Friday, January 28, 2011

Are you sure that’s what you’re taking?

This post is going to play with your conceptions of what you’re given. I shall have a look at the great medical phenomenon called the Placebo Effect and how it can make people think that ridiculous “treatments” can work, so let’s get started.

Placebos basically trick your body into fixing itself without giving it any medication. I’ve personally had these work for me, I was given a hay fever pill which looked like an antihistamine. It worked fine until I found out that it was actually a homeopathic remedy, and it promptly stopped working. This affect is so powerful that drug companies tend to have to control for these effects when they test new drugs. Often, placebos will only be effective for mild conditions, such as hay fever, nausea and for headaches, but it can be effective for much harsher conditions.

So, how can your mind fix your body without taking any medication?

Well, the placebo effect and its evil twin, the nocebo effect, rely on a patient’s expectations for how a treatment will affect them. If a patient is expecting a treatment to make them better, then the placebo effect can cause that improvement, but it can also work the other way. If you take a pill for, say, a headache, it is better if it is a big red capsule rather than a blue chewable pill. Likewise, you’ll get a better placebo effect in patients if you give them a needle, or some sham surgery. It’s strange, but the more invasive a treatment is, the more likely you are to get better from what the treatment is treating. Also, the amount of consultation and follow up a patient has can affect their improvement as well.

So, what’s going on? To be short, we don’t really know. There isn’t anything mystical or anything, but when a person expects to get a drug which will help with pain relief, say, they will produce more natural endorphins which will help with the pain. There is something going on in the brain to tell the hormone glands to produce these things. But, there are also several different placebo effects affecting different parts of the immune system. This is basically due to the vast difference in the molecules which are produced by the body.

Ok, so we know a little about what the placebo effect is, how can it affect proper medical treatments?

Well, drug companies have to factor this into their studies to show their drugs are actually effective. This effect is well recognised in the medical literature, so there is plenty of information about how it might affect certain conditions. What isn’t so well controlled is a fair bit of alternative medicine.

One classic mistaken “treatment” is homeopathy. Homeopathy operates under the premise that what causes you symptoms will cure them too. So, if you’re suffering from anaphylactic shock from eating peanuts, you better eat more peanuts! But the crazy doesn’t stop there, they also reckon that if you dilute something, it becomes… stronger! That’s right, if there is less of the thing that’s supposed to make you better in the thing your taking, it will be better at making you better. Duh!

This becomes fairly stupid when you see how dilute some of these treatments are. So, the average concentration of homeopathic treatments is about 30C, or there is one part of the ingredient in 100 x 100 repeated 30 times, so REALLY dilute. The problem with this is they put a drop on a little pill for you to take. That little drop won’t have ANY of the crushed up peanut in it, so at least it won’t make your anaphylactic shock any worse. But, really, wouldn’t there have to be something in the water to actually get you better? You’d think so, huh?

These pills rely on the placebo effect to work. Also, homeopaths tend to be really good at consultation, and generally have really good people skills, so this amplifies the placebo effect. They also don’t test their products to the same levels which drug companies and independent trials go to. They tend to rely on what people say about feeling better or the like, and tend not to rely on independent measures of improvement.

It also gets really bad. Some homeopaths are touting things like cures for cancer and homeopathic vaccines. Now, if you’re taking a little pill that might stop your head hurting, that’s fine, but when you start telling people you can treat serious medical conditions which could kill people if not treated properly, then you’re being dangerously dishonest. I really wish these people had to test their products for their claims, but for some reason we think there is a benefit in these non-medicine medical treatments. Really, there is just medicine and not medicine. Those things which are proved to work are called medicine, whilst those which aren’t proved to work are not called medicine. If we then test something which is not medicine and find out it has an effect, guess what… it becomes medicine! This is the problem with a lot of alternative “medicine”, especially because people take what the homeopaths, naturopaths, chiropractors and other quacks say, and it can be dangerous.

Anyways, here’s a little movie about homeopathy which explains it well: All Hail the Great Randi!

To recap: Medicine – good, Placebo effect – interesting, Homeopathy – really bad, Questions – great!

PS. sorry for no pictures this week, but you know what pills look like.

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