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Placebo, Are You There?

By Jean Brissonnet, translation by Harriet Hall

Note: This was originally published as “Placebo, es-tu là?” in Science et pseudo-sciences 294, p. 38-48. January 2011. It came to my attention in the course of an e-mail correspondence with the editors of that magazine, where one of my own articles was published in French translation in January 2015. I thought this was the best explanation of placebo that I had ever read. It covers the same points my colleagues and I have addressed and more. It describes the pertinent research and uses particularly effective graphs to illustrate the principles (a picture is worth a thousand words). The author, Jean Brissonnet, kindly gave his permission for me to translate it and share it with our readers.


In fact, you don’t need to give a placebo to get a placebo effect and therefore we can now think about how we can maximize the placebo component of routine care.

~ Damien Finniss, 2010

The scene takes place in a surgical suite where they are preparing to do a cataract operation. The patient is lying on the operating table. A few minutes earlier the anesthetic gel was applied to the cornea to permit an operation under simple local anesthesia. The surgeon arrives in the company of the anesthetist. They are engaged in a spirited discussion and don’t seem to be agreeing.

“It has been proven,” says the surgeon, “that 30% of the action of a medical treatment is due to the placebo effect.”

“I doubt that,” retorts his interlocutor, “I think that placebo story is one of those medical myths on a par with the idea that we only use 10% of our brain, that nails and hair grow after death, or that cellphones create interference in hospitals.”[1]

“No,” insists the surgeon with a superior tone, “the fact is established and has been proven by numerous studies.”

The anesthetist shakes his head with a slight smile, but he doesn’t reply. As for the patient, who might have much to say on the subject, he keeps quiet, because it would not be prudent to argue with someone who is about to suck the lens out of your eye.

This true anecdote would not be of interest if it didn’t concern two members of the medical profession. Why such uncertainty? Why such lack of knowledge about such a fundamental subject? This faith in an all-powerful, magical, and mysterious placebo is common among the general public and it serves as justification for resorting to unconventional medicines that have never been able to show solid proof of efficacy; but we see that it still persists among the medical profession.

To know whether the placebo effect is real or should be relegated to the same category as poltergeists, it will help to go back in history.

cartoon

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Posted in: Clinical Trials, Science and Medicine

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Special thanks to Dr Andrey Pavlov

I don’t write posts very often. In fact, I’ve only ever written one before, and I didn’t even post it under my account. That’s because I’m not a doctor or a scientist, I just babysit the server on a volunteer basis.

Trying to keep a site as popular as SBM running on a non-profit budget is no easy feat. Especially when everyone involved has their own day jobs. I’m constantly amazed at the dedication of the SBM staff. The hours everyone puts in writing these posts is nothing short of monumental.

Well, something happened today, and SBM reader and contributor Dr Andrey Pavlov deserves recognition and gratitude.
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Posted in: Announcements

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The Hippocrates Health Institute: Cancer quackery finally under the spotlight, but will it matter?

This is a screenshot from the website of the Hippocrates Health Institute, showing its grounds.

This is a screenshot from the website of the Hippocrates Health Institute, showing how high end its grounds and facilities are.

I first came across Brian Clement, the proprietor of the Hippocrates Health Institute in West Palm Beach, Florida, a little more than a year ago based on the story of Stephanie O’Halloran. Ms. O’Halloran was—word choice unfortunately intentional—a 23-year-old mother of an 18 month old child from Ireland who was diagnosed with stage IV breast cancer in 2013, with metastases to her lymph nodes, liver, lung, and leg. Unfortunately for her, she found Brian Clement at the Hippocrates Health Institute, who gave her false hope with his claims that a raw vegan diet and wheatgrass can treat just about everything. Unfortunately, but not unexpectedly, Ms. O’Halloran died in June 2014, less than nine months after having been diagnosed with metastatic breast cancer.

