Placebo in Alt Med
Posted: 22 March 2012 07:39 AM   [ Ignore ]
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It is apparent that a lot more attention these days is given to alternative therapies and thier ilk as a result of a heathcare system overload and people getting frustrated with a lack of decent timely care. I have no decent reputable statistics on this at this time. Anyone? I do have a subjective impression related to numbers of people coming in to my clinic seeking help for musculoskeletal pain issues. There is a lot to be sure. And when first visit/interview discussion happens and I question them on what they have tried thus far it is clear that the homeopaths and chiropractors are some of the first things tried outside of regular MD referral. People will ultimately seek out thier own solution given enough time/frustration.

Anyway, my point in this thread is to iterate that in alt med there is little discussed relative to placebo effect via conditioning of the patient. I have my own ideas as to why this might be (showing the emporor has no clothes for one). I would not have as much of an issue with these therapies if there was more truth put out relative to this effect on thier clients via the therapies/techniques used. Placebo can account for as much as a 30% pain reduction and a complete reversal of symptoms occasionally. This I have seen but is subjective only.

I wondered if any of you have any GOOD information relative to placebo effect using alternative therapies. I’d love to discuss this.

Thankyou.

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Posted: 22 March 2012 07:53 AM   [ Ignore ]   [ # 1 ]
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There is a lot of good information in the Skepdic entry on placebo, along with the citations at the end of the article.

E.g., THIS entry from Dr. Novella on Science Based Medicine:

Existing evidence strongly suggests that placebo effects are mostly comprised of bias in reporting and observation and non-specific effects. There is no measurable physiological benefit from placebo interventions for any objective outcome. There is a measured benefit for some subjective outcomes (mostly pain, nausea, asthma, and phobias), but the wide variation in effect size suggests this is due to trial design (and therefore bias) rather than a real effect.

In any case, any perceived benefit in subjective symptoms seems to be greater for physical interventions (perhaps a hands-on benefit) but is the same for mainstream vs novel treatments.

Therefore, there is no justification to be found in the placebo effect for using unscientific or dubious interventions. Placebo medicine is a sham. And any potential placebo benefit worth having can be fully realized with science-based interventions.

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Posted: 22 March 2012 11:04 AM   [ Ignore ]   [ # 2 ]
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As far as the popularity of Alt Med, it does appear to be growing but it is far smaller than proponents would make it. The surveys that purport to show widespread use often include non-medical things like massage, yoga, relaxatin, and such that really aren’t intended to treat disease but to help patients cope. Here are a couple of articles on the subject:

How Popular is Acupuncture?

CAM in Hospice Care

National Health Interview Survey 2007- CAM use in Adults

As for the placebo, this is a huge multifaceted and complex subject. The effects of belief and expectancy on reporting of subjective symptoms, which is what most people mean when they think of the word placebo, is certainly an improtant part of the perception of efficacy for some CAM therapies.

Acupuncture, for example, has indisputable effects on how people perceive their pain and nausea. But these effects are just as strong for “fake” acupuncture (needles in places not consider true acupuncture points, retractable needles that don’t penetrate the skin, and even poking people with tooothpickks), and they are elicited better by enthusiastic and empathetic acupuncturists than by business-like and matter-of-fact acupucbturists. The CAM folks try to spin studies like these to say that placebo effects are really min-over-matter effects, and that real healing is going on. But what they really show is that these interventions don’t change the physical disorder that causes symptoms, only the perception of those symptoms by the patient. There ay be some value in that, but as Doug’s citation from Dr. Novella above points out, this can just as easily be had with therapies that also really work.

Goldman, R.H., Stason, W.B., Park, S.K., Kim, R., Schnyer, R.N., Davis, R.B., Legedza, A.T., Kaptchuk, T.J. (2008). Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use: A Randomized Controlled Clinical Trial. Clin J. Pain, 24(3), 211-218.

Sjöling M, Rolleri M, Englund E.. .Auricular acupuncture versus sham acupuncture in the treatment of women who have insomnia. J Altern Complement Med. 2008 Jan-Feb;14(1):39-46


A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain (Arch Intern Med. 2009;169(9):858-866


White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G .Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain. 2011 Dec 12. [Epub ahead of print]


Ernst, E. Soo Lee, Myeong. Choi, Tae-Young. Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011;152:7555-764. (mixed results but studies with sham, as opposed to placebo, have clarified)


However, the placebo efect also encompasses a number of biases, confounders, and outright errors that plague clinical trials. Many of the reasons for having a placebo comparison group in a trial have nothing to do with beleif or expectation, but with effects of participating in clinical trials that can create the inaccurate impression or a significant treatment effect. In any case, none of this has anything to do with the current spin that says even if CAM is not better than placebo, placebo is real therapy after all so CAM works. Sheesh!

Here are some more dtetailed articles on the issue.

Michael Specter on the Placebo Effect

Placebo Again

Does Thinking Make it so? CAM placebo fantasy vs scientific reality

[ Edited: 22 March 2012 11:06 AM by mckenzievmd ]
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Posted: 29 March 2012 06:10 PM   [ Ignore ]   [ # 3 ]
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Thankyou so much for the information. Quite helpful to me. I’m glad I found this forum smile

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