El nuevo disco, que supone el cuarto del grupo en su carrera, es una pequeña maravilla, para los que les guste la música y el estilo de The Verve, la gran cantidad de matices de sus canciones requiere una escucha detallada de cada una de ellas, pequeños detalles de producción que hacen que podamos descubrir nuevos sonidos debajo de las tradicionales guitarras o sintetizadores. Y es que mantienen intacto ese sello pseudopsicodélico de atmosferas evanescentes con el que comenzaron en el mundo de la música y que llegaron a hacerles famosos con el disco "Urban Hymns".

A veces suenan parecidos a otros grupos, en algún momento son capaces de recordar a The Cure con bastante fuerza, pero tienen su propio estilo y su música y sus canciones resultan inconfundibles. Muy diferentes a otros miembros de su generación como Primal Scream, Charlatans, Placebo o Ride.

Es un disco que aburrirá a los que el grupo les parece aburrido y hará las delicias de los que ya han escuchado su música en alguna ocasión y estaban deseosos de conocer lo que este nuevo lanzamiento podía brindar, el single "Love is noise" puede ser un buen ejemplo de ello o la primera canción del disco "Sit and wonder", una de las mejores del album sin ninguna duda.

Os dejo esta canción en concreto

"csi episodes go-kart decapitation"

A great episode, but I thought "What does go-kart decapitation have to do with me?" So I tried the search. VmpyrDavid.com doesn't show up first, or second, or third. It's sixth. Then I realized why I got tagged. It was my covers article.

I had fun doing that one. Great music. Some not-so-much.

Catching up on the 23 August New Scientist with an article "The Power of Belief" about new work on the placebo effect. I guess we all know that you can get an effect by giving someone a sugar pill and telling them it will make them better. But this article suggests it is more complex than that. Even if a drug is active, the effect depends on whether the patient knows what the drug is supposed to do. To quote: "If you don't tell people that they are getting in injection of morphine, you have to inject at least 12 milligrams to get a painkilling effect, whereas, if you tell them, far lower doses can make a difference."

You can't depend on your own experience here - it is too subjective and you never do the control experiment. But here is an observation which may or may not be relevant.

A few years ago I began to suffer from stiff knees, especially after driving for a while. I though it was just old age but H, who was probably getting fed up with me complaining, said I should take cod liver oil. I resisted for a bit but then saw an advertisement in a walking magazine offering a years supply of cod liver oil capsules plus, as a gift, a years supply of glucosamine sulphate. I started taking both every day (already I am altering two variables at once) and it did seem to have an effect. I carried on for over a year - even ordering a repeat dose - but then I went away for a week or so and forgot the pills. When I got back something else intervened and I never got back into the habit of taking the pills.

After a couple of months I realised that (a) I was not taking the pills and (b) I did not feel any worse. Now, two questions, probably never to be answered in any rigorous scientific way:

1. Did I feel better because I was expecting to, after starting on the pills?

2. Would I have felt worse when I stopped if it had been a conscious act, rather than stopping without thinking about it?

A charmstone is a mineral specimen believed to have healing, mystical or paranormal powers or energy. The mineral specimen may either be naturally occurring or honed from a natural stone; in some cases, the specimen may be entirely manufactured as in the case of certain Mayan pottery finds. For example, the Miwok and Pomo tribes of Northern California have left thousands of charmstones in the bed of Tolay Lake in Sonoma County. Charmstones are evidenced by the Shalagram and lingam in the Hindu tradition and by maban in the indigenous Australian tradition. Jigme Lingpa in the Vajrayana tradition wrote a treatise on charmstone usage which Namkhai Norbu mentions. Charmstones were used in prehistoric Native American cermonies for broad spiritual purposes including securing of productive harvests. Today charmstones are popular among certain countercultures within Western society such as the New Age movement. Belief in the powers of charmstones is criticized as baseless by scientists and medical professionals and there is no known scientific basis for such a belief.

Crystal healing is considered to be pseudoscientific, since there is no scientific evidence that healing can be achieved by 'crystal power'. The placebo effect, cognitive bias and memory biases are strong possible explanations for any examples of healing that occurs in the presence of a crystal. Even some crystal healing practitioners have cautioned that crystal healing should be used as a supplement to and not a replacement of conventional medicine.

