Monday, September 15, 2014

Placebo Paradoxes

When you research medicines, alternative medicines, even medical treatments that do not involve a physical substance, you will see reference to the "placebo effect". Statements like:

X is no better than a placebo.
Y is probably just a "placebo effect".
Treatment X is just a placebo.
Medicine X failed to beat a placebo in controlled clinical studies.

What is a placebo? What is a placebo effect? Are they real, fake, or something else? Is the placebo effect magic?  No, but placebo effects are a paradox. Merriam Webster defines placebo effect thus:

"improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used"

Placebo effect is a real effect in response to a treatment that cannot cause the effect.

A paradox.

Each instance of "placebo effect" contains the theory that this instance of the effect "cannot be due to the action of the medicine identified as a placebo". Theory is impossible to, prove. It can only be disproven - by proving what caused the effect. But, when you prove that the effect was caused by something, it is no longer a placebo effect.

Placebo effects are real. They really do exist.  The dictionary and medical textbooks agree. But, a placebo effect, as currently defined, is a  logical paradox.

Maybe we should look at the definition of a placebo? Merriam-Webster defines a placebo:

"medicine : a pill or substance that is given to a patient like a drug but that has no physical effect on the patient"

However, this is not precisely true, as evidenced by their further definitions, which say:

"a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder"

In the first definition Webster's says "has no physical effect", but in the second it says it is prescribed for the 'mental relief'' (a physical effect no doubt) of the patient. Medical authorities have problems defining physical things having a 'spirit' effect, while brain and mental effects are within their scope.

Webster's also describes a different type of placebo: "an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance".  We will come back to this type of placebo later, but for now, we will simply name it differently, as a 'clinical placebo', because it is a very different case. I will refer to the first type of placebo as 'placebo', because it matches the origin of the word placebo, which is Latin for "to please". A clinical placebo is not created 'to please' the patient. It is simply a "fake medicine".

Why would a doctor give a patient a drug that has no physical effect? A placebo is:

 placebo: a lie from your doctor. 

or, in dictionary lingo: "a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder, because the doctor believes the lie it will have a positive effect on the patient

Doctors prescribe placebo medicines, which they believe have no effect - in full anticipation of a positive effect. A placebo is created when a doctor lies to a patient, and possibly to themselves. White lies, useful lies. Statistical surveys have shown that most doctors 'admit to' prescribing placebos some of the time. The words 'admit to' are used because the prescription of a placebo is a lie.

What do we call it when someone does something, in full belief that it cannot work, expecting it to work, and it actually works?

A paradox

Placebos are paradoxical.  Doctors 'know' that the placebo they prescribe cannot work. They prescribe them, and they tell the patient they will work - or might work, and sometimes,  'magic happens' - they actually work. Some doctors are quite good at knowing when "something that doesn't work" will actually work. Are they magic?  Are these doctors 'witch doctors'?

Of course calling it 'magic medicine', or 'paradoxical' is not considered scientific, so instead, it is called a placebo. Placebo sounds scientific. In medical research, placebos are used in clinical studies - so they must be scientific.

Placebos can have placebo effects. Placebo effects are real. Thus, placebos are real medicines, even though they are lies.

Summary so far:

Placebos are lies. Your doctor prescribes something that cannot directly help your illness. 
Placebos can have placebo effects. 
Placebo effects are real. 
Placebos are real medicines. 

Is the naming of placebos, and placebo effects done under the theory that these are real effects, caused by something else? No. The word placebo is Latin and it means 'to please'. The doctor 'pleases' the patient. What happens when the doctor pleases the patient? Does it help the patient's body?  Does it help the patients mind?  No.

It helps the patient's spirit.

The Hierarchy of Healthicine rises from genetics and nutrients, through cells, tissues, organs, systems, body, minds, spirits, and communities.  Medicine, in theory, treats the body - which includes the mind, but not the spirits, and not the communities.

