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even if it is placebo -- if it works -- it works. so, then let's just have it done --

though, it seems pretty obvious that it's not placebo, but even if it was -- who cares!!

Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003974.
Placebo interventions for all clinical conditions.

Hróbjartsson A, Gøtzsche PC.

The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 3343, Copenhagen, Denmark, 2100.

Update of:

* Cochrane Database Syst Rev. 2004;(3):CD003974.

Abstract

BACKGROUND: Placebo interventions are often claimed to substantially improve patient-reported and observer-reported outcomes in many clinical conditions, but most reports on effects of placebos are based on studies that have not randomised patients to placebo or no treatment. Two previous versions of this review from 2001 and 2004 found that placebo interventions in general did not have clinically important effects, but that there were possible beneficial effects on patient-reported outcomes, especially pain. Since then several relevant trials have been published.

OBJECTIVES: Our primary aims were to assess the effect of placebo interventions in general across all clinical conditions, and to investigate the effects of placebo interventions on specific clinical conditions. Our secondary aims were to assess whether the effect of placebo treatments differed for patient-reported and observer-reported outcomes, and to explore other reasons for variations in effect.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4, 2007), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), PsycINFO (1887 to March 2008) and Biological Abstracts (1986 to March 2008). We contacted experts on placebo research, and read references in the included trials.

SELECTION CRITERIA: We included randomised placebo trials with a no-treatment control group investigating any health problem.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Trials with binary data were summarised using relative risk (a value of less than 1 indicates a beneficial effect of placebo), and trials with continuous outcomes were summarised using standardised mean difference (a negative value indicates a beneficial effect of placebo).

MAIN RESULTS: Outcome data were available in 202 out of 234 included trials, investigating 60 clinical conditions. We regarded the risk of bias as low in only 16 trials (8%), five of which had binary outcomes.In 44 studies with binary outcomes (6041 patients), there was moderate heterogeneity (P < 0.001; I(2) 45%) but no clear difference in effects between small and large trials (symmetrical funnel plot). The overall pooled effect of placebo was a relative risk of 0.93 (95% confidence interval (CI) 0.88 to 0.99). The pooled relative risk for patient-reported outcomes was 0.93 (95% CI 0.86 to 1.00) and for observer-reported outcomes 0.93 (95% CI 0.85 to 1.02). We found no statistically significant effect of placebo interventions in four clinical conditions that had been investigated in three trials or more: pain, nausea, smoking, and depression, but confidence intervals were wide. The effect on pain varied considerably, even among trials with low risk of bias.In 158 trials with continuous outcomes (10,525 patients), there was moderate heterogeneity (P < 0.001; I(2) 42%), and considerable variation in effects between small and large trials (asymmetrical funnel plot). It is therefore a questionable procedure to pool all the trials, and we did so mainly as a basis for exploring causes for heterogeneity. We found an overall effect of placebo treatments, standardised mean difference (SMD) -0.23 (95% CI -0.28 to -0.17). The SMD for patient-reported outcomes was -0.26 (95% CI -0.32 to -0.19), and for observer-reported outcomes, SMD -0.13 (95% CI -0.24 to -0.02). We found an effect on pain, SMD -0.28 (95% CI -0.36 to -0.19)); nausea, SMD -0.25 (-0.46 to -0.04)), asthma (-0.35 (-0.70 to -0.01)), and phobia (SMD -0.63 (95% CI -1.17 to -0.08)). The effect on pain was very variable, also among trials with low risk of bias. Four similarly-designed acupuncture trials conducted by an overlapping group of authors reported large effects (SMD -0.68 (-0.85 to -0.50)) whereas three other pain trials reported low or no effect (SMD -0.13 (-0.28 to 0.03)). The pooled effect on nausea was small, but consistent. The effects on phobia and asthma were very uncertain due to high risk of bias. There was no statistically significant effect of placebo interventions in the seven other clinical conditions investigated in three trials or more: smoking, dementia, depression, obesity, hypertension, insomnia and anxiety, but confidence intervals were wide.Meta-regression analyses showed that larger effects of placebo interventions were associated with physical placebo interventions (e.g. sham acupuncture), patient-involved outcomes (patient-reported outcomes and observer-reported outcomes involving patient cooperation), small trials, and trials with the explicit purpose of studying placebo. Larger effects of placebo were also found in trials that did not inform patients about the possible placebo intervention.

