Tag Archives: Placebo

Does Homeopathy Work?

How can homeopathy help to stop the Ebola outbreak?

Via Skeptical Raptor

In case you’re assuming that it can, it really can’t.

homeopathySince any reasonable person would understand that homeopathy violates some of the basic principles of physics, chemistry and biology. And because there is no viable mechanism that would make you think homeopathy actually could work, clinical trials show that it doesn’t work, or, at best, it is a mythical placebo. So, if it doesn’t work in clinical trials, and there is no possible mechanism underlying it, employing Occam’s Razor, we would have to say the simplest explanation is the best: Homeopathy does not work. It’s a lie. It’s a scam. Period. End of story.

The current outbreak of the Ebola virus in West Africa has been making significant headlines lately. The virus is deadly, with a mortality rate well over 90%, easily transmitted by any bodily fluid, and there is no known cure. The course of the disease is horrifying, starting with symptoms similar to a bad flu, but eventually leading to blood clotting problems, failing organs like the kidney and liver, then finally death. The disease is not selective about whom it attacks, young or old, healthy or not.

Early treatment may increase the survival chance, since there is no known cure. Treatment focuses on replenishing fluids, maintaining proper blood pressure, replacing lost blood, and treating related infections.

Ebola Virus Disease 838_225pxAnd there is no vaccine to prevent the virus from infecting individuals. This isn’t a massive conspiracy to prevent a new vaccine from coming to the market. Developing the vaccine has been incredibly difficult because traditional vaccine development strategies, such as inactivation, have not been successful. In fact, several vaccines have shown to be successful in preventing Ebola infection in animals and non-human primates, but as I’ve said many times, success in animals only rarely translates to success in humans. Those vaccines that have shown promise are now undergoing substantial clinical trials, but human clinical trials for vaccines are complex and take time. In fact, there might Ebola vaccines available in the next few months.

Of course, the lack of a cure or prevention for Ebola means the anti-science quack pushers are out in force. And that means homeopaths.

One of these deranged homeopaths even suggested a treatment:

SnakeOil_150pxDr. Gail Derin studied the symptoms of Ebola Zaire, the most deadly of the three that can infect human beings. Dr. Vickie Menear, M.D. and homeopath, found that the remedy that most closely fit the symptoms of the 1914 “flu” virus, Crolatus horridus, also fits the Ebola virus nearly 95% symptom-wise! Thanks go to these doctors for coming up with the following remedies:
1. Crolatus horridus (rattlesnake venom) 2. Bothrops (yellow viper) 3. Lachesis (bushmaster snake) 4. Phosphorus 5. Mercurius Corrosivus

Yes, three snake venoms. Ebola is dangerous, but I’m not sure getting venom from snakes is a risk I’m willing to take, even if all of this pseudoscience actually worked. Oh, and the irony of “Mercurius Corrosivus”, which is nothing more than mercuric chloride. Yes, mercury. My irony meter just blew up.

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BBC Fail on Acupuncture Documentary

steven_novellaby via BBC Fail on Acupuncture Documentary

Alternative Medicine’s best friend, and in my opinion largely responsible for what popularity it has, is a gullible media. I had thought we were turning a corner, and the press were over the gushing maximally clueless approach to CAM, and were starting to at least ask some probing questions (like, you know, does it actually work), but a 2006 BBC documentary inspires a more pessimistic view.

acupucture_chinese_medicine_300pxThe documentary is part of a BBC series hosted by Kathy Sykes: Alternative Medicine, The Evidence. This episode is on acupuncture. The episode is from 2006, but was just posted on YouTube as a “2014 documentary.” Unfortunately, old news frequently has a second life on social media.

First, let me point out that Sykes is a scientist (a fact she quickly points out). She is a physicist, which means that she has the credibility of being able to say she is a scientist but has absolutely no medical training. It’s the worst case scenario – she brings the credibility of being a scientist, and probably thinks that her background prepares her to make her own judgments about the evidence, and yet clearly should have relied more on real experts.
She does interview Edzard Ernst in the documentary, but he mainly just says generic statements about science, rather than a thorough analysis of specific claims. I wonder what gems from him were left on the cutting room floor.