Placebos arise from the community.  Your doctor, part of your community, provides a prescription for hope. Placebos treat the spirit. A good doctor can treat the spirit of the patient, sometimes by providing hope, and sometimes even with a lie.

The positive effects of a medicine are not limited to physical effects, they can also include spirit effects. Are all non-physical effects as spirit effects? If not, what are they? Note: Not 'spiritual' effects. Spirituality is a small part of our spirits. Spiritual effects are a small part of spirit effects.

Spirit effects have physical effects. So a medicine that does not have physical effects, and only has effects on our 'spirit', leads to physical effects.  This makes measurement and distinction between physical effects and spirit effects difficult. If a medicine lifts only your spirits, and when your spirits are lifted, you feel better, take your other medicines on time, change your diet, get out and walk the dog - and your health improves.  Did the medicine have only a spirit effect?  No, the first effect was on your spirit.

It wasn't the 'medicine' that caused the placebo effect. It was the doctor's hope. The dictionary definition of a placebo is actually incorrect.. A placebo is something the doctor recommends when he has no solution to sell. It is a recommendation of hope. Prescribing a placebo is the act of prescribing hope.

Placebos lift the patients spirits. What we call 'placebo effect' is actually the of lifting the patient's spirits.  It is not the medicine that the patient takes, it is that the patient believes in the medicine. Belief has real, powerful effects.

Of course there are medicines that can depress or lift the spirits, like alcohol and caffeine. But none of these are placebos. These typically result in rebound effects, often called 'side effects' as your body recovers from them.

We can now define placebo, placebo effect, active placebo and medicine, to remove all of the paradoxes.

A placebo is a prescription given to lift the spirits of the patient. It often contains a medicine recommendation that the doctor does not believe will have any direct physical effect on the body of the patient. The spirit lift often results in positive physical effects on the patient. 

 - What's different about that definition?  It feels right. And there is no paradox.
 - The medicine prescribed is not a placebo. Nothing is a placebo in itself. It becomes a placebo only when it is prescribed by a doctor. The act of giving a prescription, creates a placebo and the placebo effect.

Placebo effects are the effects of a placebo, on the spirit of the patient, and the subsequent effects on the patient's body.  Placebo effects are 'spirit effects'. The strength of a placebo effect is determined not by the substance recommended, but by the sincerity of the doctor, and the belief of the patient. 

Note: Placebo effects are not effects of the actual medicine. They are the result of the patient's belief in the doctor.

An active placebo is a prescription that contains a something that has an effect on the patient's body, not related to the illness.  It does, as a placebo, have an effect on the patient's spirits, often a stronger effect, because the patient's spirit is lifted by the physical sensations.. 

A medicine has an effect on the patients illness, the patient's body. To a certain extent, medical prescriptions are also placebos, even if the doctor is absolutely certain they will work. If the doctor believes, the patient's spirit, the patient's "will", is more likely to believe in, and to take, the medicine. Medical prescriptions also have spirit effects on the patient. 

Medicines that are prescribed are also placebos. They have medical effects and also placebo effects. Even the wrong medicine might have a positive effect, due to the strengths of the placebo effect. Medicines can have positive medical effects, when the doctor is wrong.

Once we correctly define placebo and placebo effect, there are no paradoxes.

Even self-medication can have a placebo effect. A patient chooses a self-medication because of a belief that the medication can have a positive effect. The act of choosing and using the medication lifts the patient's spirits. Self-medication can be based on previous experiences, or it might come from other people in the patient's community.

There is an interesting technical issue.  The prescription of a placebo is still a lie. A white lie. If the doctor tells the patient what he believes to be the truth, then the 'placebo prescription' will not work. The doctor doesn't tell the patient he is prescribing a placebo - he says "I'm prescribing a medicine.", knowing himself that it is a placebo.  The nurse, the pharmacist, and others might not know that it is a placebo, or a spirit medicine.  They don't need to know for it to work. And if they know, and they tell the patient, it might be less effective.

