Talk:Placebo/Archive 5

Archive 1

←

Archive 3

Archive 4

Archive 5

Archive 6

Archive 7

Archive 8

unsupportable

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

The judgement "unsupportable" is not in the source. This article was changed to win a debate in homeopathy. I guess this comment will be reverted and I will be blocked for troublemaking. If anyone sees this before it's beign reverted and I am blocked, please keep arguing for neutrality. Read this piece from Larry about this small group of users that has managed to replace the principle of neutrality by a principle of scientism and spread the word. Best wishes. --rtc (talk) 11:20, 16 June 2018 (UTC)

Probably because they don't want to alienate themselves from the possibilities of future funding from Alt-Med supporters. -Roxy, the dog. barcus 11:23, 16 June 2018 (UTC)

I watched that thread develop. There is a reason Larry is no longer involved with this project. -Roxy, the dog. barcus 11:34, 16 June 2018 (UTC)

Yes, because the dignity of his neutrality policy was taken away by the edits of group of naive and radical adherents of scientism. Probably? I mean seriously? We can use probable cause to put our own judgements, unsupported by the source, into the article? --rtc (talk) 11:41, 16 June 2018 (UTC)

Science is very important—this is realism, not scientism. Tgeorgescu (talk) 12:07, 16 June 2018 (UTC)

Please focus on the issue at hand, which is the use of a judgement that is unsupportable given the source cited. --rtc (talk) 12:15, 16 June 2018 (UTC)

I guess that point has been answered more than a hour ago. Tgeorgescu (talk) 12:25, 16 June 2018 (UTC)

No it has not been answered in any way whatsoever. The word "unsupportable" is nowhere in the source, that's the only fact. The rest is editors arguing for unsupportable judgements with the use of further unsupportable judgements. The reverter says '"no evidence was found of any placebo effect in any of the studies cited by him" - it's fine' No it's not. This is a very old study that's being criticized, and it is based on even older sources. The critic's paper says that older study is fallacious and the effects observed by its sources can be attributed in obvious ways to explanations which do not rely on the placebo effect. The authors did not even look at data from the many more recent sources that were published since the 1950 paper they criticize. The author's actual conclusion is that "the existence of therapeutic effects of placebo administration seems questionable", and not that it is unsupportable. The word "unsupportable" was defended above with the ridiculous claim that the authors did not use that word merely because they feared that this could risk future funding. --rtc (talk) 12:37, 16 June 2018 (UTC)

The change has clearly improved the article, though it is still erroneously focusing on what the study has to say about the ancient evidence from before 1955. The actually relevant judgement of that paper is what it has to say about the placebo effect itself, and, as already stated, in this respect it says "the existence of therapeutic effects of placebo administration seems questionable". There are more recent papers with more citations than this one on placebo effects, why is it mentioned so prominently? It merely showed severe errors in interpretation of ancient sources by the popular Beecher paper, and did not contain any new reserach on the actual question. --rtc (talk) 14:10, 16 June 2018 (UTC)

Do you have a MEDRS-compliant source for the change you are proposing? Brunton (talk) 15:07, 16 June 2018 (UTC)

dafuq? The quoted passage is from the same paper. --rtc (talk) 15:29, 16 June 2018 (UTC)

What change are you now proposing? Brunton (talk) 15:47, 16 June 2018 (UTC)

As I already said, what the study has to say about the ancient evidence from before 1955 is rather irrelevant. Iif the paper is to be used at all its bottom line should rather be quoted, which is, as already stated "the existence of therapeutic effects of placebo administration seems questionable". And, as already stated, it should be called into question whether this paper should be cited at all in this context, rather than one of the more recent ones on the actual issue (about which this paper has nothing actually new to say), of which there are abundantly many in the article, such as http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003974.pub3/abstract or at least the one I ref'd here (unfortunately it didn't make it very long). As you can see I am mostly repeating myself. IMO this article was actually fairly fine before it was changed to win the discussion on homeopathy. The passage "However, some recent research has called into question..." has everything there is to say. Apparently the way it said it was not strong enough for my opponents from the homeopathy article who are apparently not satisfied with the placebo effect being merely called into question, but want it to be presented as a complete myth, such as to make completely sure it cannot possibly be used as a rationalization for homeopathy. --rtc (talk) 15:56, 16 June 2018 (UTC)

The 1955 paper is historically important in the context of the article, and therefore so is the paper calling its conclusions into question, for that reason. The reviews you cite both fail to find anything beyond subjective effects. Again, what specific changes do you propose? Brunton (talk) 16:09, 16 June 2018 (UTC)

