Author Topic: Episode #664  (Read 3834 times)

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Online CarbShark

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Episode #664
« Reply #15 on: April 04, 2018, 01:56:53 AM »
You are bot confusing placebo with the placebo effect.

https://www.webmd.com/pain-management/what-is-the-placebo-effect

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Offline daniel1948

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Re: Episode #664
« Reply #16 on: April 04, 2018, 09:09:16 AM »
You are bot confusing placebo with the placebo effect.

https://www.webmd.com/pain-management/what-is-the-placebo-effect

According to Mark Crislip, that "effect" does not exist. Actual clinical symptoms do not improve. People report feeling better, but when their clinical signs are measured, there is no improvement.
Daniel
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Offline Ah.hell

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Re: Episode #664
« Reply #17 on: April 04, 2018, 09:26:47 AM »
You are bot confusing placebo with the placebo effect.

https://www.webmd.com/pain-management/what-is-the-placebo-effect

According to Mark Crislip, that "effect" does not exist. Actual clinical symptoms do not improve. People report feeling better, but when their clinical signs are measured, there is no improvement.
I saw him give a presentation on this and was quite surprised by it.  I believe it is debatable frankly.  Some folks, even skeptics think the evidence indicates an actual effect and other agree with Dr Crislip, that its only a perceived effect.

Online CarbShark

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Episode #664
« Reply #18 on: April 04, 2018, 09:43:15 AM »
Two things. He has the same definition of placebo effect as I do and most everyone else, he simply believes it doesn’t exist.

Second he freely admits he’s in the minority, even among his fellow SBM bloggers. Nothing wrong with that, of course, he may be right.

Personally, I think in some contexts there is an actual effect but in others, no.

https://sciencebasedmedicine.org/the-placebo-myth/

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« Last Edit: April 04, 2018, 11:07:07 AM by CarbShark »
and Donald Trump is President of the United States.

I'm not a doctor, I'm just someone who has done a ton of research into diet and nutrition.

Offline daniel1948

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Re: Episode #664
« Reply #19 on: April 04, 2018, 10:32:35 AM »
Two things. He has the same definition of placebo effect as I do and most everyone else, he simply believes it doesn’t exist.

Second he freely admits he’s in the minority, even among his fellow SBN bloggers. Nothing wrong with that, of course, he may be right.

Personally, I think in some contexts there is an actual effect but in others, no.

https://sciencebasedmedicine.org/the-placebo-myth/

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Fair enough. I agree with Mark.
Daniel
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Online CarbShark

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Re: Episode #664
« Reply #20 on: April 04, 2018, 12:58:37 PM »
Interesting. Does it raise any issues for you? You often defer to Dr Novella’s authority in your posts, but here you’re disagreeing with him (and the Mayo Clinic, I believe). I have no issues accepting a minority expert opinion (obviously ) but it seems you are the first to reject that in favor of your preferred authorities (Novella, Mayo, etc. )


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Offline brilligtove

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Re: Episode #664
« Reply #21 on: April 04, 2018, 02:45:24 PM »
This is great news if true, as one of the commenters pointed out. We can immediately eliminate placebo controlled trials from all scientific study.
evidence trumps experience | performance over perfection | responsibility – authority = scapegoat | emotions motivate; data doesn't

Online CarbShark

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Re: Episode #664
« Reply #22 on: April 04, 2018, 03:00:09 PM »
This is great news if true, as one of the commenters pointed out. We can immediately eliminate placebo controlled trials from all scientific study.

You're joking, right?
and Donald Trump is President of the United States.

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Offline albator

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Re: Episode #664
« Reply #23 on: April 04, 2018, 03:38:45 PM »
Even if there's no placebo effect, placebo-controlled studies will still be better.
https://theness.com/neurologicablog/index.php/placebo-myths-exposed/

Offline brilligtove

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Re: Episode #664o
« Reply #24 on: April 04, 2018, 04:26:37 PM »
This is great news if true, as one of the commenters pointed out. We can immediately eliminate placebo controlled trials from all scientific study.

You're joking, right?

Even if there's no placebo effect, placebo-controlled studies will still be better.
https://theness.com/neurologicablog/index.php/placebo-myths-exposed/
Hyperbolic, but not joking. (I read the links, thx for the shares.) If blinding is all you need, you could test two active agents against each other in a randomized double blind experiment with no placebo and drastically reduce the cost of drug trials.

