Talk:Placebo/Archive 8

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Archive 8

Real or not

There seems to be consensus at this page that the placebo effect is not "real" in the sense that it can only improve self-reported outcomes and does not result in healing. This viewpoint is based on a few rather old reviews, and is contradicted by numerous more recent reviews such as these. This list of references is by no means comprehensive and represents just a small part of the recent research that has been conducted on the subject. This article's view on placebos needs to be updated. --Wikiman2718 (talk) 20:48, 18 August 2019 (UTC)

References

Medicine is littered with studies of imaginary things. Homeopathy, for example. The issue here is that those arguing for the existence of a placebo effect are primarioly either quacks trying to use it to validate inert treatments (usully acupuncture) or are ctually studying something else - the effect of perception on physical symptoms. What you're offering is primary studies into a thing, predicated on the belief that it exsts, as rebuttal to review studies that say the thing does not exist. Guy (Help!) 07:50, 19 August 2019 (UTC)

I'm offering up six reviews saying that it exists, all published in Medline indexed journals. And this was just what I found on my first pass of pubmed. You are offering up one review saying that it doesn't. --Wikiman2718 (talk) 12:37, 19 August 2019 (UTC)

No, they assume it exists and try to quntify it. Guy (Help!) 16:12, 19 August 2019 (UTC)

1) That is not so. These reviews show a lot of empirical evidence. 2) Wikipedians should not try to peer review studies. If the bulk of the literature finds that it exists (even if it doesn't) than Wikipedia should too. See Wikipedia:Verifiability, not truth. --Wikiman2718 (talk) 13:23, 20 August 2019 (UTC)

@JzG: I see that you reverted by addition of these two books to the further reading section, saying that it makes no sence to have a book on the neurobiology of something that doesn't exist. I would like to add these two books to the pile of evidence that the placebo effect does exist. It should be noted that the amount that we know about the neurobiology of the placebo effect is too large to fit into one book. --Wikiman2718 (talk)

• Neurobiology of the placebo effect. Part I. Colloca, Luana,. Cambridge, MA. ISBN 9780128143261. OCLC 1032303151.{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: others (link)
• Neurobiology of the placebo effect. Part II. Colloca, Luana, (First edition ed.). Cambridge, MA, United States. ISBN 9780128154175. OCLC 1049800273. {{cite book}}: |edition= has extra text (help)CS1 maint: extra punctuation (link) CS1 maint: others (link)

Actually one book. Show me the evidence that this is considered to be a worthwhile contribution to reality-bsed treatment? You seem very keen to refactor this article to show the belief that placebos are real. That's problematic. I note also that virtually everything the (single) author has ever done, is promoting the idea that the placebo effect is a thing. She seems very vested in this notion. You'll forgive me for being suspicious: this field of research looks incredily like acupucture studies or homeoapthy studies - endless discussion of "how X works" while studiously ignoring anything that shows it doesn't. Guy (Help!) 14:15, 19 August 2019 (UTC)

Most medical professionals seem to take the placebo effect as a given, assuming that the patient's expectation of something can result in a change in perception or a psychosomatic response. That may very well be incorrect, but it's far from being a fringe belief. This is what my pharmacology textbook has to say:

The 'placebo response' (see review by Enck et al, 2013) is widely believed to be a powerful therapeutic effect, producing a significant beneficial effect in about one-third of patients. While many clinical trials include a placebo group that shows improvement, few have compared this group diretly with untreated controls. A survey of these trial results (Hróbjartsson & Gotzche, 2001) concluded (controversially) that the placebo effect was often insignificant, except in the case of pain relief, where it was small but significant. They concluded that the popular belief in the strenght of the placebo effect is misplaced, and probably reflects in part the tendency of many symptoms to improve spontaneously and in part the reporting bias of patients who want to please their doctors. (Rang & Dale's Pharmacology, 2016)

The paper they cite for "widely believed" is this 2013 review in Nature Reviews Drug Discovery. The website of the American Cancer Society which we cite says: Even though they don’t act on the disease, placebos affect how some people feel. This happens in up to 1 of 3 people. – Thjarkur (talk) 14:16, 19 August 2019 (UTC)

@JzG: Placebos have been found to produce clinically significant improvements in some diseases, but this is not the same as asserting that they should be used in clinical settings. Some argue that they should, while others argue that this amounts to deceiving the patient and is therefore unethical. We should keep these two discussions distinct. --Wikiman2718 (talk) 14:23, 19 August 2019 (UTC)

@Þjarkur: I have seen no evidence that placebos shrink tumors. I'm sure that everything the American Cancer Society said is true in the context of cancer treatment. --Wikiman2718 (talk) 14:38, 19 August 2019 (UTC)

No, they have not been found to produce clinical improvements in any disease. They have been shown to produce temprary changes in symptoms of diseases, but this is generally restricted to self-reported and subjective symptoms. Example: the infamous asthma study found that patients resported improvements, but measurements showed no change at all in lung function - which is pretty dangerous. Thikning your asthma meds are workign when they aren't is a realy bad outcome. Guy (Help!) 14:39, 19 August 2019 (UTC)