I won't repeat myself a third time. In doubt, the article should be reverted to the version from before the dispute. The actually relevant bottom line statement "the existence of therapeutic effects of placebo administration seems questionable" does not go beyond "some recent research has called into question" --rtc (talk) 16:20, 16 June 2018 (UTC)

@Rtc: "some recent research has called into question" is weasel-wording and downplayed to the extent it is wrong. The settled scientific consensus is that the so-called placebo effect either does not exist or is of no clinical value at all; it does however complicate reporting of various subjectively measured phenomena (e.g. pain) in a way which is clinically measurable. Alexbrn (talk) 16:14, 16 June 2018 (UTC)

Please provide reliable sources for your claims about the allegedly settled alleged scientific consensus. --rtc (talk) 16:20, 16 June 2018 (UTC)

See the Cochrane review PMID 20091554. This is a top-quality WP:MEDRS and so far as I know has not been challenged (except in various quack circles). Alexbrn (talk) 16:41, 16 June 2018 (UTC)

I have read that source (the full text of the monstrous full version can be found at [1]); in fact I pointed to it myself above stressing that it is much more recent than the 1997 source and actually discusses the core of the problem rather than merely reevaluating sources that are over 60 year old. This more recent source does not say "no clinical value at all", it says "in general [whatever that means] did not have clinically important [whatever that means] effects". It does not say "complicate reporting" either, it says "there were possible beneficial effects on patient-reported outcomes, especially pain" with a reservation to the effect that "it is difficult to distinguish patient-reported effects of placebo from biased reporting". The study lists the quality of the evidence as moderate at best. Further, the study contains the following important reservation: "It is a question of definition whether our review evaluates the 'placebo effect'. This term does not only imply the effect of a placebo intervention as compared with a no-treatment group, but is also used to describe various other aspects of the patient-provider interaction, such as psychologically-mediated effects in general, the effect of the patient-provider interaction, the effect of suggestion, the effect of expectancies, and the effect of patients' experience of meaning (Hróbjartsson 2002b). As patients in the notreatment group also interact with treatment providers, a no-treatment group is only untreated in the sense that they do not receive a placebo intervention (Hróbjartsson 1996). Our result is therefore neutral to many of the meanings of the term ’placebo effect’ cited above, and we do not exclude the possibility of important effects of other aspects of the patient-provider interaction" Fair enough, the author's ultimate judgement is "placebo prescription seems to lack both ethical and empirical justification", however what they really mean they stress just before making that statement: it holds within the bounds of their own ethical framework only, which they describe as "a clinical placebo intervention is ethically acceptable only if it fulfils two criteria. First, patients must be informed about the nature of the intervention. Second, the effect of placebo must be reliably demonstrated in trials that disclose to patients that they receive placebo." Thus they restrict practical treatment proposals and empirical evidence to what they consider ethical. It is obvious that such a position (or opinion, as the authors themselves call it), which is ultimately rooted in ethics, not in science, cannot be qualified at all as a "settled scientific consensus". In the homeopathy article, I gave management of moderate pain as an example (a fairly common condition). The authors seem not to have a truly convincing, purely empirical argument against a placebo effect in that case. They say they think it might be patient reporting error but that's really not much more than speculation. The fact is, if you tell the patient that the medication helps with the pain (which is ultimately not a lie, as it is kind of a self-fulfilling prophecy) this study does not deny that you may actually have a benefit, even if the authors consider it somewhat "unethical" (I guess they think it's more ethical to recommend iboprufen or even prescribe opioids) --rtc (talk) 18:40, 16 June 2018 (UTC)

The source doesn't mention homeopathy, so this would appear to be entirely your flight of fancy. We do know from various other sources that quacks latch on to the supposed "placebo effect" to further their frauds. This aspect could usefully be expanded in this article. Alexbrn (talk) 18:43, 16 June 2018 (UTC)

I didn't refer to homeopathy at all except by pointing to the discussion in that article. There I said objectively homeophatic medicine is way cheaper than conventional placebo. A conventional placebo costs almost twice as much. Many doctors are thus prescribing homeophathy, as a placebo. Howver, I can only speak for the situation in Germany. I do not know about other parts of the world. Plus, if you prescribe a conventional placebo and the patient figures out he tends to get pretty angry, you don't have those issues with homeophathy. --rtc (talk) 18:46, 16 June 2018 (UTC)

This is just utter nonsense (trolling?). So long as we point out that placebo prescription lack both ethical and empirical justification, without adding daft editorial interpretations, we shall be fine. You should probably look at WP:Lunatic charlatans. Alexbrn (talk) 18:51, 16 June 2018 (UTC)

