Author Topic: The ethical dilemma of the placebo effect  (Read 2881 times)

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Offline rumborak

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The ethical dilemma of the placebo effect
« on: August 06, 2010, 09:02:55 AM »
So, I was listening to an audio podcast ("Skeptics podcast") yesterday, and they were talking about how the British Health Institute (or whatever it's called) declared that homeopathy and acupuncture, while having no scientifically grounded basis, still "works" due to the placebo effect, and thus should be continued as a viable treatment to ailments.
So, the creators of the podcast were ranting about how this was all bullshit and how it was misleading the public, and that they should oust essentially all products that are relying on the placebo effect.

I have to say that I found myself somewhat disagreeing with this notion. After all, at least to me, the goal of treatment is to help the patient. And how that happens, be it through transcriptase inhibitors (whose function you can show and demonstrate), or poking somebody with needles (whose effects you can't show) doesn't matter, does it?
Now, of course the big problem is that if you start endorsing placebo-effect based medication, the door is open for quacks all over the world (and the homeopathic industry is already full of it), resulting in massive rip-off of patients for questionable treatment results.

Thoughts?

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Offline robwebster

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Re: The ethical dilemma of the placebo effect
« Reply #1 on: August 06, 2010, 09:10:44 AM »
If anything, I'd say a placebo probably helps a patient help themself.

Tell a depressed patient that you've got a pill that helps them think more positively, and you might trick them into cheering up a bit.

That said, depends on what form it takes. If they're just exhibiting demand characteristics 'cause they think they're meant to say they feel happier, then it's a waste of time, and just as importantly of the patient's hard-earned money. But if it helps, then why not give it a shot? It's not exactly dangerous, it's the kind of superstition everyone clings to. It's just like a comfort blanket. Everyone's got one in some form. No, the comfort blanket doesn't do anything. It just sits there. If you were attacked, the blanket would just sit there doing fuck all while you got your head bludgeoned. But if it gives you psychological strength, it's doing something! But I mean, it works everywhere. Not confined to superstition. How about how people feel safer in their own houses? Are they safer? Not especially. But it's a human impulse.

If you can craft the way a patient thinks, that's almost more powerful than medicine. It's like the old storybook cliche. "It was you all along." Giving a patient the power to feel better on their own terms is, in some ways, better than making them dependent on x chemical.

I think placebos have a place in medicine. It's a very small niche, and it's got to be done carefully, and it won't work on skeptics, and blah-de-blah-be-blah but when the planets align they can be golden.

Offline William Wallace

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Re: The ethical dilemma of the placebo effect
« Reply #2 on: August 06, 2010, 09:15:25 AM »
So, I was listening to an audio podcast ("Skeptics podcast") yesterday, and they were talking about how the British Health Institute (or whatever it's called) declared that homeopathy and acupuncture, while having no scientifically grounded basis, still "works" due to the placebo effect, and thus should be continued as a viable treatment to ailments.
So, the creators of the podcast were ranting about how this was all bullshit and how it was misleading the public, and that they should oust essentially all products that are relying on the placebo effect.

I have to say that I found myself somewhat disagreeing with this notion. After all, at least to me, the goal of treatment is to help the patient. And how that happens, be it through transcriptase inhibitors (whose function you can show and demonstrate), or poking somebody with needles (whose effects you can't show) doesn't matter, does it?
Now, of course the big problem is that if you start endorsing placebo-effect based medication, the door is open for quacks all over the world (and the homeopathic industry is already full of it), resulting in massive rip-off of patients for questionable treatment results.

Thoughts?

rumborak

It's a difficult subject. Like you, my inclination is to approve of it so long as the treatment does no harm and the patient understands what he is subjecting himself to. However, I also like science and assholes not abusing it for their own purposes. I think the best thing for the time being is for scientists and watchful consumers to call bullshit as soon as quackery rears its head. There are a lot of good writers and researchers who are doing just that; this guy is my personal favorite.

Offline rumborak

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Re: The ethical dilemma of the placebo effect
« Reply #3 on: August 06, 2010, 09:21:58 AM »
BTW, I've always wondered whether you could sell a product called "Placebo". I mean, you could tout the most marvelous effects ("shown to help with gout, depression, unfaithfulness ...") without lying, and you wouldn't need to have it approved by the FDA since it has absolutely no active ingredients.

rumborak
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Offline Neurasthenic

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Re: The ethical dilemma of the placebo effect
« Reply #4 on: August 06, 2010, 09:24:36 AM »
For me the problem is not with the rip-off itself but the extent to which it goes. For example, my mother uses those ''cold-fx'' pills which supposedly prevent common cold and flu but really are overpriced ginseng pills which have been shown to be as useful as a placebo. I don't really care if my mother's being ripped off because in the end the information is available and she claims it helps her. Whatever works for her I guess.

On the other hand, sometime this is taken way too far. For example there was a case a few years ago in my area involving a naturopath who had convinced one of her diabetic patients to replace her insulin by some kind of natural remedy. The patient died shortly after. I also remember reading about another case about a man who made thousands of dollars with a cancer cure that was shown to actually be worse than the placebo.