Þjarkur, it's not a fringe belief, what's fringe is the move from "placebos make people feel better" to "this is how placebos maake people better". That's the problem. All the objective data says people feel better, but not much, not for long, and they nly feel it, it doesn't translate into objective effects. Bear in mind that there are at least two widely-promoted forms of SCAM that claim to harness the placebo effect: acupuncture and homeopathy. Neither of these is actually shown to have any objectively measurable effect on te disease proecesses when you blind and test properly. Guy (Help!) 14:44, 19 August 2019 (UTC)

On the contrary, acupuncture and homeopathy claim to be active treatments, not placebos. It's their opponents who dismiss them as placebos. Anywikiuser (talk) 16:06, 19 August 2019 (UTC)

In some diseases placebos produce only perception of improvement (such as asthma) while in others (such as pain and Parkinson's) it can produce real improvement. This has been determined by empirically, and the biological mechanisms have been identified. For example, this review finds that placebos reduce symptoms in Parkinson's disease. In finds that placebos cause the brain to release dopamine. That means the mechanism of action for placebos in Parkinson's is the same as for active drugs: they raise dopamine levels in certain parts of the brain. Furthermore, the size of the effect depends on the patient's expectation of improvement, and larger dopamine release can be conditioned through prior exposure. It is also well-verified that placebo analgesics reduce pain, and even the 2010 review that is cited in the article finds this. Placebo analgesics cause the release of endorphins, which are natural painkillers. Another study (that I can't seem to find right now) found that placebo analgesia is blocked by the opiate antagonist naltrexone. --Wikiman2718 (talk) 14:51, 19 August 2019 (UTC)

I would be fine with the Parkinson's disease study, as it fits the criteria for being a reliable secondary medical source. Ideological discussions about the placebo effect won't get us anywhere − it comes down to whether editors can supply information that is supported by acceptable sources. Anywikiuser (talk) 15:42, 19 August 2019 (UTC)

Both acupuncture and homeopathy have a history of claiming to harnes the "placebo effect", including acupuncture claiming that because sham acupuncture and real acupuncture are indistinguishable, so acupuncture harnesses the "placebo effect" relaly well, give us more money please.

Meanwhile back in the real world the evidence for objective effects is sketchy at best, and the risks of claiming the placebo narrative are demosntrated by the asthma case. Guy (Help!) 16:12, 19 August 2019 (UTC)

Wikiman2718 I am looking for a critique of that naltrexone study. As Ir ecall it was the usual shit: based on self-reported subjective outcomes. Virtually every study of the "placebo effect" is based on patient questionnaires. Guy (Help!) 16:14, 19 August 2019 (UTC)

@JzG: Can you show the review (and the original study)? Even the American Cancer society article stated that placebo analgesics cause the release on endorphins. That makes it completely implausible that placebo analgesics would not produce clinical improvement in real outcomes. There seems to be far more evidence for than against here. --Wikiman2718 (talk) 16:27, 19 August 2019 (UTC)

If you have reliably sourced information (see WP:MEDRS for guidelines), feel free to add it to the article. I'm wary that this discussion is turning into a debate on the placebo effect and I don't think that's going to get us anywhere. Anywikiuser (talk) 17:59, 19 August 2019 (UTC)

I am familiar with the analysis you just added ([1]). It's perfectly emblematic of the problem: virtually every included study has subjective endpoints (e.g. Parent-reported ADHD Scale, SDQ). There is a profound lack of data based on objective measurements, and on the rare occasions when subjective and objective outocmes are compared (e.g. [2]) the result clearly shows no objective effect. Guy (Help!) 09:51, 20 August 2019 (UTC)

A few months ago I added a meta-analysis on insomnia treatments that makes a similar point. Anywikiuser (talk) 10:39, 20 August 2019 (UTC)

These studies have al the elemnts of "tooth fairy science". Guy (Help!) 11:37, 20 August 2019 (UTC)

Do you have any studies to show this? So far it just seems to be one 2010 review and a statement from the American Cancer Society based on that review. In a field like this with lots of research, we should rely on reviews from the last five years. --Wikiman2718 (talk) 13:17, 20 August 2019 (UTC)

• See also: User talk:Wikiman2718#Parkinsons --Wikiman2718 (talk) 13:23, 20 August 2019 (UTC)

  We seem to have consensus that placebos improve objective outcomes in at least two illnesses-- pain and Parkinson's. We also have consensus that placebos do not improve objective outcome is asthma or cancer. We should evaluate each claim on a case-by case basis, taking care to distinguish between objective and subjective outcomes. --Wikiman2718 (talk) 13:48, 20 August 2019 (UTC)

I would argue that pain is neither a fully objective nor a fully subjective experience. And I'd be careful about saying placebos can objective outcomes for Parkinson's (my hunch is that it can't improve life expectancy, for instance). But the source does provide evidence that there is a link between placebo treatment of Parkinson's and the release of hormones, which is an objective effect. And I agree about the need to evaluate each claim on a case-by-case basis. It comes down to whether the information is backed by reliable sources. Anywikiuser (talk) 14:43, 20 August 2019 (UTC)

This review finds that placebos can improve motor control in Parkinson's disease by causing the brain to release dopamine. That's the same mechanism as the active drug. That's about as objective as it gets. I don't think anyone's ever studied the effect on life expectancy. --Wikiman2718 (talk) 15:20, 20 August 2019 (UTC)