"we shall be fine" No, we shall not be fine, as that statement clearly holds, as I said, within the ethical framework of the authors only. The authors themselves say that very clearly. I see we're wielding weapons again to ge the "lunatic charlatan" blocked. It's a pity. Happy blocking. PS: What is "utter nonsense" about what I wrote? Is anything wrong with it? Please use argument instead of thought-terminating cliché --rtc (talk) 18:58, 16 June 2018 (UTC)

Homeopathic medicine is an oxymoron. And no, homeopathy is sugar pills plus magic and marketing, so taking out the magic and marketing and leaving the conventional placebo is going to be cheaper. Plus, the doctor giving you the placebo probably won't lie about how the medical establishment is a giant conspiracy to suppress this wonderful medicine and next time you should go straight to the placebo salesman and eschew the medical profession, leaving you to, oh, I don't know, die of untreated cancer in horrible agony.

You claim that increasing numbers of doctors are prescribing homeopathy. That's what homeopaths claim, but there's no evidence for it, and it would be a fallacious appeal to popularity anyway. Most doctors don't prescribe homeopathy. Under 0.2% of British doctors did, before a recent review that advised them to stop entirely, homeopathic prescriptions have been in steep decline int he UK for decades, and Prince Charles' favourite quackademic medicine establishment, formerly the Royal London Homeopathic Hospital, no longer provides homeopathy at all. Regardless iof the fate of the numerous other pseudomedical placebos (acupuncture, for example), homeopathy is recognised by pretty much every scientific authority as complete bollocks and is in terminal decline in many countries. Reviews by the Swiss Federal Office of Public Health, the British Parliament, the Australian Healthcare Commission and the US Federal Trade Commission - all the government level reviews in recent years, in fact - have found no evidence that homeopathy works. Guy (Help!) 22:09, 16 June 2018 (UTC)

No, I have never claimed anyhting about any numbers being increasing. You claim "have found no evidence that homeopathy works". Source please for that statement -- does it really say homeopathy doesn't work or does it actually say it doesn't work better than a placebo? (though for you it may be the same since you believe a placebeo doesn't work either. yet I want to know what the source actually says, not what you believe) --rtc (talk) 22:26, 16 June 2018 (UTC)

"if you prescribe a conventional placebo and the patient figures out he tends to get pretty angry, you don't have those issues with homeophathy" In other words, homeopathy makes it easier to lie to patients. This is a good thing only for unethical paternalistic doctors and charlatans. --Hob Gadling (talk) 11:55, 17 June 2018 (UTC)

Your statement is rooted in controversial ethics, not in science. --rtc (talk) 13:01, 17 June 2018 (UTC)

Actually, those were two statements. The first was basic logic. As for the second - those who think dishonesty is a good thing have a bad standing among scientists and among Wikipedia editors. --Hob Gadling (talk) 19:15, 17 June 2018 (UTC)

Making the statement "those who think dishonesty is a good thing ..." is ultimately presupposing a very naive moral and false dichotomy, actually invented by Kant, that total honesty is good and dishonesty is thus always and under all circumstances a totally bad thing, as if there could not be a valid, more nuanced view that sees dishonesty in certain situations as morally right and honesty as morally wrong. It may be true that in science telling the truth is moral duty, but we are talking about medicine. It would be very naive to use the moral of science and apply it without change to the entirely different area of doctor-patient relationship. This is so typical for people including some but not all scientists to believe their morals are above everyone else's. Humaneness may not be an absolute thing in the way truth is, but sometimes the value of human dignity trumps the value of truthfulness. --rtc (talk) 19:23, 24 June 2018 (UTC)

You have the luxury of speaking like a philosopher. An MD who would promote such thing would soon find himself/herself in hot water. Tgeorgescu (talk) 20:50, 24 June 2018 (UTC)

Rightly so. Would he promote this in its own naive way he would be rightly accused for paternalism. There is a heated debate and the last word on it has not been spoken yet. --rtc (talk) 20:54, 24 June 2018 (UTC)

All this is just hot air. You are suggesting we should make it easier for doctors to lie to their patients. I quote you again: "if you prescribe a conventional placebo and the patient figures out he tends to get pretty angry, you don't have those issues with homeophathy." A doctor who prescribes homeopathy cannot be trusted; he is either incompetent or dishonest. Is the patient who gets angry at being prescribed a placebo being "very naive"? Why does he get angry? Because he has been lied to. It is not "naive" to demand honesty from people who you should be able to trust with your life.

