is relatively inexpensive
Yeah, "if". But it doesn't, it does, and it isn't. Placebo treatment is fraud, plain and simple.
Another thing: even if placebo "works" the effect is much smaller than the effect of proper treatment (that is actually the prerequisite for FDA approval for drugs and treatments that clinical trials must prove). So, if by selling placebo you're discouraging patient from seeing doctor and getting actual treatment then you are in a way harming them.
I don't think you understand what placebo is because placebo is all it takes for someone to believe in (tied to optimism and hope that you're trying to gate keep as irrelevant) for some people to feel benefit - regardless if there's another mechanism causing that or not.
Otherwise apples to oranges comparison - we're not talking about anything else.
You don't know if patients treated with a placebo feel a benefit, you only know that they report feeling a benefit.
What's the task of the physician? Is it to relieve the patient's pain or is it to get the patient to shut up about his pain? Do you think there is a difference?
It's not entirely fraud because placebo does have an effect. The important thing is to communicate to the patient that it is not a complete solution, and that they should also seek additional treatment if it exists.
from a moral standpoint, it's also not right to prevent some people from getting a placebo that will help them.
placebo is similar to religion: it can do so much good to some people, that I don't think you have the moral right to take that away from them, even if that religion include absurd things.
"It is evident that placebo effects are real and that they have therapeutic potential. Laboratory evidence supports the existence of numerous placebo mechanisms and effects in both healthy volunteers and patients with a variety of medical conditions. Furthermore, clinically relevant evidence demonstrates that placebo effects can have meaningful therapeutic effects, by virtue of magnitude and duration, in different patient populations. Although substantial progress has been made in understanding placebo effects, considerable scientific work remains to be done in both laboratory experiments and translational clinical trial research, with the ultimate aim of harnessing placebo effects to improve patient care."
The more nefarious aspect is that people can think themselves sick; it's awful watching a group of mutually reinforcing hypochondriacs work themselves up from a minor sniffle or bit of dust in the eye to full incapacitation and dosing themselves with every over-the-counter snake oil imaginable.
> Chang says that the paper is evidence that subtle, nonverbal factors "can have a large impact on the experience of pain"
and Chang is wrong, wrong, wrong. The phrase should have been "can have a large impact on how the experience of pain is reported".
There is no evidence that the patient actors experienced the pain any differently, only that they reported differently on it. Who knows, maybe they tried more to be good actors than they tried to be good patients?
Until a study shows up that measures sham treatment to be more effective than no treatment, I maintain that the placebo effect is simply regression to the mean, or unreliable self reporting, and prescribing a placebo, or a placebo under another name (homeopathy, alternative medicine, etc.) under any circumstances is fraud and a violation of the Hippocratic Oath.
How am I supposed to know and how is it even relevant?
The point is, the "placebo effect" (this is actually incorrect usage of the term) only seems to affect things that can't be measured. Why don't placebos heal infection or lower cholesterol levels or blood sugar or supplement thyroxin or something that is measurable?
Because there is no "placebo effect" (in that incorrect sense). There is only bad reporting.
Well... you objected to the phrase "can have a large impact on the experience of pain" on the grounds that it was only reported pain. But pain is measured by self report. There's no other way to do it.
No, there is simply no way to measure pain. Sorry about that, deal with it and just demonstrate the "placebo effect" of something that can be measured. Hasn't happened in ~50 years of breathless reporting on it, though, has it?
I know what you're getting at; you obviously can't measure pain in the same way you can measure blood pressure or heartrate (both of which, by the way, are affected by placebo.) But it's abject nonsense to extend that to the idea that you can't measure pain at all. Do you claim that the effect of opioids on pain is unmeasurable?
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[ 3.0 ms ] story [ 68.7 ms ] threadDuh.
If a placebo "works" for some people - doesn't harm them, is relatively inexpensive, is a free choice for them to make - should it be prevented?
https://news.ycombinator.com/newsguidelines.html
Irrelevant. But do I think selling (nothing but) hope and optimism should be outlawed? Hell, yes!
For anything else, you couldn't get away with this argument. You can't sell a brick as a loaf of bread, knowing that it isn't nutritious, then claim that what you really sold was "hope and optimism" for nutrition. It's fraud, no matter what you call it.
> If a placebo "works" for some people - doesn't harm them, is relatively inexpensive
Yeah, "if". But it doesn't, it does, and it isn't. Placebo treatment is fraud, plain and simple.
Otherwise apples to oranges comparison - we're not talking about anything else.
What's the task of the physician? Is it to relieve the patient's pain or is it to get the patient to shut up about his pain? Do you think there is a difference?
from a moral standpoint, it's also not right to prevent some people from getting a placebo that will help them.
placebo is similar to religion: it can do so much good to some people, that I don't think you have the moral right to take that away from them, even if that religion include absurd things.
"It is evident that placebo effects are real and that they have therapeutic potential. Laboratory evidence supports the existence of numerous placebo mechanisms and effects in both healthy volunteers and patients with a variety of medical conditions. Furthermore, clinically relevant evidence demonstrates that placebo effects can have meaningful therapeutic effects, by virtue of magnitude and duration, in different patient populations. Although substantial progress has been made in understanding placebo effects, considerable scientific work remains to be done in both laboratory experiments and translational clinical trial research, with the ultimate aim of harnessing placebo effects to improve patient care."
and Chang is wrong, wrong, wrong. The phrase should have been "can have a large impact on how the experience of pain is reported".
There is no evidence that the patient actors experienced the pain any differently, only that they reported differently on it. Who knows, maybe they tried more to be good actors than they tried to be good patients?
Until a study shows up that measures sham treatment to be more effective than no treatment, I maintain that the placebo effect is simply regression to the mean, or unreliable self reporting, and prescribing a placebo, or a placebo under another name (homeopathy, alternative medicine, etc.) under any circumstances is fraud and a violation of the Hippocratic Oath.
Also, the "doctors" were actors, not the patients.
Edit: rather both were actors
The point is, the "placebo effect" (this is actually incorrect usage of the term) only seems to affect things that can't be measured. Why don't placebos heal infection or lower cholesterol levels or blood sugar or supplement thyroxin or something that is measurable?
Because there is no "placebo effect" (in that incorrect sense). There is only bad reporting.
> to be more effective than no treatment,
Effectiveness of sham acupuncture (placebo) was almost twice that of conventional therapy. ( https://www.ncbi.nlm.nih.gov/pubmed/17893311 )
what is the ethical decision according to Hippocratic Oath?
sham acupuncture (placebo) or conventional therapy ?
Edit: also, how's that relevant? Acupuncture and sham acupuncture are the very same thing, so what's the placebo (no treatment) group here?
placebo acupuncture == sham acupuncture
placebo != no treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749386/