Expectations For The New Obama Democrat Government

Sorry to piss on your strawberries, but...

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Rep. Jim Ramstad's name is bouncing around as a possible "drug czar" ” the name given the head of the White House Office of National Drug Control Policy. Ramstad, a Minnesota Republican, is in recovery himself and has been a longtime proponent of treatment for drug abuse.

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{snip} Ramstad has consistently voted against medical marijuana in Congress, opposing an effort to prevent the federal government from raiding or arresting medical marijuana clubs in states where it is legal.

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SourceIf he is appointed, you can forget it. Let's hope not, because I too think that legalisation would be a wise move. Of course the Ramstad thing is just a rumour as yet. Either way, I wouldn't hold my breath for legal marijuana (sorry, couldn't resist).Mutate and Survive.

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"The Bible is like a person, and if you torture it long enough, you can get it to say almost anything you'd like it to say." -- Rev. Dr. Francis H. Wade

Hi Straggler, I know where you're coming from, I think homoeopathy is bunk too. But a reasonable argument can be made for including it in the NHS.Most users of alternative medicine take it for chronic complaints or minor illnesses (colds and such). The placebo effect can be a valuable tool in fighting such minor maladies. If people are queuing up for CARM placebos, the NHS may as well provide them. It will provide real benefits, even if the drugs are bogus.What's more, it keeps people who are not particularly ill from cluttering up the surgeries of real doctors!Just a thought.Mutate and Survive

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"The Bible is like a person, and if you torture it long enough, you can get it to say almost anything you'd like it to say." -- Rev. Dr. Francis H. Wade

Hi Rrhain,First of all, I would like to make clear that I do not necessarily agree with the homoeopathy on the NHS, I was playing something of a Devil's advocate in my previous post because I think there is an interesting case to be made here. In fact, I'm not sure what I think. I brought it up because I think that it is an argument with some merit, even though it goes against my own instinctive hostility towards homoeopathy. I think you are overstating that somewhat.Now I admit that I was not familiar with the Hrobjartsson paper. Having read it, it certainly does shine a new and rather damning light on the placebo effect. Thanks for bringing it to my attention. In retrospect, I was probably talking placebo up a little more than it deserves. But, no placebo effect? At all? I don't think that is quite what the study is saying.They do say that the placebo effect doesn't have any physiological effect, but they still acknowledge it in pain control, as they note here;

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The pooled standardized mean difference was significant for the trials with subjective outcomes but not for those with objective outcomes. In 27 trials involving the treatment of pain, placebo had a beneficial effect, as indicated by a reduction in the intensity of pain of 6.5 mm on a 100-mm visual-analogue scale.

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Even if the placebo effect is wholly restricted to combating pain, that is a very real benefit where it reduces patients suffering. Pain medication can have serious side effects, so if the placebo effect can help reduce the amount of medicine they need, that is a good thing.Also, the Hrobjartsson study isn't the only one out there. This meta-analysis uses much of the same data as Hrobjartsson and Gotzsche, but comes to a different conclusion.

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The explorative analysis of outcome parameters and strength of placebo effects yielded a classification into responsive "physical" versus non-responsive "biochemical" parameters. In total, 50% of trials measuring physical parameters showed significant placebo effects, compared with 6% of trials measuring biochemical parameters.

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From Evidence for placebo effects on physical but not on biochemical outcome parameters: a review of clinical trials by Meissner, Distel and Mitzdorf, 2007The full text is available here.Another recent study claimed to find a host of sub-groups of placebo type effects. Here is the abstract;

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A broad view of the “placebo effect” incorporating neurobiology, individual psychology, epistemology, history, and culture deeply enriches our understanding of these complex and powerful forces and, indeed, urges us to abandon that narrow and logically inconsistent concept for a much more interesting one. We review some of the data and background for such a contention in a thoroughly interdisciplinary way showing how differently presented, but equally “inert,” treatments (2 placebo tablets versus 4, for example) can have different effects; how the same inert treatment can act differently in different historical times and cultural places; and how crucial is the attitude of the clinician in shaping these intensely meaningful forces. These matters, which typically are left to chance, to ideology, or to market forces, should be embraced by the scientific community. We believe that fundamental insights into human biology remain to be discovered in this area.

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Unfortunately only this miserable little abstract is available on-line without a fee. It's here.I'm not trying to get in to a game of your-study-my-study ping-pong here, I'm just trying to point out that the issue is far from done and dusted. Personally, I think I'll reserve judgement for a while, not least because the meta-analyses you and I linked to are based on trials that were not primarily concerned with the placebo effect itself. Some trials that do look directly at placebo are needed I think. I disagree. The placebo effect does seem to exist with regards to pain. Much of what doctors do is not curative, but merely palliative. If the placebo effect can help lessen someone's pain or discomfort, I call that a real benefit, even if it is primarily happening in their imagination. I couldn't agree more.The problem is that doctor's surgeries are beset by people who are not really sick or only trivially so. That's fine at a private clinic, but not so good in a tax-funded healthcare system that is stretched to capacity. What's more, doctors are often unable to do anything for a patient with a chronic complaint beyond providing a sympathetic ear and a shoulder to cry on. That is one thing that CAM practitioners tend to be quite good at.Don't get me wrong; the first port of call for someone who is unwell should always be a doctor. There is no way I trust some ridiculous homoeopath to do triage. I do think though that they might be able to take some of the hypochondriacs and other time-wasters away from doctors waiting rooms whilst still giving them the help they need (even though a hypochondriac's latest disease may be imaginary, their distress is very real and they do deserve help).Having said all of this, I'm still pretty hostile to CAM treatments on the NHS, just for different reason than the ones you give above. I think that providing these treatments on the NHS gives them an undeserved veneer of respectability that helps prop up the wider CAM market and mostly for that reason, I am, on balance, against it. I think.I just think that the placebo argument is an interesting one, with some merit, even if it is restricted to subjective symptoms.Mutate and Survive.

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"The Bible is like a person, and if you torture it long enough, you can get it to say almost anything you'd like it to say." -- Rev. Dr. Francis H. Wade