Medicine



Image: Bill Brooks Creative Commons; Some Rights Reserved

Or: You Keep Using That Word. I Do Not Think It Means What You Think It Means

Homeopathy is crap. Serious, unmitigated, archaic, superstitious hogwash-laden crap. There is no defensible argument for why it might have the magical qualities with which it is imbued by some. On that, Faithful Acowlytes, I think you and I are agreed. I’ve noticed in recent times, however, a growing tendency from the dozen or so remaining supporters of homeopathy, to wheel out the justification that its validity might lie in the Placebo Effect.(i) The Placebo Effect is also cited by supporters of various other dubious unscientific medical practices (yes, I’m looking at you Mr Acupuncture) as a possible legitimate modus explainii.(ii)

The problem is that the concept of the Placebo Effect has become eroded over the decades into a magical-thinking term of its own, specifically, a notion that a placebo invokes some kind of Mysterious Ability Unknown to Science for the human body to heal itself, based on a sort of ‘mind-over-matter’ mechanism that remains to this day entirely unexplained. As someone who understands what the Placebo Effect actually is, this really annoys me. And when I’m annoyed, I dust off the soapbox.

Today on TCA, we’re going to look at the exact meaning and intention of running placebo mitigated trials in medicine, and why the explanation for the Placebo Effect is most likely dull and unexciting. Prepare to have your illusions shattered.

To help illustrate things, I’m going to give you a very basic example of how a clinical trial involving placebos might work – it’s not the definitive way of conducting a placebo-based experiment, but for the sake of simplicity it covers all the issues that we need to examine.

Imagine that you have invented a new drug for the relief of nausea. All your theory says that this drug is the bees knees, but to meet the many requirements of getting a modern pharmaceutical legally to market, you must demonstrate this to the satisfaction of the various bodies that regulate this kind of thing (and, as unbelievable as a lot of people seem to find it, this is actually quite tough). What you are obliged to do is to set up a blind – or double-blind – trial (we’ve talked about blind trials before on the Cow, but click on that link it you want a refresher) which takes into consideration numerous factors that might influence your potential outcome. Understand: you do this in order to rule out as much external influence as possible that might offer alternative explanations for results of your experiment. In other words, you’re trying to demonstrate that your drug, and your drug alone, is responsible for any observed lessening of nausea for your patients.

The problem is this: in many areas of medicine, the results of interventions are not totally clear cut. Experience of nausea, for example, is partially subjective, and what you’re trying to do with your experiment is to get an objective overview of how your drug influences a patient’s assessment of nausea. It is very important, therefore, to iron out any irregularities that might be caused by, for example, a subject’s expectation of what a treatment might do.

If you have a hundred patients, and you give fifty of those patients a pill and fifty nothing at all, then half your study knows with certainty that they didn’t get the ‘anti-nausea pill’. This might influence what they report in regard to their nausea. Maybe it won’t, but you have to consider the possibility that it will, and set about ruling it out. The obvious thing to do, then, is to split your group into three parts instead of two, give one third the new drug, one third a capsule identical to the one containing the anti-nausea drug – but with no active ingredient – and one third nothing at all. If the drug has any merit, then what you would expect to see here is positive results from the drug, and then equally neutral results from both the the empty pill (the placebo) and those who got nothing at all.

Are you with me? Does this sound reasonable?

Well that’s exactly what scientists do in blind test trials with placebo controls. Only… pretty much every time this kind of experiment is run, the results inevitably look funny. If the drug is efficacious, the patients who get an active ingredient post a positive assessment of their nausea relief, as you would indeed hope. The patients who got zip (representing what is called the baseline) report a neutral assessment of change in nausea levels. The placebo arm in this kind of experiment, however, almost invariably returns a result of marginal improvement. Better than baseline, but not as good as the active drug. In other words, it seems that the patients who think they might be getting some kind of medicine appear to get an actual physiological benefit from simply popping a pill.

How utterly weird is that? Imagine the puzzlement among experimenters the first few times these kinds of results came back!

Now we get to the real problem of the misunderstanding of the Placebo Effect. Over the years, this result, which is a very real result and is seen almost without fail in a great number of clinical trials, has been taken to mean that the ‘idea’ of taking a pill (or indulging in some other kind of intervention) can have an actual physiological effect on a patient. To put it another way, it appears that if someone thinks they’re being treated, then somehow they seem to physically benefit from being under that illusion.