Indeed, and I'm fine with that studies' findings being added to the article. Anywikiuser (talk) 15:35, 20 August 2019 (UTC)

That is indeed what it appears to show, but I think you may be missing my point. Overall, the evidence strongly shows that placebo effects are purely subjective. If, uniquely, Parkinsons can show an objective effect, then that would be a remarkable finding but it doesn't change the fact that if you look at pretty much any review of placebos, you find all the outcomes to be subjective and self-reported, and very few actually even test for any objective outcome. Where this is done, none is found. So if we cover PD it should be as an exception that's not yet understood, rather than as rebuttal to the fact that the placebo effect is not a thing. Guy (Help!) 16:41, 20 August 2019 (UTC)

The reviews listed above cover Parkinson's, pain, depression, and even some immunological disorders. You keep saying that there are many reviews debunking these claims, but I have yet to see them. The reviews presently cited in the article are not from the last five years. It looks like the sources that say that placebos can effect only self-reported outcomes are outdated. If you have any WP:MEDRS sources that say otherwise, please show them. --Wikiman2718 (talk) 16:52, 20 August 2019 (UTC)

So, this lands us with "extraordinary claim, probably bogus, yet not debunked in the scientific literature". Do you think we play whack-a-mole? Tgeorgescu (talk) 00:08, 26 August 2019 (UTC)

Show sources, please. --Wikiman2718 (talk) 00:14, 26 August 2019 (UTC)

I don't have sources, but we have WP:RULES, such as WP:REDFLAG. Do you realize that this could be the misconception of the year, next year will be another misconception about placebos which will still be not debunked, the year after that another misconception and so on. That's what I mean by whack-a-mole. You will keep edit warring to include the misconception of the current year. Tgeorgescu (talk) 00:17, 26 August 2019 (UTC)

@Tgeorgescu: 1) My edits come nowhere near the threshold for an edit war. Please do not accuse me of that without evidence. 2) WP:REDFLAG states that extraordinary claims must be justified by multiple high quality sources. I have shown seven so far, and there are a lot more available. There were only ever two studies finding the opposite: one was from 2010, and the other from the 1990s. Neither is WP:MEDRS. If you want your claim to stand, you will have to show some valid sources. --Wikiman2718 (talk) 00:29, 26 August 2019 (UTC)

The WP:ONUS is upon those who want to change the status quo. Wikipedia isn't for bleeding-edge knowledge, it is for established, banal and boring knowledge. Also, there is no need that an edit war is fast-paced. Slowly changing an article with yet undebunked knowledge is still edit-warring. Tgeorgescu (talk) 00:34, 26 August 2019 (UTC)

@Tgeorgescu: I have shown the appropriate sources. The knowledge is well-established. If you disagree, I challenge you to find one WP:MEDRS source to validate your opinion. Also, WP:ONUS only applied to verifiable claims, which yours isn't. --Wikiman2718 (talk) 00:36, 26 August 2019 (UTC)

You're working under the misconception that WP:RS trump WP:PAGs. Tgeorgescu (talk) 00:40, 26 August 2019 (UTC)

WP:MEDRS is a guideline... Are you proposing we ignore it? --Wikiman2718 (talk) 00:56, 26 August 2019 (UTC)

I know. And I find bizarre to say that Cochrane isn't MEDRS-compliant. Previously I meant: reliable sources do not trump policies and guidelines. Perhaps I was too concise. Tgeorgescu (talk) 01:02, 26 August 2019 (UTC)

@Tgeorgescu: It is not from the last five years. --Wikiman2718 (talk) 01:05, 26 August 2019 (UTC)

• The article currently reflects both viewpoints. I have added the self-contradictory template until such time as this is resolved. --Wikiman2718 (talk) 20:00, 25 August 2019 (UTC)

  Template removed. Problem resolved. --Wikiman2718 (talk) 00:14, 26 August 2019 (UTC)

Actually, Tgeorgescu, it isn't an extraordinary claim to say that the placebo effect has objective effects. The science shows that the placebo effect influences neurotransmitters, which is clearly objective. It would be more of an extraordinary claim to say that the placebo effect has no objective effects, which seems to be what the article is saying at the moment.

It seems there is a bit of cherry picking in terms of the reviews used here. The sleep review that we use says there are no objective changes to sleep onset. However, as far as I can see, the review didn't actually look at any studies that measured objective sleep onset. Other reviews do find a significant difference in sleep onset. And the Cochrane review is 18 years old.

The problem with depression is that there are no 3-arm trials comparing antidepressants to placebo to no treatment, so we don't have any studies to definitely say there is an objective placebo effect. However, given what we know about neuroscience, it would be somewhat extraordinary if there wasn't any objective placebo effect.--sciencewatcher (talk) 00:40, 26 August 2019 (UTC)

Do you realize that your argument applies to any form of quackery, e.g. faith healing? And in which way "placebo changes neurotransmitters" is different from "watching A Clockwork Orange changes neurotransmitters"? Tgeorgescu (talk) 00:55, 26 August 2019 (UTC)

We already discussed truth. Let's keep this about verifiability, please. --Wikiman2718 (talk) 01:01, 26 August 2019 (UTC)

Extraordinary claims need extraordinary evidence, that is what WP:REDFLAG means. You cannot trump Cochrane with an ordinary review, which might as well get debunked in a couple of years. Tgeorgescu (talk) 01:05, 26 August 2019 (UTC)

