Spontaneous Remission and the Placebo Effect

I had fully intended to write a piece today on spontaneous remission and how it influences treatments and results that people choose.
I had, recently, an occasion to be privately messaged by a peddlar of a wieght loss MLM product line to inform me that my information regarding a particular product that appeared in her blog could potentially damage her efforts to sell the multi thousand dollar remedies.
I have to take exception to putting sales before health and wonder how some can sleep at night.
My research to date suggests that the product line leaves much to be desired from the persective of science and the effectivenes of it's main ingredients but that is for another blog.
I found this page while googling and it mirrors what I was about to discuss regarding the association in the mind between cures and disease.

Quackwatch Home Page

Spontaneous Remission and the Placebo Effect
Stephen Barrett, M.D.
When someone feels better after using a product or procedure, it is natural to credit whatever was done. However, this is unwise. Most ailments are self-limiting, and even incurable conditions can have sufficient day-to-day variation to enable quack methods to gain large followings. Taking action often produces temporary relief of symptoms (a placebo effect). In addition, many products and services exert physical or psychologic effects that users misinterpret as evidence that their problem is being cured. These "Dr. Feelgood" modalities include pharmacologically active herbal products, quack formulas adulterated with prescription drugs, colonic irrigations (which some people enjoy), bodywork, and meditation. Scientific experimentation is almost always necessary to establish whether health methods are really effective. Thus it is extremely important for consumers to understand the concepts of spontaneous remission and the placebo effect.

Spontaneous Remission
Recovery from illness, whether it follows self-medication, treatment by a scientific practitioner, or treatment by an unscientific practitioner, may lead individuals to conclude that the treatment received was the cause of the return to good health. As noted by Medical historian James Harvey Young, Ph.D.:

John Doe does not usually realize that most ailments are self-limiting and improve with time regardless of treatment. When a symptom goes away after he doses himself with a remedy, he is likely to credit the remedy with curing him. He does not realize that he would have gotten better just as quickly if he had done nothing! Thousands of well-meaning John and Jane Does have boosted the fame of folk remedies and have signed sincere testimonials for patent medicines, crediting them instead of the body's recuperative power for a return to well-being. . . .

The unscientific healer does not need to observe the restraints of reputable medicine. Where true medical science is complex, the quack can oversimplify. . . . Where ailments are self-limiting, the quack makes nature his secret ally [1].

It is commonly said that if you treat a cold it will disappear in a week, but if you leave it alone it will last for seven days. Even many serious diseases have ups and downs. Rheumatoid arthritis and multiple sclerosis are prime examples. On rare occasions, even cancer can inexplicably disappear (although most testimonials for quack cancer remedies are based on faulty original diagnosis or simultaneous administration of effective treatment).

Quackery's victims are not the only ones who can be fooled by the placebo effect, spontaneous remissions, and other coincidental events. The gratitude and adulation of people who think they have been helped can even persuade charlatans that their methods are effective!

The Placebo Effect
The power of suggestion has been demonstrated by many investigators in a variety of settings. In a classroom, for example, a professor sprayed plain water about the room and asked the students to raise their hands as soon as they detected an odor. Seventy-three percent managed to smell a nonexistent odor.

Persons with a dominant or persuasive personality often have considerable impact on others through their ability to create confidence, which enhances suggestibility. Many individuals who are taken in by a charlatan later tell their doctors, "But he talked to me; he explained things; he was so nice."

Individuals who are psychologically susceptible to suggestion often feel better under the influence of counseling or reassurance. Several years ago, an airline flight attendant told me, "I take a multivitamin pill that Consumer Reports says is useless. But I don't care. It makes me happy."

Gullibility and wishful thinking are common human characteristics. People are willing to believe in untrue things in varying ways and to varying degrees. Even scientifically sophisticated people may respond to the power of suggestion.

In medicine the effect of suggestion is referred to as the "placebo effect." The Latin word placebo means "I shall please." A placebo effect is a beneficial response to a substance, device, or procedure that cannot be accounted for on the basis of pharmacologic or other direct physical action. Feeling better when the physician walks into the room is a common example.