Only, that’s not exactly what the Placebo Effect is showing us.

In science, a placebo trial has a specific and clearly defined purpose: to account for all other variables from the experiment that can’t be explained by the agonist of the experiment itself. This would indeed include any strange psychological influence on physiology should such a thing exist,(iii) but it need not necessarily be constrained to only this. What most people fail to understand is that the Placebo Effect may also include numerous other factors. Some of these are: patient reporting bias; risk justification; confirmation bias and even just the kind of bias that might be inherent in being involved in a clinical trial in the first place. What do I mean by some of these? Well, let’s say you’re a patient in a study such as the one I suggested above. You are given a pill twice a day for the period of two weeks. You’ve given up some of your time to be on this trial (recording and reporting results and so forth) and you like the doctor who is treating you. This might very well influence what kind of modification to your results you record – only a little bit, perhaps, but ‘only a little bit’ is the scale of the typical observed Placebo Effect.(iv) Note that you might not necessarily be really feeling any difference in your nausea levels, but you are being ‘kinder’ on reporting them to the nice doctor (you would not even be aware of this – you are being given a pill and, in your mind, hey, it might be the anti-nausea drug… maybe you should be feeling a little better…) In addition to this kind of scenario, people involved in clinical trials behave differently to people in their actual usual lives. There is a tendency, for example, for them to be more aware of their day to day health and to take a little more care than usual with it. This of course can produce real physiological results that can easily colour their experience in the trial.

These things are very difficult to iron out of an experiment, and that’s EXACTLY what the Placebo Effect is all about – it is a generic container for the strange and uncatchable inconsistencies that occur when attempting to run an experiment where there are a lot of variables.

To boil all this down, it may well be that the Placebo Effect in any given clinical trial – and perhaps in all clinical trials – is down to nothing more than erroneous reporting; not any kind of physiological outcome at all, but just a noise phenomenon in the experiment that produces illusory effects simply because it is an experiment and not reality. In the actual real world, the thing we think of as the Placebo Effect may not even exist, and it’s impossible to verify such a speculation since trying to do so would necessitate the undertaking of an experiment and thus risk producing a horrible spiral of nausea-inducing recursion.

So the next time you hear someone justifying some kind of pseudoscientific ‘alternative’ remedy or other by invoking the Placebo Effect, I suggest you do the following: look them squarely in the eye and say, with a lisp… “Inconceivable!”

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Footnotes:

  1. For numerous reasons that I won’t even bother to go into here, that’s seriously clutching at straws, in any case. []
  2. Yes, I know that I just made that term up, and it bears not even the faintest resemblance to correct Latin. []
  3. And it should be noted that in the special case of pain – and a few other stress-related illnesses – it has been shown that a psychological element can come into play depending on the subject’s mental state. It is well to clearly understand, though, that it’s rare for such a psychological element to come even close to matching the level of pharmacological effects []
  4. Placebo Effects are never profound. []

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Charles Bonnet Syndrome is an unusual neurological affliction that causes mentally healthy people to see things that aren’t actually there. It is usually associated with advancing age and is thought to affect between 10% – 40% of people. Hallucinations seen by those with Bonnet’s Syndrome range from colourful patterns and textures on walls, through out-of-place objects such as bottles and vases of flowers, to animals and faces and people. Perhaps one of the strangest things about the affliction is that the hallucinated items often appear to interact with the sufferer’s real environment. Charles Bonnet, who first described the disorder, observed it in his 89 year old grandfather who hallucinated birds, horse-drawn carriages, animals and perhaps most disturbingly of all, a man who would come into his bedroom and smoke a pipe in the evenings, and who was still there the next morning when the old man awoke…

The British Medical Journal reports the case of an 87 year old widower who had, for six weeks previous to his diagnosis with the condition, been seeing people and animals in his house, including bears and Highland cattle.

He knew that these visions were not real and they didn’t bother him much, but he thought he might be losing his mind. The visions lasted for minutes to hours, and the cattle used to stare at him while quietly munching away at the grass.

Bonnet’s Syndrome occurs mostly in people with some kind of macular degeneration, and the most likely explanation for what is going on is that the sufferer’s brain, lacking the visual information it is accustomed to receiving, feels obliged to conjure up something to fill the space. That it chooses to integrate that ‘something’ with the world of the patient is perhaps the weirdest part of the illness.