It can also be classified as a pseudo-science under a number of Stephen Carey's criteria. Carey explains that the "respectability" of science and scientific concepts comes from the experiments and the manner in which they are performed. He goes on to assert that the difference between pseudo-science and science includes the "self-correction" of science, where incorrect conjectures have been reversed by further investigation, and the publication and reversal of reviewed journals. Thus far there are very few to no reviewed journals or published experiments regarding the use of crystal healing, further strengthening the argument for it as a pseudo-science. Moreover, scientific findings are "open to revision" where seldom do the declarations of pseudo-sciences change, as illustrated with the old theory of the planets and sun revolving around the earth, whereas the claims of crystal healing are based on historical beliefs.

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• Arranging for Serenity: How Physical Space and Emotion Intersect

References:

Karow J-H, et al. Efficacy of Arnica Montana D4 for healing of wounds after hallux valgus surgery compared to diclofenac. J Altern Comp Med 2008;14(1):17-25

Dr Briffa: 'Homeopathic arnica found to be an effective post-operative aid'

Bei der heutigen Vielzahl von Möglichkeiten, beim unüberschaubaren Angebot von naturheilkundlichen Behandlungen und durch die Informationsflut ist jeder Verbraucher bzw. Patient dazu aufgerufen, sich vorher eingehend selber zu informieren, bevor er einen Arzt aufsucht oder sich für eine Therapie entscheidet. Ich lese immer wieder in Foren, dass Patienten gerade im naturheilkundlichen Bereich eine für sie logische Einstellung gefunden haben: Sie misstrauen allem und jedem solange, bis sie vom Gegenteil überzeugt wurden. Eigentlich klingt das ja auf anhieb auch erstmal vernünftig, denn gerade in einem Bereich der Medizin, in dem sich der eine oder andere Wunderheiler rumtreibt, ist Kontrolle besser als Vertrauen. Doch wie kann man sich in die Hände eines Arztes begeben, ohne ihm zu vertrauen? Eigentlich ist es fast unmöglich und das Misstrauen senkt auch signifikant die Heilungschancen, denn gerade das Gefühl sich fallen zu lassen und Hilfe zu bekommen, wenn man krank ist, führt oft schon alleine zu einer Heilung. Die Einstellung, ich werde mal sehen was der Arzt kann, verhindert eine aktive Mitarbeit des Patienten am Genesungsprozess und macht es auch dem besten Arzt und der besten Therapie schwer, gute Erfolge zu erzielen.

Ich kann natürlich nicht raten unkritisch zu sein, doch ohne Vertrauen geht es eben auch nicht. Trotz allem Rationalismus sollte sich der Mensch auch von Zeit zu Zeit auf seine Instinkte verlassen. Ist einem ein Arzt von Grund auf unsympatisch, so muss man wechseln, erscheint er jedoch kompetent, dann sollte man sich auch in die Hände des Arztes begeben und darauf vertrauen, dass man Hilfe bekommt. Wer hier schlechte Erfahrungen gemacht hat oder einfach einen neuen Arzt sucht, weil er umgezogen oder im Urlaub ist, der findet unter www.imedo.de eine deutschlandweite Online-Arztsuche mit Bewertungen von Patienten, die einem einen ersten Eindruck vermittteln, mit wem man es zu tun hat. Ich finde diese Möglichkeit sehr gut und zeitgemäß.

In the movie Space Jam, starring Michael Jordan and Bugs Bunny, the Looney Tunes character was trailing in the basketball game. As only Bugs Bunny could, he got a bottle of water and put a label that read “Michael’s Special Stuff” (or something to that extent). The players drunk this water and all of a sudden they were a different team. This may appear to be something that was built for an animated movie, but this is true in the real world. Medical Science have realized the stunning effects of placebos. A placebo in the medical world is a sugar pill, but people are told that it is more, but it is surprisingly effective and even more effective than the actual medication in some cases. This shows the power of the mind. Never forget, you determine what you feel about yourself. Never give that power to other people. Now ask yourself… What can you accomplish?

Bottom Line: Stay confident. No one can steal your mojo.

Io bisessuale, io tossico, io androgino, io dark, io trasgressivo, io decadente, io ambiguo, io glamour, io vizioso, io maledetto, io reietto...

Io mezz'etto de lupini...

A special colour-themed podcast this week, with all tracks containing the words black or blue......