A placebo may be used in medicine to satisfy a patient that something is being done. By lessening anxiety, placebo action may alleviate symptoms caused by the body's reaction to tension (psychosomatic symptoms). In certain circumstances, a lactose tablet (sugar pill) may relieve not only anxiety but also pain, nausea, vomiting, palpitations, shortness of breath, and other symptoms. The patient expects the "medication" to cause improvement, and sometimes it does.

Many studies suggest that placebos can relieve a broad range of symptoms. In many disorders, one third or more of patients will get relief from a placebo. Temporary relief has been demonstrated, for example, in arthritis, hay fever, headache, cough, high blood pressure, premenstrual tension, peptic ulcer, and even cancer. The psychologic aspects of many disorders also work to the healer's advantage. A large percentage of symptoms either have a psychologic component or do not arise from organic disease. Hence, treatment offering some lessening of tension can often help. A sympathetic ear or reassurance that no serious disease is involved may prove therapeutic by itself. Psychologist Barry Beyerstein, Ph.D., has observed:

Pain is partly a sensation . . . and partly an emotion. . . . Anything that can allay anxiety, redirect attention, reduce arousal, foster a sense of control, or lead to . . . reinterpretation of symptoms can alleviate the agony component of pain. Modern pain clinics put these strategies to use every day. Successful quacks and faith healers typically have charismatic personalities that make them adept at influencing these psychological variables that can modulate pain. . . . But we must be careful that purely symptomatic relief does not divert people from proven remedies until it is too late for them to be effective [2].

Confidence in the treatment -- on the part of the patient and the practitioner -- makes it more likely that a placebo effect will occur. But the power of suggestion may cause even a nonbeliever to respond favorably. The only requirement for a placebo effect is the awareness that something has been done. It is not possible to predict accurately or easily a particular patient's reaction to a placebo at a particular moment. However, the psychologic predisposition to respond positively to placebos is present to some extent in most people. Some are very likely to obtain relief from placebos in a wide variety of situations, whereas others are very unlikely to do so. Most people's response lies somewhere inbetween.

Another factor that can mislead people is selective affirmation -- a tendency to look for positive responses when improvement is expected. As former National Council Aghainst Health Fraud president William T. Jarvis, Ph.D., has noted:

A culturally significant setting can also produce a potent effect, as folk healers know well. Effective settings can be as divergent as the trappings of an oriental herb shop to Asians, a circle of witchcraft paraphernalia to a primitive tribesman, or the atmosphere of a modern clinic to a modern urban American. Social expectations can also play a role, as occurs in stoic cultures where people are taught to endure pain and suffering without complaining. . . .

Operant conditioning can occur . . . when behavior is rewarded. . . . Thus, people with a history of favorable responses to treatment are more apt to react well to the act of treatment [3].

Moreover, says Dr. Jarvis:

People suffering from chronic symptoms are often depressed, and depression often produces symptoms that the patient attributes to the underlying disease. If the quack's promises make the patient feel hopeful, the depressive symptoms may resolve, leading the patient to conclude -- at least temporarily -- that the quack's approach has been effective against the disease [4].

Responses to the treatment setting can also be negative ("nocebo effects"). In one experiment, for example, some subjects who were warned of possible side effects of a drug were given injections of a placebo instead. Many of them reported dizziness, nausea, vomiting, and even mental depression. A recent review of 109 double-blind drug trials found that the overall incidence of adverse events in healthy volunteers during placebo administration was 19% [5].

Placebo responses, such as feeling less pain or more energy, do not affect the actual course of the disease. Thus placebo responses can obscure real disease, which can lead to delay in obtaining appropriate diagnosis or treatment.

The placebo effect is not limited to drugs but may also result from procedures [6]. Devices and physical techniques often have a significant psychologic impact. Chiropractors, naturopaths, and various other nonmedical practitioners use heat, light, diathermy, hydrotherapy, manipulation, massage, and a variety of gadgets. In addition to any physiologic effects, their use can exert a psychologic force that may be reinforced by the relationship between the patient and the practitioner. Of course, devices and procedures used by scientific practitioners can also have placebo effects.