A website which says homeopathy works cannot be trusted either - that is why it would be a bad idea to make the article say that. And you, who favors lying, cannot be trusted either. This is not about morals, it is about trustworthiness and reliability. Trusting liars is naive, not distrusting them. --Hob Gadling (talk) 21:55, 24 June 2018 (UTC)

Wikipedia just isn't the venue for such debate. We only follow WP:MEDRS, not random philosophical musings. Tgeorgescu (talk) 21:57, 24 June 2018 (UTC)

MEDRS is to be followed when it comes to biomedicine, not when it comes to ethics of medicine, which is an entirely different topic. If a MEDRS source has a naive opinion on ethics then that doesn't make it in any way trump reputed philosophy journals discussing the question. --rtc (talk) 22:09, 24 June 2018 (UTC)

I am not suggesting anything except following the sources rather than personal opinions of wikipedia editors. You are the one who is lying by claiming I were "favoring lying". What you write can be considered a bad caracature of what I said at best. You are full of ideological prejudices, different from many years ago, when you were an editor open towards opinions different from yours. --rtc (talk) 22:09, 24 June 2018 (UTC)

If the germane subject is ethics of medicine, then yes, you may produce WP:RS written by established moral philosophers. If the germane subject is placebo, you are not allowed to do that. Tgeorgescu (talk) 22:19, 24 June 2018 (UTC)

There's no such thing as a "germane subject", that's simply nonsense. An article has many different aspects. The biomedical ones have to be sourced by WP:MEDRS, other aspects like ethics not. --rtc (talk) 22:22, 24 June 2018 (UTC)

Such content does not belong inside this article. Placebo is covered by WP:MEDRS, Legality of euthanasia isn't. Tgeorgescu (talk) 22:31, 24 June 2018 (UTC)

Of course the ethics of placebo belong into this article. WP:MEDRS does not talk about articles, but material being covered. But this discussion is getting way too abstract. What I am saying here is that the Hrob2001 is significant for its empirical results, not for the opinion of the authors on ethics that they smuggled into it to make their point. Questions about ethics are best sourced by medical guidelines and secondary sources from philosophy discussing them critically, not by metastudies that are mainly empirical. --rtc (talk) 22:34, 24 June 2018 (UTC)

In case you did not get it, citing philosophers is prohibited because you try to use them for drawing your own original research conclusions or WP:SYNTH. Tgeorgescu (talk) 22:38, 24 June 2018 (UTC)

citing philosophers and WP:OR/WP:SYNTH are two entirely independent topics. Just because it's a philosopher doesn't mean it's WP:OR/WP:SYNTH violation in any way. Nowhere do those guidelines in the slightest manner say "you may not cite a philosopher's writings on ethics of placebo use". And, in the opposite direction, just because a source is otherwise WP:MEDRS doesn't mean its claims on ethics are to be taken as authority. --rtc (talk) 22:53, 24 June 2018 (UTC)

You forgot what we were discussing: homeopathy/placebos are effective because there are good philosophical reasons for it. It is simply not the job of philosophers to evaluate the effectiveness of placebos. Tgeorgescu (talk) 22:56, 24 June 2018 (UTC)

What? No, we were not discussing any of that. We were discussing that there are positivst positions held by some editors, who say placebos are ineffective because there are no good philosophical reasons in the form of positive evidence for them, trumping the judgement of WP:MEDRS sources which say that the situation is unclear. So what you are saying is in fact that positivist philosophers should evaluate the effectiveness of placebos by their epistemological sophistry about "burden of evidence". --rtc (talk) 23:03, 24 June 2018 (UTC)

Gosh, I thought that that's how science works: Occam's razor, organized skepticism and all that. Tgeorgescu (talk) 23:05, 24 June 2018 (UTC)

We don't need to discuss about how science works or does not work, but about how wikipedia works. Wikipedia works by describing what the sources say, not by WP:SYNTH and WP:OR based on those sources plus your own philosophical assumptions based on popular philosophy (such as "occam's razor" and "organized skepticism"). Proceeding from "We don't know if placebos are truly effective or not" (which is in the source) to "by the burden of proof, it must be assumed they aren't" (which is not in the source but only in your own opinion) very obviously introduces bias and thus violates NPOV. --rtc (talk) 23:16, 24 June 2018 (UTC)

I did not plead "shown not to be real", but I plead "not shown to be real". Do you acknowledge the difference? If I say "fairies are real", the WP:BURDEN is on me to show they are real. Tgeorgescu (talk) 23:18, 24 June 2018 (UTC)

You're putting up a smoke screen. The MEDRS source says it's unclear. Thus it should be said like that and not that it's clear that placebo is not useful. WP:BURDEN is not in any way about twisting the statements made by a MEDRS source based on your own philosophical prejudices. --rtc (talk) 23:21, 24 June 2018 (UTC)

