The Placebo & Homeopathy effects

9 03 2010

Ben Goldacre is the man behind the book “Bad Science“, the blog “Bad Science” (http://www.badscience.net/) and the weekly Bad Science column in the Guardian. He is a medical doctor who specializes in unpicking dodgy scientific claims made by scaremongering journalists, dodgy government reports, evil pharmaceutical corporations, PR companies and quacks.

One of Ben’s favorite subjects is “the placebo effect”.  He wrote a two-part documentary series called The Placebo Effect on BBC Radio 4.

Recently Ben also made a short video, released by NHSChoices, on the placebo effect. Here he explains this difficult topic in a clear and comprehensible fashion.

Somehow I always think of Ben as his logo suggests: dr. Frankenstein. It is a relief to see that dr. Ben is almost the opposite: friendly, enthusiastic and crystal clear (without needing a crystal ball ;).

The video is not only recommended for people who don’t have a clue about the placebo effect but also for those (like me) who already know that a placebo is a dummy treatment.
Did you know, for instance, that one placebo can be more effective than another, depending on your expectations or the color of the capsule/pill or the expectations of the one who treats you?

Seeing the video I wondered in what respect homeopathy would differ from the placebo.

And you know what? Ben Goldacre explains that too in an older video. Really wonderful how “magically” homeopathic dilutions are graphically explained.

———

The first video has been tweeted about and blogged about several times. First that was a reason not to blog about it. But on the other hand the topic is well suited for this blog and many people who aren’t on Twitter or don’t follow those blogs might like it anyway.

To you my dear reader the following question: do you like me to include such videos, short notes or  trendy topics on my blog alternating with the longer in depth posts)?

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20 responses

9 03 2010
Dr Shock Md

I like your style, especially the alternating of short and long posts. Shows your broad area of interest and maybe something about the woman behind all these worthwhile posts, keep up all the good work and tweets, take care Dr Shock

9 03 2010
heidi

yes – like the mix between short and long posts

10 03 2010
Nancy

Real is Homeopathy. Homeopathy for Everyone

10 03 2010
Janneke

Please keep the movies etc. Besides that I like the mix, I often like to reread something I read when I encounter a situation where it suddenly applies. As you know, searching in twitter is not an easy thing, so if it fits into your story; please do!

14 03 2010
mkirschmd

Homeopathy and its cousins are highly popular. As far as actual mecdial evidence, who cares? It’s the healing, stupid! Calling them placebos is too kind. http://www.MDWhistleblower.blogspot.com

17 08 2010
Nancy Malik

Real is scientific homeopathy. It cures even when Conventional Allopathic Medicine (CAM) fails. Nano doses of evidence-based modern homeopathy medicine brings big results for everyone

21 08 2010
laikaspoetnik

Exactly, nano-doses of evidence diluted to homeopathic proportions

17 08 2010
Keith Grimaldi

I wish I could find a placebo for how I am feeling now! Seriously though it is interesting – especially BG’s view about incorporating what has been learnt, such as “positivity”, nice surroundings, etc, etc, all stuff associated with alternative and complementary medicine and of course homeopathy, so they have contributed something!

While docs cannot lie to patients I think it would be very interesting to do some studies on this – to see if improving the “positivity” can allow a doctor to use a lower dose or a less powerful (and fewer side effects) medicine. Would save a lot of money if it worked as well, don’t suppose it would be sponsored by pharma companies though…

21 08 2010
laikaspoetnik

You are absolutely right. It would be good to investigate.

But my gut feeling says it is always good if a caregiver is positive, believes in the remedy himself and listens to the patient.

17 08 2010
Keith Grimaldi

Also I suppose the NHS in the UK has found a way around the placebo-deception dilemma, by providing homeopathy on the NHS… A homeopathic doctor can’t be described as lying, but the treatment given will be inexpensive and at least will encourage the placebo effect. I didn’t really follow the long parliament enquiry and debate into continued funding, I know it went into the evidence or lack of, but I wonder if it compared performance and cost of homeopathic clinics vs. conventional?

