"zzyzx, what did you find challenging? Mind elaborating on alt med and any practical consequences for EMS or nursing? "
The main thing I took away from Dr Newman's long exploration of placebos is that we should not dismiss placebos as not being real.
When we say that, for example, a certain antidepressant is only slightly more effective than a placebo, we might say that the drug doesn't work, that it doesn't have a real effect. However, if say, 30% of people who took the drug say they felt better, and 25% of those who took the placebo also said they felt better, but hardly anyone who had no treatment at all reported any improvement in their mood, then in fact the drug really did have a positive effect on patients and it certainly was effective.
Yeah, of course this opens the door for lots of BS, both from established pharm companies and sellers of supplements. ("Hey, let's get a bunch of people with fibromyalgia to say that our antidepressant also reduced their pain, and then we can get the FDA to let us market it as a pain medication as well!")
Back in the days when doctors took a paternalistic approach toward their patients, they might give them a sugar pill but tell them that it was a real medication, knowing that the placebo effect could make them feel better. That would be hugely unethical today. Yet in a way doctors are doing something similar in prescribing medications that are effective, yet not really much more effective than a placebo. Again, anti-depressants are an obvious example. But is that unethical? If you truly informed the patient and said, "This drug is effective in 30% of people with your symptoms, but it's really not any more effective than a placebo pill, so basically it only works if you believe that it does," then it doesn't seem likely that the medication would work on many patients or that they would even want to take it.
What I also found interesting was the study Dr Newman cited in whichpatients were given a placebo pain medication, and told that it was an IV narcotic. Their vital signs were then measured. If I remember correctly (it's been a year since I listened to the podcast), their breathing and pulse slowed significantly. Then, without them knowing it, they were given Narcan. When their vitals signs were rechecked, their breathing and pulse had both quickened. This study seemed to show that placebos can in fact have a truly measurable physical effect.
From what I remember Dr Newman saying, the most important point related to all this is that the healer-patient relationship is often undervalued when you have a lot of drugs available to treat patients. Anyhow, it was a great podcasts and I hope these guys keep finding the time to so carefully research and present these "deep dives" into evidence-based practice.
