mental concepts

[igH]

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[Vladex]

 This is an excellent point knowing that all the biological processes are controlled by the brain and thus can be directly and indirectly be influenced by it. it's all about environment and the person's perception of it but the trick is that this is controlled by subconcious mind as opposed to the concious mind so you can't really will yourself to it but have to work for it . The placebos work but they also don't come cheap either. I don't know if anybody read a book "the biology of belief" but it's explained really well in there how placebos and other beliefs work on a biological level.

[bjm]

like most things in this world, perhaps not as it seems

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and if that doesn't open...an excerpt by another surgeon..Dr. Johnson is Director of the Carleton Sports Medicine Clinic in Ottawa, Ontario,

"The main flaw lies with the selection of patients. The patient selection criterion was arthritis, and it wasn't any narrower than that. We had an opportunity to speak to some of the coauthors when this paper was first presented, and both admitted that the patients picked for this study were not ideal. At the VA hospital, the residents picked off patients who had mechanical problems, the ones who looked like suitable candidates for surgery. The patients who were picked for this study were probably not ones who would have benefited from surgery, and would not be appropriate candidates in my own practice. It wasn't surprising to me that patients didn't get any better from the placebo operation, because you wouldn't expect them to. If they had a category of patients who had mechanical problems, then this group would have probably shown considerable improvement over the other 3 groups.

So the 2 points to be gleaned are that (1) there is a strong placebo effect, but that (2) the study is flawed because of this selection bias of this patient population." endquote

I think might say as much about the eagerness to do profitable knee surgery in the US and the patients wish to please, need for attention and caring including other psychological factors we all have such as preening behavior.

here's the original study.. You are not allowed to view links. Register or Login

[igH]

like most things in this world, perhaps not as it seems

why do you say that?

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You are not allowed to view links. Register or Login

and if that doesn't open...an excerpt by another surgeon..Dr. Johnson is Director of the Carleton Sports Medicine Clinic in Ottawa, Ontario,

"The main flaw lies with the selection of patients. The patient selection criterion was arthritis, and it wasn't any narrower than that. We had an opportunity to speak to some of the coauthors when this paper was first presented, and both admitted that the patients picked for this study were not ideal. At the VA hospital, the residents picked off patients who had mechanical problems, the ones who looked like suitable candidates for surgery. The patients who were picked for this study were probably not ones who would have benefited from surgery, and would not be appropriate candidates in my own practice. It wasn't surprising to me that patients didn't get any better from the placebo operation, because you wouldn't expect them to. If they had a category of patients who had mechanical problems, then this group would have probably shown considerable improvement over the other 3 groups.

So the 2 points to be gleaned are that (1) there is a strong placebo effect, but that (2) the study is flawed because of this selection bias of this patient population." endquote

i don't suppose the good doctor is intending to use statistical inference to refute the observed placebo effect...

Medscape: Can you provide a summary of the controversial study that was released in The New England Journal of Medicine?

Dr. Johnson: The study[1] took patients from the VA hospital and broke them down into 3 categories: (1) the traditional arthroscopic debridement group, which is really just a clean-up of the joint; (2) a group who had saline fluid flushed through the joint; and (3) a group who had a knife stuck in their skin to create "portals." This last group was the placebo or "sham" arm of the study, as no one actually underwent a surgical procedure. The results that came out were that all of the groups were essentially the same after 2 years in terms of pain relief. The 2 major [pieces of information] that came out of this paper were that surgery has a high percentage of placebo effect, which a number of people didn't think could happen, but it does; and that unfortunately a lot of people will generalize that arthroscopy for knee surgery is not effective.

bolding mine for emphasis, which is basically the point that he is trying to defend...

[bjm]

like most things in this world, perhaps not as it seems

why do you say that?

i can't see your links...but i mean they selected patients who might normally not be a good candidate for surgery ie would make little outcome difference as the surgeon in my link suggests  then i would guess the placebo effect (which i believe in) would probably be more pronounced..

i think its a form of hypnosis...you are surrounded by trained doctors that believe they can help..you believe they can help, there is your expectation of help, your need to fulfill that expectation to them and yourself, and your belief that you have done everything a concerned patient would do for himself....etc...your original symptoms were vague ...then you would believe you were better..you may walk more, improving motion, and all the beliefs i mentioned reinforces your belief of improvement

but, if you had a more mechanical problem as the doc suggests and as the study group didn't.. perhaps like a bone chip or a torn cartilage etc,  it would be much harder to believe away the pain if the operation never took place or failed

there are many sick people who would love to  have the placebo effect  but i think it can exist in only certain situations..

thats all i mean...

[igH]

i agree with you there and even the dr said...

Medscape: What sort of beneficial data came out of this study?

Dr. Johnson: It was surprising that so many patients reported pain relief just from a sham operation. I think this is very interesting, but this doesn't really help the way I practice orthopaedic medicine.

i wasn't trying to address its applicability in any targeted sense, just about the underlying factors... as vladex had also mentioned, tricking the subconscious is not an easy task... but more importantly another point which came to mind was the effectiveness of unproven treatments, whereby subjects swear with the healing power of xyz for instance, since such 'stimulants' have not been subjected to the rigor of scientific testing, couldn't the placebo effect account for such instances?

in any case, its good to be skeptical but one should also be positive and trusting at the same time... i don't think the opposite is any better... You are not allowed to view links. Register or Login