My concern with his arguments is that the active processes of generating experience in the brain are contextual. Of course changing the context changes the experience. The wine bottle and the experience of wine, the treatment and the experience of pain. As I understand it, the placebo effect is much more significant at the experiential level, not at the physiological level. Still, some types of experience do have direct physiological outcomes - notably stress and its effects on immune function.

If his concern is that the word placebo and the term placebo effect are misused or misunderstood I would be interested in hearing what more appropriate term might be used in their place.
evidence trumps experience | performance over perfection | responsibility – authority = scapegoat | emotions motivate; data doesn't

Offline daniel1948

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Re: Episode #664
« Reply #25 on: April 04, 2018, 05:20:13 PM »
Interesting. Does it raise any issues for you? You often defer to Dr Novella’s authority in your posts, but here you’re disagreeing with him (and the Mayo Clinic, I believe). I have no issues accepting a minority expert opinion (obviously ) but it seems you are the first to reject that in favor of your preferred authorities (Novella, Mayo, etc. )

That's because I do not regard Dr. Novella as a god, the way some people regard their favorite diet guru. I listen to what he says and I deeply respect him and his judgement. I am not bound to agree with him on everything. In this case I agree with his fellow Science-Based-Medicine blogger, Mark Crislip.

This is great news if true, as one of the commenters pointed out. We can immediately eliminate placebo controlled trials from all scientific study.

"The placebo effect" as defined by CarbShark above does not exist. But there is a very real psychological effect of taking a pill of any sort, and this must be controlled for. It is controlled by having both groups take a pill. One group take the drug being studied, and one group takes a nothing pill, a placebo, and this way the psychological effect of "taking something" is level across both groups. There's also a psychological effect on the examiners, which is likewise evened out by having them administer a pill to everyone. The test must be double-blinded so the examiners don't know which are the real pill and which the placebo, so their analysis is not affected by the psychology of knowing which group took the real drug.
Daniel
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Online CarbShark

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Re: Episode #664
« Reply #26 on: April 04, 2018, 06:00:56 PM »
Interesting. Does it raise any issues for you? You often defer to Dr Novella’s authority in your posts, but here you’re disagreeing with him (and the Mayo Clinic, I believe). I have no issues accepting a minority expert opinion (obviously ) but it seems you are the first to reject that in favor of your preferred authorities (Novella, Mayo, etc. )

That's because I do not regard Dr. Novella as a god, the way some people regard their favorite diet guru. I listen to what he says and I deeply respect him and his judgement. I am not bound to agree with him on everything. In this case I agree with his fellow Science-Based-Medicine blogger, Mark Crislip.


Yet when I do the same thing, agree with an expert in the field of diet an nutrition, you accuse me of claiming that I'm smarter than Novella, the Mayo Clinic (who also disagree with you here, and who you frequently cite).

It would be as if I were to say "how dare you suggest you are smarter than and know more than and are better able to evaluate the science than Steve and the Mayo Clinic and the rest of the medical establishment?"

That's exactly the argument you throw at me repeatedly for exactly the same thing.
« Last Edit: April 04, 2018, 06:03:55 PM by CarbShark »
and Donald Trump is President of the United States.

I'm not a doctor, I'm just someone who has done a ton of research into diet and nutrition.

Offline albator

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Re: Episode #664
« Reply #27 on: April 04, 2018, 06:45:19 PM »
Hyperbolic, but not joking. (I read the links, thx for the shares.) If blinding is all you need, you could test two active agents against each other in a randomized double blind experiment with no placebo and drastically reduce the cost of drug trials.

I've no idea what's actually done but if there's already an approve treatment and the treatments are similar enough that you can make a blind comparative study between the two, it seems unethical to use a placebo.

My concern with his arguments is that the active processes of generating experience in the brain are contextual. Of course changing the context changes the experience. The wine bottle and the experience of wine, the treatment and the experience of pain. As I understand it, the placebo effect is much more significant at the experiential level, not at the physiological level. Still, some types of experience do have direct physiological outcomes - notably stress and its effects on immune function.