Ethical Considerations
Doctors are confronted by many people who complain of tiredness or a variety of vague symptoms that are reactions to nervous tension. Far too often, instead of finding out what is bothering them, doctors tell them to take a tonic, a vitamin, or some other type of placebo.

A recent study has challenged the widely held view that the placebo effect is a major factor in the outcome of clinical trials. Most placebo-controlled trials compare the active treatment with a placebo, not with no treatment. This design cannot distinguish an effect of placebo from the natural course of the disease, regression to the mean (the tendency for random increases or decreases to be followed by observations closer to the average), or the effects of other factors. After analyzing 114 randomized trials that had a "no-treatment" group in addition to active treatment and placebo groups, the authors concluded:

Placebos appeared to produce modest benefit in studies of pain and in other studies where the outcome being measured was similarly subjective.
Some of the reported benefit may be the result of placebos may be the result of patients wishing to please their doctors.
There is no justifiable placebo use outside of clinical trials [7].
An accompanying editorial stated that placebo use should be sharply reduced but may still be justified in carefully selected situations where pain relief is needed [8]. The study also casts doubt on the widely promoted notion that "alternative methods" may work by stimulating a placebo effect

Quacks who rely on the placebo effect pretend that (a) they know what they are doing, (b) they can tell what is wrong with you, and (c) their treatment is effective for just about everything. Many of their patients play the equivalent of Russian roulette. Medical doctors who use vitamins as placebos may not be as dangerous, but they encourage people to habitually use products they don't need. Because most people who use placebos do not get relief from them, their use is also a financial rip-off.

References
Young JH. Why quackery persists. In Barrett S, Jarvis WT, editors. The Health Robbers: A Close Look at Quackery in America. Amherst, N.Y., 1993, Prometheus Books.
Beyerstein BL. Testing claims of therapeutic efficacy. Rational Enquirer 7(4):1-2, 8, 1995.
Jarvis WT. Arthritis: Folk remedies and quackery. Nutrition Forum 7:1-3, 1990.
Jarvis WT. Personal communication to Dr. Stephen Barrett, Dec 18, 2001.
Rosensweig P and others. The placebo effect in healthy volunteers: Influence of experimental conditions on the adverse events profile during phase I studies. Clinical Pharmacology and Therapeutics 54:578-583, 1993.
Turner JA and others. The importance of placebo effects in pain treatment and research. JAMA 271:1609-1614, 1994.
Hrobjartsson A, Gotzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. NEJM 344:1594-1602, 2001.
Bailar JC III. The powerful placebo and the Wizard of Oz. NEJM 344:1630-1632, 2001.

Quackwatch Home Page

This article was posted on December 18, 2001.

another resource for a specific critique of product is Dr. Harriet Hall:
http://healthfraudoz.blogspot.com/2006/11/critique-of-isagenix.html
I found the information provided not only interesting but somewhat distrubing.

Arguing just to win is counter productive

http://dumbscientist.com/archives/people-who-argue-to-win-annoy-me

Posted December 1st, 2008 in Philosophy. Tags: Introductory-Phil., No Equations, Quickie.
I enjoy civilized debates, but I rarely get the chance to engage in them. That’s because in my experience nearly everyone assumes they’re correct, so they only debate to beat their viewpoint into the other person’s head at all costs.

In other words, most people argue to win… and I can’t stand it. Whenever I mention this pet peeve, the response is almost always “Oh, so you argue to lose, huh?”
Not exactly. I see a third alternative, one that seems more productive. I argue to learn.

In fact, I think the best possible outcome of a debate is when my opponent convinces me that he’s right and I’m wrong. That way, I’ve learned something new or improved my worldview by fixing a mistake. It’s just boring to convince someone else that I’m right. What do I gain from a debate that I “win” in that manner? Very little, I think.

That’s the point of this website. I’ve decided that I can no longer develop my ideas in isolation. I’m blind to the flaws in my own ideas because I’m simply too biased towards believing they’re true.

