Archive for category Medicine

The Power of the Placebo: a skeptical view

Something has always bothered me about the placebo effect. And I don’t just mean the way it is co-opted by advocates of pseudomedical bollocks to justify their claims. I’ve lost count of the number of people I’ve heard defend homeopathy or acupuncture with the statement “It does work – it just works through the placebo effect”.

Well, no. If something works as well as a placebo, that’s the same as saying it doesn’t work. If a plain sugar pill works as well as a homeopathically treated sugar pill then – whatever else might be helping the patient feel better – it is not the homeopathy.

No, my problem is why a placebo helps at all. How can actively doing nothing be different from passively doing nothing? Mind over matter? I’m skeptical.

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The Doctor Says: There May Be Trouble Ahead

Dr Selva Rasaiah is a regular at Merseyside Skeptics in the Pub. Here, in response to my support for real medicine, he takes an inside look at the NHS, and doesn’t like what he sees…

The other day, I read Marsh’s latest post ‘Real Medicine: I Wonder’ with interest – as (hopefully!) one of the “good doctors” he wrote of, I would like to report all is well within the NHS. Unfortunately I can’t. Virtually all the comments on his piece were positive about the use of conventional medicine, but an important point was raised regarding the care of osteoarthritic hip pain. Currently the options for “wear and tear” arthritis are very limited, the options being:

  1. do nothing
  2. take painkillers
  3. hip replacement surgery.

The only definitive treatment is option 3, which for most patients is a life changing procedure. Unfortunately it has a limited lifespan, and in general is only offered to more severely affected patients. As this condition can start in the 50’s or younger, we have the difficult task of informing people that they will have to put up with the pain for many years before surgery will be considered. The problem with evidence based medicine (EBM) is that it leaves lots of gaps, which CAM (complementary and alternative medicine) is more than happy to fill.

On a daily basis, we have to inform patients that their self limiting viral illness/gastroenteritis etc. will not respond to antibiotics. It is so easy to skip the explanation and just dish out the pills, but with the advent of MRSA and other drug resistant nasties, the finger is pointing more and more at “irresponsible GP’s” and their over-prescribing of antibiotics as the cause of this new epidemic. How tempting it would therefore be to prescribe a harmless placebo that might make people feel better, psychologically if not physically. There is however, something inherently dishonest about this approach that would prevent me and most of my colleagues from doing so.

However, a small – but noisy – bunch of GPs DO seem to have followed this route, and regularly post articles and comments in GP magazines. Read the rest of this entry »

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