Mod+ The Dr. Malerba Interview and Alex's surprising skepticism
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IMO the best treatment of placebos (lol . see what I did there) is The Placebo Effect - An Interdisciplinary Exploration
David Bailey
Member
Well the main take home message from that link, is that a lot of doctors in the UK are worrying about statins.
However, consider part of the above:
What produced the huge difference in the placebo side effects in the various studies? Was the doctor dressed as the grim reaper in those trials that produced the highest levels of side effects in both placebo and statin patients? Would anyone with any sense accept such data at face value when there are substantial numbers of patients reporting really nasty side effects? When you get on sites that report these problems, a substantial number involve people who start to get problems much sooner after starting the drug, but are left permanently disabled by statin treatment (fortunately mine reversed completely).
Furthermore, a few people treated with statins develop rhabdomyolysis, where the muscles start to break down in a big way, and the kidneys are liable to fail as a result. This is acknowledged as a very rare side effect on the information sheet that comes in every box. Doesn't that tend to corroborate the reports of less extreme side effects from so many other patients?
David
Arouet
Member
I was trying to understand what they meant by that line too. They put the phrasing very strangely:
Why do they only refer to the placebo adverse effect when it was nearly identical to the statin adverse effect (which ranged from 3.2% - 83.3%).
David: what do you make of the similarities between the control and the subject group? When there is very little difference between the two groups, don't we usually say that the reason for the effect (in this case adverse effects) is due to something other than the use of the drug?
The authors of the letter seem to acknowledge that by suggesting that the results could only be that way if there was fraud (ie: because they presume in the absence of fraud there would be a significant difference between the groups).
David Bailey
Member
I don't know if these studies were performed by the drug companies themselves - but remarkably, this is often the case. Furthermore, after they have done a study, they don't need to publish the results! That doesn't in itself explain this result, but it shows how corruptible the process is. There have also been some eye wateringly large fines levied on pharmaceutical companies in recent years - often effectively for fraud:
http://projects.propublica.org/graphics/bigpharma
They will do whatever they think they can get away with, and if all that ever happens is that they get fined, the they just factor this in as a cost!
All I can do is guess, but perhaps they started off fiddling the data so as to reduce the reported actual side effects, and then gradually switched to inflating the placebo side effects as suspicions were raised.
Possibly the level of placebo side effects did go up somewhat, because if you ask around statins have become notorious for their side effects. This may have worried people on the studies. Maybe that provided somewhat more placebo side effects, and then they managed to manipulate the figures up higher - who knows!
My original point was that you can apply all the sophisticated statistics you like, but if you don't start by applying a bit of common sense, you can reach totally the wrong conclusion when deceit of various sorts is present. Notice that Linda hasn't really addressed why so many doctors signed that letter of complaint to NICE.
David
David Bailey
Member
Well actually there is, because as I tried to explain, I stopped and started the drug 3 times because I didn't really believe that what I was experiencing could be described as 'muscle aches' - so I didn't believe the link myself! Stopping the drug caused the symptoms to subside, and resuming the treatment brought them back. I suppose since I knew whether I was on the drug or not, it was all down to placebo effect according to you!
David
nbtruthman
New
Did you try taking Co-Q10, or preferably Ubiquinol?
Regardless of whether it works or not. Once it is found to work, it's not alternative. That is, unless you believe there is a large body of medicine that works but that the medical community refuses to accept. In that case, surely you can present us with a long list of therapies that were found to work by the NCCAM yet are not accepted by the medical community.
~~ Paul
Except that "what is currently sanctioned by the status-quo" is "anything which might work".
Linda
Well, nine doctors out of over 200,000, anyways. I suppose 0.0045% counts as a lot in a thread about homeopathy. ;)
I'm sure it's more, though. It shows that there are diverse opinions among physicians and that individuals argue their perspective, rather than some sort of monolithic status-quo. That's a good thing, from my perspective.
Different populations will experience quite different rates of subjective experiences. Variation in what questions are asked, and how, will get quite different responses.
As there are in placebo groups.
As there are in placebo groups.
As there were in the placebo group.
Corroborate how?
Linda
Here's the problem. Your actions could have created the appearance of an effect in the same way that people who use quite useless therapies think that they are having an effect. If you have a condition whose symptoms wax and wane, then all you need is for someone to try the therapy whenever the symptoms are at their worse, and attribute any subsequent waning to the therapy, without taking into account how much they were going to wane regardless of what you did. Or in your case, stopping the medicine when your symptoms waxed and restarting it when they waned, giving the appearance that the medicine was causing the symptoms.
