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I know what you don't know but might casually assume. Such as thinking that the electrical stimulation was at all useful in helping your sciatica.
Posts: 805 | Registered: Jun 2009
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In cases of pain, a triggered placebo effect can actually work significantly better than actual treatment. I don't doubt that going to a chiropractor relieves pain, but I suspect that if a fake chiropractor did fake adjustments and did fake electrical stimuli, you'd get similar results.
The placebo effect is crazy. I wish I didn't know as much about these things, since now I doubt I'd get the same effect for my own back pain.
Posts: 5656 | Registered: Oct 1999
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Wow, Xavier. The fact that 47% of those with real acupuncture felt relief and that 44% of those with "sham acupuncture" felt relief is pretty damning, as far as acupuncture goes.
And wow, the placebo effect is crazy.
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From another POV, it means acupuncture really rocks. You can do substantially better than conventional medicine with very little training and no drugs.
Bend the curve, baby! Posts: 7593 | Registered: Sep 2006
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quote:Originally posted by kmbboots: So I would have been better off had I not followed my doctor's advice and gone?
Not necessarily. It's just that the electrical current itself didn't do anything. Most likely your believing that it would do something is what did something. For nonspecific symptoms like "pain", placebo can be remarkably effective and can be safely "prescribed" to all. When the situation is a recognized physiological problem, placebo is less likely to be the most effective solution.
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Again, how exactly do you know what happened to my back? Are you saying that electical current doesn't have any effect on nerves or muscles?
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When dealing with one person's back and a subjective symptom like "pain", there is absolutely no way to demonstrate whether something did or did not work. People report positive results for sham acupuncture at the same rates as people report positive results for "real" acupuncture. Because of this, your personal experience is literally of no informational value.
All that can be reasonably discussed is whether a given treatment works by means of careful study and there is slim evidence of that sort in favor of electrical stimulation as a treatment for pain. Given a body of research that basically says "it doesn't work", the most reasonable (tentative, of course) conclusion is that it didn't actually do anything to you.
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quote:Originally posted by MattP: When dealing with one person's back and a subjective symptom like "pain", there is absolutely no way to demonstrate whether something did or did not work.
Right. So please stop acting like you know what happened. It was demonstrated to me in that particular circumstance, which is all I am claiming.
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This gets into some really interesting discussion of medical ethics. Many treatments are now being shown to either be worse than a placebo or, in some cases, have been shown to provide benefit only because of the placebo effect.
Is it ethical for a medical practitioner to prescribe a placebo if doing so requires lying to the patient about the actual mature of the treatment?
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Kate, if I claim that a pill called "Xavosin" cures my headaches very effectively, and you know it's actually just a sugar pill, should you just take my word for it that it works for me?
Edit: I don't know much about the medical research for chiropractic treatments on lower back pain. All I am objecting to is the "its my body so I know whether it was the thing that helped" logic.
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I don't know. I am not a doctor; I don't know what effect sugar has on you. My headaches respond to hamburgers. Electrical current is more complicated than a sugar pill. I don't think we know everything there is to know about the human body.
I am not so arrogant as to assume that I know better than you do about what you experience.
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quote:Originally posted by Xavier: Kate, if I claim that a pill called "Xavosin" cures my headaches very effectively, and you know it's actually just a sugar pill, should you just take my word for it that it works for me?
Well, unless she has reason to think you're lying, sure. If you think the placebo works for you, then it probably does work for you.
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Yeah I wrote that on my way out the door and then realized I didn't word it very well. I meant something a little different from how that reads, but I'm finding myself lacking the energy to correct it.
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Km, it's not arrogance, I think you're taking the wrong sense from what he's saying. I myself had electrical stimulation of my lower back for a broken disk. It worked- the pain decreased after the treatment both times I had it done.
He is not invalidating your experience, he is attempting to falsify your reasoning for that experience, which is a different thing. He's saying yes, you may have had that experience, but no, your belief that it was caused by a particular phenomenon may not be right. It's a perfectly valid point, and I don't think it warrants too much defensiveness from you. Nobody I think is denying that you really experienced this. However, given that the evidence is on his side, his argument that what you think happened probably *didn't* happen, is not arrogant, it's practical. He's saying that yes, you may have experienced a relief of pain, but that that relief of pain may not have been the result of the electrical stimulation's doing anything to you physically.
The fact remains that you had this treatment, and you felt less pain. However, you are not really in a position to insist that this treatment (specifically the supposed physiological effects of this treatment) is the reason why you felt less pain. You do not know whether that is true or not, especially considering that some scientific studies show that these supposed effects are not real, even while other effects, such as the placebo effect *are* real, in every way that actually matters to your personal experience.
