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Interesting Links for 09-06-2014
Illuminati
andrewducker

Original post on Dreamwidth - there are comment count unavailable comments there.

I'm sort of against banning homeopathy because there are lots of studies that show that the placebo effect is real and does help lots of people get better.

I'm absolutely against selling anything which involves lying to your customers.

If they want to sell "Placebo pills, they help you get better!", then I'm absolutely fine with that.

But they don't get to make medical claims that aren't backed up.

Here's the thing though, as soon as you say they are placebo pills they will no longer work.

And most ads don't make false medical claims. In general they say "xxx has helped some people with xxx" - which is, generally, true.

And, most doctors do agree that placebos work well for tons of people.

As the NHS says:

"Placebo medicine has even been shown to cause stomach ulcers to heal faster than they otherwise would.

These amazing results show that the placebo effect is real, and powerful. They mean that fake or placebo treatments can cause real improvements in health conditions: improvements we can see with our own eyes."

http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/placebo-effect.aspx

I know what the placebo affect is.

And it works even if you know it's a placebo:
http://www.theguardian.com/science/2010/dec/22/placebo-effect-patients-sham-drug

So I'm fine with selling them, so long as you make it clear that they're inert.

That study is somewhat suspect given that while they were told it was a placebo they were also told that it helped (in other words being given contradictory information.) I could easily see myself in that study thinking "Oh, these aren't placebos they are just telling me they are placebos to make sure they really work and don't work just because of a placebo effect, so they must be real medicine."

So, if we tell people it's a placebo and it'll help,then it'll help?

Then there's no problem making it clear on the packaging that it's a placebo!

Well in a clinical trial where people may think they are being lied to about it being a placebo, yes.

When it comes to the commercial market, maybe not so much.

And placebos can be safer.

Take an example from real life.

A client I was working with about two years ago sold a pill to help with erectile dysfunction. It was mostly just a bunch of herbs. But... man did he get lots of emails from dudes telling him that it worked really wonderfully for them and solved their problem.

Now, the thing is it wasn't dangerous and had no side effects at all and was cheap.

Compare that to viagra which has been proven to work, but has also been proven to kill a shit ton of dudes who have heart attacks when they take it because it works by raising their blood pressure.

Which would you rather have one of your friends take?

I would rather that people didn;t make a whole profession out of lying to people.

If they can sell water without making medical claims,then I'm perfectly happy for them to do so.

There's also the question of whether the good of the placebo affect is outweighed by the evil of spending outrageous sums of money on said placebo.

If homeopathic practitioners want to sell water at the price of water (plus a reasonable sales markup, comparable, say, to what you'd pay for bottled water), that's one thing. But my understanding is that homeopathic "consultations" are absurdly expensive.

(This is leaving aside, of course, the potential problem of people with serious, treatable illnesses turning to homeopathy instead of taking actual medicine that could help them.)

ISTR that spending more money on it also makes you feel better though... it's one of those actually hard problems to solve - an actual tradeoff between honesty and wellbeing.

Probably only so long as you don't tell them what the word 'placebo' means.

Or define it as 'Amazing miracle cure-all drug!'

Yep.

That's my thought too.

Probably wouldn't be too difficult either. Get a few celebs to talk about their amazing new miracle Placebo Health Routine, makes you healthy, sexy, and thinner!

The thing is we already do this. We just don't tell people "homepathy = placebo."

This is sort of why I don't see the point in changing the system.

Homeopathy helps some people. It doesn't help other people. But the same thing can be said of medicine itself.

For example, I have anxiety disorder. The first three prescription medications they put me on did nothing to help it - and one made it worse because it made me impotent.

The fourth one, thankfully, did work. But the point is that no medicine is really "proven" to do anything for a specific person until it does.

Not for a specific person. But they are tested to show that they work for _some_ people. Better than a placebo.

The research frequently isn't as good as it could be. And there are pretty much always side-effects.

But the answer is better research, more accuracy, and more understanding, not letting people lie to the desperate.

But at what point does it become a lie?

Take my erectile dysfunction example above. Any psychologist will tell you that not getting it up more of a mental challenge than a physical one for the vast majority of men with erectile dysfunction.