Linda
HFS!
. I keep re-reading your post in disbelief that anyone actually posted such utter nonsense. - The term alternative doesn't mean or connote viability or efficacy. It means "not the common standard." Period. This is a case where that's true even colloquially. When someone suggest taking an alternative approach they are not suggesting "do something that doesn't work."
Beyond that basic term that you somehow don't grasp, the rest of your post is almost as silly. Of course there are modalities that work but are not accepted by the status-quo US medical arbitrators. Duh!!
BTW Perhaps you may want to contact the NCCAM about changing their name. After all according to you either the modalities they do list don't work or they're not alternative. Either way that makes their moniker nonsensical.
There's no alternative to medicine. Once something has become demonstrably shown to work it's medicine. There's no other alternative.
David Bailey
Member
So if this were to happen to you, you would assume the statin was not responsible - despite several stops and starts as I described - and just go on taking the stuff! After all, if you really believe what you say, it could apply to you too - if you stopped the treatment, you wouldn't really be consistent, would you:)
Your explanation would only work if I had a condition that came from nowhere, lasted for about 3 months varying in intensity as you hypothesise, and then just happened to begin disappearing the moment I stopped the statin for good - never to reappear!
David
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I realize that alt-med pretends that it is something different. But realistically, there isn't anything which makes something alt-med a priori.
Sticking needles in the body? Finding therapeutic potential in natural substances? Looking to the eyes for evidence of disease elsewhere? Differing actions of low-dose vs. moderate dose therapies? Exposure to causative agents in order to prevent disease? The usefulness of reference to vague, holistic, concepts ("health", "well-being", "quality of life", etc.)? Nutrition, lifestyle, a holistic perspective? The far-reaching effects of musculoskeletal condions?
Medicine already includes all those ideas. The only thing which distinguishes whether or not something falls under "alt-med" is whether the specific practices have been shown to be ineffective (or there is no reasonable expectation that they might be 'the one'). If an idea is fruitful with respect to whether it works, it's medicine. The only thing holding the various contradictory alt-med ideas together is "the idea has proved to be fruitless with respect to identifying stuff which works".
(Note: by "works" I mean "improves quality of life, relieves discomfort, prevents or modifies impairment, cures disease, reduces deaths, etc.")
Linda
HFS!
- The term alternative doesn't mean or connote viability or efficacy. It means "not the common standard." Period. This is a case where that's true even colloquially. When someone suggest taking an alternative approach they are not suggesting "do something that doesn't work."
That's what it's supposed to mean, and that's how they perceive themselves. But the common standard is "the idea is fruitful with respect to finding stuff that works". The only way to make something "not the common standard" under those conditions is to make it "not fruitful".
Can you give an example (and by works, I mean, it is different from whatever would have happened had you done nothing or had a cup of tea and a chat with your mom)?
Well, lots of people (including me) are in agreement with you on that one.
Linda
Yes, I very much presume that this is also applicable to me. And I have found myself under similar circumstances with other medications. I understand that it is difficult overcoming the "after this, therefore because of this" pattern-finding which we intuitively fall into. But that it is why it is helpful to have outside information from what other people have experienced both on the medication and on placebo.
You said earlier that it came from nowhere (it was unrelated to when you started the statin, coming after you had been on it a while). You also said earlier that it didn't disappear the moment you stopped the statin for good, but that it took 9 months. What you described was a condition which waxed and waned over a 1 year period before disappearing. It didn't seem to have much to do with your statin use except that at the beginning, you began to deliberately stop and start your statin in response to whether it was waxing and waning.
Linda
David Bailey
Member
Well the only reason why I stopped and started 3 times was because I reasoned much as you are doing - that coincidence was involved. But how many times would anyone cycle like that before reaching a conclusion. As for the aftermath, yes it took some time to disappear completely but the intensity was way down and dropping all the time. There were no further intensifications after I stopped.
Enough of me!
The more general point, is that on this basis nobody could ever report a side effect of anything - unless perhaps it was confirm-able by a lab test of some sort!
David
I wasn't making the point that nothing can be attributed to a medication. My point was that much more can be attributed to taking a placebo than people realize.
Linda