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134 thoughts on “Benedetti on Placebos

  1. jmcohen87 says:

    @ D2U

    Most of your questions and comments is addressed by watching all of his videos.

    “where he brings up mercury and loss of glutathione as the “cause” of Alzheimer’s. This is not correct. There is no excess mercury in the brains of individuals with Alzheimer’s. Autism is not associated with mercury, with leaky guts, SIDS is not associated with vaccination. The way he talks about physiology shows a profound misunderstanding of what is going on. He does not understand phosphorylation, or thiol physiology.”

    This is valid criticism if true. How do you know there is no correlation between brain mercury and AD?

  2. jmcohen87 says:

    @weing

    If he’s getting physiology wrong then I agree that’s an issue. But more specifics would be helpful.

  3. jmcohen87 says:

    @nybgrus

    If it’s as easy as you make it seem to get published in a journal like JAMA then that is a good point.

  4. jmcohen87 says:

    @micheleinmichigan

    I think it’s more accurate to say that 70% of drugs in the past generation were inspired by nature. To my understanding, the compound has to be different than its natural counterpart, or at least not derived from the plant directly. So drug companies will chemically synthesize the same compound in the lab rather than getting it from the plant.

    So something like galantamine can be sold as a drug and as a dietary supplement. The drug I assume is synthesized and the “natural” one is extracted from a plant (there’s more than one plant to extract it from).

    You can also patent a novel method of extraction, which is done sometimes. I sometimes buy supplements that have patents on them -like Longvida curcumin, AHCC, Epicor and others.

    With that said, if somebody spends tens of millions of dollars demonstrating that increasing glutathione levels can impact the progression of AD then it’s not easy to make money off of that piece of knowledge because curing AD through that method won’t be lucrative. Here is how to do it naturally with little cost:
    http://www.huffingtonpost.com/dr-mark-hyman/glutathione-the-mother-of_b_530494.html

  5. Harriet Hall says:

    @jmcohen87,

    “How do you know there is no correlation between brain mercury and AD?”

    That’s the wrong question. The question is how does he know there is?

    One question you might want to ask yourself is: throughout the recent history of medicine, how many important scientific discoveries have been found by an isolated individual and publicized in books and videos, skipping the route of careful experimentation and publication in peer-reviewed journals? Can you think of even one?

  6. Harriet Hall says:

    @jmcohen87,

    “Here is how to do it naturally with little cost:
    http://www.huffingtonpost.com/dr-mark-hyman/glutathione-the-mother-of_b_530494.html

    Quoting the Huffington Post and Mark Hyman shows that you have not been reading this blog long enough to understand what constitutes a credible reference.

    Michele is right, there is plenty of money to be made from natural products.

  7. daedalus2u says:

    I was remembering having read this paper.

    http://www.ncbi.nlm.nih.gov/pubmed/10036842

    which found no differences in mercury levels in AD and normal controls.

  8. jmcohen87 says:

    @ D2u

    That study is talking about a correlation between amalgams and brain mercury levels. Although it does also say “They also found no statistically significant differences in brain Hg level between subjects with AD and control subjects.”

    What do you make of these studies:
    http://www.ncbi.nlm.nih.gov/pubmed/15580166
    http://www.ncbi.nlm.nih.gov/pubmed/17628833

  9. jmcohen87 says:

    @Harriet Hall

    Well, I don’t know of any that had “scientific discoveries.” But I also wouldn’t classify Steve Fowkes’ findings as scientific discoveries either.

    In the same vein, I wouldn’t call the mediteranian diet or caloric restriction scientific discoveries either, even though they are correlated with lower disease rates and may even reverse some illnesses or conditions.

    I also wouldn’t call the health effects of fish oil and its ability to moderate and prevent some illnesses a scientific discovery either.

    They all have one thing in common: they are no silver bullet and they have always been around, but it just didn’t have any clinical evidence (in the past, although that’s now changing).

  10. nybgrus says:

    @jmcohen:

    I wouldn’t call the mediteranian diet or caloric restriction scientific discoveries either,

    Really? Because I worked in a lab where we employed the scientific method to test the limits, contraints, and effects of caloric restriction on Drosophila melanogaster. I was working on other assays, but the question was very important for my work since it had been demonstrated (and published!) that CR significantly affected lifespan of the flies and I needed to ensure that was not a confounding factor in my assays. So yeah, CR as in “you can theoretically eat less calories” is not a scientific discovery, but the outcomes and applications of it sure are.