The documentary does get better in the second half, as she starts to mention things like placebo effects, and the problems with the evidence-base for acupuncture. But she follows a disappointing format – setting up a scientific premise, then focusing on the positive evidence. There is a clear narrative throughout, that acupuncture is amazing and surprising.

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Your days are numbered

Gordon Bonnetby Gordon Bonnet via Skeptophilia

Most people have heard of the placebo effect.  The name comes from the Latin word meaning “I will please,” and refers to the phenomenon that people who are given an ineffective medication after being told that it will ameliorate their symptoms often find that the symptoms do, indeed, abate.  The mechanism is still not well elucidated — it has been suggested that some of the effect might be caused by the brain producing “endogenous opioids” when a placebo is administered, causing decreased sensations of pain, feelings of well-being, and sounder sleep.  But the fact is, we still don’t fully understand it.

Less well-known, but equally well-documented, is the nocebo effect.  “Nocebo” means “I will harm” in Latin, and it is more or less the placebo effect turned on its head.  If a person is told that something will cause pain, or bring him/her to harm, it sometimes does — even if there’s no rational reason why it would.  Individuals who believe in voodoo curses, for example, sometimes show actual medically detectable symptoms, even though such curses are merely empty superstition.  Nevertheless, if you believe in them, you might feel their effects.

[image courtesy of the Wikimedia Commons]

[image courtesy of the Wikimedia Commons]

Naturally, this further bolsters the superstition itself, which ramps up the anxiety and fear, which makes the nocebo more likely to happen the next time, and so round and round it goes.  And this seems to be what is happening right now in Uganda — a bizarre phenomenon called “numbers disease.”

In “numbers disease,” an affected individual suddenly notices a raised pattern on his/her skin that looks like a number.  The number that appears, it is said, represents the number of days the person has left.  Once the number shows up, the individual begins to sicken, and when the allotted time is up, the person dies.

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Homeopathy is bunk, study says

By via World news | theguardian.com

homeopathy 803_250pxHomeopathy is no more effective than a placebo, according to an extensive study by a peak science body.

The draft paper by Australia’s National Health and Medical Research Council (NHMRC) assessed research into the effectiveness of the alternative medicine on 68 health conditions and concluded “there is no reliable evidence that homeopathy is effective”.

Homeopathy claims to “let likes cure like,” by using highly diluted forms of the ailment it is treating. The Australian Homeopathic Association states the practice treats patients as a “whole person, taking into account personality, lifestyle and hereditary factors as well as the history of the disease.”

But the NHMRC review, conducted by a working committee of medical experts, said it had no impact on a range of conditions and illnesses including asthma, arthritis, sleep disturbances, cold and flu, chronic fatigue syndrome, eczema, cholera, burns, malaria and heroin addiction.

For the 68 conditions – including those listed – the review either concluded definitively that homeopathy was not more effective than a placebo, or at the very least there was no reliable evidence to suggest it was.

Placebo Side Effects

“No good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than a substance with no effect on the health condition (placebo), or that homeopathy caused health improvements equal to those of another treatment,” read the report’s summary.

Doctors welcomed the findings.

Professor John Dwyer, an immunologist and Emeritus Professor of Medicine at the University of New South Wales, told Guardian Australia that the report was long overdue.

“Obviously we understand the placebo effect. We know that many people have illnesses that are short lived by its very nature and their bodies will cure them, so it’s very easy for people to fall in the trap that because they did ‘A’, ‘B’ follows,” he said.

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67 claims about Coconut Oil: Which ones are true, and which ones are BS?

by via The Soap Box

coconut oil uses

Recently I came across this picture that were making all of these claims about coconut oil (67 claims to be exact).

Now normal when I see something like this and it has the word “Proven” in the title, I automatically assume that most or all of it is just a bunch of BS.