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Also, this stick of parafin wax here can cure your headaches. Just apply directly to forehead.
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Of course he is trying to invalidate my experience. He (not just him of course) is telling me what I experienced didn't happen. He can certainly posit a liklihood about what happens to people generally but the only evidence of what happened to me specifically is what I tell him. He (not just him of course) doesn't know my reasoning or that of the MD that sent me to the chiropractor.
Why would you have a treatment you believe to be a placebo twice? I only had it once. Are you twice as foolish?
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Interestingly, there is evidence that placebos can have an effect even if you know it is a placebo.
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quote:Originally posted by kmbboots: Of course he is trying to invalidate my experience. He (not just him of course) is telling me what I experienced didn't happen.
No, I don't think so. There's a difference between what you experienced, and what happened. I think he's saying that what you think happened didn't. He is not saying that what you experienced was not real. So, he believes you when you say it worked, because it worked- but *why* it worked, according to you, he doesn't agree with. Is that so bad? Of course he doesn't *know* for sure what happened to you. But for that matter, *you* don't really know what happened to you either- you just know what you felt. It's like that feeling you get when someone runs their finger up your inner arm to your elbow- you feel the finger touch your elbow when it's still a few inches away. You still feel it- but that doesn't mean it really touched you.
What you told him is *not* good evidence that the treatment actually did what you think it did. It's only evidence that it worked on you for some reason. Sorry, that's just how it is.
And no, at the time I had no idea this was a scientifically questionable treatment. I just know I had it, and it relieved my pain. I'm perfectly willing to accept, though I am surprised, that my experience may have been the result of a placebo effect. I don't really care, and I don't know why you do.
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quote:He (not just him of course) is telling me what I experienced didn't happen.
Nobody has said any such thing.
You: Electricity made my sciatica better. Matt: That was placebo. You: My back really did get better!
Yes, we know it did; nobody disputes that. It doesn't follow that it was the electricity that did it.
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However it does reasonably follow that it was the process of the treatment, some part thereof, that may have done it. Not specifically the electricity, is the main sticking point here.
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Based on what is known about the Placebo effect, the fact that kmboots had sought and received numerous treatments for her pain that were ineffective before she went to the chiropractor, greatly reduces the probability that the chiropractic treatment was solely a placebo effect.
This doesn't say anything about why or what part of the chiropractic treatment was effective, but it does invalidate the hypothesis that it was a simple placebo effect.
Posts: 12591 | Registered: Jan 2000
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No, it doesn't invalidate the hypothesis that it was a placebo effect. Those other treatments were given under different circumstances. We don't know why they didn't work.
I know from my own experience that with the electrical stimulation, I could feel tiny pricklings and a warming sensation in the area where the electrodes were. It was a palpable sensation. There is zero proof that that stimulation actually did anything, but I felt it- so my having a simple placebo effect would have been even easier.
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I'm very curious about the relationship of belief to physical pain relief. Doesn't it also work the other way? Can beliefs cause real physical pain? I find it interesting that from antiquity, there have been shamans and medicine women and the like who combine proven methods (for instance, herbal medicines that have been scientifically shown to be effective) with religious ones. Does this imply that religious (however you take that term) beliefs and practices are important to overall well-being? And why does Western medicine focus on the physical concerns almost exclusively? I know that I personally experience more pain relief for my migraines, with fewer side effects, when I am able to see my masseuse or get acupuncture (tell you the story in a bit). With the meds, I still feel woozy and nauseated and am pretty much out of it all day. How much of my reaction is due to scientifically traceable chemistry, and how much is "belief"? How much of the headache is brought on by psychological effect? I know my triggers, and some of them are uncontrollable physical phenomenon, and some are certain thought processes! I find that it usually takes a combination of triggers to cause the migraine. Does it make more sense to pursue "alternative" cures or alleopathic ones? I have so many questions, as usual!
Posts: 3141 | Registered: Apr 2000
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I work at the local farm market, selling tea and incense that I make. One day, there was a fellow offering free acupuncture as a way to drum up business for himself. I found myself hitting the start of a migraine. I knew, from prior experience, it would only get worse from there. When one has a bad migraine, most folks will try ANYTHING to make it go away. (You don't even want to know what I've fantasized). I thought, why the hell not? Worst that happens is I get poked with sterile needles. So I tried it out. I honestly didn't expect anything much to happen.