It might seem like I shouldn’t be annoyed with people who argue to win, because they’re doing me a favor by enthusiastically attacking my ideas. While it’s true that I desperately want people to attack my ideas in order to identify flaws in my reasoning, the problem is that people who argue to win generally aren’t very persuasive. They’re certainly motivated to attack my ideas (which I appreciate), but the resulting arguments have always been much less enlightening than conversations with people who disagree with me in a calm, non-confrontational manner.

That’s because you have to understand another person’s position at least a little bit before you criticize it. Otherwise your attacks might not be aimed at their central point, or you may misinterpret their position altogether. Your arguments must also serve as a “bridge” between the other person’s position and your own, to show the other person how to cross the intellectual distance that separates your positions. Finally, you can’t simply grab the first argument that appears to support your position or attack your opponent’s. This happens most often in verbal debates where there isn’t much time for research or introspection between intellectual salvos. But it also occurs in written debates with depressing frequency, and the resulting arguments simply aren’t challenging enough.

For me, debating means to seriously entertain my opponent’s viewpoint, to examine the world through the lens of his assumptions. If I happen to like his viewpoint better than mine (which happens occasionally) I cheerfully say “thank you for correcting me” and drop my old position like the proverbial hot potato. I’m not on anyone’s side but my own, and sometimes I’m not even on my own side…

God did not create the universe, says Hawking

NewsDaily: God did not create the universe, says Hawking

NewsDaily (2010-09-05) -- God did not create the universe and the "Big Bang" was an inevitable consequence of the laws of physics, the eminent British theoretical physicist Stephen Hawking argues in a new book. ... > read full article

Benefits of Buying Local Can Be a Far-Off Fantasy

This information seems to provide more "food for thought" about different approaches to sustainabilty.

There's some pretty outrageous assumptions out there coming from the misinformed.
There must be a decent balance that preseves the environment without impacting the lives of our neighbours.

Benefits of Buying Local Can Be a Far-Off Fantasy

The origins of the Big Green Swindle

Organic Food Miles Take Toll On Environment

http://www.sciencedaily.com/releases/2007/06/070606113311.htm

ScienceDaily (June 7, 2007) — Organic fruit and vegetables may be healthier for the dinner table, but not necessarily for the environment, a University of Alberta study shows.


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The study, conducted by a team of student researchers in the Department of Rural Economy at the University of Alberta in Edmonton, Canada, showed that the greenhouse gas emitted when the produce is transported from great distances mitigates the environmental benefits of growing the food organically.

"If you're buying 'green', you should consider the distance the food travels. If it's travelling further, then some of the benefits of organic crops are cancelled out by extra environmental costs," said researcher Vicki Burtt.

Burtt and her fellow researchers compared the cost of 'food miles' between organic and conventionally grown produce, and found that there was little difference in the cost to the environment.

Food miles are defined as the distance that food travels from the field to the grocery store. The study found that the environmental cost of greenhouse gas (CO2) emitted to transport 20 tonnes of organically grown produce was comparable to that of bringing the same amount of conventional fruit and vegetables to market.

For the study, the team collected retail price data from six grocery stores and interviewed suppliers about their shipping methods. They created comparable food baskets of both organic and conventionally-grown fruit and vegetables being transported to Edmonton stores by truck, train or ship, and found that most travels by truck. Since 1970 truck shipping has increased, replacing more energy-efficient rail and water transport.

The researchers calculated that the annual environmental costs for a city the size of Edmonton were $135,000 to $183,000 (5,492-7,426 tonnes CO2) for conventional produce and $156,000 to $175,000 (6,348-7,124 tonnes CO2) for organic produce. Many of the organic products are travelling further than the conventional food. Two items in particular, mangoes and green peppers, were shipped much further than their conventional counterparts (4,217 and 1,476 kilometres, respectively). The mangoes were shipped from Ecuador and Peru as opposed to Mexico, and the peppers came from Mexico as opposed to Canada or the United States.