But I decided to give these claims the benefit of the doubt and examine all of them to see if there is any truth behind them.

1. To cook with instead of vegetable or seed oils.

This one is true. You can cook with it, but it’s advised by many health organizations not to, or not to use to much due to it’s high amount of saturated fat.

coco-milk-creamer-original2. In your coffee/tea instead of creamer.

Sure. Infact non-dairy creamers are often made out of coconut oil.

3. To wash your face with instead of soap.

Yes, this is true. Also most hard soaps are made with coconut oils.

4. To brush your teeth with.

You could. There’s nothing dangerous about coconut oil (except maybe increasing your chance of having a heart attack if you eat to much of it) but I would stick with good old fashion (and proven) toothpaste.

My advice is that you should ask your dentist first before using coconut oil toothpaste and see what they have to say.

5. For oil pulling.

Yes, you can use coconut oil for this, although oil pulling itself hardly does anything and only really decreases the amount of tooth decaying bacteria in your mouth. Mouthwash is far more effective to use, and takes less time. Vodka also works to, and unlike mouthwash, you can actually swallow it!

IMG_2636_200px6. As a body moisturizer.

Yes, this is true.

7. As a sun-screen.

Lets go back to #1 on the list, shall we. It’s used as a cooking oil. What do you think it’s going to do to you?

For those who answered incorrectly, it’s going to cook you!

8. As a hair conditioner.

It does reduce protein loss in hair, so yes you could use it as a hair conditioner.

9. As a supplement.

For what? That’s kind of vague. Plus considering how high coconut oil is in saturated fat, I wouldn’t use it as a food supplement.

massage1_250px10. As a massage oil.

You can use it for that.

11. To reduce scars.

It helps with dry skin, and it might help acne scars, but scars from a cut it’s not going to help.

12. To treat for lice.

Yes, you can, but you have to use a lot of it to work, and you have to leave on for 12 to 18 hours, and it probably won’t kill the eggs.

hair-growth.-Coconut-milk1_250px13. To soften cracked heels.

Yes, you can use it for this.

14. As a hair serum.

Yes, this is another thing you can use it for.

15. As a buttery spread.

Sure you can… if you don’t mind increasing your risk of having a heart attack in a few years.

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The Placebo Effect and Pharmaceutical Companies

Stuff They Don’t Want You to Know – YouTube

Scientists have noticed that patients may experience improvements just from thinking they’ve had medicine, even if that medicine is fake. But why does the placebo effect work, and why do some researchers believe it’s growing stronger?

This Video Will Hurt

H/T: Thomas J. Proffit

Warning: This video isn’t kidding about its title. Don’t believe us? Go ahead and press play.

Via CGP Grey – YouTube

Changing Your Fate

steven_novellaby Steven Novella via Skepticblog

There is a cartoonish sight gag that I have seen multiple times – a patient lying ill in a hospital bed has some indicator of their health, on a chart or monitor. The doctor comes by an flips the downward trending chart into an upward trending one, or adjusts the monitor so the readings are more favorable, and the patient improves.

This is a joke that a child can understand, even if they don’t explicitly understand that the humor lies in the reversal of cause and effect. And yet more subtle or complex forms of this same flawed reasoning is quite common, especially in the world of pseudoscience.

Even in medicine we can fall for this fallacy. We often measure many biological parameters to inform us about the health of our patients. When the numbers are out of the normal range it is tempting to take direct action to correct those numbers, rather than address the underlying process for which they are markers. Medical students have to learn early on to treat the patient, not the numbers.

palm_225pxOf course when the underlying belief is magical, rather than scientific, it is hard to argue against just changing the signs so that the reading is more favorable. Since the cause and effect is pure magic to begin with, does reversing it make it any worse?

Apparently not – at least for those in Japan who still believe in palmistry, according to the Daily Beast. At least one cosmetic surgeon, Dr. Matsuoka, is offering surgery to change the lines in the palm of your hand in order to change your fortune. Living longer, therefore, is just a matter of extending the life line. Of course this is absurd, but is it really more absurd than palmistry itself?