The lesson here, in case this post seems somewhat obtuse, is that you quite literally can’t always believe your eyes. The strangeness of Charles Bonnet Syndrome illustrates profoundly how deeply etched into our being is the ‘need’ to make sense of the world in some way when deprived of the proper data. In the case of the sufferer of Bonnet’s Syndrome, the brain makes an unmistakeable and totally misleading judgment call.

If you’d like to read more about Charles Bonnet Syndrome there’s a great piece on Damn Interesting.

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Image (in part) by William Fox Talbot from Wikimedia Commons

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Good morning Acowlytes! How are your livers this morning? Nice and squeaky clean? Not sure what I’m on about? Then allow me to introduce you to Tsetsinka, Goddess of Liver Cleansing. If you travel over to CureZone.com (‘Educating Instead of Medicating’), you can read Tsetsinka’s mind-boggling instructions on how to cleanse your liver without using oil or lemon juice! Incredible, I know! To you and me it sounds completely ridiculous, but it’s true! Instead of unpleasant oil and lemon juice concoctions, Tsetsinka has come up with a method that uses… oil and LIME juice! And egg yolks!

“But Reverend,” I hear you exclaim, “My liver isn’t even dirty!” Well, Tsetsinka begs to differ. According to her, your liver is a filthy steaming worm-infested putrid lump. You might want to read the entire text of her ‘method’ before we carry on (I was tempted to quote the whole damn thing here, but on reflection I decided you might just prefer to come back for the highlights).

OK. Has the urge to laugh (or vomit) subsided? Very well, let’s begin.

Have you asked yourself… why do i have to endure such unpleasant moments when flushing my liver of Gallstones and filth? I have!

Yes, but more importantly my dear Tsetsinka, have you asked yourself why you have gallstones in your liver?

You certainly don’t have feel unconfortably during the flush at all. there is a much easier and more pleasant way of cleaning your liver ducts and gall bladder, and even your intestants get cleaned from this procedure.

Intestants! Now there’s a word you don’t hear every day.(i)

I believe you will look at least 10 years younger and more beautiful! No need for oil and lemon juice, when you are using this method. it amazes me that this information is not posted here or anywhere else on the liver detox knowledge pages of this website.

Us it doesn’t amaze so much.

you will experience a perfectly pink tounge in just 3-4 days and your skin will begin to glow like a peach and you will get long, very shiny hair, your nails will grow rapidly and you will feel like you can lift a mountain.

I’m not entirely convinced I want to look like a hairy peach with long nails and a pink tounge. Or tongue, for that matter. Even if I was preternaturally strong.

Tsetsinka goes on to give us a step-by-step outline of her recipe, which consists solely of limes, egg yolks and sunflower oil. A cup of sugar and you could make a nice Key Lime pie, but I digress.

8. using a wooden utencil (any utencil except for metal), gently beat the mixture only a couple of times. simply a couple of stirs are sufficent to get the juice and yolks to mix.

Gee whiz – that’s so EASY! Almost as easy as being able to spell ‘utensil’ and ‘sufficient’ correctly!

11. you may feel the urge to sleep almost immediately after that, so you may want to drink this potion right before bedtime, instead of in the morning. most importantly, be sure that you have not eaten or drank anything in the last 3 hours.

12. when you wake up from your nap, after 2-3 hours have elapsed, you will feel like you have 10 horse powers instead of 1 human power. the energy you will aquire from this is instant and perminant.

Your horse powers come at a cost, however – a depletion of your spelling powers. It’s a small price to pay for having a mane and hooves.

13. your nose will feel clogged. this is because your liver has just purged an incredible amount of tixins and dirt into your intestine. even if there is nothing blocking your nose cavity, your nose will feel clogged. for those who have done Liver Flushes will know what i am talking about. this is the very feeling of stones and gunk leaving the liver and entering the entstine.

Ah, the ol’ enstsine! Just next to the intestants, if I remember my medical studies correctly. Of course I didn’t aquire my doctorate, but luckily I had sufficent utencils to deal with tixins and was confortably able set up my site at CureZone.com!

14. finally, if you have an enema kit, you need to use very warm water to clean out your intestines, and it is imperative that you use 2 full enemas with very warm water, in order to draw the gunk out from the top of the small upper instestine to the lower one and then out.(ii)

I guess if you try every possible combination of letters, you’ll get it eventually.