I didn’t write about Stephanie O’Halloran at the time (at least not here), but I did write about Brian Clement and the Hippocrates Health Institute (HHI) twice over the last several months in the context of the cases of two 11-year-old Aboriginal girls in Canada with cancer, specifically lymphoblastic leukemia. One was —word choice again unfortunately intentional—named Makayla Sault and the other is referred to as “JJ” in news reports to protect her privacy in her parents’ legal proceedings to assert their right to use traditional medicine to treat their daughter’s cancer rather than curative chemotherapy, which was estimated to have a 75% chance of curing Makayla Sault and an 85% to 90% chance of curing JJ. Unfortunately, both girls and their parents fell under the spell of Brian Clement and his cancer quackery. The result was one unnecessarily dead girl (Makayla Sault, who died last month) and one likely to be dead by the end of this year or not much longer (JJ). Such is the price of cancer quackery. In this case, even more puzzlingly, these girls’ parents seemed quite content to conflate the quackery of Brian Clement, a white man practicing in Florida, with “traditional Aboriginal medicine,” the sort of practices they were claiming to have a right to.
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Posted in: Cancer, Health Fraud, Herbs & Supplements, Legal

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A Day of Science and Skepticism with NECSS SfSBM

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Full Conference schedule here with Bill Nye as the KeyNote.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

Preliminary SfSBM Program  (Updated 2.15.15, subject to change)

09:00 – 10:00 60 minutes Registration/Will Call
10:00 – 10:10 10 minutes OPENING: Steve Novella and David Gorski
10:10 – 10:45 35 minutes: Steve Novella. SBM – Going Beyond Evidence-Based Medicine.
10:45 – 11:20 35 minutes: Harriet Hall. Chiropractic.
11:20 – 11:55 35 minutes: David Gorski. Integrative Medicine
11:55 – 12:30 35 minutes: Mark Crislip. How Acupuncture ‘Works’
12:30 – 02:00 90 minutes LUNCH
02:00 – 02:35 35 minutes Speaker 4: Jann Bellamy. Political Pseudoscience
02:35 – 03:35 60 minutes Panel 1 Discussion
03:35 – 03:50 15 minutes BREAK
03:50 – 04:35 45 minutes Q&A from Twitter & Audience
04:35 – 05:20 45 minutes SBM Jeopardy
05:20 – 05:30 10 minutes CLOSING
05:30 – 06:00 30 minutes SBM Business Meeting

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Posted in: Announcements

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Traditional Chinese Pseudo-Medicine Hodgepodge

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back.  Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back. Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

As I have noted before, more is published on acupuncture and traditional Chinese pseudo-medicine than the other SCAM. Here are some of the articles that drew my attention.

Captain Hook and acupuncture

Here is one of the more curious articles on acupuncture I have yet to find, “Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand.”

I did not know this, but you can fool a person into thinking that a rubber hand is their own.

The synchronous tactile stimulation of the real hand of an individual and rubber hand leads to the feeling that the rubber hand is incorporated with the body of that individual. This is referred to as the rubber hand illusion (RHI), and it occurs because the brain is attempting to interpret the interaction of the visual, tactile, and proprioceptive systems of the body, which in turn, leads to a re-calibration of the touch and the felt position of the hand. The multimodal visuotactile stimulation inherent in the RHI induces the brain to temporarily incorporate external objects into its body image. In addition, when the experimenter threatens the rubber hand with a needle during this illusion, it generally elicits an enhanced sympathetic response and a measurable cortical anxiety response, which indicates that the bodily ownership of the rubber hand causes changes in the interoceptive system of the brain.

Cool. Check out this video to see how it is done. So what happens when you do acupuncture on a rubber hand that the brain thinks is its own?

The findings of the present study clearly demonstrate that acupuncture stimulation to a rubber hand resulted in the experience of the DeQi sensation when the rubber hand was fully incorporated into the body.

As judged by fMRI findings (always taken with a grain of salt substitute) and patient reports. DeQi is what dey feel when de needle is twirled in de skin. (more…)

Posted in: Acupuncture, Science and Medicine, Traditional Chinese Medicine

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2015 NHIS Report on Complementary Health Approaches (whatever that means)

Formerly known as "relaxing," now known as a "complementary health approach." Gustav Courbet, "Young ladies on the banks of the Seine," 1857.

Formerly known as “relaxing,” now known as a “complementary health approach.” Gustav Courbet, “Young ladies on the banks of the Seine,” 1857. Public domain, via Wikimedia Commons.

Back in 2004, data from the 2002 National Health Interview Survey (NHIS) appeared in a report titled “Complementary and Alternative Medicine Use Among Adults: United States, 2002.” It showed a whopping 62% of adults had used CAM in the past 12 months, but only if prayer for health reasons was included. With prayer excluded, the percentage was substantially lower, at 35%.

“CAM” was defined as:

a group of diverse medical and health care systems, therapies, and products that are not presently considered to be part of conventional medicine.

The authors noted that, in earlier surveys of CAM use, “CAM has been operationally defined in a variety of ways” and the lists of CAM interventions/therapies included “varied considerably among the surveys.”