So, after decades of investigations placebo has not been shown to heal anything. That's the current state of research and that's what the article should say. Tgeorgescu (talk) 23:26, 24 June 2018 (UTC)

No, the article should say what the MEDRS source says, not whatr your own opinion on the history of placebo research says. What are you keeping discussing? Resistance is futile. You may have the more powerful cabal, but not the more powerful argument. You should simply accept that. --rtc (talk) 23:28, 24 June 2018 (UTC)

Well, what does it heal and which are your WP:MEDRS for such claim? Tgeorgescu (talk) 23:30, 24 June 2018 (UTC)

When the MEDRS source says it does heal we have to say it does heal. If it says it does not heal, we have to say it does not heal. And when it says (which it does) it is unclear for some conditions we should say that. Please stop this cascade of sophistic arguments. --rtc (talk) 23:32, 24 June 2018 (UTC)

No, I have moved the question on the turf of positive knowledge (i.e. knowing what one speaks about, in terms of evidence). You cannot claim "Placebo is effective, but we have absolutely no idea what it heals." Tgeorgescu (talk) 23:36, 24 June 2018 (UTC)

Ough, this is ridiculous. I never said anyhting remotely like that. The authors say, for some conditions (which they list), it is unclear whether it is truly effective or not. They don't say (nor anyone sle) that it is effective but unclear for what condition. The more we discuss the more my impression you have not actually read the source. --rtc (talk) 23:40, 24 June 2018 (UTC)

I don't have to read the paper. I asked a real question: what does it heal? Does it heal tuberculosis? Does it heal syphilis? If you cannot show WP:SOURCES that it heals a real disease, then you have admitted that I had correctly evaluated the state of research. Tgeorgescu (talk) 23:46, 24 June 2018 (UTC)

"I don't have to read the paper." Oh yes you have to. and please not only the abstract, but the entire paper. --rtc (talk) 00:59, 25 June 2018 (UTC)

If you cannot answer a simple question, you have lost the debate: which diseases get healed by placebo and how do you know it? This requires a clear-cut answer, certainly not invoking philosophical musings about medical ethics. Tgeorgescu (talk) 18:36, 25 June 2018 (UTC)

If you read the paper, it is obvious to you. The paper contains a nicely formatted table that lists all this. It says it's unclear whether this is a true effect or reporting error, for sure. "how do you know it?" is a philosophical question if it is to be answered differently from "from said paper". --rtc (talk) 18:47, 25 June 2018 (UTC)

I guess that means that you have conceded the point that placebo has not been shown to heal any real disease. Case closed. Tgeorgescu (talk) 18:49, 25 June 2018 (UTC)

I have in fact never made the point, nor anyone else here. Case is not closed at all. I said "it's unclear whether this is a true effect or reporting error" and this is what I want to see in the article -- which currently claims it is not useful for healing any disease. The authors certainly admit the possibility (though not proof) that there might be "true effects". You seem to imply that it is relevant whether something has been shown or not. That's a philosophically biased assumption which the authors don't make. They were unable to refute the claim, and unable to prove it, they simply don't want to make a commitment whether it's true or not. --rtc (talk) 18:57, 25 June 2018 (UTC)

If you cannot fulfill WP:BURDEN that there is reasonable evidence that placebo heals some real diseases, you have conceded the point. I asked if there is any evidence that placebo heals any real disease and you could not mention any such evidence. Tgeorgescu (talk) 19:08, 25 June 2018 (UTC)

Please read the source. The source says there is evidence of moderate quality, though it is unclear whether this is a true effect or reporting error. This statement is basically in the source. WP:BURDEN is thus clearly fulfilled. You're acting as if statements can only be relevant for wikipedia if they are about positive proof for something. That's positivism. Just because the MEDRS source makes a statement that is outside of the framework of positivist philosophy doesn't mean that this statement cannot be cited in wikipedia. MEDRS is enough; there doesn't need to be compliance with positivist tenets. PS: Huh? The source seems to be gone in the lede, which now only cites ancient versions of the study. The source I am referring to is the most recent one at [2] in particular the table on p. 3 an 4. --rtc (talk) 19:13, 25 June 2018 (UTC)

Let's rehearse the data: there is no evidence that placebo heals tuberculosis or syphilis or any other real disease. You point is that it could heal some real disease, but there is certainly no clear-cut evidence that it does. We're not interested in placebo could, would, should... We're interested if it is a scientific fact that placebo heals anything. All that you say above is that there is no such scientific fact and no evidence for it. So, you have conceded that you have lost the debate. Tgeorgescu (talk)