15. unbelieveable things will come out of you, sometimes green stones, sometimes plaque, sometimes worms and parasites and sometimes just black, black, black filty water.

I…. er… well… BLEURRGGGHHHH. Oh. Sorry about that. Green stones? Plaque? Worms and parasites? Tsetsinka, my dear, you really might like to think about changing your diet.

you will be literally wowed at the results after the first day and double-wowed of the results after the 2, 3,4th day. by the end of the week, you will feel like you can take over the world! yes, the feeling is incredible!

Ehhhh. I dunno…. I’ve never been ‘double-wowed’ by anything Oh… yeah I guess there was that thing that Cindy Lawler could do with her tongue… but passing black black black filt(h)y water doesn’t sound like it would be double-wowing so much as just plain disgusting.

If you feel unconfortable using an enema, stones, gunk, mucouid plaque, worms, parasites and eggs can still come out, but not as full-capacity as when you flush with an enema

Oh, well, yes, with a sales pitch like that everybody definitely wants the full capacity enema. How could anyone possibly resist the allure of a comprehensive flushing sluice of worms, parasites, eggs and mucuoid plaque! My imagination is just going wild here – maybe Tsetsinka should consider whipping that sentence up into a screenplay and seeing if she can get some traction in Hollywood with an Alien sequel!

If you have any questions, email me at [email protected]! i answer all emals.

There ya go Acowlytes. She answers all emails! Your mission, should you choose to accept it – ask Tsetsinka some questions and get back to us here with the answers!

And if your brain isn’t reeling after all that, then I suggest that for some further mucuoid plaque fun you might like to delve into the thread replies of Tsetse’s(iii) post. Me, I’m having a hard time believing it’s not all some kind of elaborate practical joke. And yet….

Above all, remember : CureZone.com ‘Educating Instead of Medicating’!

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A big shout out to the redoubtable Ed for digging this one up.

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Footnotes:

  1. It’s a word that imagine could be coined to describe the participants of a medical quiz show… []
  2. Does anyone else get the impression that Tsetsinka is rather… er… fond… of enemas? Just asking… []
  3. Oooops. I made a spelling mistake… []

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Yesterday I had to go to hospital to have a colonoscopy. Don’t worry dear Acowlytes – all is well, it was just a precautionary check-up prompted by the only inheritance I received from my parents – my genes.

Of course, this kind of experience is by its very nature humourous, involving as it does rectal passages, cameras and therefore (quite obviously, if you have been following recent Cow reports) the possibility of ghost photography. Mind you, I was pretty sure there weren’t going to be any ghosts up there. The stuff they made me drink the day before the procedure is surely an essential part of the the Anal Ghost Exorcist’s tool kit – after I swilled down 3 litres of the goddamn stuff there wasn’t much in my bowel that didn’t rapidly go towards the light. It was called ‘ColonLYTELY’ (catchy, huh?) and when I purchased it the pharmacist put two packs on the counter:

Pharmacist: Which one do you want? The lemon flavour, or the original flavour? They’re both disgusting.

Evidently there isn’t much competition in the market for bowel sluicing preparations.

Me: Shouldn’t that be ‘Great!’ original flavour?

I imagine the ad in Pharmacist’s Insider is something like this:

Mmmm!

In the event, the outcome of the exam was as good as one could hope for. Two thumbs up! (Hmmm. Maybe not the most appropriate expression…) The finding of the doctor was that:

Excellent views were obtained through to the caecum.

It’s the sort of verdict that you might expect to find on a Edwardian postcard from the Alps. Excellent views!

Yodel-ay-ee-hoo!

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*It actually wasn’t too bad – I’ve consumed more disgusting things voluntarily. The worst part was the sheer amount of the stuff you have to get down. I don’t think I’ve ever drunk that much of anything in the space of four hours before.

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An Xray of a Crucifix in a Woman's Throat

This Xray from 1924 shows a crucifix wedged in a woman’s throat. According to the article that accompanies the image, the crucifix was eventually removed without surgery.

The story does not say how the Holy Object got there in the first place.

Suggestions?

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I found this story at the amazing Modern Mechanix – Yesterday’s Tomorrow Today, a blog that presents high quality scans of old Popular Mechanics mags. WARNING: Maximum Time Waste if you go there!

(The Impractical category is particularly worthwhile)

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