The Cochrane review is not from the last five years. I have have not shown one review, but several (as WP:REDFLAG requires). --Wikiman2718 (talk) 01:10, 26 August 2019 (UTC)

You have to have better sources that a scientific revolution has happened. Tgeorgescu (talk) 01:20, 26 August 2019 (UTC)

I see no evidence that the conclusion of the Cochrane review was widely accepted in the first place. The studies I am looking at show that it wasn't. The evidence in favor of a placebo effect is absolutely overwhelming. --Wikiman2718 (talk) 01:24, 26 August 2019 (UTC)

Why then isn't your claim big news all over the world: "Placebos finally vindicated"? Tgeorgescu (talk) 01:28, 26 August 2019 (UTC)

That is a loaded question. It implies that the placebo effect was ever in genuine doubt. But regardless, you can find tons of news articles on this subject (both mainstream and scientific). —Wikiman2718 (talk) 01:34, 26 August 2019 (UTC)

IMHO, that smacks of WP:PROFRINGE. The reality-based community doubts that there is any solid evidence for placebo healing anything, except imaginary illnesses. You have been warned of discretionary sanctions. Your POV is: Cochrane on placebos is not good now and was never good, there wasn't ever any genuine doubt about placebos. Are you for real? Do you realize that our article tells a quite different story? Do you realize that when people wanted hard evidence of objective effects of placebos, they could not find any or they had stumped on a statistical fluke? Tgeorgescu (talk) 03:02, 26 August 2019 (UTC)

@Tgeorgescu: Refusing to acknowledge WP:MEDRS guidelines is disruptive. --Wikiman2718 (talk) 03:12, 26 August 2019 (UTC)

I agree with you that it is disruptive. The question is, however: who does that, you or me? E.g. I'm not the one bashing Cochrane... Tgeorgescu (talk) 03:15, 26 August 2019 (UTC)

You are. The rule says five years. That rule was created specifically for situations like these-- information becomes outdated. --Wikiman2718 (talk) 03:17, 26 August 2019 (UTC)

WP:Wikilawyering. Do mind that I wasn't the only one who has reverted your edits today. See WP:1AM. You need WP:CONSENSUS for your edits, otherwise status quo wins by default. Also, daring to bash Cochrane on Wikipedia means that you have huevos: such daring usually ends badly. Tgeorgescu (talk) 03:28, 26 August 2019 (UTC)

That one old review is the entire argument. We have consensus that placebos work for some conditions (e.g. Parkinsons), which means we have consensus it is outdated. Despite the massive amount of research that has been conducted in this field, there are literally no reviews from that last five years that support your viewpoint. --Wikiman2718 (talk) 03:51, 26 August 2019 (UTC)

I did not know that there is anyone who really suggests treating Parkinsons with placebos. Otherwise, why bother with expensive, sophisticated research? As others have told you, in the research about placebos there is a lot of bunk research. Garbage in, garbage out. As the old rhyme says, "Catch Eusapia by the toe". So that five years limit is not as hard as you might think. Tgeorgescu (talk) 03:58, 26 August 2019 (UTC)

Please read the entire talk page. This is not about whether or not placebos should be used in clinical practice. That question is entirely separate from their efficacy, which most certainly exists for Parkinson's, pain, and some other conditions. And your one review is nine years old.--Wikiman2718 (talk) 04:03, 26 August 2019 (UTC)

Placebos are effective against Parkinson's.

Therefore placebos should be used as medicines against Parkinson's.

But that does not happen.

Do you realize we have a logic problem here? Tgeorgescu (talk) 04:11, 26 August 2019 (UTC)

Nope. There are a lot of reasons not to prescribe an effective medication. In this case, the main argument against is the ethics of deception. It's not even about biology. --Wikiman2718 (talk) 04:16, 26 August 2019 (UTC)

Wrong: the ethics of deception only applies to ineffective medicines. If the medicine is really effective, there is no deception involved. You cannot eat your cake and still have it. Tgeorgescu (talk) 04:21, 26 August 2019 (UTC)

Nonsense. And even if that logic were valid, it would be original research. If you're unwilling (and unable) to show sources, this will have to go to arbitration. --Wikiman2718 (talk) 04:28, 26 August 2019 (UTC)

Much luck with that. You'll need it because of WP:BOOMERANG (like I were the only one who has reverted your edits today).

Our house, our rules is a blunt way of saying that the Wikipedia community has a set of norms that govern how the encyclopedia is built: norms about what kind of sources we use, about how we handle conflict, and so on. Those norms include not using self-published internet sources, not making blanket statements about ethnic groups (Jews, in this case) without support, not editing against the consensus of editors, and so on. You may consider discussion of those norms as "off-topic," but the Wikipedia community tends to think they are important. Wikipedia articles aren't "owned" by individuals, but they are "owned," in a sense, by the Wikimedia community and the consensus of editors. When an editor, like yourself, decides they want an article to go in a direction other than what the majority of editors want to do, the majority of editors typically preserve their preferred version. Adding material to an article, and then having other editors take that material out, is part of the normal editing process. It's not "force" and it's not "vandalism." It happens to all of us. I'm pretty sure that none of us have our edits here accepted by the community 100% of the time. Learning to abide by Wikipedia's communal decisions is an important part of getting along here as an editor. And if you don't want your editing to be limited by the Wikipedia community's particular goals and methods and decisions, the good news is that there's plenty of other outlets for your work, like perhaps Conservapedia, or getting a personal blog. At the end of the day, Wikipedia really is the private project of the Wikimedia Foundation. It is, roughly, a service that provides summaries of the contents of mainstream scholarship, in the specific sense that "mainstream scholarship" has here at Wikipedia. It's really not an experiment in treating all views equally, and if you think it is, you're likely to wind up frustrated. Alephb (talk) 12:16, 24 January 2018 (UTC)

