Exquisite theory

[Guest guest]

>>http://www.annals.org/cgi/content/full/136/11/817

Besides clinical and scientific value, the question of enhanced placebo

effects raises complex ethical questions concerning what is

" legitimate " healing. What should determine appropriate healing, a

patient's improvement from his or her own baseline (clinical

significance) or relative improvement compared with a placebo

(fastidious efficacy)? As one philosopher of medicine has asked, are

results less important than method (3) ? Both performative and

fastidious efficacy can be measured. Which measurement represents

universal science? Which measurement embodies cultural judgment on what

is " correct " healing? Are the concerns of the physician identical to

those of the patient? Is denying patients with nonspecific back pain

treatment with a sham machine an ethical judgment or a scientific

judgment? Should a patient with chronic neck pain who cannot take

diazepam because of unacceptable side effects be denied acupuncture

that may have an " enhanced placebo effect " because such an effect is

" bogus " ? Who should decide?>>

 

Douglas,

Thanks for the quotations.

 

Having treated conditions such as chronic neck pain with acupuncture,

I find the image of the well meaning acupuncturist enhancing his

placebo effect healing because he believes in what he's doing (or

maybe he's a very good charlatan and doesn't believe it, but holds the

patient's welfare foremost in mind) , and we should feel this is OK,

because the placebo effect is, after all, ENHANCED, just that little

bit invalidating and demeaning. That's even though I'm all for placebo

effect, even the unenhanced variety.

 

But what if the side effects of diazepam ARE acceptable? Then should

be decide differently?

 

I sometimes suspect that the future of biomedical research into

complementary and alternative medicine will result in two basic

categories -

1) CAM modalities that are found to work with scientifically

understood mechanisms, whence they will be integrated into biomedicine

and practised within a biomedical theoretical framework

2) A new exquisite science of different types of placebo effects.

 

 

Wainwright

..

[Guest guest]

Unfortunately I think you may be right. However Kaptchuk, if I am reading him

correctly, is that he is trying to actually show the placebo in Western

Medicine. His

use of acupuncture is because he feels it, it its true form, can never be shown

within

the biomedical framework. (And I think we all agree on that?) In effect, his

work is to

take away " placebo " as a word and as a variable, having been put it directly

into all

medicine/healing. Therefore ultimately we will no longer see " scientifically

understood mechanisms " without placebo and placebo will cease to exist. Again it

seems to me that his work is trying to head off the categories you outline.

 

doug

 

>

> I sometimes suspect that the future of biomedical research into

> complementary and alternative medicine will result in two basic

> categories -

> 1) CAM modalities that are found to work with scientifically

> understood mechanisms, whence they will be integrated into biomedicine

> and practised within a biomedical theoretical framework

> 2) A new exquisite science of different types of placebo effects.

>

>

> Wainwright

> .

[Guest guest]

Wainwright,

 

Be careful, because we never know who is listening. (What is this the Weather

Underground?- BEWARE THE PATRIOT ACT!) Seriously, we really need to understand

an important distinction as to what is a placebo? Is a placebo:

 

a)A treatment effected exclusively through the power of suggestion in which the

patient is convinced of the efficacy of the treatment. In other words the

awareness of and belief in the given arbitrary therapy activates immune

neurotransmitters?

 

or is it:

 

b)A specific treatment (not at all arbitrary!) in which body/mind homeostasis

and balance is achieved in a global sense through the given therapy, but whose

efficacy can't be explained or measured. (at least not yet, with science's

current tools)

 

The practical difference between the two definitions would be as to what would

be the effect on babies or animals.

 

Yehuda

 

______________

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[Guest guest]

While I appreciate what you, Wainright, Douglas and others have said

about placebos and this study at Harvard, it is frustrating that there

is no open communication with Ted, Dr. Eisenberg and other parties to

the Harvard study, so we really know what is going on there. Some

clarity in communication on their part would be very satisfying, and

reduce the issue of rumor and speculation that inevitably arises.

 

 

On Wednesday, October 22, 2003, at 03:36 PM, wrote:

 

>

> Wainwright,

>

> Be careful, because we never know who is listening. (What is this the

> Weather Underground?- BEWARE THE PATRIOT ACT!) Seriously, we really

> need to understand an important distinction as to what is a placebo?

> Is a placebo:

>

> a)A treatment effected exclusively through the power of suggestion in

> which the patient is convinced of the efficacy of the treatment. In

> other words the awareness of and belief in the given arbitrary therapy

> activates immune neurotransmitters?

>

> or is it:

>

> b)A specific treatment (not at all arbitrary!) in which body/mind

> homeostasis and balance is achieved in a global sense through the

> given therapy, but whose efficacy can't be explained or measured. (at

> least not yet, with science's current tools)

>

> The practical difference between the two definitions would be as to

> what would be the effect on babies or animals.

>

> Yehuda

>

> ______________

> The best thing to hit the internet in years - Juno SpeedBand!

> Surf the web up to FIVE TIMES FASTER!

> Only $14.95/ month - visit www.juno.com to sign up today!

>

>