The most commonly used CAM therapies (excluding prayer) were non-vitamin, non-mineral natural products (18.9%), deep breathing exercises (11.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%) and diet-based therapies (3.5%). CAM was most often used to treat back pain or problems, head or chest colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. Most CAM use was self-prescribed. Rebranding things like exercise (yoga) as “CAM” was in the mix from the get-go.

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Posted in: Acupuncture, Chiropractic, Clinical Trials, Energy Medicine, Herbs & Supplements, Homeopathy, Naturopathy, Traditional Chinese Medicine

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Reporting Research Misconduct

Perhaps one of the greatest threats to the enterprise of Science-Based Medicine is research fraud and misconduct. Rigorous research methods can be used to minimize the effects of bias, but when those methods themselves are the problem there is no easy fix. Related to this is the need for transparency. When fraud or misconduct is uncovered it erodes confidence in the system because it provokes speculation about how much fraud and misconduct has not been uncovered.

A recent study published in JAMA looks at one aspect of this issue – reporting of misconduct uncovered by the FDA. The good news here is that FDA trials, those that will be used to apply to the FDA for approval of a drug, are carefully monitored and inspected by the FDA. This is an important quality control measure. When the FDA uncovers misconduct it takes steps to correct it. If the misconduct is severe enough then any data that is associated with the poor research practices will be excluded from the trial so as not to taint the results. Even an entire study can be disqualified if necessary.

The problem highlighted by the study is that there is no systematic way for the FDA to communicate its findings through the peer-reviewed literature. Tainted studies, or ones that require a correction or retraction (because the violations were discovered after publication) may therefore persist in the peer-reviewed literature without any indication of the uncovered misconduct.

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Posted in: Science and Medicine

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Glucosamine Update

 Stick-and-ball model of the glucosamine molecule (from the Wikimedia Commons, image by Benjah-bmm27)

Stick-and-ball model of the glucosamine molecule (from the Wikimedia Commons, image by Benjah-bmm27)

Osteoarthritis, the “wear-and-tear” type of arthritis, affects a great many of us as we grow older. Knee pain is a common symptom. The diet supplements glucosamine and chondroitin have been proposed as a more “natural” treatment than pharmaceuticals, and they are components of a number of proprietary “joint health” formulations like Osteo Bi-Flex. The GAIT study (Glucosamine/Chondroitin Arthritis Intervention Trial), compared glucosamine, chondroitin, a combination of the two, and a pharmaceutical (celecoxib) to a placebo in patients with knee pain from osteoarthritis. The only one that worked better than placebo was celecoxib. I wrote about the GAIT trial in 2008. The study was reported in the media as both negative and positive. The positive reports emphasized the subgroup analysis: in one of ten subgroups, patients with moderate to severe pain, the combination of glucosamine and chondroitin outperformed placebo. But in the subgroup of patients with mild to moderate pain, it did not. The authors themselves commented that their study was not powered to draw any conclusions from subgroups and that further studies would be required. (The “power” of a study is a measure of its ability to show an association or relationship between two variables if such a relationship exists.) Now a further study with sufficient power claims to have confirmed the subgroup findings. This may encourage some people to try glucosamine/chondroitin, but I remain skeptical.

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Posted in: Clinical Trials, Herbs & Supplements

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How not to report about vaccine safety issues, Toronto Star edition

This is the original headline of the Toronto Star's scientifically incompetent and fear mongering Gardasil story. It was later changed to "Families seek more transparency on HPV vaccine."

This is the original headline of the Toronto Star‘s scientifically incompetent and fear mongering Gardasil story. It was later changed to “Families seek more transparency on HPV vaccine.”

I remember it well, because several of my readers forwarded it to me not long after it appeared on the website of the Toronto Star: An eye-catching headline proclaiming a “wonder drug’s dark side,” that “wonder drug” being Gardasil, one of two vaccines against the human papilloma virus (HPV) designed to prevent cervical cancer by preventing infection with the HPV virus. The story’s caption blared:

Hundreds of thousands of teen girls in Canada have safely taken Gardasil, a vaccine shown to prevent HPV. But a Star investigation has found that since 2008 at least 60 Canadians have experienced debilitating illnesses after inoculation. Patients and parents say the incidents point to the importance of full disclosure of risks.