I don't know what you mean by "real disease" and i certainly never used that term. What you say is completely unrelated to what I said. Certainly I never claimed placebo could heal tuberculosis or syphilis or anything even remotely like that. --rtc (talk) 21:03, 25 June 2018 (UTC)

The point was: placebo cannot heal any real disease. I saw the paper and some quotes are: "Thefore, placebo prescription seems to lack both ethical and empirical justification. ... Therfore, we suggest that placebo interventions are not used outside clinical trials." (p. 15). So Cochrane states what I have stated and you have been unable to refute. Tgeorgescu (talk) 21:05, 25 June 2018 (UTC)

You don't say what you consider a "real disease", and the article does not discuss any such thing. What you say does not relate to the debate. "some quotes are" certainly, but those passages were already discussed ("Fair enough, the author's ultimate judgement is"). What you quote is only half the truth --rtc (talk) 21:13, 25 June 2018 (UTC)

E.g. we are not interested if placebo heals electromagnetic hypersensitivity, since that is not a real disease. Tgeorgescu (talk) 21:16, 25 June 2018 (UTC)

Are we not? electromagnetic hypersensitivity is commonly used as an euphemism for a mild form of psychosis. Is that not a "real disease"? I am unsure about your use of words. Either way, what the source mainly discusses is pain, not psychosis. --rtc (talk) 21:21, 25 June 2018 (UTC)

If you want to be nitpicky, "the belief that one suffers from electromagnetic hypersensitivity" can be viewed as a mild form of psychosis, because the hypersensitivity itself is not a real disease. One could also use morgellons as an example. But all this is immaterial. You know now what your opponents mean by "a real disease": one that is not psychosomatic. Diseases that are made by belief, can be unmade by belief, i.e. by placebo. Otherwise, there is no evidence that placebo cures anything.

Regarding what the paper says: Your quotes from that paper are typical scientists' cover-your-ass statements. It is a rephrasing of "we didn't find anything, but please do not hit us if somebody else does one day." That is how science works: you can never prove that the thing you measure is exactly zero, only that it is as close to zero as makes no difference. When people do that, "zero" is the result that is commonly assumed and commonly put in Wikipedia articles. If we wrote "maybe, maybe not" every time somebody measures a zero-plus/minus-a-tiny-epsilon, that would be to overemphasize the level of uncertainty of scientific results in general. And this is a general question. This is not just about measuring the curing power of placebos, it is also about measuring everything else that is as zero as that. We cannot give this one special treatment.

But if you were able to find other relatively current reliable sources (real experts! no sociologists!) that give this "maybe-it-exists-in-spite-of-our-failure-to-find-it" idea more leeway than those cover-your-ass statements, sources that emphasize that it could seriously be a real thing, that would be another story. --Hob Gadling (talk) 06:53, 26 June 2018 (UTC)

So you are saying that psychosomatic diseases are not real diseases. Psychosis is made by belief and can be unmade by belief. All theories about the chemistry of the brain and its involvement in mental illnesses are lies. Antipsychotics are placebo, the area of psychiatry and psychotherapy is pseudoscience. If the MEDRS paper says placebo might improve a pain condition (with a footnote to the effect that it may also be reporting error) that is a "cover-your-ass statement" and justifies changing the author's judgements to make it understandable to the layman what the real thing is, that placebo is completely useless in every respect. The fact that MEDRS sources say that brain scans and biochemical theories about pain are in line with those cover-your-ass statements is unreliable bunkum. Pain is an illusion; the patient does not suffer pain but merely believes he has pain. Citation needed?! --rtc (talk) 07:46, 26 June 2018 (UTC)

Facepalm And I think with this kind of fuckwittedness we can safely close this thread, which has long since devolved into being non-productive. Alexbrn (talk) 08:16, 26 June 2018 (UTC)

So how about a real, productive argument? Yeah, presenting your opponent as a complete idiot and closing discussion without replying to his argument, that's your way to resolve disputes. Making undiscussed large-scales changes to the article is a sand thing to do; criticizing the radicality of them by pointing out the source says differeent however is overemphasizing alleged "cover-your-ass statement" and general fuckwittedness, timesink, sealioning and what not?! You are free not to reply to my statements. By "Closing discussion" what you really mean is you do a soft block on me, saying I may not write any further comment or else I will be blocked the hard way. What policy justifies this kind of "soft block"? If you do not want to discuss, why don't you simply ignore me? --rtc (talk) 08:20, 26 June 2018 (UTC)

