Tag Archives: medicine

All About Placebo

Wired has published what must be one of the most comprehensive articles looking at the phenomenon of the placebo effect.

From its humble beginnings in WWII with anesthetist Henry Beecher to the placebo’s transition from being treated as a purely psychological trait to a physiological one; there’s some great material here.

Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.

The fact that an increasing number of medications are unable to beat sugar pills has thrown the [pharmaceutical] industry into crisis. The stakes could hardly be higher. In today’s economy, the fate of a long-established company can hang on the outcome of a handful of tests.

Related: Placebo in History.

via @jonahlehrer

Children Exposed to ‘Dirt’, Healthier

From the ‘Science proves mum right’ and ‘Obvious, but still needs to be stated’ file comes the news that children who are exposed to bacteria, viruses, worms, and dirt have healthier immune systems.

Public health measures like cleaning up contaminated water and food have saved the lives of countless children, but they “also eliminated exposure to many organisms that are probably good for us.”

“Children raised in an ultraclean environment, […] are not being exposed to organisms that help them develop appropriate immune regulatory circuits.”

Of course there are caveats, or at least common sense rules (although even the researchers in this field are debating exactly how far to take this):

“I certainly recommend washing your hands after using the bathroom, before eating, after changing a diaper, before and after handling food,” and whenever they’re visibly soiled, [one researcher] wrote.

Dr. Weinstock goes even further. “Children should be allowed to go barefoot in the dirt, play in the dirt, and not have to wash their hands when they come in to eat.”

via Kottke

Ideology Getting in the Way of Evidence-Based Medicine

Giving beta blockers to a person in the early stages of a heart attack makes sense: the drugs reduce oxygen consumption by calming and slowing the heart; something that is ideal during a heart attack.

However despite evidence showing that beta blockers may actually increase heart failure, the practice of administering them continues. As Dr. David Newman states in The New York Times, medical ideology regularly triumphs over evidence-based research and non-working treatments are still given to patients because they should work.

Other revelations from Dr Newman:

  • No cough remedies have ever been proven better than a placebo, either for adults or children. Yet their use is common.
  • Patients with ear infections are more likely to be harmed by antibiotics than helped. While the pills may cause a small decrease in symptoms (for which ear drops work better), the infections typically recede within days regardless of treatment. The same is true for bronchitis, sinusitis, and sore throats.
  • Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment.
  • Arthroscopic surgery to correct osteoarthritis of the knee [is] no better than sham knee surgery, in which surgeons “pretend” to do surgery while the patient is under light anesthesia. It is also no better than much cheaper, and much less invasive, physical therapy.

via Overcoming Bias

Vitamins: A Pointless Expense?

Medical research is beginning to suggest that vitamins have questionable health benefits.

One study found that vitamin C is ineffective for cold–prevention unless you’re exposed to extreme physical stress (read: ultramarathon runners and “soldiers during sub-Arctic winter exercises”).

The New York Times looks at this trend, noting that in some cases, vitamins may do more harm than good. However, there are always exceptions (B12 supplements for the elderly and folic acid for women of child-bearing age have proven health benefits) and caveats:

Despite a lack of evidence that vitamins actually work, consumers appear largely unwilling to give them up. Many readers of the Well blog say the problem is not the vitamin but poorly designed studies that use the wrong type of vitamin, setting the vitamin up to fail. Industry groups such as the Council for Responsible Nutrition also say the research isn’t well designed to detect benefits in healthy vitamin users.