So, they buy "herbal viagra" and suddenly they can get it up - because they've told themselves that they will now be able to get it up.

Is it a lie to say that the herbal viagra helped cure their erectile dysfunction?

Now I'm not saying that we should sell stuff like this to cancer victims. But there are plenty of medical problems that start in the brain and not the body - and if believing that a bunch of herbs will solve the problem solves the problem I'd argue that the herbs work.

No, the belief works.

So teach them mindfulness, teach them meditation, teach them breathing exercises.

Teach them that if it's not working then they should try relaxing for a while with their partner, and working through their frustration. Which will not be a quick fix, but will help them in the long run without leaving them dependent on a trick.

Teach them ways to deal with their stress and anxiety that will actually help them, not provide a momentary distraction that allows them to act normal for a moment.

Or, alternatively, hand them some sugar pills, tell them that they're inert, but that some people find that taking one helps. Because that way you're not lying to them, and you're still probably helping at least some of them.

Like "Herbal Ignite contains herbs like avena sativa"...

On that basis, one would expect the Scots to be a lot more fecund than they are...

Edited at 2014-06-10 07:03 pm (UTC)

Anything with 'herbal' in the name is never going to sell in scotland, sounds too healthy. You'd have to call it 'deep fried avena sativa'.

I should note that I suspect I'm using a placebo at the moment, but am forcing my brain not to admit to itself too much that it's a placebo.

My back is giving me problems but I won't be able to see my osteo for a couple weeks because he's on vacation.

My doctor told me to buy this cream and have rome girl rub it on my back three times a day. My back feels much better.

I strained my finger last week and thought to myself -"well if it has analgesic properties on my back it will have some on my finger."

It did nothing.

Then it occurred to me "wonder if my doctor has simply gotten me to get my girlfriend to give me three backrubs a day and that's what's helping."

If that's the case, I don't care. I feel better. If someone made money off of that, fine.

I completely object to your doctor lying to you. Your doctor has a duty to treat you like an adult, and to help you find the things that work for you.

If a backrub will help then he should be telling you _that_! How on earth does selling you pointless cream do anything to help anyone?


Well I don't know it's a pointless cream. It could actually be a really good cream and have properties for backs that don't translate to fingers.

Part of me just wonders. But, my back doesn't care either way.

You could Google it - but that might break the spell :->

(And if you knew it was back rubs that were helping you could go pay a masseur and get a really good one!)

Which would cost a lot more and take up a lot more of my time than a two euro tube of cream.

And, yep, don't want to google. Don't want to know.

Oooh.

I _would_ be fine with your Doctor getting a release from you saying "I don't care if what you prescribe is just water, and I give you total permission to lie to me if you think it will help."

Do that when you sign up with them and we're all good!

I'm pretty sure my doctor knows I feel that way. This is a small neighborhood. I drink and smoke with him. He knows me.

GP's have a tried and tested traditional get out clause. It goes:

"A lot of my patients have tried X and got better. Would you like to try X?"

Not a word of a lie.


I've gone back and forth on this. By inclination I agree with you, but I also feel obliged to pay attention to anything which makes people better.

I think maybe it's something like, if a patient is unconscious and can't give informed consent, what should you do? You normally do the best you can for what most people would want, with the understanding of erring on the side of not doing anything irreversible. Offering a placebo is similar -- it's difficult to give informed consent, so you have to decide if the benefits of imposing a treatment without consent are worth it, and if most people would be ok with that.

And it's a balance between "the benefits of a placebo" vs "the detriment of lying to the patient". However, I think the detriment is often underestimated, not because it matters in a theoretically perfect case, but because giving someone power over someone else's body is open to abuse, either from malice or inattention. Eg. all the cases where placebos get more and more expensive and are sold to governments as if they're active, or the cases where a patient has to decide whether they have something serious wrong and the doctor refuses to listen. Or the risk that someone will disastrously give antibiotics as a placebo! Hence, I much prefer to err on the side of "not lying", because of how bad you can be screwed if lying goes wrong.

However, that's sort of predicated on the idea that you can get by by saying "it's probably nothing, but why not try [this thing which helps a lot of people in unspecified ways], because we don't know why, but sometimes it helps", and sort-of promote a placebo without lying and saying it's proven active in double-blind study.