Tracklisting

Supermassive Black Hole by Muse

Black and White Radio by British India

Blue Orchid by The White Stripes

Many Shades of Black by The Raconteurs

Black Tongue by Yeah Yeah Yeahs

The Blues Are Still Blue by Belle & Sebastian

Black Shoes by The Films

Blue Note by The Harrisons

Blue Balloon by Ween

Black Cadillacs by Modest Mouse

Blues From A Gun by Jesus and Mary Chain

Black-Eyed by Placebo

Non Photo Blue by Pinback

Blacking Out The Friction by Death Cab For Cutie

Blue Monday by Nouvelle Vague

Mermaid Blues by Tom McRae

Window Blues by Lykke Li

http://dj_hotjack.podomatic.com/rss2.xml

Enjoy :)

http://www.youtube.com/watch?v=IXgX_tF9PuE

Hoppas Pipi fattar att det bara är att gå in när jag inte hör att hon ringer på.

Brian ser fortfarande lovely ut på 42".

Bad Science's Ben Goldacre has done a two-parter for BBC Radio 4 about the placebo effect. They make a really accessible description of what the effect is (in part 1) and what its implications - practical and ethical - are (in part 2).

EDIT: and Ben's got a newer post about hotel housekeepers that might show another, quite fascinating, placebo effect in action.

A spoonful of water might have a place in a study of placebos but it's definitely not what the doctors ordered.

As my handwave for the content and themes of the programmes, the Shapiros gave an excellent overview of the history of medicine and placebo:

It is a mystery how a treatment used since antiquity was unknown, unnamed, and unidentified until recently. It is even more remarkable because this is the only treatment common to all societies and cultures. When we examine the long history of medicine, it is the only common denominator between the Egyptian physician who prescribed crocodile dung and the modern physician who prescribes penicillin. Moreover, its effectiveness has been attested to, without exception, for more than two millennia.
One of the many secrets enshrouding this remarkable treatment is that when its effectiveness wanes, it metamorphoses into a new, seemingly different, and culturally more appropriate form of effective treatment-somewhat as bacteria develop a resistance to antibiotics. Trousseau (1833) discerned this covert mischievousness in the middle of the nineteenth century, and he urged healers to hurry and use new drugs while they still worked. [Shapiro AK, Shapiro E. 1997. The Powerful Placebo: From Ancient Priest to Modern Physician.]

It is clear that a healing response in patients seems to be enhanced by confidence in the doctor/healing figure and a meaningful theatrical ritual (whether physician, herbalist or shaman, depending upon history or culture, as Goldacre's discussion of Quesalid indicates). Dr Houston wrote: “the placebo has always been the norm of medical practice” and suggested that, doctors themselves:

were the therapeutic agent by which cures were effected. Their therapeutic procedures, whether they were inert or whether they were dangerous, were placebos, symbols by which their patients' faith and their own was sustained. [Houston WR (1938). Doctor himself as therapeutic agent. Annals of Internal Medicine, 11, 1416–1425.]

Houston's description may seem a little hyperbolic but it seems to be borne out by the many interesting studies, experiments and anecdotes that Goldacre reports in the programmes. What the doctor says, how the doctor behaves and what the doctor believes, all have an effect on healing. This probably explains why, despite some of the ethical issues associated with the use of placebo, the placebo is still in use in clinical practice. At the beginning of 2008, Sherman and Hickner^[1] announced that the placebo is still in (occasional) use among academic physicians in Chicago. 45% reported that they had used it to calm a patient or as supplemental treatment. Only 12% thought that placebo use in routine medical care should be prohibited.

Goldacre discussed ethical issues surrounding the use of placebo in Part 2. Sir Ian Chalmers has a long-standing interest in the evidence underpinning healthcare. He explored the notion that full information about the administration of placebos in a trial may have a downside for patients as well as advantages. Chalmers gave the example of a trial in which some participants were warned that the active drug might cause stomach upsets as part of the side-effects. When the results were analysed, more patients who received the placebo but had been warned about the stomach upsets reported this side-effect than those who took the drug or were not warned (it was slightly unclear).

Goldacre explored whether there is an ethical dilemma if honesty, transparency and fully informed consent mitigate against the use of placebo but thereby deny patients some of the most effective therapeutic techniques and diminish the full effectiveness of treatments. Goldacre stated his own distaste at the notion of deception but explored whether it was possible "to provoke placebo researchers into justifying mild deception, overstating the benefits of a treatment, perhaps, or underplaying the potential risks".