Why is the cherry-picked statement "no evidence [...] of any placebo effect in any of the studies cited" misleading? It is misleading because it may be read as saying that the authors reevaluated the data but found no effect at all that could possibly be explained as a placebo effect. But they are not saying that. They are saying that effects are there, but that those effects "can be fully, plausibly, and easily explained" with explanations other than the placebo effect. So they do not at all rule out placebo effects, they merely say that it not the only, let alone the simplest explanation for the data. --rtc (talk) 19:36, 16 June 2018 (UTC)

Paging Mr. Ockham. Brunton (talk) 19:48, 16 June 2018 (UTC)

Yes, but as I said this paper is over 20 years old and it evaluates the evidence from 60 years ago so it is pretty nonsensical to apply heuristics like Ockham's razor to this ancience state of evidence instead of looking at the full evidence as known today. There are more recent papers, in particular the one discussed just above, which says, yes, "placebo prescription seems to lack both ethical and empirical justification", but with the reservation that "there were possible beneficial effects on patient-reported outcomes, especially pain"; the authors simply do not consider such empirical evidence as collected in an ethical way or such use of placebos as compliant with their ethical opinion, and they stress that those effects may be fully explained by reporting error. --rtc (talk) 19:52, 16 June 2018 (UTC)

Where are you going with this? What changes are you proposing? Brunton (talk) 20:11, 16 June 2018 (UTC)

Stop acting stupid; the changes I made that were reverted, of course. (I re-added them but obviously they will soon be reverted again, that's for sure) --rtc (talk) 20:14, 16 June 2018 (UTC)

Note that Placebo#Criticism brings up the same topic again, this time without even mentioning the 1997 methodological criticism. Also it notes that the study which in updated form resulted in the 2010 source discussed above "received a flurry of criticism". @Alexbrn: claimed above that the 2010 source "has not been challenged". This is a half-truth. As can be seen in [3], the original version of that study "occasioned a blizzard of criticism (13–26) and some support (27). It’s in the papers (28, 29)." The journal that published the original version published 9 dissenting opinions in the next volume. The more recent versions of the study seem not contain any reply to the critics at all. The introduction does not mention those facts and those facts alone refutes the claim that the opinion of those authors can be considered the "settled scientific consensus", especially given the fact that they employ ethical arguments rather than purely empirical ones. I don't see how this can be explained as the opinion of "various quack circles". This seems to be a highly controverstial issue rather than a settled one. --rtc (talk) 20:32, 16 June 2018 (UTC)

• The relevance of the 1997 study is clear from the 1955 study which has been in the lede for a very long time, and is almost certainly the origin of the pervasive placebo myth. If you read a study, and then go back and re-analyse the sources it purported to review, and you find no evidence at all to support the main conclusion of the study, which is what happened here, that's rather significant. Beecher has been cited over 2,000 times and is still being cited now even though his conclusions are definitively refuted by Kienle and Kiene. That's not unusual, by the way: there are articles that have been retracted and are still being cited. What is rather clear now is that most studies purporting to show that the placebo effect is real, are written by "integrative medicine" advocates, i.e. by people whose living depends on the idea that their favoured woo can maguically harness the placebo effect, as a backstop position when (inevitably) they run out of any actual evidence of any mechanism of effect. Beecher is the Andrew Wakefield of the placebo myth, and an authoritative refutation of Beecher is clearly significant in that context. Guy (Help!) 21:59, 16 June 2018 (UTC)
  • What the 1997 study means by "no evidence" is that nothing points towards a placebo effect as the only possible explanation. The other statements in that study which were reverted make that perfectly clear. The 1997 study is a purely a methodological one. Just because it debunks faulty reasoning that has been used as an argument for the placebo effect does not mean it debunks the placebo effect itself. It is completely uncontroversial that Beecher's work is faulty, however, that does not mean it is consensus that the placebo effect does not exist or is a myth. This is a highly controversial claim ("blizzard of criticism"). --rtc (talk) 22:15, 16 June 2018 (UTC)

Here is the paragraph, word for word:

Recently Beecher's article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever.