Dr. Matsuoka does not make direct claims about the efficacy of his procedure, but does justify it with the placebo effect and anecdotes:

“If people think they’ll be lucky, sometimes they become lucky.”

There is some truth to that, actually. Belief in being lucky or fortunate does seem to lead people to exploit more opportunities because they are more positive about their chances of success. This reasoning could be used, however, to defend any superstition, and it’s difficult to measure the psychological benefit against the risks of being that gullible and believing in magic.

He also reports:

The woman with the early wedding line wrote to the doctor that she got married soon after he had performed the operation. Two male patients wrote to him that they had won the lottery after the surgery. His luckiest patient collected more than $30,000 (3 million yen).

Well, there you go. I have no way to counter these completely unsubstantiated anecdotes.

Now excuse me while I roll back the mileage on my car. It’s been acting up a bit lately and I’m hoping this will make it run more like it did when it was new.

[END] via Skepticblog

“Small Study of Reflexology Finds Nothing,” Headline Should Read

Written by Kyle Hill via randi.org

If alternative medicine wants to be taken more seriously, the studies must be better designed and be put in the proper context.

UK’s The Telegraph reported last month that a study published in the journal Complimentary Therapies in Clinical Practice showed that reflexology was “as effective as pain killers.” It’s a bold claim.

However, this claim is backed up by nothing in the study. In fact, all the methodological flaws encourage a reflexive rejection of the study’s conclusions.

No Control, No Power

Reflexology is based on the unsubstantiated belief that each part of each foot is a mirror site for a part of the body. (source: The Skeptic’s Dictionary)

You don’t have to be a scientist to know what questions to ask about a study. Some of the most basic are “What was the sample size?” and “Was it double-blinded?” Even these basic questions can tell you a lot about what researchers find.

The reflexology study had a sample of 15 participants, most of them women, and each received both experimental conditions (we will come back to this point later on). If 15 sounds like a small number to you, that’s because it is. In fact, because the statistical analyses they were using looked at group averages, this small number gets broken down even further. With so few participants, this study does not have the power to comment on very much. In larger studies, vexing variations between individuals “cancel out” to hit on some average value. Whether this study hit on something interesting or not, we wouldn’t be able to tell—values are lost in the large variations between so few people.

To control for possible placebo effects, the researchers used transcutaneous electrical nerve stimulation (TENS) as the “sugar pill” comparison to reflexology.

Transcutaneous electrical nerve stimulation (TENS) device placed on the wrist.

Transcutaneous electrical nerve stimulation (TENS) device placed on the wrist.

But the famous “sugar pill” experimental design comes from the idea that subjects should not be able to tell the difference between one pill and another. In this study, every subject could easily tell the difference between a massage of the foot and some electrodes placed on the wrist. And this brings in other problems. Because each subject, and each researcher, knew what treatments were given, there was effectively no blinding. Blinding is the best way to avoid the pernicious biases that tend to creep into studies like this. Needless to say, an unblinded study is far less persuasive.

And what of the TENS treatment that was supposed to act as a placebo? One systematic review concluded that there is “no benefit of TENS compared with placebo.” Another review found that “evidence for the efficacy of…is limited and inconsistent,” in regards to treating chronic back pain. The New England Journal of Medicine concluded that “treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone,” also referring to treating chronic back pain.

So, according to much larger studies, there is no reason to believe that TENS does much for pain. TENS could then effectively be a placebo, but the authors of the reflexology study . . .

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Nocebo Mass Delusion

by via NeuroLogica Blog

Nocebo_150pxExpectation bias cuts both ways, for positive and negative expectations. Expectation bias, the tendency to perceive and accept data that reinforces your expectation, is one of the many contributors to placebo effects (the illusion of a positive benefit that derive from something other than an active treatment). It is also, however, part of nocebo effects  (the illusion of negative side effects from something other than active treatment).

