Thursday, April 26, 2007

Placebo-izing

I came across an article mentioned in a blog post about how China plans to modernize traditional Chinese medicine. Unfortunately you need a subscription to read the article, so I've only read the blog post. Everything has a blog these days. Even Nature has blogs.

Western medicine seems to rely solely on the randomized double-blind placebo-controlled clinical trial to research and prove that treatments work. This is well suited to treatments you can take in a pill form. And yes, Western medicine seems to rely solely on the taking of little pills to treat everything. Magic pills indeed.

Now how would one conduct a placebo-controlled trial on whether massage therapy or acupuncture work? Or tai chi or yoga or just plain exercise. Or changes in diet.

The solution so far seems to be to just ignore and dismiss all possibility of anything that is not a pill and cannot be placebo-ized. It doesn't fit into the one trusty scientific methodology that has been developed, so let's just not look at it.

Instead of, how about trying to come up with and use research methods that do work for something different?

Some people say things are not possible. Some people ask, how? How can it be possible? How can it be done?

4 comments:

Mai-Sie said...

I think you're over-generalizing a bit, no? :) True, the randomized, double-blinded trial is considered the strongest evidence, but it's a bit of an exaggeration to say that western medicine relies _solely_ on it. There are multiple levels of strength of evidence, like single-blinded, randomized but not placebo-controlled, retrospective cohort studies, etc.... Of course we doctors make recommendations on "non-placeboized" things like diet all the time. And even acupuncture is getting quite a foothold in major medical centers these days. They try to do things like "sham" acupuncture. Not that that's the perfect placebo. Then there's the argument that who cares if it's placebo-ized or not, even if it is a placebo effect, as long as it works, great.

I would say probably another big contributor to how and what research is done is $$$$. Big pharma companies for instance fund a lot of research. It seems much easier for a company to make money if they can come up with a pill that they make and package and market and sell. Versus trying to coordinate and make money off of a bunch of acupuncture practitioners (or a creative way to patent some fancy new acupuncture needle), or make profits from organizing a bunch of yoga instructors.

dancing dragon said...

That was partly a response to the blog post quoting the article, about whether the research would meet standards necessary for international recognition, and mentioning concern about whether there would be randomized double-blind placebo-controlled studies.

But I also meant more of, there are too many doctors in practice who don't consider things unless there's a lot of double-blind randomized placebo-controlled studies, whether or not research using other methods exist. The research might exist but unless there's indisputable proof, you probably can't find a doctor to treat it or acknowledge it. But then there are also doctors who don't believe what double-blind placebo-controlled studies show.

Mai-Sie said...

I think your last statement about the docs who don't even believe the randomized double-blind studies is probably the key. People believe what they want, don't believe what they want, not always consistently. Impossible to placebo or double blind a study on diet, for whatever problem you're trying to treat. But dietary changes are widely accepted for treating a variety of conditions...if it's a condition that is believed to exist in the first place.

Adit said...

So I took a few min to understand this blog (-: I didnt know anything about double-blind and placebo effect. Now I do.

This is mostly a Western phenomenon where a lot of emphasis is placed on scientific rigor. One key reason is the host of legal compliance issues that arise from inadequately tested solutions.

In India, for example, while I dont have statistics, most small towns and villages have medical practitioners that widely prescribe pills and other health related actions without any double blind rigor behind it. Does it work, is it consistent? Many would say yes, many would not know, and some would say no. But for these people, the placebo effect is as important as the effectiveness of the actual treatment. Its part of the treatment! Maybe thats a good thing? Pills + placebo = more effective treatment?

I think modern science is open to all kinds of treatments. As long as the user is clear on the claims of the solution and the statement of facts to support the effectiveness of that treatment.