None of the placebo researchers considered that deceiving a patient could be justified and considered that the long-term damage to the relationship of trust with medicine would outweigh any short-term advantage to the patient. Various clinicians discussed a form of words that allowed them to present the facts about a placebo treatment to patients. Goldacre wondered whether medicine was prevented from exploiting placebo by knowledge of the efficacy and quantification of treatment effects and concerns for patient autonomy, but CAM practitioners were less inhibited because their interventions had not been disproven, so there were notionally free to present their therapy in reassuring terms and perhaps exaggerate its expected efficacy, which, paradoxically, might provide a degree of confidence, authoritativeness and reassurance that is more effective for patients. A slightly convoluted argument for 'ignorance is bliss if it gives you plausible deniability for your recommendations'.

Professor George Lewith is a researcher and practises both CAM and medicine. When Goldacre presented this idea to him, Lewith argued that a lack of funding for CAM in the UK makes it an evidence-free zone, and so, when it is offered, it is mostly done so on the basis of a practitioner's prior experience that such interventions have been helpful. Lewith argued that that might be an example of a placebo effect but, in the absence of evidence to the contrary, it is a legitimate use of it. Goldacre demurred that when doctors try to enhance the effect of a treatment that they recommend, they do so with a knowledge that there is an evidence-base to support their recommendations but Lewith countered that that is not always true and offered the example of the use of SSRIs for depression in primary care.

Goldacre then said that he would be clear that "prescribing SSRI antidepressants for mild depression...is a bad idea because the evidence for benefit is very limited". He asked Lewith: "Do you think it is acceptable...to prescribe a homeopathic sugar pill for mild depression; given that the evidence of benefit there is equivalently poor?". Lewith argued that in the case of mild depression:

Very often, the homeopathic consultation...will be focusing on why the patient got depressed. What their overwhelming emotion is. How they might be thinking about managing that emotion. What kind of remedy picture that might fit and that might give you other clues. And then at the end of your 35-45 minutes you'll make a symbolic gesture. You'll say, "I think we might be able to help you a little bit with this particular sugar pill for this particular reason". It's almost even shamanistic.

Goldacre objected that in that case, the doctor/practitioner was recommending a pill for which there was no established efficacy but Lewith rejected that and claimed that the therapeutic effect lay in the whole package, which includes the consultation. Goldacre expressed his concern that in the scenario that Lewith outlined, "the patient has been reassured by a white lie". Lewith said that it isn't a white lie if the practitioner is clear with the patient that s/he is not sure whether it is the process of homeopathy or the proferred remedy that works.

Professor Irving Kirsch objected to the long-term harm that would result from violating patient trust by deception or less than transparency. Professor Edzard Ernst is a CAM researcher and was adamant that the only ethical use of placebos would be if they were used openly and with fully informed patient consent, in which case he denied that they would work. Ernst claimed that as an experienced clinician he is capable of forming a good, therapeutic alliance with a patient "without being bogus".

Goldacre mused that although he fully accepts the admirable ethical arguments against placebos, there are times when it is difficult for doctors to hold the line: e.g., in the face of patients requesting antibiotics for a viral cold. Professor Walter Brown took a somewhat robust attitude and said that some patients would be indifferent to what actually relieved their symptoms, they would just be grateful for the relief. He says that there are times when doctors should feel comfortable with prescribing placebos because it can be done without deceiving patients. Brown offered some forms of words but Goldacre argued that although the sentiments were fine as they stood, in the context of a patient's expectations of a doctor, there was a reasonable assumption of clinical research to support the recommendation.^[a] Brown countered that with the argument that there is good quality research to support the placebo. Which may be true, but at this point, the discussion felt like semantic point-scoring rather than a genuine engagement with the issue although Brown gave several fine examples to support his stance.

Goldacre worried away at the issue of whether all of the above might be true but, at the heart of the matter, the patient is still deceived, and it may be difficult to disentangle this from a sense of medical paternalism. Brown give a good answer, but again, it seemed to rely upon framing and word games that sound manipulative in discussion but may not appear so in practice.^[a] There was further exploration of whether a pill or specific intervention was necessary or whether it was the whole process of the visit, the consultation, the interaction, the evaluation, diagnosis, confidence about the treatment (as referred to by Lewith) that combined to make the placebo effective.

Goldacre suggested that the best proof of concept for the efficacy of placebo would be if it could be demonstrated that they work, even when openly and honestly prescribed.^[b] Fortunately, just such a study was published earlier this year.