Expectation bias can be powerful enough in some people to lead not only to the perception of a benefit or side effect but to a frank delusion. When this happens on a large scale, that can lead to a mass delusion. There are many episode that demonstrate this effect, but now there is also a controlled experiment that also confirms it.

A recent study looked at sham exposure to wifi signals in 147 subjects. They were first exposed to either a documentary about the dangers of wifi, or to a documentary about internet security. A total of 54% of the subjects experienced

“…agitation and anxiety, loss of concentration or tingling in their fingers, arms, legs, and feet. Two participants left the study prematurely because their symptoms were so severe that they no longer wanted to be exposed to the assumed radiation.”

wifi ouch_300pxFurther, the group exposed to the wifi documentary experience significantly more symptoms.  This is a small study but it matches prior research showing that those who believe they have electromagnetic sensitivity will experience symptoms when exposed to sham EMF. The difference with the current study is that it used healthy volunteers and controlled for media exposure.

Systematic reviews of the research on EM hypersensitivity show that those who self-identify as having EM hypersensitivity (which has now been renamed in the technical literature as “Idiopathic environmental intolerance attributed to electromagnetic fields”) cannot tell the difference between real and sham EMF. This review concluded:

“ No robust evidence could be found to support this theory. However, the studies included in the review did support the role of the nocebo effect in triggering acute symptoms in IEI-EMF sufferers. Despite the conviction of IEI-EMF sufferers that their symptoms are triggered by exposure to electromagnetic fields, repeated experiments have been unable to replicate this phenomenon under controlled conditions.”

The new study suggest that this nocebo effect can happen on a large scale due to media reports, and cautions the media about sensationalizing such reports.

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Revenge of the Woo

by via NeuroLogica Blog

Sometimes the targets of our skeptical analysis notice, and they usually are not pleased with the attention.

acupuncture_1_250pxLast year the Acupuncture Trialists Collaboration published a meta-analysis of acupuncture trials in which they claim, “The results favoured acupuncture.” The report was widely criticized among those of use who pay attention to such things. In my analysis I focused on the conclusions that the authors drew, rather than their methods, while others also had concerns about the methods used.

The authors did not appreciate the criticism and went as far as to publish a response, in which they grossly mischaracterize their critics and manage to completely avoid the substance of our criticism.

To review, the original meta-analysis concluded:

Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

In my critique I pointed out that the results do not show that acupuncture is effective, nor that it is a reasonable referral option. What they characterize as “modest” differences were, rather, not clinically significant.acupucture_chinese_medicine_cartoon_400px Further, such tiny differences are most parsimoniously explained as the result of researcher and publication bias, two phenomena that are well established in general and specifically within the acupuncture literature. Unblinding alone would be sufficient to explain these results.

What they call “factors in addition to the specific effects of needling” the rest of the scientific community would call “placebo effects,” which are not an indication that a treatment works, but rather the result of bias, noise, and statistical illusions. These results are due to unblinded comparisons with untreated groups in clinical trials – they are not evidence of any kind of efficacy.

Their conclusions are part of a pattern visible within the acupuncture community – attempting to parlay placebo effects into the mirage of a real effect from acupuncture. I commented in my original article that such a conclusion was evidence of pro-acupuncture bias in the authors.

In their response, the authors write:

Although there was little argument about the findings in the scientific press, a controversy played out in blog posts and the lay press.

Only one substantive critique of the paper has appeared in a scientific forum.

We find that there is little argument in the scientific press because most scientists pay little attention to what they consider fringe practices. That is precisely why it is left to those of us who do care and pay attention to fringe medicine to provide a detailed analysis and point out the flaws in reasoning used by proponents.

In fact we did submit a letter in critique of the study, in a traditional scientific forum, but it was not published. Only the brief letter by David Colquhoun was.

This represents a typical strategy by proponents of dubious fringe medicine – interpret lack of resistance by mainstream scientists as acceptance.