AUTHORS' CONCLUSIONS: We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.

PMID: 20091554 [PubMed - indexed for MEDLINE]

1eye wrote:Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003974.
Placebo interventions for all clinical conditions.

Hróbjartsson A, Gøtzsche PC.

..annnd print.. this one is coming to my next appt. Thanks 1eye !

hargarah wrote:I am so glad you mentioned that name: Dr. Freedman.

This self-indulging prick is the biggest goof in the world. He cares only about his own opinion and has screwed up countless patients, both emotionally and with treatment.

Little do you know how many people have verbally told this piece of %$#@ to go %$#% himself. Yes - I know people that have.

Don't strain your eardrums listening to one piece of garbage that comes out of this %#%hole's mouth. He is not a man and should not be treating patients.

P.S. For all of you that think that this is not appropriate for this site, I totally disagree. This is free speech and an EXTREMELY IMPORTANT WARNING to new M.S. patients. Don't be hurt or feel helpless after Dr. Freedman talks to you. He will probably try to convince you to join one of his studies and be a "guinea pig", as he openly told me the day I was diagnosed with M.S. It turns out this study fell to pieces as liver enzyme levels went through the roof! Thank-God I didn't listen to him and went on an actual effective treatment.

So how far does this free speech thing go?

It is good to see supporters of CCSVI are so reasonable and objective.

hargarah wrote:I am so glad you mentioned that name: Dr. Freedman.

This self-indulging prick is the biggest goof in the world. He cares only about his own opinion and has screwed up countless patients, both emotionally and with treatment.

Little do you know how many people have verbally told this piece of %$#@ to go %$#% himself. Yes - I know people that have.

Don't strain your eardrums listening to one piece of garbage that comes out of this %#%hole's mouth. He is not a man and should not be treating patients.

P.S. For all of you that think that this is not appropriate for this site, I totally disagree. This is free speech and an EXTREMELY IMPORTANT WARNING to new M.S. patients. Don't be hurt or feel helpless after Dr. Freedman talks to you. He will probably try to convince you to join one of his studies and be a "guinea pig", as he openly told me the day I was diagnosed with M.S. It turns out this study fell to pieces as liver enzyme levels went through the roof! Thank-God I didn't listen to him and went on an actual effective treatment.

Neuros and pharmas and placebos oh my! Neuros and pharmas and placebos oh my! Sorry watching The Wizard of OZ with the kids.

another populistic thread. A new drug has shown to improve walking of the very same MS patients with "motor/nerve damage". Have you considered the idea that for some it may be real and for others placebo? Where does this absolute devine knowledge come from? We are starting to sound like the mirror image of those who say CCSVI is crap without even taking a careful look at the theory and good results some, I repeat SOME people are having.

There should be a study on results of studies on the placebo effect. Inclusion criterion is that you have a strong opinion one way or another (not disclosed as inclusion criterion to candidates). Participants are asked to give acetaminphen and sugar pills to a set of participants. I predict that prior declared opinion will be an accurate predictor of results. Both sets of tests are double blind and randomized as to declared opinion, in the one case, and acetaminophen or sugar in the other.

So if the results of a study are always just predetermined by the researchers preconceived notions, and therefor invalid, what exactly was the point of posting that study, or any study?

Not always. Just when you are trying to find out about whether those notions can affect a study of psychological phenomena. Blinding should help. But I say it doesn't, in this case.

NOT NEURO... IT IS THEIR BREAD AND BUTTER. AND OF COURSE DRUG COMPANIES. WE WANT TO TRUST OUR NEURO.. BUT...

NOT NEURO... IT IS THEIR BREAD AND BUTTER. AND OF COURSE DRUG COMPANIES. WE WANT TO TRUST OUR NEURO.. BUT...