Placebos are not 'physical things'.  They can lift the spirit, because they are imaginary things - rising above the physical realm. Placebos are real aspects of medicines, they have real effects and they can even have side effects - effects that were not intended by the doctor. All medicines have the attributes of placebo, when they are actually prescribed.

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To this point, we have not discussed Clinical Placebos.

Clinical placebos have a different definition, and should not be confused with the real placebos. Clinical placebos are null medicines, not real placebos. They could be named 'fake placebos', but I believe the term 'null medicine' or simply Clinical Placebo is more accurate.

Clinical placebos only exist in a clinical trial, and only when a 'test medicine' is being tested in a clinical trial.

Clinical placebos do not require the doctor to lie to the patient.  When clinical placebos are used, the doctors are not allowed to lie to the patient, rather - they tell the patient that the doctor does not know if the patient is receiving the 'medicine being tested', or a clinical placebo.

Clinical placebos are not designed, nor delivered, to improve the spirits of the patient.

Clinical placebos are actually designed to eliminate the real placebo effects from the mathematics of clinical studies. However, this theory is weak and problematical, because, even though clinical placebos are not real placebos -they sometimes have placebo like effects.

Clinical placebos are not 'prescribed', they are 'administered'.

Clinical placebos are not given in the best interest of the patient. They are administered to assist medical scientists gain knowledge for future use.

Doctors who administer clinical placebos want the clinical placebo to fail. If the clinical placebo fails, and the 'medicine being tested' works, then the clinical trial has been a success.

Clinical placebos are very, very different from a placebo from your doctor,  A placebo from your doctor is an honest attempt to provide effective medicine for your condition.  A clinical placebo is an attempt to determine if a specific medicine provides some statistical benefit.

Clinical Placebo Effects - are still a paradox. We can understand that a normal placebo lifts the patients spirits, and results in better health. But clinical placebos are not designed to lift the spirits of the patient. But the fact is that clinical placebo effects also exist. Why? Because we don't understand. When we do understand, this paradox will also fade away.

So...When you read statements like:

X is no better than a placebo.
Y is probably just a "placebo effect".
Treatment X is just a placebo.
Medicine X failed to beat a placebo in controlled clinical studies.

Ask "Are you talking about a real placebo, or a clinical placebo?"

to your health, tracy

Thursday, July 24, 2014

Should Homeopathic Medicines be Banned?

You might also enjoy 10 Reasons to Love your Homeopath

Should homeopathic medicines be banned? I've seen this statement quite a few times in recent months. I just returned from a trip to England and Scotland, where there has been a lot of discussion of banning homeopathic medicines. The Daily Mail Reporter headlines "Homeopathy remedies should be labeled as placebos and banned on NHS", but added, "But some doctors said their patients seemed to benefit despite no clinical trial evidence that homeopathy worked."

Thursday, July 17, 2014

Pseudo-Pseudo Science in the Blogosphere

I recently read a post claiming to bust “10 pseudo-science theories”. However, like many posts claiming to be science based, claiming to be about science it is actually a ‘pseudo-pseudo-science’ post, presenting many ‘pseudo-pseudo-science’ theories. Many people commented on the post, most with simple statements like ‘great’ and others with minor complaints.

To be honest, when I first read the post, I thought – this makes some sense, but the author(s)? have made a few simple errors.  As I read the post over, and over, and over again, I found more holes, more nonsense, more ‘pseudo-pseudo-science’ with each re-read.

If you want to test your own sense of science, you can read the post here.  Of courses internet posts are always ‘subject to change’, so by the time you read this, the post might have changed. I often improve on my posts after they are published.

10 Pseudo-Science Theories We'd Like to See Retired Forever
If you have seen this post before, no matter what you thought, you might be very surprised by my conclusions - I have read the post at least 5 times.  I have taken the time to research many of the points, the words, the ideas and the sciences discussed therein.

Thursday, March 20, 2014

Can the rich buy healthiness?