There was even a video that would have been right at home on a variety of antivaccine websites, such as Age of Autism, SafeMinds, or VaxTruth:

Indeed, the video above reminded me more than anything else, of a segment from the antivaccine “documentary” that functions as antivaccine propaganda, The Greater Good, which portrays as one of its vaccine “victims” Gabi Swank, a girl whose story is not unlike that of Kaitlyn Armstrong, the teen profiled by the Star. Both girls had a deterioration of their health that appears to have happened sometime after receiving Gardasil. Both attribute their health issues to Gardasil. Neither story was examined with even a modicum of skepticism or critical thinking. In fact, part of the reason I recognized immediately how bad the Star story was derives from my previous experience examining similar stories promoted by the particularly vociferous wing of the antivaccine movement that focuses on the perceived “evils” of Gardasil. That’s something we expect from an antivaccine propaganda film like The Greater Good. We expect better from investigative journalists like David Bruser and Jesse McLean. We don’t get it.

I had meant to blog about this incident because the Star story was such a horrendously bad story from a scientific perspective, but, blogging being what it is, other topics intruded and for some reason I never got back to this topic. Over the last 11 days, however, the criticism and inept responses kept percolating along, as you will see, involving a clueless editor who lashed out at critics, a public editor who just didn’t “get it,” and a newspaper that took far too long to admit that it had screwed up epically and only then after sliming its critics. Fortunately, an excellent analysis in the Los Angeles Times by Michael Hiltzik provided me with an “in” to do the post I had wanted to do before. How the Toronto Star wrote the story is an object lesson in how not to do a vaccine safety story, and how it responded to reasonable criticism was an even more pointed lesson in how not to deal with scientific critics.

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Posted in: Science and the Media, Vaccines

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The Food Babe’s war on “chemicals” heats up again

The Food Babe

[Note: This is an extra bonus post. Because The Food Babe has been in the news and I couldn’t wait until today, I discussed it at a certain not-so-super-secret blog. If you’ve read it before, it’s only somewhat modified and updated. If you haven’t, it’s new to you. Either way, feel free to comment. Completely new material by me will appear here in a scant few hours.]

It’s been a while since I’ve taken notice of Vani Hari, a.k.a. The Food Babe, the misguided “food safety” activist who sees chemicals, chemicals, chemicals everywhere and raises fears about them all, especially the ones that she can’t pronounce. The first time I took any significant notice of her was about a year ago, when she was making news for lobbying Subway to remove the “yoga mat chemical” azodicarbonamide from its bread, although I didn’t write about her here for a few months after that. As I explained at the time, azodicarbonamide is a chemical used in small amounts to mature bread dough, improve its handling properties, and produce a drier, more cohesive, and more pliable dough that holds together better during kneading by hand or machine. It is safe, breaks down during baking into small amounts of safe substances, and is only a hazard if you inhale it in powder form, where it can be a pulmonary irritant. Then, she made some astonishingly ignorant statements about beer, where she pulled the same routine, to the point where I labeled her tactics as the “appeal to yuckiness.” Basically, if something sounds yucky to her (such as isinglass, which is derived from the swim bladders of fish and is used in some beers to remove haziness and yeast byproducts), then it must be bad, either for you or just bad because it’s gross. It also turns out that The Food Babe makes quite a pretty penny spreading her ignorance and has become sought after to feature in various media appearances, such as magazine covers.

For the last few months I’ve been somewhat dreading February, because I knew Hari was poised to release her first book. As I described before, she has more than a fair amount of social media savvy and business acumen, which have allowed her to build the Food Babe brand rapidly and explains (to me at least) why she seemed to come out of nowhere on a trajectory to become as influential as Dr. Mehmet Oz. Her book, released this week, is called The Food Babe Way: Break Free from the Hidden Toxins in Your Food and Lose Weight, Look Years Younger, and Get Healthy in Just 21 Days! (Talk about ridiculously long subtitles!) You see, I knew that when it came time for Hari’s book to come out we’d be seeing a lot more of her, and unfortunately that’s what happened. As part of that publicity, Hari was featured in a fairly long feature article in The Atlantic by James Hamblin, The Food Babe: Enemy of Chemicals. It’s a relatively amusing title, to be sure, and there’s a lot that’s good about the article. Unfortunately, there’s also a lot that’s downright infuriating about it as well, the more so given that Hamblin is a physician and really should know better, but unfortunately in this piece he shows himself far more respectful of pseudoscience of the sort promoted by The Food Babe than a physician should be.
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Posted in: Nutrition, Science and the Media

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