Placebo Effect or "Why drugs have NOT been proven more effective than homeopathy"
It's a challenge for even the most rational mind to fully appreciate the extent of the placebo effect. Many people believe that the effect is minor or even that it doesn't apply to them!
But the proven fact is that the placebo effect accounts for the majority of benefit provided by modern medicine. Not just medicine either, the ability to optimise our belief system is surely the most powerful tool any human can learn.
Let me define the placebo effect as any improvement in the patient's condition resulting from increased expectations about the intervention. This excludes any pharmacological and/or counselling effects, as well as any healing/improvement that would have happened anyway.
Scientific basis of modern medicine?
Traditional medicine is perceived to be more scientifically proven than modern medicine.
In 1993, the following undisputed article was published in The Journal of Nervous and Mental Disease Vol.181, No.6, 1993 (stocked by most university libraries):
How Sound Is the Double-Blind Design for Evaluating Psychotropic Drugs?
Seymour Fisher, PhD and Roger P Greenberg, PhD
Fisher and Greenberg were reviewing the scientific literature for studies on psychiatric medicines that were truly double-blind. They wrote:
"Without proper controls, the testing of drugs becomes somewhat meaningless, unacceptably vulnerable to the intrusion of bias and expectation. Consider, for example, that when Wechsler et al. (1965) analysed the effectiveness of antidepressant medications, as defined by 103 studies over a five-year period, the highest rate of patient improvement (57%) occurred in those with no controls, the next highest (49%) in those where another antidepressant served as a control and the lowest (23%) in those with a placebo control."
One might expect the odd study to show evidence of bias. But when the whole range of studies (103) shows a hugely significant variation (34%) where there should be none... What is going on???
How can the effectiveness of the same drug vary so much? Basic logic tells us that some other variables in the experiments must be to blame. Fisher and Greenberg started looking for evidence of the double-blind being broken. Scientific method relies on the patient not knowing what he/she is taking. That means that the control patients should not know anything about the active drug. Yet Ross and Olson (1981) showed that:
"... the strength of the placebo effect is often proportional (roughly 50%) to that of the drug. Second, they point out that the side-effects of placebos not infrequently mimic those of the active drug. Finally, they indicate that short-term, time-effect curves have, in some instances, been shown to be similar for the active drug and its associated placebo."
How can the control patients mimic the effects of the drug being tested in a supposedly double-blind trial?
Furthermore, Fisher and Greenberg found 22 double-blind studies where a new antidepressant was compared with an older antidepressant as well as a placebo. Now since the older antidepressant had been previously tested when it was the new darling of the pharmaceutical industry, Fisher and Greenberg were able to compare the effectiveness of a drug when it is in favour vs out of favour. They found that out of favour drugs now only performed...
"... approximately one half to one quarter the size of those reported in earlier studies in which the older drug represented the only agent appraised."
I repeat - these are not isolated examples. The double-blind methodology "appears to be penetrated over 80% of the time. As many as 75% or more of patients are typically able to guess their treatment condition accurately."
Nor have these research flaws been corrected. This is the current state of medical research.
The double blind standard is our most pure form of proof for a very good reason. It eliminates bias from experimenter and subject.
http://en.wikipedia.org/wiki/Randomized_controlled_trial
It means working with unidentifiable data as early as possible in the experiment:
There was quite a well-publicised case of this regarding Randi's million dollar prize. Several scientists came forwards to suggest they'd proven (using a "double-blind") that homeopathy worked better than placebo.
Randi made one change to their experiment to ensure that "none of the experimenters knew whether they were dealing with homeopathic solutions, or with pure water." The experiment subsequently showed no difference between homeopathy & water.
Active Placebos
Because every medication in the US is tested against a placebo, there is more data on the effectiveness of placebo than on any drug. However, this does NOT measure the full placebo response.
Most medications are tested against sugar pills. Active placebos are ones which provide a noticeable but non-therapeutic response eg caffeine. Because you can feel something happening, you are more likely to believe 1) you are taking the medication rather than the placebo and 2) the medication is working.
Since the drug companies sponsor nearly all the testing, active placebos are almost never used. This is because they tend to perform significantly better and hence make the medication look less effective.
The presumption that placebo controls exist and can be used is dubious at best.
Gelatin shells might help taste differentiation although it doesn't stop a patient opening the shell themselves. I know I would.
All serotonin agonists produce common similar sensations: the sensations of increased serotonin reception itself. Consequently, you're going to have to use patients who've never taken any (LSD & MDMA included).
Every single medication double-blind methodology that I've read or have so far imagined is flawed.
Either way, we simply have to discard 40+ years of research and invent new protocols.
Nocebo Effect
When people who are taking sugar pill placebos are duped into believing they are taking a real medication, they will usually manifest that medication's side effects and withdrawal symptoms.
When aspirin was being tested on heart patients, one study compared the effects of warning the patients about gastrointestinal problems. Those warned about the gastrointestinal problems were almost three times as likely to have the side effect.
Absolute effectiveness of medications and placebo
Those patients in medical trials are told that they have a (usually) 50% chance of being on placebo. Because of the undervaluing of the placebo response, this lowers the reported absolute effectiveness of both the medication and the placebo!
What you need to research is the likely relative effectiveness of any help for your individual needs. This page is intended to correct your over-expectation of standard medical treatment whilst allowing you to genuinely compare your options. Simply do as much research as you can, pick the one you think most likely to help with your individual requirements and then believe in it as strongly as you can.
Placebo operations
Placebo doesn't only apply to medication. It applies to every treatment under the sun. Until recently, there has been little attempt to distinguish surgical procedures from placebo. Here is one attempt.
Conclusion: Any supposed scientific validation of modern medicine is a complete myth. When you consider that modern medicine is also the 3rd leading cause of death in the US then I hope you will take more responsibility for your health.