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Post by ianl on Feb 26, 2009 21:31:09 GMT
Hi
Thought I'd start this one.
Based on personal experience and then upon personal practice (i.e. providing the treatment) I have found reflexology and/or reflextherapy to have personal benefits, both to me and to pts I have treated.
So, firstly, how many of our group have found similar or not? Secondly, do those who have or who practice it go along with the concept of reflex zones or do they consider it to be something else? (NB see how long we can go before resorting to the catch all placebo concept ;D)
Of course this may go no where.
Ian
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Post by Martin Harvey on Feb 26, 2009 23:05:02 GMT
Ian, Reflextherapy, what that Regarding the ‘Placebo Effect’ what happens if it IS proved to be an endogenous biopharmacotherapeutic effect May not be as far fetched as it sounds, when Kirsch & Sapirstein, looked at the PE in 1998 (1) they claimed that a proportion of antidepressant drug therapy efficacy came from the PE and Leutcher et al, in 2002 (2) went much further and suggested there was a substantial biochemical effect due to endogenous neurotransmitter modulation. So, in that case, how long before The Placebo Effect finds its way into the BNF? and we start writing Rx for; “Placebo 50mg QDS”? (1) KIRSCH, I. & SAPIRSTEIN, G., Listening to Prozac but hearing placebo: a meta-analysis of antidepressant medication. Prevention & Treatment, Journal of the American Psychological Association., Vol 1(2), Jun 1998, Art ID 2a. (2) LEUCHTER,A. F., COOK, I. A.,WITTE, E. A., et al (2002) Changes in brain function of depressed subjects during treatment with placebo. American Journal of Psychiatry, 159,122-129. Cheers, Martin now, where did I put that Cat?
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Post by Admin on Feb 27, 2009 7:08:38 GMT
Regarding the ‘Placebo Effect’ what happens if it IS proved to be an endogenous biopharmacotherapeutic effect Ah... - the famous "Talking Prozac - Hearing placebo" Paper. This is an excellent read - thanks for introducing it Martin. My personal opinion on reflexology is that it is placebo-effect at work. Regards,
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Post by ianl on Feb 27, 2009 7:14:33 GMT
Hi Martin
I'll come back to reflextherapy later as I'm dashing out, but many years ago came across this paper which is interesting:
Placebo effect and placebo concept: a critical methodological and conceptual analysis of reports on the magnitude of the placebo effect.
Kienle GS, Kiene H. Insitut für angewandte Erkenntnistheorie und medizinische Methodologie (Institute for Applied Epistemology and Medical Methodology), Freiburg, Germany.
Since 1955, when HK Beecher published his classic "The Powerful Placebo," it generally has been accepted that 35% of patients with any of a wide variety of disorders can be treated with placebos alone. In recent years, average cure rates of 70%, and up to 100%, also have been quoted. Like pharmacological preparations, placebos are credited with possessing time-effect curves; cumulation and carry-over effects; differentiated actions depending on color, size, or packaging; even toxic effects. It has been postulated that placebos can prolong life, that their effects occur in surgery as well as in medicine, and that they are mediated by endorphins. In this article source material that forms the scientific basis for such claims is examined. Analysis shows that the studies on which such ideas are based, except perhaps in bronchial asthma, do not in any way justify the conclusions drawn from them. The truth is that the placebo effect is counterfeited by a variety of factors including the natural history of the disease, regression to the mean, concomitant treatments, obliging reports, experimental subordination, severe methodological defects in the studies, misquotations, etc; even, on occasion, by the fact that the supposed placebo is actually not a placebo, but has to be acknowledged as having a specific action on the condition for which it is being given. A further reason for misjudgment is the lack of clarity of the placebo concept itself. Experimental subordination and conditioning are other areas of insufficient conceptual differentiation. The authors conclude that the literature relating to the magnitude and frequency of the placebo effect is unfounded and grossly overrated, if not entirely false. They pose the question whether the existence of the so-called placebo effect is itself not largely-or indeed totally-illusory.
Martin : "what happens if it IS proved to be an endogenous biopharmacotherapeutic effect?"
I think that if an effect is achieved then fine and, even if you take the energy approach to things, there would have to be a biochemical action. So, if you took the view that there may be energy zones and they could influence change there still has to be a biochemical affect. However, empirically, if you encounter repeated biochemical results from working on what are traditionally thought to be energy aspects can we dismiss it as placebo only or do we start to think differently.
