http://scienceblogs.com/insolence/2010/12/more_dubious_statements_about_placebo_ef.php#more"In discussing "alternative" medicine it's impossible not to discuss, at least briefly, placebo effects. Indeed, one of the most common complaints I (and others) voice about clinical trials of alternative medicine is lack of adequate placebo controls. Just type "acupuncture" in the search box in the upper left hand corner of the blog, and you'll pull up a number of discussions of acupuncture clinical trials that I've done over the years. If you check some of these posts, you'll find that in nearly every case I discuss whether the placebo or sham control is adequate, noting that, the better the sham controls, the less likely acupuncture studies are to have a positive result.
Some of the less clueless advocates of "complementary and alternative medicine" (CAM) seem to sense that much of what they do is nothing more than placebo effects and will as a result simply argue that what they do is OK because it's "harnessing the placebo effect." One problem that advocates of science-based medicine (like me) have with this argument is that it has always been assumed that a good placebo requires deceiving the patient by either saying or implying that they're receiving an active treatment or medicine of sometime. Then, as I was watching the news last night (amazingly, I was actually home in time for the news--things are slowing down right before Christmas, I guess), I saw this story:
"Placebos can help patients feel better, even if they are fully aware they are taking a sugar pill, researchers reported on Wednesday on an unusual experiment aimed to better understand the 'placebo effect.'"...
In other words, not only did Kaptchuk et al deceive their subjects to trigger placebo effects, whether they realize or will admit that that's what they did or not, but they might very well have specifically attracted patients more prone to believing that the power of "mind-body" interactions. Yes, patients were informed that they were receiving a placebo, but that knowledge was tainted by what the investigators told them about what the placebo pills could do. After all, investigators told subjects in the placebo group that science says that the placebo pills they would take were capable of activating some sort of woo-ful "mind-body" healing process. In fact, I would say that what Kaptchuk et al did was arguably worse from an ethical standpoint than what investigators do in the usual clinical trial. Consider: In most clinical trials, investigators tell subjects that they will be randomized to receive either the medicine being tested or a sugar pill (i.e., placebo). This, patients are told, means that they have a 50-50 chance of getting a real medicine and a 50-50 chance of receiving the placebo. In explaining this, investigators in general make no claim that that the placebo pill has any effect whatsoever and, in fact, are explicitly told that it does not. In contrast, Kaptchuk et al explicitly deceived their subjects for purposes of the study by telling them that the sugar pill activated some sort of mind-body woo that would make them feel better Yes, they did tell the subjects that they didn't have to believe in mind-body interactions. But did it matter? I doubt it, because people with authority, whom patients tend to believe (namely doctors) also told subjects that evidence showed that these placebo pills activated some sort of "mind-body" mechanism that was described as "powerful." This alone makes proclamations about how the investigators triggered placebo effects without deception--shall we say?--not exactly in line with the reality of the situation. At least, I don't buy the investigators' explanation, even though Ed Yong states that "no one I spoke to criticised the design of this trial," and Edzard Ernst described it as "elegant.
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Yet another bad study pushing bogus results to push treatments that don't work on an unsuspecting public. When will the citizenry stand up and stop the CAM scam? There is no real difference between the bogus crap pushed by CAM (supposed complementary and alternative medicine, now relabeled integrative medicine. why all the relabeling you ask? uh, well. that's what scam artists do.) and global warming denialists or any other form of blind faith. It's long past time where humans move beyond being fooled by the cons among us.
:toast:
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