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Meditation – Specific or Non-Specific Effects

by Dr. Steve Novella via randi.org

whoa_250px_slowedOne of the challenges of scientific investigation, perhaps especially in the complex arena of medicine, is teasing apart specific from non-specific effects. A specific effect is one that derives from the details of a particular intervention, with a distinct mechanism of action. Non-specific effects are everything else.Non-specific effects are part of placebo effects, but not the same as placebo effects also include statistical effects, bias, and other sources of illusory effects. Non-specific effects are real; they just do not derive from the specific intervention itself.

For example, with therapy techniques for anxiety or depression, non-specific effects would include the caring attention of the therapist, taking time out from one’s regular schedule to think and talk about their feelings and problems and the hope generated from taking positive action to address one’s symptoms. Any specific technique, therefore, would seem to be effective due to these non-specific effects of the therapeutic interaction.

Before one claims that moving the eyes back and forth, or guided imagery, or being regressed to a prior life has specific effects, and is therefore evidence of a specific mechanism, the non-specific effects outlined above need to be carefully controlled for. This is especially true when the alleged mechanism is outside the bounds of currently known biological phenomena.

This confusion of specific with non-specific effects is at the core of much of what is labeled “alternative” medicine. Acupuncture is another great example. The best evidence strongly supports the conclusion that there are only non-specific effects from acupuncture, deriving from the kind attention of the acupuncturists. It doesn’t seem to matter where or even if you stick needles through the skin, arguing against any specific underlying mechanism.

Another treatment increasingly popular in the world of alternative medicine is meditation, or specifically transcendental meditation. Interestingly, one study on TM (http://www.ncbi.nlm.nih.gov/pubmed/23204989) contained the following statement: “Transcendental Meditation and TM are trademarks registered in the US. Patent and Trademark Office, licensed to Maharishi Vedic Education Development Corporation and are used with permission.” I noticed that few other studies of TM contained this statement, and realized it was probably because the studies were all conducted at the Maharishi University of Management (more on that below).

TM is a specific meditation technique and proponents claim that it is effective at reducing blood pressure, reducing cardiovascular risk factors and generally promoting health. This sounds like another perfect example of confusing specific and non-specific effects. Relaxation therapy and stress reduction have been demonstrated to lower blood pressure and cardiovascular risk. There is a known mechanism for this – emotional stress increases sympathetic tone, which raises blood pressure and stresses the heart.

Unless there is very good evidence controlling for the non-specific effects of stress reduction, there is not reason to believe that TM has any additional specific effects that relate to the details of the TM procedure. Occam’s razor would favor the known over the unknown as an explanation.

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Homeopathic Logic

by via NeuroLogica Blog

homeopathyHomeopathic logic is real logic that has been diluted into non-existence. The solvent is bias and propaganda. I was recently pointed to an excellent example of this – an article written by a homeopath arguing that homeopathy is superior to modern medicine. It’s published in what appears to be an obscure rag, but it does represent common arguments put forth by homeopaths so it doesn’t really matter.

Here is the main point of the article:

There are many differences in both the disciplines of medicines. Let’s just focus on one main difference and that is the fact that none of the homeopathic medicines introduced during the last two hundred and fifty years was withdrawn from the market.

The author, Asghar Ali Shah, uses the term, “allopathy” throughout the article. This is a derogatory term used mainly by critics of science-based medicine, and immediately reveals the author’s bias. In the statement above he is also trying to present homeopathy and mainstream medicine as two “disciplines of medicines,” which is a false equivalency. This is a common tactic of fringe beliefs, to appear as a viable alternative to the mainstream, followed, of course, by arguments for its superiority.

Homeopathy, however, is a prescientific superstition that is at odds with basic science, and not just medicine but physics, chemistry, and biology.

Ali Shah’s argument is that real medicine has side effects, and sometimes need to be pulled from the market, while homeopathic potions do not have side effects and are never withdrawn. Ironically, he is actually making an argument for that fact homeopathic products are both worthless and not science-based.

Homeopathic products (mostly – some products labeled homeopathic may have active ingredients) do not have side effects because they do not have any effects. Most are diluted well past the point of having any active ingredient. What is left is ultimately just a sugar pill – a pure placebo.

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