How the fuck you spin that as "nothing points towards a placebo effect as the only possible explanation" is a mystery to me. It is absolutely unambiguous. You don't say "the original author's conclusions are a crock of shit" in a scientific paper, but this is about as close as you get. Guy (Help!) 22:28, 16 June 2018 (UTC)

Yes, it is indeed unambigous. Note the statement "There were many other factors that could account for the reported improvements". This is exactly what I said: The authors do not claim a placebo effect necessarily does not exist, they merely say a lot of other (more plausible) factors could account for everything at least as well. At least in the evidence used by the study, which is over 60 years old. The cherry-picked quote, taken out of its context, makes it seem as if there were no "reported improvements in patients in these trials", ie., no evidence at all, so a placebo effect could not possibly exist. But that's precisely not what the authors say. Note they say "most likely". They prefer the plausible factors as explanation over the placebo effect hypothesis. They don't say the assumption of a placebo effect is fundamentally ruled out, they just don't think that this explanation is the most likely one. --rtc (talk) 22:32, 16 June 2018 (UTC)

Which comes between In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him and most likely there was no placebo effect whatsoever. I don't think anyone else here is going to interpret this as anything other than unambiguous refutation. Guy (Help!) 00:13, 17 June 2018 (UTC)

Well of course if you simply ignore the statement that contradicts what you say then everything look as if it supported what you say. See, the great thing is we don't need to interpret based on those statements. They are merely the abstract. We can have a look at the main text of the paper. --rtc (talk) 00:17, 17 June 2018 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Kaptchuk

It's time to start reducing this article's reliance on Kaptchuk. He's an acupuncture shill engaged in policy-based evidence making, his studies are uniformly shoddy and the data never live up to the spin he puts out. If you can find a Kaptchuk study that's based on robust objectively measured data instead of subjective outcomes and/or self-reported questionnaires I'd be astonished. He is single-handedly trying to keep the placebo myth alive in the face of increasing evidence that it's baloney, and every time you hear some new hype around the magic of placebo somehow it always seems to be Kaptchuk behind it. Guy (Help!) 21:35, 16 June 2018 (UTC)

Kaptchuk is certainly a relevant and influential author on the subject and his views should thus be mentioned. If his publications are controversial, it should be easy for you to find publications that criticize him. Those can be cited to say his views are under attack, and his views can be attributed to him, thus presenting them not as the uncontroversial truth, but as Kaptchuk's opinion. NPOV permits presenting multiple views, it does not require The One True Scientific Viewpoint to be presented to the reader. -rtc (talk) 00:11, 17 June 2018 (UTC)

Well, he certainly publishes a lot, but consider:

Although albuterol, but not the two placebo interventions, improved FEV1 in these patients with asthma, albuterol provided no incremental benefit with respect to the self-reported outcomes. Placebo effects can be clinically meaningful and can rival the effects of active medication in patients with asthma. (https://www.nejm.org/doi/full/10.1056/nejmoa1103319)

What he actually found was no statistically significant difference in objective outcomes between placebo, sham acupuncture and no treatment, but a substantial objective difference for albuterol. He is then spinning this as a validation of his sham treatment, based on prioritising the self-reported subjective outcomes over the objective ones.

As an asthmatic, I think I prefer an inhaler that objectively improves lung function over one that does nothing but makes me feel as if I have better lung function. Because, you know, asthma can actually kill you, and the objective, not the subjective, outcome is what makes the difference between being objectively dead or not. And this is not a lone example. He has a vested interest in "proving" that a placebo effect exists and that acupuncture, specifically, harnesses it in a uniquely powerful way. Every paper he publishes has positive findings based on self-reported and subjective outcomes. When there are objective measurements, they show no effect, so he waves them away.

It's hard to see that as anything other than research misconduct. Guy (Help!) 00:22, 17 June 2018 (UTC)

You have to option of raising the issue of research misconduct with his employing unversity, or alternatively publish a criticism of his claims. I don't think wikipedia is the right place for making a judgement. If the reader is informed that the existence of placebo effects is controversial, then he will automatically read Kaptchuk in a critical way. If there's a publication that accuses Kaptchuk of misconduct it can be cited as criticism of his work. Kaptchuk is cited so often, it would simply not be due weight to make it seem as if he didn't even exist. --rtc (talk) 00:28, 17 June 2018 (UTC)

Or we could start applying WP:MEDRS and reducing the references to primary research like Kaptchuk's. Guy (Help!) 07:23, 17 June 2018 (UTC)

• I came here because my spidey sense told me someone was actually taking Sanger's talk page temper tantrum seriously instead of laughing it off the way it deserves, but I see that discussion is closed. But I now notice this one, to which I have some commentary to add.

This was a pilot study. It had three test groups and only 43 participants. We should never cite it as evidence of anything except the fact that a pilot study was done and that it didn't indicate that further study would be worthless, or that the authors seemed not only willing to ignore the actual findings (that real treatment outperformed placebo in their tiny little pilot study), but even go on to directly contradict those findings by artificially (and one must presume, willfully) inflating the meaningfulness of self reported data to a greater importance than empirical data. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 14:14, 26 June 2018 (UTC)