Author Topic: What is a myth that should be dispelled because it is costing us all money?  (Read 22802 times)

Rhinodad

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #250 on: December 20, 2020, 05:41:05 PM »
Well, neither actually “worked”, because if a placebo actually fixes anything, you never really had anything “wrong” to begin with.

Green_Tea

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #251 on: December 21, 2020, 05:43:43 AM »

Ah, but we rarely know when something is a placebo, and if we do, it doesn't work anymore.

Let's say you have two treatments, they both work for you and they both cost the same thing, except one is an active medication with side effects and one is a placebo, with no side effects, you just don't know it, which is why it works.

Which would you prefer? And which is worth more?

Think about it, the answer isn't obvious, or, it shouldn't be.

In this case I would advocate for a third option, that is in my opinion the best way: finding out how the placebo effect helps and work out how to replicate it without either medication or placebo.

Here is a simple example. I know a couple of people who take some placebo medication if they bumped into stuff because they believe they will be getting less hematomas. If they realized that a small superficial hematoma isn't a bad thing at all, they wouldn't need the placebo in the first place, saving themselves the money, the worry and a good minute going to the fridge to get the placebo pill. This would even work if they had a medication that actually worked.

Other placebo effects might be more difficult to get though because they might be more complex to figure out or more difficult for people to comprehend or to execute. Examples could include that people relax in anticipation of relief and that that helps with the symptoms. In this case relaxation exercises could work.

I'm not totally against using the placebo effect, but I don't think it's the optimal way.

Also, just to add: Placebos can produce placebo side effects too.
« Last Edit: December 21, 2020, 05:50:57 AM by Green_Tea »

Malcat

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #252 on: December 21, 2020, 06:23:12 AM »

Ah, but we rarely know when something is a placebo, and if we do, it doesn't work anymore.

Let's say you have two treatments, they both work for you and they both cost the same thing, except one is an active medication with side effects and one is a placebo, with no side effects, you just don't know it, which is why it works.

Which would you prefer? And which is worth more?

Think about it, the answer isn't obvious, or, it shouldn't be.

In this case I would advocate for a third option, that is in my opinion the best way: finding out how the placebo effect helps and work out how to replicate it without either medication or placebo.

Here is a simple example. I know a couple of people who take some placebo medication if they bumped into stuff because they believe they will be getting less hematomas. If they realized that a small superficial hematoma isn't a bad thing at all, they wouldn't need the placebo in the first place, saving themselves the money, the worry and a good minute going to the fridge to get the placebo pill. This would even work if they had a medication that actually worked.

Other placebo effects might be more difficult to get though because they might be more complex to figure out or more difficult for people to comprehend or to execute. Examples could include that people relax in anticipation of relief and that that helps with the symptoms. In this case relaxation exercises could work.

I'm not totally against using the placebo effect, but I don't think it's the optimal way.

Also, just to add: Placebos can produce placebo side effects too.

Yes, I know placebo can cause side effects, but I was leaving it out to make a point.

As for your hypotheticals, they depend on being able to tease out and utilize the placebo affect, but that's for the lost part impossible, and we have no idea how it works.

What I was actually trying to illustrate is that you *can't* separate out the value of the placebo from the value of the treatment. They are, in essence, the same, and the placebo isn't free, it's a fundamental part of the treatment, of virtually ALL treatment.

Green_Tea

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #253 on: December 21, 2020, 06:50:36 AM »
Yeah, I figured you know, it was meant for people who didn't.

Is it necessary to get to the molecular level of how the placebo effect works in that specific case though to use it? Just like we don't know with many medications, I think it is not. If it's one of the two
1. natural healing
2. mind-body (neurobiological) interaction leading to either actual healing or reduction of symptoms
Shouldn't we be able to use both without figuring out the exact pathways? Clearly there are limits to what a person is prepared and able to do and it might be easier or better in some cases to give/take a pill or whatever other placebo (which is why I wrote the above caveat), but in general I think the better way is to rely on treatments that are effective in themselves whenever possible (meaning having a greater effect than placebo alone).

Sure, placebo effect is part of all treatment. While I agree that you cannot separate out the effects of placebo and the treatment itself in the individual, you can on the larger scale in studies: give a treatment to one group and a placebo to the other and if the groups are large enough you do get a good grasp on the part that's placebo and the part of the effect that's caused by the treatment.
« Last Edit: December 21, 2020, 06:55:21 AM by Green_Tea »

Malcat

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #254 on: December 21, 2020, 07:29:33 AM »
Yeah, I figured you know, it was meant for people who didn't.

Is it necessary to get to the molecular level of how the placebo effect works in that specific case though to use it? Just like we don't know with many medications, I think it is not. If it's one of the two
1. natural healing
2. mind-body (neurobiological) interaction leading to either actual healing or reduction of symptoms
Shouldn't we be able to use both without figuring out the exact pathways? Clearly there are limits to what a person is prepared and able to do and it might be easier or better in some cases to give/take a pill or whatever other placebo (which is why I wrote the above caveat), but in general I think the better way is to rely on treatments that are effective in themselves whenever possible (meaning having a greater effect than placebo alone).