Quoted by Tgeorgescu (talk) 05:10, 26 August 2019 (UTC)

@Tgeorgescu: How many WP:MEDRS reviews would it take to make you change your mind? --Wikiman2718 (talk) 14:43, 26 August 2019 (UTC)

Well, I think this is what Tgeorgescu's argument boils down to: " The reality-based community doubts that there is any solid evidence for placebo healing anything, except imaginary illnesses." So are you saying that depression is imaginary? What about Parkinson's? And no, wikipedia isn't about the "majority" of editors holding an article hostage. It is based on evidence, reviews, and logical discussion. Calling depression imaginary isn't based on any kind of logic or science, never mind basic humanity. If you have anything useful to add, go ahead. Otherwise I'm not sure how useful further discussion is. Wikipedia uses high quality reviews. End of story. If you want to discuss the reviews then we're all ears, but this discussion is getting silly and useless. --sciencewatcher (talk) 17:04, 26 August 2019 (UTC)

• Here are some reviews that find evidence of a placebo effect. They are all medline indexed and from the last five years. If this goes to dispute resolution, I will submit these as evidence. If not, these reviews will be useful to editors wishing to improve the article. @Tgeorgescu: You have stated that you have no reviews from the last five years. Just to make it clear, the only evidence for your case is this nine year old review? If you want to continue this dipute, tell me now and I will submit the form. Otherwise I am ready to declare consensus and begin improving the article. --Wikiman2718 (talk) 17:15, 26 August 2019 (UTC)

References

I much prefer the wording "which is not designed to have a therapeutic value" (which is very similar to the current wording, so that's fine). Because it paraphrases a professional medical organisation's definition, that means it wasn't simply made up on the spot by a Wikipedian. Likewise I prefer the wording that "In general, placebos...have no impact on the disease itself" because it avoids stating this is particularly common while leaving open the possibility of exceptions. Even when they actually do have objective effects, such as with Parkinsons, this may be more to do with helping the brain produce hormones that relieve symptoms, rather than fighting the disease. We can do more to cover conditions where an objective effect has been noted. There is also some later wording on the Cochrane article that could be tweaked, but I would be careful, as these are usually the best evidence you can get for medical evidence. Anywikiuser (talk) 18:45, 26 August 2019 (UTC)

Well, then show me the evidence that placebos are healing any real illness, instead of some transient effects of feeling better. There is a catch-22 involved here: if the placebo is effective, it should be marketed as a cure for that illness. So, what does it even mean to say that the placebo is effective? It leads to logical paradoxes, so of course saying that is nonsense. And User:Sciencewatcher: don't put your words in my mouth. Tgeorgescu (talk) 18:44, 26 August 2019 (UTC)

@Tgeorgescu: The above studies answer your first challenge. And the argument that placebos are not prescribed is invalid. Discuss sources or drop the stick.--Wikiman2718 (talk) 18:47, 26 August 2019 (UTC)

I've taken the matter to WP:FTN. Tgeorgescu (talk) 18:50, 26 August 2019 (UTC)

Are you honestly suggesting that my viewpoint is fringe? I showed thirteen high quality reviews. This is forum shopping, and your editing is becoming tendentious. --Wikiman2718 (talk) 18:53, 26 August 2019 (UTC)

WP:NPA. I've done it according to WP:SEEKHELP. Since there is only one forum, there is no forum shopping involved. Tgeorgescu (talk) 18:55, 26 August 2019 (UTC)

@Tgeorgescu: I'm not making a personal attack. I'm warning you that I'm going to report you to ANI if you don't change your editing pattern. --Wikiman2718 (talk) 19:06, 26 August 2019 (UTC)

As Anywikiuser told you above There is also some later wording on the Cochrane article that could be tweaked, but I would be careful, as these are usually the best evidence you can get for medical evidence. In case you did not get it: you are the Cochrane basher at this talk page. Tgeorgescu (talk) 19:12, 26 August 2019 (UTC)

I’m sure it was great evidence... ten years ago. —Wikiman2718 (talk) 19:25, 26 August 2019 (UTC)

Your exception to Cochrane's finding is already integrated in our article. What we (me and several other editors) don't allow you to do is claim all-out victory, namely claim that placebos do heal real illnesses, which is a fringe view according to Cochrane. Tgeorgescu (talk) 19:28, 26 August 2019 (UTC)

The claim is that the evidence has changed in the last decade. In fact, we have consensus for this in the cases of pain and Parkinson’s. Therefor, if you want to call my 13 studies fringe, you will have to do it with an up-to-date source. And read the studies again. This goes a lot further than Parkinson’s.

