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Prepare to be amazed by some evidence-based magic


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I like to pretend I practice evidence-based medicine. Pretend in the sense that I make a big fuss about how EBM I am when what I already do accords with a recent meta-analysis. But when it doesn’t, I make a point of rubbishing the research, on account of it being rubbish, or quietly carrying on as I am and hoping that no one will notice.

Thankfully, slabs of evidence which crush my pre-conceived notions of good practice come along fairly rarely. That said, I have only just recovered from that shocker in the college rag that concluded patients who believe they’re suffering from cardiac pain really are more likely to be suffering from cardiac pain. That is just so counter-intuitive on every level that I am still demanding a recount.

Anyway, now there’s this: ‘Can honestly prescribed placebos evoke meaningful therapeutic benefits?’ .

I’ll lead you gently through this, and those of a nervous disposition should look away now. So, you know about the placebo effect, yeah? Good. And you know they only ‘work’ because patients are lured into thinking they might genuinely benefit – the psyche therefore tricking the soma into feeling better, right? Wrong.

Because, apparently, even if you tell the patient that the treatment being administered is a placebo – in essence, that this is fresh air in tablet form that I’m giving you, but, hey, let’s give it a go – the patient still gets better. That’s right: fessing up that you’re giving them nothing, and therefore not building in a psycho-tickling expectation of improvement, does not stop them from improving.

The only rational conclusion to draw from this is, WTF?

I have always steered clear of placebos on the basis of the deceit required. Now it seems the supposed sleight-of-prescribing was real magic all along: you can adopt a policy of complete honesty and still cure all those migraines, IBSs and TATTs.

I don’t know whether to laugh or cry. But I do know that I’m thoroughly confused. Would someone who knows about research kindly take a look at this paper with a view to finding enough flaws to allow me to reconvene back in my comfort zone?

In the meantime I will console myself with the fact that, at last, homeopaths have no reason not to practice in an honest way. Because, now, they can dish out their various versions of water without having to dress it up in pseudoscientific claptrap. And it will remain as effective as it ever was.

Dr Tony Copperfield is a GP in Essex

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Readers' comments (7)

  • Unbelievable
    You came across a ‘shocker in the college rag’
    Whatever were you thinking of when you picked it up?

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  • Yes Copperfield. It’s nothinh to do with the pill. It’s all to do with the attention from a lovely person that cares.
    I’ve just been to a conference where the speaker showed evidence that behavioural activation ( cheaper) is equally efficacious to CBT ( more expensive) in mild/ mid depression and then further meta analysis which shows that actually all the different modalities are actually fairly equivalent for big standard depression/ anxiety.
    Lots of talk about the common denominator- hey presto a study showing that therapy is pretty equivalent to being regularly seen by concerned professional person doing no active harm.

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  • That should be bog standard depression not big standard depression ( which of course is much more severe)😐

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  • I had to stop my honest placebo treatment as the side effects were just too severe, I had them all, nausea, vomiting, dizziness, headaches and skin rashes. It has taken a long time to recover, but I am being helped by taking a two different coloured honest placebo capsules. Is honest placebo polypharmacy bad for you?

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  • AlanAlmond

    Legalise placebos just like they have done in Canada.

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  • On the back of this research I demand the NHS resumes funding homeopathy.

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  • Practise!

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