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TFarnon
New Member
USA
17 Posts |
 Posted - 11/07/2008 : 21:40:24 [Permalink]
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Originally posted by tomk80
Originally posted by chefcrsh
Originally posted by Ricky
| And if the placebo is to work they will need to charge as if the med is real in order to fool the patient. |
You have a rather uncreative mind, chef. "The government offers a subsidy reducing the price of this drug," would suffice.
| in the cases mentioned the doctor is using a placebo as a wild guess |
Where do you get this from?
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The adhom is irrelevant, plus do you always equate creativity with ability to add one lie to another?
As to where I get this: QED. If there is only a 1 in 3 chance that a placebo will have any effect at all. Ordering placebo in the cases regarding arthritis and other joint problems, pain treatment and such, is at best a stab in the dark. Especially when actual pain medicine is proven to be significantly more efficacious for the management of pain. |
That depends on the case. Even where pain medication works better than placebos it is still a matter of averages, especially in the case of pain medication. In the case of pain medication, doctors will always need to do a stab in the dark to determine correct dosage and to determine which kind of medicine works best. In these cases a doctor will start with the lightest forms of medication that he thinks will work first and work up or down from there. Especially in cases where the pain is not severe, a placebo is not a stab in the dark, at least not more than prescribing any other real pain medication.
It is also important to note here that pain medication often has side-effects like fatigue and that habituation to pain medication will often take place. A placebo may help while avoiding these negative effects, although this again will differ from case to case.
The problem with prescribing medication for pain system is that there is no reliable system for measuring reported pain. One person carries on, howling and moaning over a freakin' broken fingernail, while another calmly observes that there's an axe head buried in her thigh and it's kind of bleeding. The number scale doesn't help, because even there the relative perception of pain varies from person to person.
Sometimes it's the result of experience--there was a study done in the Netherlands with pain perception as measured by tolerance to immersion in hot (not scalding--just hot like hot bath, jacuzzi and dishwashing hot) water. Veterans with PTSD (from the Bosnian crises) showed significantly higher tolerance for heat-induced pain than veterans without PTSD.
If you were to use any painful stimulus that could be (ethically and safely) delivered to study subjects (for example, an electric shock at a given voltage and amperage) and then deliver the minimum amount of a given drug which would block that pain, I hypothesize that the amount of drug required would vary tremendously from subject to subject based on life history, life experience, physiology, sex, age and perhaps even geography or weather conditions.
Given this variability, a doctor can not reasonably be expected to prescribe pain medication based on anything other than an educated guess.
In the case of vague symptoms like pain the effectiveness is close to 2/3 by the way.
Part of the problem with vague symptoms, especially vague or diffuse pain, is that a diagnosis and evidence-based treatment plan for those vague symptoms may be difficult or impossible. Lyme disease, which has a very clear etiology and treatment, is a good example of a disease which often goes undiagnosed and untreated for weeks, months or years because the symptoms are vague and nonspecific (except for the target rash, which may well be gone by the time the patient seeks treatment). There is a significant frustration component as well when a patient experiences vague, nonspecific symptoms not amenable to quick diagnosis and specific treatment. The patient may be seen as a "whiner" or "drug seeking", because it's nearly impossible to distinguish between legitimate distress and declared distress in order to gain attention or drugs. A patient (with legitimate but vague symptoms) may feel relief as the result of being handed a bottle of tablets which the doctor claims will treat the problem, and that psychological relief may lead to a perception of physical relief as well.
| Which again is why we skeptics rail against such things as acupuncture or Reiki. Because they show no more benefit than placebo. i/e random shot-in-the-dark roll-of-the-dice chance. |
The effectiveness or not of a placebo is not the same as chance. At least not more than any other medication I know of.
I rile against acupuncture or reiki because they make claims they cannot uphold. I especially rile against alternative medicine when it purports to offer treatment for curable diseases when this treatment doesn't work, which can lead to fatal outcomes.
Personally, I am ambivalent in the use of alternative treatments for the treatment of symptoms or for the treatment of vague complaints or socalled MUPS (Medically Unexplained Physical Symptoms). Here, conventional medicine cannot cure the disease, or cannot even given an answer as to the underlying causes (which may well be psychological). Alternative treatments may well provide relief here and I'm not wholly against using it in these cases.
And even when I go to a casino, to play a game of chance, I want to know the rules first, I want to be fully informed. If the Casino is rigging the game and hiding the real odds from me, we call it fraud. Same so with a doctor, a butcher, a baker or a brewer.
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I don't know whether I agree with you if successful treatment with a placebo leads to a better quality of life.
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Bacteria RULE, Hominids drool |
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Half of U.S. doctors use placebo