—Wikiman2718 (talk) 19:40, 26 August 2019 (UTC)

There has to be extraordinary evidence that a world-shattering revolution took place in medicine. We have already integrated your POV, what we don't claim is that it would be "WP:THETRUTH, the whole truth, nothing but the truth". Tgeorgescu (talk) 19:44, 26 August 2019 (UTC)

You’re repeating yourself. —Wikiman2718 (talk) 19:48, 26 August 2019 (UTC)

I do see some evidence for your POV, what I don't see is extraordinary evidence for trashing Chochrane's findings. Tgeorgescu (talk) 19:50, 26 August 2019 (UTC)

You don’t see thirteen studies contradicting a decade-old finding as evidence that the decade-old finding is out of date? I can find more, if you demand it. —Wikiman2718 (talk) 19:54, 26 August 2019 (UTC)

Again: you exception was noted. What you did not show is that placebos (speaking in general) heal any real illness. What you did not show is patients who have permanently switched from medicines to placebos without compromising their health. We all agree that placebos could change neurotransmitters (as does watching A Clockwork Orange), what we don't agree is that placebos heal real diseases. For if all evidence is confined to experimental conditions for a short period, you don't have much. Even the ring of a bell could make dogs salivate, we knew that much. Tgeorgescu (talk) 20:00, 26 August 2019 (UTC)

Why should anyone have to show those things? —Wikiman2718 (talk) 20:03, 26 August 2019 (UTC)

Because you have been trashing Cochrane's conclusion that placebos do not heal any real disease. Tgeorgescu (talk) 20:12, 26 August 2019 (UTC)

That conclusion is false. The last decade of research has shown that placebos can produce objective improvements in various diseases. —Wikiman2718 (talk) 21:01, 26 August 2019 (UTC)

So, your evidence that placebos may safely replace medicines for healing/managing certain real diseases is... ? Tgeorgescu (talk) 21:57, 26 August 2019 (UTC)

I should note that the recent findings on pain and Parkinson's don't contradict the 2010 Cochrane review. The Cochrane review did suggest that placebos can help relieve pain. It did not examine Parkinson's specifically, as only one study on Parkinson's fitted the criteria. It suggests that "in general" placebos don't have significant effects (other than improving patient-reported outcomes), however there may be exceptions to that trend. Anywikiuser (talk) 21:19, 26 August 2019 (UTC)

Well, "Placebo does heal real illnesses" is very vague, and isn't what anyone is saying on the talk page. Sciencewatcher quoted by Tgeorgescu (talk) 21:24, 26 August 2019 (UTC)

Till now Wikiman2718 is the only editor who thinks that there is a silver bullet against Thefore, placebo prescription seems to lack both ethical and empirical justification. ... Therfore, we suggest that placebo interventions are not used outside clinical trials. Tgeorgescu (talk) 21:31, 26 August 2019 (UTC)

I suspect that as frustrating as you find this, he's acting in good faith, and isn't trying to promote alternative medicine or anything. Some find it counter-intuitive that placebos can't affect the underlying disease, because they can have strong surface-level effects. I found it counter-intuitive, because I used to cure kids' nettle stings with a fake dock leaf. Anywikiuser (talk) 21:59, 26 August 2019 (UTC)

That isn't the problem. Till now I have seen only one editor and zero peer-reviewed evidence that the conclusion placebo interventions are not used outside clinical trials has been overturned. Of course MDs are free to choose any treatment they wish. So, what I want from him is to let Cochrane be. Tgeorgescu (talk) 22:03, 26 August 2019 (UTC)

The use of placebos is entirely different from the question of efficacy. This discussion is about efficacy, which is undeniable in some cases. —Wikiman2718 (talk) 22:59, 26 August 2019 (UTC)

Ok, enough of quarreling: what we (me and other editors) want from you is letting Cochrane be in the article. This is a simple solution to comprehend and abide by. The text can be tweaked to express reservations/exceptions to Cochrane. Tgeorgescu (talk) 23:06, 26 August 2019 (UTC)

Won’t work. Cochrane was wrong. That study’s conclusion is contradicted by more than a dozen high quality reviews, and supported by none. While the conclusion may have made sense at the time, the research of the last decade has fallen unilaterally in the other direction. —Wikiman2718 (talk) 23:20, 26 August 2019 (UTC)

Your fault is that you are not ready to agree to a compromise solution. For a therapy that never left the experimental setting, it is flat-out wrong that its evidence is world-shattering. So, "placebo does not heal any real disease" has not been overturned. Your evidence is simply not strong enough to leave the experimental setting and become a real therapy. Tgeorgescu (talk) 23:25, 26 August 2019 (UTC)

Did you even look at the evidence? This has been a massive waste of my time. —Wikiman2718 (talk) 23:37, 26 August 2019 (UTC)

It's the "placebo has healed this real disease in 40% of the patients" part which I'm missing. Also, saying that placebo is effective but not effective enough to be marketed as a cure is self-defeating. Tgeorgescu (talk) 23:44, 26 August 2019 (UTC)

We would need to show that if we were arguing that it was true. —Wikiman2718 (talk) 23:54, 26 August 2019 (UTC)

You are the only one at this talk page who thinks that Therfore, we suggest that placebo interventions are not used outside clinical trials is bunk. You are the only one who wants to get rid of Cochrane from our article, which is a typical case of WP:1AM (see what people wrote above and what they wrote at the WP:FTN topic I have opened). Tgeorgescu (talk) 23:57, 26 August 2019 (UTC)