Sure, placebo effect is part of all treatment. While I agree that you cannot separate out the effects of placebo and the treatment itself in the individual, you can on the larger scale in studies: give a treatment to one group and a placebo to the other and if the groups are large enough you do get a good grasp on the part that's placebo and the part of the effect that's caused by the treatment.

Yes, on average you can.

But that's 100% useless for the individual patient. There's absolutely no way to tease out how much healing is the result of a treatment and how much is from the body healing itself in response to the treatment.

I say this as someone who has been both a scientist and a medical professional. I think people wildly underestimate how much of medicine is "*shrug* we'll see what happens".
« Last Edit: December 21, 2020, 07:31:14 AM by Malcat »

Rhinodad

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #255 on: December 21, 2020, 07:30:48 AM »
Yeah, I figured you know, it was meant for people who didn't.

Is it necessary to get to the molecular level of how the placebo effect works in that specific case though to use it? Just like we don't know with many medications, I think it is not. If it's one of the two
1. natural healing
2. mind-body (neurobiological) interaction leading to either actual healing or reduction of symptoms
Shouldn't we be able to use both without figuring out the exact pathways? Clearly there are limits to what a person is prepared and able to do and it might be easier or better in some cases to give/take a pill or whatever other placebo (which is why I wrote the above caveat), but in general I think the better way is to rely on treatments that are effective in themselves whenever possible (meaning having a greater effect than placebo alone).

Sure, placebo effect is part of all treatment. While I agree that you cannot separate out the effects of placebo and the treatment itself in the individual, you can on the larger scale in studies: give a treatment to one group and a placebo to the other and if the groups are large enough you do get a good grasp on the part that's placebo and the part of the effect that's caused by the treatment.

I actually don't think it's necessary to get to the molecular level, but I also think that we need to teach and recondition most of the general public that we aren't going to feel great all the time either. There was a study a while back that upwards of 80% of advice given by ER docs has no basis in evidence. Not to say it's wrong, but there is no evidence to back it up. I don't necessarily blame the docs either, as most people want AN answer, and certainly don't want to a doc to shrug and say something like "No idea why your back is stiff, but 99% of the time it clears up on it's own". Research on shoulder surgery's shows that there really isn't a significant benefit over rest. The research into the effectiveness of cortisone shots vs. placebo is incredibly shaky at best. We need to re-educate that pain is incredibly complex and multifactorial, and in most cases there is not a "pain generator" that can easily be fixed. And if we don't think all of those things cost us money, we are out of our ever loving mind.

Malcat

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Re: What is a myth that should be dispelled because it is costing us all money?
« Reply #256 on: December 21, 2020, 07:35:32 AM »
Yeah, I figured you know, it was meant for people who didn't.

Is it necessary to get to the molecular level of how the placebo effect works in that specific case though to use it? Just like we don't know with many medications, I think it is not. If it's one of the two
1. natural healing
2. mind-body (neurobiological) interaction leading to either actual healing or reduction of symptoms
Shouldn't we be able to use both without figuring out the exact pathways? Clearly there are limits to what a person is prepared and able to do and it might be easier or better in some cases to give/take a pill or whatever other placebo (which is why I wrote the above caveat), but in general I think the better way is to rely on treatments that are effective in themselves whenever possible (meaning having a greater effect than placebo alone).

Sure, placebo effect is part of all treatment. While I agree that you cannot separate out the effects of placebo and the treatment itself in the individual, you can on the larger scale in studies: give a treatment to one group and a placebo to the other and if the groups are large enough you do get a good grasp on the part that's placebo and the part of the effect that's caused by the treatment.

I actually don't think it's necessary to get to the molecular level, but I also think that we need to teach and recondition most of the general public that we aren't going to feel great all the time either. There was a study a while back that upwards of 80% of advice given by ER docs has no basis in evidence. Not to say it's wrong, but there is no evidence to back it up. I don't necessarily blame the docs either, as most people want AN answer, and certainly don't want to a doc to shrug and say something like "No idea why your back is stiff, but 99% of the time it clears up on it's own". Research on shoulder surgery's shows that there really isn't a significant benefit over rest. The research into the effectiveness of cortisone shots vs. placebo is incredibly shaky at best. We need to re-educate that pain is incredibly complex and multifactorial, and in most cases there is not a "pain generator" that can easily be fixed. And if we don't think all of those things cost us money, we are out of our ever loving mind.

Ding ding ding

As someone who treats pain and is in constant pain, I can tell you that pretty much no one has a clue when it comes to treating pain. At all, period.

I also reject the assumption that understanding how something functions on a molecular level means understanding the mechanism by which is exerts its effects.

We have a pretty decent understanding of the molecular functions of the brain, and precisely a fraction above ZERO understanding of how the hell it actually works to do what it does.