The fella sat me down and pulled out three needles from sterile packages. Swabbed alcohol on the spots where they were going in. That made me more nervous - I associate the smell with hospitals and big needles and having people do things to me against my will. Then came the needles. A quick tap to insert it, then a few more to drive them into place. Didn't hurt, but definitely an odd sensation. Then I was to sit with the needles embedded for a few minutes. It was absolutely not scary when the needles were put in. After a few moments, I had the oddest sensation...it was as if there was something alive inside my head and neck, racing around where the needles poked. I began to feel relaxed and a bit lightheaded. The acupuncturist's wife was helping him watch the guinea pigs and told him maybe I was done. So he removed the needles. I got up, and felt not only better, but AMAZING. I was buzzing in the way you do when pleasantly tipsy, but without the muzzy headedness. I felt alert and alive and positively joyful. Quite unexpected. It was a getting-high experience,I guess. Which I certainly didn't anticipate. And it lasted most of the day.
I have no explanations for my experience, but all I can say is if THAT was placebo effect, I'd very much like to experience it again.
Posts: 3141 | Registered: Apr 2000
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quote:Originally posted by The Rabbit: Based on what is known about the Placebo effect, the fact that kmboots had sought and received numerous treatments for her pain that were ineffective before she went to the chiropractor, greatly reduces the probability that the chiropractic treatment was solely a placebo effect.
This doesn't say anything about why or what part of the chiropractic treatment was effective, but it does invalidate the hypothesis that it was a simple placebo effect.
First, does it reduce the probability or does it completely invalidate it? Seems to be some skipping around going on.
Second, when you say "based on what is known about the Placebo effect..." you must know something different than I do. Placebo effect can vary greatly as long as the human mind can distinguish between the placebos given. The effect is so subtle that double-blind studies are more convincing than single-blind studies, because people can have different placebo effects from the exact same unmarked tablet if they pick up subconscious signals to its efficacy from the person administering it. When the difference is as radical as spinal manipulation & electrical current vs. whatever else was tried, I wouldn't draw any conclusions about different individual responses to those placebos.
Posts: 563 | Registered: Feb 2006
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quote:Originally posted by The White Whale: Wow, Xavier. The fact that 47% of those with real acupuncture felt relief and that 44% of those with "sham acupuncture" felt relief is pretty damning, as far as acupuncture goes.
I guess that means that acupuncture is so effective that even pretending to do it works. Posts: 12266 | Registered: Jul 2005
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And we are absolutely sure, since we know everything there is to know about the human body and everything about electricity that nothing other than a placebo effect could possibly have taken place.
Posts: 11187 | Registered: Sep 2005
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quote:Originally posted by kmbboots: And we are absolutely sure, since we know everything there is to know about the human body and everything about electricity that nothing other than a placebo effect could possibly have taken place.
All evidence is against it, and there is no evidence for it.
But there is abundant, ample, and reproducable evidence for the power of placebos.
Why do you care? You feel better. Why do you care about the mechanism? Although I do think it is important for other people to point out that it was a placebo, because that way the next person doesn't end up shelling out money for expensive, placebo treatments. Sugar pills are so much cheaper.
Posts: 26077 | Registered: Mar 2000
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quote:Originally posted by Jenny Gardener: ... Does this imply that religious (however you take that term) beliefs and practices are important to overall well-being?
TCM and acupuncture are normally classified as superstitious rather than religious, if that helps.
Posts: 7593 | Registered: Sep 2006
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posted
It's complicated. Placebos *do* work and in many cases they work as well as traditional treatments, which may indicate that the traditional treatment was just a placebo treatment in the first place.
But, except in cases where they are being deliberately used as placebos in blind tests, the promotion of placebo treatments as something other than placebo is fraudulent. That said, most practitioners of "sham" treatments which rely on placebo effect actually believe in the implausible mechanisms which they describe as being the cause of relief. There is little deliberate fraud and people do feel better so there's not a lot of outrage to drive change.
Additionally, chiropractic has pretty broad acceptance amongst the public as a viable treatment. Given that, insurance companies that don't cover it are at a competitive disadvantage against those that do. All that really matters from a business perspective is whether, on balance, chiropractic costs more money for the company to provide than it would lose if it didn't provide it. Medical efficacy is only incidentally important.
It seems instructive that chiropractic is often covered on a similar schedules to mental health benefits - X number of treatments per calendar year - rather than on the same schedule as other medical coverage, which tends to have lifetime or annual maximums but otherwise no limits.
Posts: 3275 | Registered: May 2007
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BC/BS is in the business of spending the least amount possible. Therefore, it makes sense that paying for a person to get treated for a back injury at a chiropractor might save more epensive diagnostic tests down the road.
In other words, BC/BS may well know it is paying for placebo effect, but deems it a financially wise thing to do. If someone is complaining of back pain and sending them to a chiropractor fixes it (placebo or otherwise), then good - if they didn't reimburse for chiropractic that same person may have had extremely expensive diagnostics like ultrasounds, CT scans, MRIs, etc.
Paying for a placebo is smarter from BC/BS' point of view, in that circumstance. I don't work for BC/BS, but that is just what makes sense to me.