"if a patient is unconscious and can't give informed consent, what should you do"

In a situation where consent is unobtainable you do the best you can.

That has nothing to do with a situation where you _can_ obtain consent.

Doctors aren't magical beings who get to call upon the powers of the Gods. They are our _employees_. They work _for us_. Nobody who works for me gets to do anything to me without my consent.

They are our _employees_. They work _for us_

I don't think this is true, is it? They work for the NHS, which is a public body. I don't think a conflict between the interests of a specific patient and the interests of The British Public comes up very often, but if it does it seems rights that they would go with the interests of The British Public. Doctors don't work for us, they work for our society.

They work for us, in the same way that MPs work for us. In the same way that civil servants work for us.

Except actually moreso - because those people have a job that means they frequently have to act against specific groups.

But with doctors, they generally _don't_ get to act on us unless we go to them and ask them, specifically, for help.

They are public servants, not enforcers of medical judgement sent from high to fix us, against our wishes - they are there to help us with problems that we want fixed.

Edited at 2014-06-11 08:38 am (UTC)

They may not legally work for you, but I thought doctors accepted an ethical and professional obligation to their current particular patient, not anyone else (except in extreme cases such as isolation for pandemics)? But now I think of it, I'm not sure how much I know from real life, and how much I got from fiction, so I suddenly realise I don't actually know...

That has nothing to do with a situation where you _can_ obtain consent.

Yes.... but for a placebo, you CAN'T obtain consent, or it doesn't work. Hence, I think, just like a young child whose parents have to decide, you have an obligation to weigh the pros and cons of what the patient WOULD want. Fortunately, I think the cons (of undermining people's trust, removing people's right to make decisions for themselves, and risks of corruption) outweigh the pros so the difficult ethical decision isn't necessary.

So, I agree with your conclusion, but not necessarily your reasoning -- I don't want to face the idea that involuntary treatments might be a good thing when they're not absolutely necessary, but I feel more sure of that for having weighed the pros and cons...?

"for a placebo, you CAN'T obtain consent, or it doesn't work"
a) Yes it does - http://www.theguardian.com/science/2010/dec/22/placebo-effect-patients-sham-drug
b) Yes you can. You ask them to sign a waiver when they join the practice "I hereby give my permission for my Doctor to lie to me if they believe it is in my interests." - and then, if they lie to you ten years later, you'll likely have long forgotten, or not consider it.

I've quit ALL drugs. Well... let me say one thing: I twisted my ankle this morning, and I was in quite a bit of pain... so I went to the doctor, and I asked him to give me some pain pills. And he didn't want to do it, but I talked him into it. So he gave me some pills -- and I shouldn't have done this, but I took some about an hour before the show tonight, and right now... I am high... as a KITE! [ audience cheers ] I mean, it is unbelievable! And I would NEVER say this to you people, but, in this case: if you EVER get a chance, to take these drugs... DO IT! They're called... [ he glances from side-to-side cautiously ] Placebos! I mean, I'm thinking that right now I have NO idea where I am at all! It is WILD! Placebo!
— Steve Martin

> I work from 10 a.m. to 6 p.m., 35 hours a week, so it's still part-time.

Huh?

Welcome to America, where working ludicrously long hours to the detriment of your job, your life, and your family is a proud tradition!

I thought it was something like that, but didn't want to immediately jump to assuming terrible things about America!

Anything less than 40 hours a week can be legitimately called part-time.

Not in the UK. In the UK 35 hours is the basic level for full-time.

In the country where the people interviewed reside, anything less than 40 hours a week can be legitimately called part-time.

Expressing surprise that 35 hours a week is considered part-time work is irrelevant.

Expressing surprise is irrelevant? I have no idea what that means.

And yes, in that country, it can be considered part-time, which is a completely ridiculous situation, hence the discussion.

I'm not entirely sure whether 40 hours per week includes lunch hours or not. I would expect a full time job to be 9-5 or 9.30 to 5.30, which is 8 hours but 7 working hours.

I would expect lunch to be 30 minutes. 37.5 hours/week.

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