I mean it's one thing to feed off the ignorance of some people, which is morally questionable but not outright wrong, but when it's being done at the expense of the patient's health (i.e, the opposite of what you're supposed to achieve), that's when it gets problematic.  

Offline Super Dude

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Re: The ethical dilemma of the placebo effect
« Reply #5 on: August 06, 2010, 09:54:22 AM »
Well isn't a large part of fighting a disease the patient's attitude? I feel like I've heard somewhere that patients with a positive attitude are more likely to overcome certain illnesses.
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Offline El JoNNo

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Re: The ethical dilemma of the placebo effect
« Reply #6 on: August 07, 2010, 12:15:06 AM »
The more people think things that don't work do work, the more money and resources are put toward garbage. The problem is, yes it does help some people, I bet it helps less than it hurts or does nothing to. Anything that is not backed by facts and research should never be pushed by the mainstream (government, doctors etc). We already have morons against vaccines, global climate change, condoms and much more.

I take issue with anything that promotes ignorance and gullibility, I don't think placebos should be used at all.     

Offline Adami

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Re: The ethical dilemma of the placebo effect
« Reply #7 on: August 07, 2010, 12:20:08 AM »

I take issue with anything that promotes ignorance and gullibility, I don't think placebos should be used at all.     

What about people who are convinced they are sick with something, but aren't?
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Offline El JoNNo

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Re: The ethical dilemma of the placebo effect
« Reply #8 on: August 07, 2010, 02:18:35 AM »
Therapy; yes there will be people that are convinced of their own illness but is that reason lie to the masses. There are people will to try anything, especially the ones who are educated about whatever illness they have. Is it right to leave the door about for them to waste their money on a fallacy?

As I said before there is way too much crap being panhandled to the masses, false hope should not be one of them. It may help one person, then that one person "spreads the word" and dig a hole for many more. Maybe a few more people are helped, but there will be more harmed then helped. The needs of the many outweigh the needs of the few. - Spock

Edit: Christopher Hitchens' outlook on his illness is in my mind the best and most healthy.

Offline Adami

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Re: The ethical dilemma of the placebo effect
« Reply #9 on: August 07, 2010, 02:25:46 AM »
Sometimes what would take 10-15 years of therapy could be solved quite easily by giving a simple plocebo. Many times, it only needs to be given once or twice, then show what it is and thus proving that the result is psychological. It's not like the person needs to be addicted to it.
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Offline Nigerius Rex

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Re: The ethical dilemma of the placebo effect
« Reply #10 on: August 07, 2010, 02:36:23 AM »
I think the status quo is the best option considering everything I can think of.

The information is there if people want to look for something that empirically disproves or strongly suggests the methods don't work. They should be able to pay a palm reader to tell them about their destiny, acupuncturist for stress, or reflexologist for back pain if they personally believe those things work. The real dilemma is if they can go too far with their claims and how or if we should limit it. If you simply blanket ban all scientifically inconclusive practices then you have to deal with moral/nanny state outrage, and if you allow it free reign people may be seriously taken advantage of (which I happen to be fine with).

Another interesting thing to think about is that a lot of people genuinely believe (regardless of if they are right or not) they can speak to the dead, work the tension out of muscles with needles or magnetize the shit out of cancer cells or that these practices are beneficial in one or more ways.  If the users and practitioners are willing customers and legitimate businessmen in the sense that they did not purposefully mislead with the intention of harm, more power to them.


Offline Dr. SeaWolf

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Re: The ethical dilemma of the placebo effect
« Reply #11 on: August 08, 2010, 06:13:15 AM »
Just because someone believes something, doesn't make it true... especially if it has been proven empirically to be false.

And if someone says something works, beyond the placebo effect (as these homeopaths are doing), then that is misleading.

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Offline El JoNNo

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Re: The ethical dilemma of the placebo effect
« Reply #12 on: August 11, 2010, 10:53:07 PM »
Sometimes what would take 10-15 years of therapy could be solved quite easily by giving a simple plocebo. Many times, it only needs to be given once or twice, then show what it is and thus proving that the result is psychological. It's not like the person needs to be addicted to it.

Well I suppose I could amend my opinion to include the usage if it were to help determine whether or not it was indeed all in the persons head. That being said it should be regulated as such that the doctor would need not only him/her own authorization but perhaps that of their supervisor. Now I know this poses the issue of Doctors whom have their own practice and basically answer to no one, but hey something could be worked out.

Offline Global Laziness

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Re: The ethical dilemma of the placebo effect
« Reply #13 on: August 11, 2010, 11:28:49 PM »
the British Health Institute (or whatever it's called) declared that homeopathy and acupuncture, while having no scientifically grounded basis, still "works" due to the placebo effect, and thus should be continued as a viable treatment to ailments.

Of course, by publicly coming out with a statement like this it kind of defeats the purpose. They're effectively telling everyone that these kinds of practices don't work, thus negating the placebo effect. :lol
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Offline Dr. SeaWolf

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Re: The ethical dilemma of the placebo effect
« Reply #14 on: August 12, 2010, 05:37:07 AM »
The bottom line is that if something only works because of a placebo effect, it shouldn't be supported publicly as serious medicine that only experts can administer, i.e. an acupuncturist, chiropractor, etc.