    And I didn’t mean to say it was easy per se to get an article in JAMA. It certainly takes hard work and some solidly presented data. But once you put in your hard work and submit then it becomes relatively straightforward. You can say you were rejected and claim persecution. But I bet Fowkes doesn’t even have an attempt at a submission.

    But more importantly, you are asking all the wrong questions and making all the wrong assumptions. As d2u has said – you aren’t even wrong.

    I think I’ll stop feeding you now.

  11. Harriet Hall says:

    @jmcohen87,

    ” I also wouldn’t classify Steve Fowkes’ findings as scientific discoveries either.”

    I would think figuring out a way to prevent and cure Alzheimer’s would be not only a major scientific discovery but would be worthy of a Nobel Prize!

  12. jmcohen87 says:

    Well, he does say that it can only be reversed in the beginning stages and certain facets of the disease are irreversible. I would also assume that he’d agree that his success rate won’t be 100%.

    There isn’t a snowball’s chance in hell that he’d win a Nobel Prize if he was indeed correct that elevating glutathione levels, getting the body into ketosis and a view other natural interventions would halt the progression of AD.

  13. jmcohen87 says:

    a few other* (not view)

  14. Harriet Hall says:

    Alzheimer’s is a serious problem for individuals and families and it is becoming an ever more serious problem for society as our population ages. If this guy can really prevent it or reverse it in the early stages, his discovery will be of monumental importance. Even if his success rate is less than 100%.

    I don’t know why he wouldn’t be eligible for a Nobel prize for discovering the cause and treatment of a previously mysterious and untreatable disease, even if the treatment is “natural.” Gee, Egas Moniz got a Nobel prize, even though his treatment later turned out to be bogus.

    If his program really works, it is criminal for him to delay its acceptance by farting around with videos and bypassing the normal processes that are needed to convince the scientific community. At the very least, he could publish carefully documented case reports that would stimulate others to investigate.

    Oh, wait. He can’t treat patients. He only has a bachelor’s degree in chemistry. He has never published anything but popular books. http://www.ceri.com/swf.htm

    Please explain to me why I should think this man has singlehandedly made a discovery that has eluded research scientists and medical experts.

  15. nybgrus says:

    Because, Dr. Hall, unlike us his mind is open….. man.

    We are bogged down by this “science” and bound by this “physiology” and “molecular biology” so we can’t think of some other way that AD might be curable.

    Besides, didn’t you know? Diet, especially a ketogenic one, is the cure for pretty much every disease and it is teh evil big pharma that wants to suppress that knowledge and keep us sick.

    And it’s working! Back before big pharma, we were healthy our entire lives until we died at 50ish. Now we are sick for almost half of our lives all the way to 80! It’s an evil plot, I tell you. Evil.

    [that was sarcasm, in case you couldn't tell]

  16. daedalus2u says:

    Mutter is a quack, IMO.

    http://www.ncbi.nlm.nih.gov/pubmed/16264412

    He writes like a quack, he hangs around with quacks, he cites quacks, quacks cite him, he gives quack treatments following quack tests.

    He is a quack. He does not honestly analyze and report what is in the literature, he cherry picks and distorts it to further his anti-mercury agenda.

    All of the “mercury causes Alzheimer’s” proponents are the same “researchers” as the “mercury causes autism” proponents. There isn’t data to support their contentions. The data they cite is flawed.

    His website reads like the website of a quack.

    http://www.zahnklinik.de/umwelt_integrativ

    He uses “challenge testing” of mercury to defraud patients into using chelation.

    He is a quack.

  17. Eugene says:

    Hi, I’m an oncology/haematology nurse who has to administer morphine to patients for cancer pain. I read your article with interest and would appreciate your help if you could help provide me with the article name or any keywords for the study mentioned here.”In studies of surreptitious vs. open IV morphine administration, patients experienced less pain relief from the morphine when they were unaware that they were getting it”

    This article sounds like an interesting one for teaching purposes, which hopefully could provide better pain relief for the patients under our care.