I’m not entirely sure what you mean. And you could stand to read WP:1AM yourself. There were other editors on your side, but they seem to have dropped the stick. You should consider doing the same. —Wikiman2718 (talk) 00:26, 27 August 2019 (UTC)

We are referencing two Cochrane reviews: a 2001 one, and another from 2010. I would agree that the 2010 one should stay even though it is more than 5 years old. Interestingly, it seems as if the authors of the 2010 review made at least one serious error with regard to pain, in that the acupuncture trials (other than the German ones) did not compare against no treatment. If there are other high quality reviews with different conclusions, we should include those as well. --sciencewatcher (talk) 00:31, 27 August 2019 (UTC)

@Wikiman2718: Oh, boy! You're using the expression dropped the stick rather wantonly. Tgeorgescu (talk) 00:37, 27 August 2019 (UTC)

User	Statement
Wikiman2718	The main conclusion of the Cochran review is that placebos cannot alter objective outcomes. This conclusion is contradicted by more than a dozen WP:MEDRS sources and corroborated by exactly zero. There is evidence that placebos alter objective outcomes in a number of neurological disorders including depression. We have already established consensus that placebos alter objective outcomes in pain and Parkinson's. Most of this research was conducted in the last decade, but the Cochran review has not been updated since 2010. Cochran reviews are generally immune to the five year rule because they are regularly updated. It is Cochrane’s policy to require authors to update reviews every two years or to include a commentary explaining why the review has not been updated. However, since Cochran has not kept this study up to date, it should be treated the same as non-Cochran reviews and thrown out after five years. If anyone could find out Cochrane why has neglected to update this study or to leave a commentary, that would be quite helpful. --Wikiman2718 (talk) 02:37, 27 August 2019 (UTC)
Þjarkur	statement needed
Anywikiuser	A Cochrane source is the strongest evidence and so it needs to retain its prominent role in the article. The evidence is that in general, placebos can cause subjective improvements but not objective ones, other than with pain relief. But there will be "exceptions that prove the rule". Anywikiuser (talk) 09:34, 29 August 2019 (UTC)
Sciencewatcher	statement needed
Alexbrn	statement needed
Tgeorgescu	Ok, enough of quarreling: what we (me and other editors) want from you is letting Cochrane be in the article. This is a simple solution to comprehend and abide by. The text can be tweaked to express reservations/exceptions to Cochrane.

Wikiman2718 Your claim is exactly this: [3], i.e. that it would be false that placebos cannot heal any real disease. You are the only editor expressing such POV at this talk page and at WP:FTN. We are willing to compromise and we have already integrated your claim about Parkinson's in the article. Your position is "my way or the highway", which is completely unreasonable. You're unwilling to make allowance for our doubt, although we allowed for yours. There is no WP:CONSENSUS of only one editor against the rest of the community. Wikipedia doesn't work like that! You may not unilaterally declare consensus. There are five editors who think that Cochrane is to be respected and one of them finds that "Placebo does heal real illnesses" is a meaningless statement. 5 against 1. Yup, you even claimed that there is a consensus for removing Cochrane when nobody else supported its removal. You are still the only one who does. And you do seem to imply that these placebo studies have left the lab in order to become real, evidence-based therapies. What's your evidence for such claim? Tgeorgescu (talk) 05:55, 27 August 2019 (UTC)

References

Tgeorgescu, Þjarkur, Anywikiuser, Alexbrn, Sciencewatcher: Let's let every user write their own statement. --Wikiman2718 (talk) 13:39, 28 August 2019 (UTC)

• Just so that everyone knows: though Tgeorgescu has repeatedly characterized me as holding the position that placebos should be prescribed in clinical settings, this is not my position. My positions is that placebos can produce objective improvements in outcome in at least several conditions. --Wikiman2718 (talk) 13:57, 28 August 2019 (UTC)

I did not write their POV instead them. I just copy/pasted their statements. So, unless they had a radical change of mind, they are all in favor of retaining Cochrane. Tgeorgescu (talk) 21:37, 28 August 2019 (UTC)

You didn’t write the statements, but you did a lot of interpreting. The positions were not clear in every case, and some statements were made early in the debate when less evidence was available. There is no need to assert what other people believe when we could just ask. —Wikiman2718 (talk) 22:03, 28 August 2019 (UTC)

Ok, maybe I wasn't too explicit why we want it to stay: there is a joke with an economist having an exam, How has French revolution affected world economic growth? Too early to say. Tgeorgescu (talk) 04:24, 29 August 2019 (UTC)

Parkinsons

User:JzG: I disagree that the Parkinsons evidence is tentative. There is strong empirical evidence, and the neurobiology has been elucidated. As for analgesia, there is again strong empirical evidence and again, the neurology has been elucidated. It is hard to deny the existence of an effect that is not only understood empirically, but biologically as well. Again, fourteen WP:MEDRS studies find that the placebos can alter objective outcomes in some conditions. To completely ignore them all in favor of one decade old study is WP:UNDUE, and possibly even endorsing a fringe view. --Wikiman2718 (talk) 07:44, 9 October 2019 (UTC)