If his concern is that the word placebo and the term placebo effect are misused or misunderstood I would be interested in hearing what more appropriate term might be used in their place.
At the start of this thread, the concerns were only with the words ; placebo effect refering to effect that actually happen like what you describe (relief of pain, stress or whatever) and not bias of reporting, misremembering, any other bais or any other actions (not drinking bc you're on medication, for exemple) that would lead people to believe it had an effect when it didn't. I think both usage are correct.
« Last Edit: April 04, 2018, 06:56:41 PM by albator »

Offline daniel1948

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Re: Episode #664
« Reply #28 on: April 04, 2018, 06:47:48 PM »
Interesting. Does it raise any issues for you? You often defer to Dr Novella’s authority in your posts, but here you’re disagreeing with him (and the Mayo Clinic, I believe). I have no issues accepting a minority expert opinion (obviously ) but it seems you are the first to reject that in favor of your preferred authorities (Novella, Mayo, etc. )

That's because I do not regard Dr. Novella as a god, the way some people regard their favorite diet guru. I listen to what he says and I deeply respect him and his judgement. I am not bound to agree with him on everything. In this case I agree with his fellow Science-Based-Medicine blogger, Mark Crislip.


Yet when I do the same thing, agree with an expert in the field of diet an nutrition, you accuse me of claiming that I'm smarter than Novella, the Mayo Clinic (who also disagree with you here, and who you frequently cite).

It would be as if I were to say "how dare you suggest you are smarter than and know more than and are better able to evaluate the science than Steve and the Mayo Clinic and the rest of the medical establishment?"

That's exactly the argument you throw at me repeatedly for exactly the same thing.

So what's your point? I gave my opinion on the placebo effect, and cited a well-known science blogger. You come back with a suggestion that I should always agree with Dr. Novella because I agree with him on many things and I respect him highly. Then you're upset because on this issue I don't agree with him? The placebo effect is a controversial issue on which there are differing views.

In my opinion, your dietary views are extreme and contrary to the preponderance of the evidence. You disagree. That's fine. We can have different views. I'm not sure what that has to do with my opinion on the placebo effect, which Mark Crislip says does not exist, and I find his reasoning convincing, just as I find Dr. Novella's reasoning convincing on many issues.
Daniel
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Online bachfiend

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Re: Episode #664
« Reply #29 on: April 04, 2018, 07:42:05 PM »
Interesting. Does it raise any issues for you? You often defer to Dr Novella’s authority in your posts, but here you’re disagreeing with him (and the Mayo Clinic, I believe). I have no issues accepting a minority expert opinion (obviously ) but it seems you are the first to reject that in favor of your preferred authorities (Novella, Mayo, etc. )

That's because I do not regard Dr. Novella as a god, the way some people regard their favorite diet guru. I listen to what he says and I deeply respect him and his judgement. I am not bound to agree with him on everything. In this case I agree with his fellow Science-Based-Medicine blogger, Mark Crislip.


Yet when I do the same thing, agree with an expert in the field of diet an nutrition, you accuse me of claiming that I'm smarter than Novella, the Mayo Clinic (who also disagree with you here, and who you frequently cite).

It would be as if I were to say "how dare you suggest you are smarter than and know more than and are better able to evaluate the science than Steve and the Mayo Clinic and the rest of the medical establishment?"

That's exactly the argument you throw at me repeatedly for exactly the same thing.

I disagree with you whenever you claim that there’s a single diet that’s better than every other possible diet for weight loss and maintenance of a healthy body weight.

Whenever you comment, regardless of the topic, you’re also displaying your opinion;  ‘I’m not a doctor, I’m just a guy who went on a LCHF ketogenic diet and lost weight and improved his health, then did a ton of research.’

My opinion is that you’re doing useless research, favouring quantity over quality.  I suspect your ‘research’ comes from the LCHF ketogenic diet partisans.  I’ve looked at their blogs.  I’m not impressed by its quality.

My experience with a high carbohydrate/low fat diet has been very good - going from 85+ kg to 64 kg and keeping it off for 30 years.  According to the LCHF crowd I should be fat and diabetic.

You’ve never been specific regarding your success with your LCHF ketogenic diet - not that I doubt that you were successful - if you’re motivated enough you will lose weight on any acceptable diet (and an acceptable diet is one that provides sufficient but not excessive calories, and adequate essential amino acids and fatty acids, minerals, and vitamins).  And attaining a healthy body weight is almost the be all and end all of health.
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