Brown gave a fine overview of the Sandler and Bodfish pilot study of open-label placebos in the treatment of ADHD.^[2] All of the children were receiving a drug therapy and they were randomised into three groups. Group 1 continued to take their usual dose. Group 2 received half the usual dose but were also given a placebo capsule that they were told was a placebo that would extend the effect of the drug - a "dose extender". Group 3 received half the usual dose but no additional placebo capsule. Group 2 fared as well as Group 1 and better than Group 3 (some of whom experienced symptom exacerbation and deterioration) although they only received the same effective dosage as Group 3 suggesting that the placebo extender was effective. If this result is replicated in a longer trial, there are obvious implications for being able to reduce the dose of medications while amplifying their effects.

It was reassuring to learn that in an analysis of the perspectives of children and parents,^[3] both were generally accepting of the use of the placebo and the parents were particularly pleased at the reduced risk of side-effects. The authors concluded:

Open-label use of placebos as part of CPDR treatment may represent an innovative, ethical way of harnessing the power of placebos in clinical therapeutics.

There was some interesting discussion of trust issues but the issue is too broad to be covered in a satisfactory manner in a few sentences. Maybe Goldacre's forthcoming and shortly-to-be-available book will cover this area in greater depth and explore why there is a history that may explain why some groups of people would find the issue of trust to be so insurmountable for historical reasons (e.g., Tuskegee, or the historical collusion of the medical and legal systems in sequestering women in asylums for scant grounds of public health or for reasons that do not seem to have applied to men^[c] ).

Perhaps unfairly, given the time constraints, it felt a little superficial to imply that most patients had no feelings of outrage at being duped when they discovered that they had been in the placebo arm of a trial and it is unclear whether (unlike the Sandler and Bodfish^[2]) it is typical for there to be some form of follow-up that collects and analyses the perspectives of the participants (although, from Brown's reference to anecdotes, it seems not). The Sandler and Bodfish^[2] trial involved a treatment for children, it would be interesting to know if there is a difference when considering the value of a placebo for others, than for oneself: further, whether there is a special consideration both for parents and children that both generations would be happier if the dosage of the drug were to be reduced because of the stigma associated with the disorder and the medication.

Last week we learned of a study that reports that the placebo effect is greater in children.^[4] Beyond the immediate significance for studying placebo, there is the interesting implication for the impact that this finding may have on the power and sample size for trials involving young children, which are already as scarce as hen's teeth.

Children with drug-resistant partial epilepsy receiving placebo in double-blind RCTs demonstrated significantly greater 50% responder rate than adults, probably reflecting increased placebo and regression to the mean effects. Paediatric clinical trial designs should account for these age-dependent variations of the response to placebo to reduce the risk of an underestimated sample size that could result in falsely negative trials.

The clear message from the programme seemed to be that the placebo is powerful and mysterious and it works for most demographics. However, we heard no discussion about whether there are agreed characteristics of patients for whom the placebo doesn't work or if it is expected to work for everyone in some contexts. If anything, it seems that it is popular with patients who consider pharmaceuticals to be synthetic and intrinsically undesirable and potentially harmful, and frequently express their desire for a 'natural remedy'.

Social anthropologist Professor Moerman suggested that placebo had been circumscribed by the medical profession who see it as something that applies to sugar pills or the placebo arms of clinical trials, isolating it from mainstream medicine. Chalmers summarised the difficulties of assessing and evaluating all of the contributory factors that contribute to the placebo effect and remarked that it is easier to make a case for a specific drug than for (say) an intervention such as an extended consultation time with GPs.

Goldacre finished by summarising the current interest in evidence-based medicine both as a means of providing good quality treatment for patients but also best return on financial investment for health services but flagged up that both of these may be compromised by medicine's inability to harness the placebo. Disappointingly, he left the final word to Professor Kaptchuk who gave rather a reductionist view of medicine as a process of establishing a diagnosis of a specific disease and knocking it down with a drug. He reported that many chronic diseases "don't have knock out drugs that work with that kind of refinement and precision" and it is possible that there never will be that perfect drug for each of those conditions.

The ideology of specificity and scientific precision sometimes clouds the need for the art of medicine...[The value of my research is] to influence health care policy to not trim the amount of time a patient receives from a doctor, will not devalue the doctor-patient relationship. Will understand that it's not just handing a pill like you're throwing feed to a chicken in a chicken coop but that the pill, the medication is part of an elaborate drama and that drama has an impact on people's illness and health.

