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Dear listmembers, Placebo Though the discussion about the sham surgery and as a spinoff the placebo effect, seems finished, I am still going to stress an important and in the discussion ignored aspect of it. Everyone who reads about research on the effects of drugs knows that in such research it is not only the patient who is not permitted to know whether he had the real stuff or the "placebo", but the researcher too, because his observations too are influenced by his expectation or by his whishes about the outcome. The importance of this effect is one of the fundamental notions from experimental psychology. To understand (in part) how this can happen without accusing the researcher of lying ( which happens too) one needs to demistify the placebo concept and scrutinize what is happening in the relation between the patient and the doctor. I have been told many years ago, by one of my post-doc instructors on psychotherapy, the following story. She had been, in the sixties, to one of the first congresses on behaviour therapy. There had been, so she told, a psychiatrist from Turkey who in his speech told the stunned audience that he treated neurotic disturbances all in the same, quite simple, way and had an unprecedented rate of succes. He encouraged the patients to talk about their symptoms and while doing so, they were given electric shocks. After some time the patients learned they could avoid the shock by answering him that they had not any symptom left. They were send home and half a year after they were phoned by the psychiatrist, who asked them whether the symptoms had shown up again, in which case the treatment had to be repeated. They all answered they had been free of symptoms ever since. So, he concluded, his rate of success was 100%. Truly an unprecedented number in medical history. Of course, this story makes a caricature of the doctor-patient relation. But it is a caricature, which illustrates in a way a phenomenon that may happen in reality between a doctor and his patient. Instead of using electrick shocks doctors might "punish" their patients, who don't ameliorate by their therapy, by subtle social cues, which causes the patient to feel rejected. That can happen on a completely sub-conscious level. But to avoid a process like this happening and making the evaluation of therapies worthless, the doctor has to be aware of the possibility it is happening. So when years later I myself lectured in psychotherapy, I in my turn told the story of the Turkish psychiatrist every time when the subject was how to get sound information from the patient about the state of his symptoms. The concept "placebo", is in generally used to permit oneself to stop thinking, just like the "it's all in the mind" concept. I have another, now first hand, story about that. A collegue psychologist, writing his thesis wanted to prove that the therapeutic effect of a med. was not real, but that its effect was was a placebo-effect. He did an experiment with a group of patients who were randomly divided into two groups. All patients got the same medicine, but one group was told that sadly there was no effective med for their symptoms but they nevertheless got a med, that had yet to be officially evaluated, but, so they were told, the researchers wanted to avoid deception by telling them from the start not to expect any amelioration. The other group was told, they were luckey, because a new med. had great promises for the curing of their disease etc. etc. When the patients from both groups reported after some weeks about their condition, the results were as was expected, the patients of the second group were in a better state than thoses of the first group. Which proved according to the researcher, that the med in itself was worthless, but an alternative explanation seemed obvious and should have been tested, i.e. the patients from the first group had flushed the meds down the toilet or something like that. What moral might be drawn from this stories? If a therapeutic effect of some treatment turns out not to be caused by the stuff that was supposed to cause it, but by an unknown factor, one does not answer the questions that arise from that notion by saying it is caused by the "placebo effect". In fact being to easily satisfied by such a non-explanation might be a hindrance in learning to understand the factor that really did cause the effect. That is a hindrance to profit maximally from the results of the research. Besides, I always suspect a docter, who claims a 100% success rate, of being one who does not "permit" his patients to say the therapy did not work. regards, Ida Kamphuis -------------------------------------------------------------- Vriendelijke Groeten / Kind regards, Ida Kamphuis mailto: [log in to unmask]