    A search under pubmed for surreptitious vs. open IV morphine administration revealed no useful articles, with variations of keywords revealing studies for narcotic delinquency instead. Thanks in advance:D

  18. daedalus2u says:

    Eugene, I have a blog post on the placebo effect where I cite a Eugene, I have a blog post on the placebo effect where I cite a reference where a resident preferred to give morphine by injection, saying something about steel hitting skin accompanied by “this is going to make you feel better” being more effective.

    http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

    I think this is the point, that when patient expectations coincide with the effects of the treatments being given, the treatments are likely to work a little better, and especially for things like pain which have a pretty large placebo effect.

    I think the point about the clinician-patient interaction is that it will work better when it is authentic, it is always easier to be authentic when you are authentic, which is why lying about placebos is always bad.

  19. Eugene says:

    thank you

  20. JPZ says:

    @micheleinmichigan

    “Why am I always hearing things like “That money can never be recouped without making a patent on the product being investigated. So by the nature of the system it will be exceedingly rare for you to find any “natural treatment” (any treatment which can’t be patented) scientifically proven, even if the treatments abound.”

    If I may provide an example, why would a dietary supplement company spend between 10^5 and 10^7 dollars on clinical trials proving that a dietary supplement has a medical benefit when the consumer can buy the same product from a competitor? The profitability of dietary supplement patents is inversely proportional to the fungibility of the product.

  21. JPZ says:

    @nybgrus

    To be fair (but not supporting jmcohen87), there is some evidence supporting the use of ketogenic diets in AD (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/). It is far from proven, but there is a company developing a medical food for AD based on their own decent studies (sorry that I can’t say more until they launch).

  22. nybgrus says:

    @JPZ:

    I am aware of those studies. Not intimately, but I do know and accept that there is some sort of positive benefit there – though I am skeptical of the effect size and mechanism. However, people like jmcohen and geoff vastly overreach the data on that and furthermore tend to lump it in to non-related arguments as a way to bolster their claim. I.e. – “Well, maybe the ketogenic diet doesn’t help as much for cancer, but it helps with AD and so we should go ahead and recommend it for cancer and kill two birds with one stone.” That is a fallacious argument that demonstrates nothing.

    At some point, probably next year during my GP rotation, I would actually like to sit down and suss out those AD studies and learn more detail on the biochem behind it. For now though, that will have to wait, and I am not terribly keen to take jmcohen’s claims on the effect size at face value. If Dr. Hall (or you for that matter) made a strong claim and presented some evidence that would be a different story.

  23. JPZ says:

    @d2u

    “The interventions he is talking about would not cost hundreds of millions to test. They are all over the counter or wholesome foods, their use does not even require an IRB”

    Actually, they would require IRB approval. The IRB provides oversight for informed consent, patient privacy, the health risks of invasive sampling procedures, the ethical recruitment of subjects, qualifications of the PI and team, etc. The threshold for IRB review is not use of a prescription drug. I speak from experience having done both observational and nutritional product clinical trials that underwent multiple IRB reviews. A gray area for IRB reviews is whether surveys need prior approval.

  24. Bart B. Van Bockstaele says:

    There certainly are ethical problems with placebos, but I can’t help but think that they may have a place. When confronted with hypochondriacs, what is better? Telling the patients that it’s “all in your head” and driving them to the alternologists who will be all too happy to take them to the cleaners while filling their heads with nonsense, or prescribing a placebo?

    While prescribing placebos is unethical, it may be -in certain cases- less unethical than not prescribing them.

    1. Harriet Hall says:

      @Bart,

      You think lying to patients may have a place? If you were a hypochondriac would you want a doctor who foisted you off with a sugar pill instead of doing something to actually help you? You have set up a false dichotomy of placebo vs. telling patients it’s all in their head and driving them away. Good clinicians don’t need to do either. They can explain the symptoms as perceptions from the way the body is functioning rather than signs of any disease process, and they can work with the patient to help him cope and live with his symptoms.

      I think we should have a firm rule that lying to patients is wrong, and if we break that rule even for what we think are the best possible reasons, we should always feel a bit guilty.

      If you were worried about a noise in your car and the mechanic determined that it was not due to anything that would cause the car to malfunction, would you want him to charge you for unneeded repairs just to keep you from going to his competitor?

  25. jb123 says:

    Benedetti explains that some placebo effects are produced unconsciously, like those acting on the immune system, while others are facilitated by conscious expectation, as in the case of pain. If this is true, would it be in any way convincing if an unproven treatment – such as acupuncture – were shown to be effective in treating staunch skeptics?

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