I'm sure that Dr Crippen, in line with other family GPs throughout the UK will be delighted by that depiction of their typical interaction with a patient albeit it is coupled with an acknowledgement of their powerful role as primary care doctors in a therapeutic alliance with their patients. This was a profoundly irritating and trite bunch of sentiments.^[d] to end this interesting pair of programmes. Goldacre might have nipped into any surgery's waiting-room and interviewed patients and he would probably have heard similar banalities from some patients while others extolled the virtues, keen interest and kindness of their GPs and Practice Nurses. I might have been more sympathetic had there been any suggestion as to how research findings from NCCAM might be translated into a form that would influence health care policy in general and not be restricted to an even more circumscribed part of the ghetto of influence that Moerman described.

My irritation with the conclusion was possibly exacerbated because there was no strong voice of dissent in either of the programmes, with the strongest disagreement being reserved for whether or not it is ethical to use a placebo even with a patient's consent. What was missing from the discussion was an acknowledgement that there are researchers who argue that the placebo is both over-rated and ineffective and that there is no role for it in medicine, outside the context of a clinical trial. And they have a systematic review of placebo trials to support their stance.

In 2001 Professors Hróbjartsson and Gøtzsche of the Nordic Cochrane Institute in Stockholm, carried out a meta-analysis of 130 clinical trials to compare the outcomes of the placebo group with a no-treatment group, to reveal and quantify the placebo effect.^[5] The studies ranged from investigations into alcohol dependence to Parkinson's disease, encompassing 40 medical conditions, around 7500 patients and placebos that were pharmacologic (e.g., a tablet), physical (e.g., a manipulation), or psychological (e.g., a conversation). The authors concluded that with some small-scale exceptions, placebos have no significant effects.

We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.

A follow-up review included data more trials and patients^[6] and the conclusions remained the same.

There was an apparent effect of placebo interventions on pain (SMD -0.25 (95% CI -0.35 to-0.16)), and phobia (SMD -0.63 (95% CI -1.17 to -0.08)); but also a substantial risk of bias. There was no statistically significant effect of placebo interventions in eight other clinical conditions investigated in three trials or more: nausea, smoking, depression, overweight, asthma, hypertension, insomnia and anxiety, but confidence intervals were wide.

In keeping with most of the studies that Goldacre discussed, it seems that if you restrict your examination to only those studies where the outcomes are dependent upon patients' reports and subjective experiences, such as their level of pain, then placebos may have a small but significant effect, although Hróbjartsson and Gøtzsche caution that the quality of the studies introduces a high risk of bias. Depending upon the condition and how it is measured, it seems that the placebo effect can make patients feel better - even if there are no observable clinical differences.

Hróbjartsson was recently interviewed as part of an article about the power of the placebo effect in the New Scientist. He reports that there will shortly be another update to the systematic review of placebo interventions for all clinical conditions but that the results are more or less the same. Hróbjartsson argues that there is no justification for offering placebos outside a clinical setting.

"My concern is not so much whether effects of placebo are real or not, but whether there is evidence for clinically relevant effects."

Giving patients plenty of TLC is where placebo intervention should end, he thinks. "Most of us working in the field think that's just another way of saying 'be a good doctor'."

Skepdic outlines some of the methodological objections in Hróbjartsson and Gøtzsche's systematic reviews. It might have been useful for Goldacre to mention the bias of compliance and whether this is a characteristic of placebo responders. Again, it is possible that there was simply not enough room in the programmes and this may be fully addressed in the book.

Yes, maybe medical practice might be substantially improved by incorporating some of the more attractive and exciting findings from placebo research (or at least the implications for higher-quality patient-doctor interactions) and Goldacre presented a fine array of them. However, the audience for the programme needed to be told that there are strong dissenting voices that argue that the placebo is less powerful than its publicity would have us believe and that, beyond the considerations of white lies, Clinical placebo interventions are unethical, unnecessary, and unprofessional.^[7] Skepdic has a good discussion of placebo, including some of these dissenting elements and an excellent series of links and references.

The placebo is intriguing and interesting and seductive, yet, like most health-related interventions, it needs to be placed in a sophisticated context that fully incorporates social, contextual and other factors. There is a nagging feeling that this didn't quite happen in the radio programmes hence the Brillat-Savarin sense of being sans fromage or gazing upon a beautiful woman with only one eye. It will be interesting to see whether or not these dissenting viewpoints receive an airing in Goldacre's book.

Update: to include Skepdic discussion and link to Gary Taubes' article: Do We Really Know What Makes Us Healthy?. I've also included a link to Glymour and Stalker.