I'm simply tossing this up for an exploration. Cheers Ian
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Post by robertisaacs on Feb 27, 2009 20:39:15 GMT
You swines. you know i can't stay away from this one! We now have two questions running here. The nature of the placebo effect and the nature of reflexology. Re the placebo effect. Thats an interesting abstract. My attention was grabbed by the phrase "the truth is", which always rings alarm bells for me. How many of us are brave enough to beleive we have found "the truth"? It seems to me that this is a good example of the "how many legs if you call the tail a leg" question. They end with the bold statement that the placebo effect is illusory. They state that the existing literature is grossly over rated, an exceeding bold and sweeping statement. I do not think I can accept this opinion as "truth" without some more specific refutation of what seem to me to be well carried out studies. One cannot simply say of something which is accepted by the scientific community that it is "not the truth" without some rather solid refutation. The abstract also fails to adequately explain many of the findings of placebo studies. are all things which most studies i have seen take into account. Like any study which makes a bold claim contrary to the balance of other studies on the subject one would need to carefully examine the whole work. Many reviews which are so critical of other work are themselves vulnerable to critism. Now. Regarding reflexology. I read something on the scientific method once. Irritatingly i forget where. There were several points 1. If somebody wishes to make a claim of something it is up to them to prove its existance, not up to everybody else to disprove it. This is because of the nature of the scientific method. If somebody claims that there is a green mouse in my house, I will be at a loss to disprove them. However carefully i search, there will always be the chance that i might have missed it. They can claim i don't really WANT to find it and point knowingly to droppings and ask how I think they got there. I am in an impossible situation. HOWEVER it is not up to me to prove that there is no mouse but for you to prove that there is! This is far simpler than to prove the negative, you have only to find the mouse. It is also upon you as the claimant to offer the justification to your statement. 2. Extraordinary claims require extraordinary proof. Reflexology works with ideas outside of accepted scientific knowledge. That means, for me, that evidence for it should be MORE solid than i would expect of conventional ideas. 3. Claims made without evidence can be dismissed without evidence. So. To answer the OP. I tried reflexology once. Observed nothing. I cannot see a mechanism for its action. I have never seen any quality research to indicate that it is effective. I am therefore inclined to opine that any effects observed are the result of the placebo effect (which i cannot dismiss) and / or psychological effects. Which i know will shock you all . Kind regards Robert Pre post modernist (or possibly post post modernist. Or even post pre post modernist.)
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Post by robertisaacs on Feb 27, 2009 20:44:19 GMT
Oh and as an afterthought, please note that i did not say that i do not think there is a role for such therapies. I think there is. But i think that as practitioners of them we have an obligation to ourselves, our patients and the investigators who will one day stand upon our shoulders to attempt to understand the mechanisms for what we do. I beleive in fundamental causality, that for every effect there is a cause. I will always seek to identify that cause.
R
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Post by Martin Harvey on Feb 27, 2009 22:55:02 GMT
Have to agree with Rob, the language used in the extract is absolutist. 'The Truth Is' sounds perhaps a little too Fox Mulder to be the best way to woo the scientific community. Also, the references to time - effect curves and carry over are couched seemingly dismissively, when in fact if there are biochemical effects taking place then surely they would be an integral part or sequelae of such effects. Endogenous chemicals, be they serotonin or endorphins will still possess the same pharmacodynamics as exogenous analogues. Whatever the mechanisms, if it works and does no harm then great! I do wonder if the 'alternative' health community is a little hypersensitive over the word 'placebo'. If it really is an effect, and its beneficial, then is it not deserving of serious research? Although how you would design a DBRCT with a suitable inactive placebo to examine the placebo effect when comparing it against an active placebo and compensate for the naturalist component whilst maintaining methodological rigor in a quantitative spectrum that eliminated confounding qualitative variables is far beyond my poor old head Scattergram on toast and a cup of Chi anyone ? Cheers, Martin
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Post by billliggins on Feb 28, 2009 14:38:13 GMT
Martin
In your original post were you referring to the cat-o'-nine tails (certainly a good flogging will cause hyperaemia, probably reflex hyperaemia elsewhere than the back and inevitably endorphin/encephalin production), a quantum cat (two cats with differing characteristics - or perhaps not - relating to quantum medicine), or a good old fashioned purring moggy?
Thanks
Bill
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Post by robertisaacs on Feb 28, 2009 18:05:41 GMT
Possibly a quantum cat. The effect is both a placebo and not a placebo until observed by an rct which collapses the uncertainty field and forces it to resolve into one state or the other. Of course schrodinger's experiment was actually a critique of quantum theory. He was seeking to illustrate a fundamental NON relativism in macro systems... Could be relevant to the present debate... I meant to ask. Martin, what's an active placebo? Regards Robert
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Post by robertisaacs on Feb 28, 2009 19:46:30 GMT
For them as HAVE social lives and don't know what the hell cats have to do with reflexology... The schrodingers cat experiment was a reaction to the copenhagen interpretation of physics. Put very, very simply this states that objective reality as we know it is not so simple as we think and that it is possible, for example, for something to be two things at the same time until observed otherwise. Simplifying schrodingers experiment. One puts a cat in a sealed box with some poison and a mechanism with an exactly 50 / 50 chance of breaking the bottle of poison. The copenhagen interpretation is that if the inside of the box is not observed and the odds are exactly 50 50 the cat is BOTH ALIVE AND DEAD, existing in both forms, in schrodingers words :- Schrodinger, and others, beleived this to be tosh. The cat is alive or dead, not both! Einstein wrote to schrodinger . We now return you to your regularly programmed viewing as a slightly more rounded and educated podiatrist. Regards Robert
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Post by Martin Harvey on Feb 28, 2009 20:15:56 GMT
Bill, exactly the point, my cat no longer knows if its alive or dead (is the smell and green colour normal?) - so confused! Rob, Active placebo. Say you were trialling a drug that has a recognised side - effect, lets hypothesise a novel anxiolytic with an imidazopyridine structure, then you could reasonably expect (or perhaps even know from pretrials) that there is a high probability it will cause drowsiness. If you just trialled it against sugar pills then the lack of side effects could be suggestive to either the Pt or the Clinician. So you just give a placebo with a primary effect that is similar to the expected side-effect, perhaps low dose temazepam or something similar. These active agents are sometimes called 'nocebos' the suggestion being that it is intentionally harmful (nocere). Problem is you then have to untangle placebo from nocebo effect and so on and so forth and,of course, in the example quoted above, perhaps 'anxious of tenbury wells' just needed a good nights sleep so the nocebo actually cured them and the drug undergoing test was no da**ned good anyway! Cheers, M
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