If you are very rich, can you buy healthiness?  It's an interesting question. We know that those with money can afford better 'medical care', but can they buy 'health'?

What if money is no object? How much would you pay to raise your health 'as high as possible'? Presumably, if you can raise your health as high as possible, you will suffer much less illness. When you do suffer an illness, you will recover much faster. If you can raise your health, you will live longer, healthier, look younger.  What's not to like?  If I had the money, that's what I'd want.

But, if I had money, what would I spend it on, to improve my healthiness? There are lots of 'theories' of how to improve healthiness. Eat a healthy diet and exercise are the two most often suggested. But what's the complete list?

Thursday, March 6, 2014

When I let loose my dog, my spirits fly free

When I'm in Arequipa, Peru, I walk Otto, the dog, every morning. When we're in the city, with lots of people, children, cats, and dogs, I keep him close - to keep himself and others safe from his exuberant spirit.  But once we reach the fields in the countryside, I ask him to sit quietly while I unhook the leash - and he's off. When I let loose my dog, my spirit flies free.

In the distance, I can hear the church bells, and the recorded music calling the parishoners: choir music, organ music, Spanish hymns, and the occasional hymn from John Lennon - Imagine is a local favorite here in Arequipa.

My spirits lift, as his freedom lifts his body.

What are our spirits? How can we make our spirits healthier? In the book Healthicine: The Arts and Sciences of Health and Healthiness, spirits are defined as "Our spirits are our wills, our desires, our longings, to be, or not to be." Do we need religion, or faith in God to have strong spirits. Are spirits only about religious spirituality? I don't think so.

When Otto runs free, he reminds me that I "want to be". My spirit soars with him, as he floats over the fields, ignoring the peruvian burrowing owls that screech above him, searching out the smells of the earth.

When I stop to think about it, I also realize that Otto has become part of my communities - and my community healthiness. When I walk with him and he runs with me - we both grow healthier.

Tuesday, January 28, 2014

Vitamin D: Science vs the Media

In early December, 2013, the Lancet published a paper measuring the effects of Vitamin D supplements on illness. On January 24th, 2014, seven weeks later, the media woke up and published many 'reports' on the unstudied effects of Vitamin D supplements on health (not on illness).  Should you trust the science? or the media?

Monday, December 23, 2013

Annals of Internal Medicine Claims Black is White: Further Explorations


The Annals of Internal Medicine today published an editorial titled "Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements". The editorial tells us that three separate research projects studied the effects of 'supplements' on different chronic illness, and found no significant disease benefit from 'supplements'.  

What's right with this picture? Seriously? What healthiness was measured? The editorial says: "most supplements do not prevent chronic disease or death". The use of supplements is not justified because they cannot prevent death? So who can prevent death? Medicines can extend life, but they can't prevent death. And chronic disease? What medicine can prevent the chronic diseases that were tested? None. Should we "stop wasting our money on medicines"? Well, maybe we should. 

Wednesday, November 6, 2013

Julian Assange, Edward Snowden and President Kennedy

I was eleven years old when President Kennedy died.  I remember coming home from school at lunch and hearing the news from my mom.

A few days ago at my local drugstore, I noticed the appearance of John F Kennedy memorial magazines. But a quick glance confirmed the truth.  Nobody knows. It's official. But it's OK, we can still sell magazines. We don't have free press, but we can pretend. We can print lots of "beautiful pictures" and happy stories.

November 22, 2013 will be the 50th anniversary of the death of President John Kennedy. It's official. Nobody knows what happened. You can be sure someone knows.  You can be certain that several people know what happened.  But you don't know.  The news media doesn't know, or doesn't dare. Fifty years later and the best we can do is, as Wiki, the new authority, reports "Lee Harvey Oswald was accused of the crime and arrested that evening, but Jack Ruby shot and killed him two days later, before a trial could take place."

To be perfectly honest, we don't even know if the President was assassinated.