Re: Re: When Feces is the Best Medicine: An Anglo-Saxon Medicine follow-up

Home Forums General Discussion When Feces is the Best Medicine: An Anglo-Saxon Medicine follow-up Re: Re: When Feces is the Best Medicine: An Anglo-Saxon Medicine follow-up



I was pleased that Jamie mentioned that some of these treatments might have had a placebo effect.  That is undoubtedly the case, but the degree of this effect is often underrestimated.  Take a look at this – pages 3 and 4 (I imagine it's all quite interesting, but its fairly dense reading).  My point is that, with the example of a common condition like arthritis, the difference between the effect of drugs we use and placebo is LESS than the effect of placebo itself.  In other words, more than half the benefit of aspirin (for pain, not cardiovascular disease) is from the placebo effect.Furthermore, the placebo effect is quite dependent on how much we've been primed to believe in the power of the treatment (google Ben Goldacre and Placebo for Dr Goldacre's excellent talks on the topic) - so injections of saline work better than sugar pills, and red sugar pills work better than green ones.  For a superstitious culture the placebo effect must have been pretty powerful.  My field is veterinary medicine which, due to the fragmented nature of its practitioners and the relative dearth of funding, is still a fair bit behind human medicine regarding an evidence base.  However at a lecture a few years ago our dilemma was put across as "only forty percent [nb: might have been 60%] of human medicine has an evidence base, and vet. med. is worse".  This isn't to say that the non evidence based stuff is useless, just that it hasn't been conclusively proven to be a good idea (as an example, steroids have been used after severe head trauma until very recently, on the basis that they reduced swelling.  It has since been found that compared to placebo they actually increase mortality over the next two weeks, because they don't work as well for trauma-related swelling as they do for tumour-related swelling, and the side effects can be significant).  So, as Jamie attested in the podcast, we should be careful not to assume that the medical fallacies which so derailed historical medicine have been even generally resolved.Must go - have another hundred or so podcasts to catch up on!