21 08 2010
laikaspoetnik

The homeopathic doctors and their “highly-diluted remedies” are not cheap. Perhaps cheaper than regular medicine (and certainly with respect to the costs of the ingredients: there is nothing in it), but the costs the NHS is making are huge: “about £4m a year is spent on homeopathy, helping to fund four homeopathic hospitals in London, Bristol, Liverpool and Glasgow and numerous prescriptions.” (BBC News: http://news.bbc.co.uk/2/hi/health/8524926.stm)
Isn’t this a lot of public money spent on something that doesn’t work (more then placebo)? I find it principally wrong to support interventions that do not work by themselves.
I agree with Ben that this is a form of lying.

As jdc325 (james) puts it, it is “the legitimisation of a bogus therapy”.

It is interesting to read James’ post which is based on a letter send to his MD regarding the government response to the Select Committee’s evidence check on homeopathy.
Here he writes that the overriding reason for the NHS provision is not the patient choice, but rather the lobbying of certain groups.

He summarizes it as follows:

“I find it bizarre that patient choice can be used as justification for the provision of an utterly implausible remedy, based on sympathetic magic, which the best available evidence shows to perform no better than placebo.”

Post: http://jdc325.wordpress.com/2010/07/30/homeopathy-and-the-nhs/

By the way the article “Biological, clinical, and ethical advances of placebo effects” is one of top 20 Lancet articles downloaded in 2010:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961706-2/abstract

18 08 2010
David Bradley

@Nancy Malik CAM does not stand for “Conventional Allopathic Medicine”. It stands for “Complementary and Alternative Medicine” or were you trying to confuse readers deliberately. Anyone who sees any merit in homeopathy should watch another video entitled – “If homeopathy works, I will drink my own piss”, it’s on Youtube etc.

21 08 2010
laikaspoetnik

Thanks David. I failed to read it carefully, because it was nonsense anyway. At the zeta or yotta level….

20 08 2010
cryptocheilus

@ Keith

I think it would be very interesting to do some studies on this – to see if improving the “positivity” can allow a doctor to use a lower dose or a less powerful (and fewer side effects) medicine.

Just something I stumbled upon today.

http://www.ncbi.nlm.nih.gov/pubmed/20506122

more on http://www.medpagetoday.com/Rheumatology/Arthritis/21719

At least it works with acupuncture.

21 08 2010
laikaspoetnik

That is a truly interesting finding. Thanks. This paper thus suggests that the extra effect of acupuncture versus sham might be the acupuncturists’ style of high expectations. I’m not familiar with the pain scores & cannot tell whether these significant differences in pain cores are really clinically relevant. Can you?

Updated: Steven Novella just blogged about it: http://networkedblogs.com/72rFu

21 08 2010
Keith Grimaldi

Thanks for the links cryptocheilus. I was just reading this excellent essay by David Dobbs on Genes x Environment and behaviour – http://bit.ly/bFCIEb. Apart from the approach (e.g. in your link the “high expectation” acupuncture got better results than “neutral”, and the latter was no better than control) it’s also possible that genetic variations in certain genes that affect responses to negative and positive (rewarding) environments are involved in the placebo effect of acupuncture, homeopathy, or similar – maybe some individuals are more responsive than others.

21 08 2010
laikaspoetnik

Thanks for the link, @Keith. It is a bit of a long story (still have to read page 2-5), but interesting.

I’m quite sure (at least it wouldn’t surprise me) when some individuals are more responsive to homeopathy/CAM/placebo-effect (more open to these effects) than others, and that part of this is determined by the differences in genetic make-up.

I really appreciate your input in this matter. You’ve revived the discussion. Thanks.

4 09 2010
kclauson

I would like to cast a belated vote of ‘yes’ for alternating post lengths (just make certain the more in-depth ones don’t go extinct!).

Also, I wrote a short round-up about a fantastic illustrated story of homeopathy (http://bit.ly/dCyUva). Or if you want to skip my brief commentary, you can go directly to Cunningham’s full comic here:

http://darryl-cunningham.blogspot.com/2010/06/homeopathy.html

1 10 2010
Nancy Malik

Triple Blind studies, Double-Blind Randomised Placebo-Controlled Trial, Systematic Reviews & Meta Analysis, Evidence-base

130+ studies in support of homeopathy medicine published in 45+ peer-reviewed international journals out of which 45+ are FULL TEXT which can be downloaded

Medicines for specific disease conditions, Ultra-molecular dilutions, Structure & Memory of Water, Animal Studies, Plant Studies

10 02 2011
David Bradley

Nancy. No.

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