Notes

[a] Philosophers Clark Glymour and Douglas Stalker contributed a classic paper on this issue: Engineers, cranks, physicians, magicians. Fortunately, Dr Kim Atwood has provided some lengthy extracts of this paper: Science, Reason, Ethics and Modern Medicine, Part 4: Is CAM the Only Alternative? It would have been useful if Goldacre had asked Brown or Lewith to rebut the concerns that Glymour and Stalker expressed so eloquently.

If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason. Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign.

[b] Again, it might have been useful if there had been an allusion to the need not only to design an ethical form of words that allows for full consent while not wholly undermining the placebo response, but also some way of encapsulating a willing acceptance of magic to enhance a healing response that should not be transferred elsewhere in life or used to undermine the public understanding of science.
[c] There are too many examples of instances where there was or is an institutional blindness to the reporting of symptoms by particular groups to the extent where flagrant instances of disease are being missed. Denise Grady gave a fine account of women's hidden heart disease risk that had been dismissed for too long because 'everyone knew that women's risk of heart disease is less than men's and the male presentation of heart disease is the only genuine symptom profile'. Constant reassurances and patient management rather than investigation had delayed recognition of significant gender differences for too long as in this story: In heart disease, the focus shifts to women.

"I was treated like a crazy woman," Ms. Kachmann-Geltz said, noting that one doctor offered her tranquilizers, implying that her problems were all in her head.

Her symptoms began during her third pregnancy, and her heart function deteriorated so much that she nearly died during labor, she said, recalling that a nurse in the delivery room actually asked whether she was an organ donor.

After her son was born, she suffered from angina for almost two years and had attacks that woke her up at night, before she found her way to Dr. Pepine.

Tests showed a blood flow deficit in her heart.

"It was 30 seconds that changed my life," she said. "It was the first time I felt acknowledged. This is real, it's not in my head, it's not some pregnancy thing. I shake when I think about it."

There is a present distrust in the US that is grounded in the comparatively recent sterilization abuse of black women and similar horrors.
[d] Glymour and Stalker as per note a.

What ties together the diverse practices [of CAM]…? In part, a banal rhetoric about the physician as consoler;… In part, familiar and rather useless admonitions about not overlooking the abundance of circumstances that may contribute to one condition or another. Such banalities are often true and no doubt sometimes ignored, with disastrous consequences, but they scarcely amount to a distinctive conception of medicine...
Insofar as it extends beyond banality, the holistic medical movement constitutes both a deliberate attempt to substitute a magical for an engineering conception of the physical and an attack on scientific understanding and reasoning. Although the holistic movement does not contain a conception of medicine distinct from those we have discussed, it does contain a reactionary impetus to return the practice of medicine to the practice of magic and to replace logic and method with occultism and obfuscation.

References

[1] Sherman R, Hickner J. Academic physicians use placebos in clinical practice and believe in the mind-body connection. J Gen Intern Med. 2008 Jan;23(1):7-10.
[2] Sandler AD, Bodfish JW. Open-label use of placebos in the treatment of ADHD: a pilot study. Child Care Health Dev. 2008 Jan;34(1):104-10.
[3] Sandler A, Glesne C, Geller G. Children's and parents' perspectives on open-label use of placebos in the treatment of ADHD. Child Care Health Dev. 2008 Jan;34(1):111-20.
[4] Rheims S, Cucherat M, Arzimanoglou A, Ryvlin P. Greater Response to Placebo in Children Than in Adults: A Systematic Review and Meta-Analysis in Drug-Resistant Partial Epilepsy. PLoS Med. 2008 Aug 12;5(8):e166.
[5] Hróbjartsson A, Gøtzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med. 2001 May 24;344(21):1594-602. Review. Erratum in: N Engl J Med 2001 Jul 26;345(4):304.
[6] Hróbjartsson A, Gøtzsche PC. Placebo interventions for all clinical conditions. Cochrane Database Syst Rev. 2004;(3):CD003974.
[7] Hróbjartsson A. Clinical placebo interventions are unethical, unnecessary, and unprofessional. J Clin Ethics. 2008 Spring;19(1):66-9.

26.08.2008: Katatonia - I Break
26.08.2008: Placebo - Running Up That Hill
26.08.2008: Mylene Farmer & Moby - Slipping Away (Crier La Vie)
26.08.2008: The Rasmus - Someone Else

Weitere Lieblingstitel unter: "Hören Sie!".