Posts: 14428 | Registered: Aug 2001
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Why not charge for placebo services? After all, we pay religious leaders, entertainers, political pundits, and stock pickers...all of whom provide dubious services...
Can a religious leader prove your life will be better if you follow the faith? That you will go to a better place?
Can an entertainer truly promise you happiness?
Does a pundit bring anyone the truth?
Do stock pickers know what they are doing, or is it more a matter of belief?
People do pay for their beliefs, whether or not you can scientifically prove the services rendered have helped them or not. Is it a crime to provide a service to a believer, when one is a believer as well? Is it a crime if you don't believe, but the other person does? What if you believe, but the customer doesn't?
Wow, economics and belief and science and morality!
Posts: 3141 | Registered: Apr 2000
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quote:Originally posted by katharina: I have no problem with people broadcasting the power of belief in curing disease.
But charging for it is fraud.
Would charging for the education be fraudulent? Or the broadcasting in media?
What if someone said, "For all I know, this may work only through placebo effect, but I know how to do it and am willing to provide this service. I am asking you to pay for my training and time to perform the service. I don't really know how it works or if it will work. But if you want me to do it, I will do it for such-and-so fee."
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The problem is that they aren't sold as placebo services. There's no ambiguity in a bottle of sugar pills labeled "placebo" but much (but not all!) of the placebo effect can be lost if you know you're getting a placebo.
If you believe the lie you're selling, it's not fraud, it's just incorrect.
Posts: 3275 | Registered: May 2007
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What's wrong with a service being labelled for what it is, and letting the consumer decide if it is a placebo service or not? Not as "health care" or anything of the sort, just straight up "acupuncture" or "chiropractics" or "faith healing"? Would that be fair?
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For instance, I would never have dreamed of paying for acupuncture. However, after getting a pretty nice and otherwise nonharmful high off of it with the added benefit of getting rid of my migraine, I might consider paying for the service. Even if I am pretty sure it's a placebo effect...I rather enjoyed the effect. And I would rather pay for that than the headache meds I currently take that leave me feeling just a little less ill than before I took them.
Posts: 3141 | Registered: Apr 2000
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I think what I'm really trying to get at is the answer to the question...
How does freedom of choice affect people's health and decisions about their health? Should it be illegal to offer placebo services that sometimes work? Should we force people only to choose methods that are scientifically tested? Why? What are the various gradations that a society might create or allow when it comes to people's bodies and their decisions about them? Who, ultimately, is responsible for the health of a person's body?
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It should not be illegal for people to go to chiropractors if they want to. But, I do believe people have a right to be informed, especially in matters of health and welfare. Chiropractors should have to dsclose that no scientific support exists for subluxation therapy, and that chiropractic is not a medical treatment for such things as infections. In addition, I think patients should be warned about the danger of manipulating the neck beyond its normal range of motion because of the small, but very real risk of stroke: Linky
quote:"Some neurologists think chiropractors are causing a lot of strokes, but we think it is a very low risk," Smith tells WebMD. "I don't think it is so low that a patient doesn't need to be informed about it. The consequences of a stroke can be enormous. People should be aware that spinal manipulation increases risk of stroke. Anybody who does a procedure of any kind that carries a risk should tell their patients about that risk."
[points up] What he said. Even though the risk appears to be small, patients deserve to be informed.
People going to chiropractice for musculoskeletal issues don't really bother me all that much. Yes, there isn't a lot of evidence that it benefits much but the act of manipulation and massage makes some people feel better. It's when people do things like take their young children to a chiropractor to have their necks cracked because the parent has bought a line that chiropractic can cure their kids' ear infections that I get a little incensed.
Posts: 14428 | Registered: Aug 2001
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quote:Originally posted by Belle: It's when people do things like take their young children to a chiropractor to have their necks cracked because the parent has bought a line that chiropractic can cure their kids' ear infections that I get a little incensed.
posted
I'm all about the information. I think people should definitely understand that homeopathic cures are essentially water (for example). If people want to use what boils down to "magic", then that is their prerogative.
It always gets trickier when it comes to children...most of us get very angry when a family who believes in faith healing doesn't get medical help for a child dying of a curable or preventable cause. But it also gets tricky when a parent, understandably, wants to help a child get over the sniffles. Most remedies don't really do much, and time for the body's defenses to activate is the real healer. Is a homeopathic dose, in this case, going to do any harm (barring the poisonous ones that aren't really homeopathy)? If the parents and children believe it will work, might a flower essence placebo help the child get better through that lovely placebo effect?
I've found there is always more gray than most of us want to admit when it comes to issues of health, belief, morality, and responsibility. A blanket rule isn't going to work in every case.
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