To help reduce greenhouse gases, Burtt recommends that shoppers switch to buying locally produced food at grocery stores or farmers' markets when possible, and that any future government policy on the environment should consider the reduction of CO2 emissions associated with food transport. The study also found that a large gap between total costs to the consumer and the price paid in the store for organic produce indicates that retailers could cover the environmental costs without passing those costs on to the consumer.

Anti oil sands groups urge Americans to boycott Alberta

http://www.edmontonjournal.com/business/Billboards+warn+Americans+travel+dirty+Alberta/3276898/story.html
From my perspective Americans can whine and complain and print banner ads and bill boards all they like the but fact of the matter is we Canadians in particular we Albertans did not get them into the mess that they are currently dealing with.

Obama and the White House might be shocked that the US federal court overturned a six-month drilling moratorium but it's not that surprising.
It seems the political posturing missed a very important detail... , the US oil industry is on the brink of collapse.

It's not just America's oil supply and energy security that's in danger, it's not just BP oil and the spill and the subsequently stupid drilling ban, it's the entire gulf economy that's hanging by a thread and it won't take much more to toss it over the cliff.
Truth is thousands and thousands of rig workers were effectively laid off in the 33 rigs operating in the Gulf stopped drilling.
There's a very real possibility that lost wages alone are running $330 million per month.
If you look at the BP 100 million-dollar compensation fund it looks rather paltry.

That's not the end of it. Each rig job supports jobs for four additional jobs for trucks, supply ships, operator service industries, telephones etc.
This work stoppage is huge.

If the drilling ban became permanent which it won't of course, the consequences could be dire and just like the towns that died out in the upper Midwest after the demise of the auto plants the steel mills the entire Gulf Coast in deep water drilling which is so crucial to the US economy could just... fade... away.
At best, we could call this economy fragile.

Recently the Chinese stepped forward to call this economy no longer a AAA credit risk but now a AA credit risk placing the United States of America number 13 on the list of viable creditors on this planet.

If in fact the Gulf accounts for 30% of all the oil produced in the US and should the Gulf be put off-limits that shortfall has to be made up somewhere.
Viable options are few and far between.
Russia may be a friend now but history tells us they're fond of turning off the taps and screwing customers present and past and will most likely do so again should the opportunity present.

The Middle East is hardly America's best friend and royalty structures there leave a hell a lot to be desired.
In Venezuela Hugo Chavez nationalized 11 oil rigs belonging to the US. -- how lovely!

Now, let's consider option number two, our friendly neighbour to the north, the little country that already plays a big role in US energy market. Truth is one of every six barrels of oil consumed daily in the United States comes from Alberta Canada and oil sands have taken a pretty controversial hit by uninformed and ill-informed and had been presented as if there are like broken landscapes wreaking carbon emissions. I humbly ask compared to what?

They can whine and belly ache all they want but the oil sands are going to change and change very soon. They are cost effective and they're becoming increasingly green. Steam assisted gravity drainage (SAGD) pumps steam into the ground to liquify bitumen and stiff crude oil and makes it thin enough to be pulled out of the ground. No giant holes no toxic pale plummes just two horizontal pipes one above the other puffing away efficiently. There's no question that the Gulf oil spill has become a game changer.

If the US court allows a somewhat watered-down version of the drilling ban that have occurred and will drive the price of US oil stocks to unheard-of low levels pushing the US ever closer to a financial collapse.

In the end, only two real options are left in the hands of the US - the oil sands of Canada or rethinking the drilling ban.

So I say respectfully to Americans who choose to ban the import of the very product that will keep your financial ship afloat, fire away!

The very best you could expect from this unjustified and unneighbourly behavior might be to find yourself without a supplier for the lifeblood of the American economy.

It might seem at this point in time there no are purchasers for this oil sand product but all over the world there is a demand for oil and, as might be expected, the contracts that will be set out will be long-term and might very well preclude a change of heart from our American friends.

So be very sure of who you boycott and the reasons for doing so.

Make sure you have your facts straight and your ducks all in a row.

This is not your fathers’ planet.

http://ge.geglobalresearch.com/blog/alberta-oil-sands-are-going-green/

http://www.edmontonjournal.com/business/More+bitumen+fewer+emissions/3221396/story.html