Ben Goldacre over at badscience covers a study which shows that your health - i.e. weight, body fat, BMI, etc - is, in some cases, pretty heavily influenced by how much exercise you think you're getting, rather than how much you actually are getting.

Without wanting to spoil it too much, the study's authors found some cleaners whose jobs involved quite a lot of calorie-burning - they just didn't realise it. When they seperated the cleaners into two groups, and educated one of the groups about how much exercise they were actually getting, that group's health suddenly shot up - even though their activity levels stayed exactly the same.

It doesn't take much imagination to wonder about the everyday implications of this. I mean, all the people on commercial slimming foods, for instance. Do the products actually help, or is it enough that the hapless consumer thinks that they help?

I really wish all the money that went into 'alternative' medicines would be redirected to figuring out the placebo effect. How unfair would it be to suggest that homeopathy is to religiousness as evidence-based science is to atheism? Alternative medicine just seems like a 'God-of-the-gaps' - scientists don't deny there are a million and one things we don't understand about the human body, we/they just want to figure out exactly what they are instead of pretending we do via some mumbo-jumbo.

Summary: Investigational Oral Medication for RRMS

The goal of this study is to determine if an investigational oral medication is safe and effective. This treatment with the investigational oral medication is compared to treatment with a placebo. A placebo is an inactive substance or preparation used as a control in an experiment or test to determine the effectiveness of a medicinal drug. If you qualify, your participation may last up to two years and will require approximately 26 visits to the research office. Throughout that time, medical professionals with expertise in Multiple Sclerosis (MS) are available to monitor you closely.

If you are between the ages of 18 and 55, and have a confirmed diagnosis of Relapsing-Remitting Multiple Sclerosis (RRMS) with at least one relapse in the past 12 months, you may qualify for this study.

If you have never been treated with Copaxone (glatiramer acetate), you may also qualify for a related study, CONFIRM. CONFIRM is evaluating an oral treatment for RRMS.

If you would like more information on this study, or to Pre-Screen Yourself, visit http://www.msclinicalstudies.com

1. Bigmouth Strikes Again (Placebo)
2. Bizarre Love Triangle (Frente)
3. Dancing In The Dark (Tegan & Sara)
4. Dead Souls (Nine Inch Nails)
5. Easy (Faith No More)
6. Flame Trees (Sarah Blasko)
7. Gold Dust Woman (Hole)
8. Hallelujah (Jeff Buckley)
9. Hey Joe (Jimi Hendrix)
10. I Heard It Through the Grapevine (Creedence Clearwater Revival)
11. It's Oh So Quiet (Björk)
12. Landslide (The Smashing Pumpkins)
13. Love Rollercoaster (Red Hot Chili Peppers)
14. Mad World (Michael Andrews ft. Gary Jules)
15. Maggie's Farm (Rage Against The Machine)
16. My Sweet Lord (Billy Preston, Concert For George)
17. Need A Little Sugar In My Bowl (Nikka Costa)
18. Running Up That Hill (Placebo)
19. Sweet Jane (Cowboy Junkies)
20. The Drover's Boy +mp3 (John Williamson)
21. Where Did You Sleep Last Night (Nirvana)
22. Whiskey In The Jar (Metallica)
23. Why Don't You Do Right? (Amy Irving)
24. Wild Horses (The Sundays)

I've included a link to an mp3 of The Drover's Boy by Ted Egan, as it's arguably the rarest track listed here. The John Williamson version was the first I heard as a child. There's no information regarding it on wikipedia.

Ted Egan, an Australian songwriter and folklorist wrote the song The Drover's Boy in recognition of the many Aboriginal women who worked as drovers in years past. With their hair cut short and breasts flattened with scarves, they were made to conceal their identity and live and work as men did, as Aboriginal women were not permitted to work as drovers. The lyrics highlight the nature of the close, yet hidden relationships that existed between many white men and these Aboriginal women: "They couldn't understand why the drover cried as they buried the drover's boy... They couldn't understand why the drover cut a lock of the dead boy's hair..." (source)

As pesquisas com microbicidas(espécie de alga brasileira,), formulados em gel ou creme para
serem usados antes da exposição ao vírus, oferecem uma ótima alternativa de prevenção para a
população feminina. O que se investiga são substâncias com ação de barreira física contra o
HIV para impedir a entrada nas células da mucosa vaginal.
A circuncisão masculina foi outro .método preventivo apresentado no evento. Segundo os
cientistas, essa operação pode diminuir em até 60% a chance dos homens de contrair o vírus da aids.

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