You make a fine argument for includsion in the body, and an equally fine argument for exclusion from the lede. Which invites the question: why did you edit-war it back in? The consensus does not show objective effects. Most of the research showing effects on pain, references self-reported subjective measures. Parkinson's is, as far as I can tell, the only area where there has been any demonstration at all of an objectively measurable effect, and the attribution to placebo is questionable since there is good reason to think that an actual therapeutic intervention tarketing the same pathways would be more effective. Remember always that the goal of quacks is to pretend that the placebo effect is real and powerful, whereas the finding inreality is that it is almost entirely illusory. Guy (help!) 09:00, 9 October 2019 (UTC)

I would like it known that I did not edit war, and the material is not back it. Per WP:STATUSQUO, the article should reflect the status quo while dispute is in progress. It was User:Roxy the dog that (successful) edit warred against the status quo. He has been doing that to me a lot lately. With regards to objective effects, the fourteen studies cited above all find evidence that they exist for some conditions. WP:DUE mandates that they deserve at least some weight, if not all of it. We seem to have some degree of consensus on Parkinsons-- you noted that placebos do have effect, but argued that other treatments are more effective. I do not dispute that other treatments are more effective-- since placebos are inert, they are certainly less effective than any active treatment that targets the disease. However, this is not about whether placebos should be prescribed. This is about biology. Placebos produce a biological response, and this has implication to their role as controls in scientific studies and to the nature of how the brain works. It is unlikely that pure placebos will ever make good prescription drugs, but that's a bit of a distraction from the main point. --Wikiman2718 (talk) 09:12, 9 October 2019 (UTC)

The history shows you did. Guy (help!) 17:00, 9 October 2019 (UTC)

Please read up on edit war guidelines and discuss sources, not editor behavior, and not truth. Now it the time that your cabal must explain why they should be allowed to ignore fourteen WP:MEDRS studies in favor of one ten year old Chochrane review that was never updated. --Wikiman2718 (talk) 19:39, 9 October 2019 (UTC)

Mate, you might want to check my user page. Guy (help!) 15:13, 10 October 2019 (UTC)

I am not impressed by your status. Reverting without discussion is edit warring, and reverting with discussion to maintain the WP:STATUSQUO is not. I certainly hope that you will not attempt to use your status to push for false consensus-- we must abide by the consensus of high-quality sources, and we cannot simply ignore fourteen WP:MEDRS sources in favor of one decade old Cochrane review that was never updated. --Wikiman2718 (talk) 15:31, 10 October 2019 (UTC)

I do understand that you have aspergers, and some nuances of interpersonal communication may be lost on you. The point I am making is this: you have been here 5 months, you have a little over 4,000 edits and most of those are to a small number of articles. You are lecturing me on policy. I have been here over 15 years, I have over 120,000 edits, the third most watched user page on Wikipedia, and I've been an admin specialising in pseudoscience articles for over 13 years. That does not necessarily make me right, but it does make what you wrote rude. See what I mean? Reasonable people can differ on things, but asserting your opinion as fact based on vastly less experience, is not a good look. Guy (help!) 15:47, 10 October 2019 (UTC)

I understand that Wikpedia is not supposed to have "high status" editors, and for you to try to wave your status around to control the contents of a page is not only rude, but in violation everything that Wikipedia stands for. Please stop. I am asserting that fourteen WP:MEDRS sources support a conclusion that is opposed by only one review that likely fails WP:MEDRS since Cochrane did not update it like they were supposed to. Therefore, the current state for the article, which completely ignores all of the WP:MEDRS sources in favor of what you believe, is POV. --Wikiman2718 (talk) 15:57, 10 October 2019 (UTC)

It's not about status, it's about dogmatically asserting your interpretation of policy as the only valid one, to someone with vastly more experience than you have. That is just plain rude. Guy (help!) 16:04, 10 October 2019 (UTC)

Let's discuss sources, please. I still have yet to hear a good explanation as to why we are completely dismissing fourteen WP:MEDRS reviews. And please, no more comments on my perceived lack of experience.--Wikiman2718 (talk) 16:07, 10 October 2019 (UTC)

Empirical evidence

The term "empirical evidence" is much repeated above, but it doesn't appear to match tbe definition given the article empirical evidence, which specifies that outcomes be testable and measurable. I wonder if the terms "anecdotal evidence" or "subjective reporting" are closer to what is intended? --Red King (talk) 11:08, 9 October 2019 (UTC)

The outcomes have been tested and measured in terms of neurotransmitter release in the brain. Also, motor function may be objectively assessed in the case of Parkinson's. But you are arguing truth, not verifiability. It is clear from examining the WP:MEDRS studies that there is consensus for this in the scientific community. --Wikiman2718 (talk) 13:44, 9 October 2019 (UTC)

Well actually I'm just arguing for careful choice of words. (FWIW, I do recognise that some, perhaps many, patients perceive real positive responses to placebo treatments. Unfortunately the alleviation of symptoms doesn't last because there has been no measurable change in the underlying condition. Doctors should have no scruples whatever in advising 'complimentary therapies' for psychosomatic illnesses. The major issue is dishonest snake-oil salesmen who take advantage of seriously ill patients who are desperate and willing to try anything. See Steve Jobs#Health issues, for example). --Red King (talk) 20:44, 9 October 2019 (UTC)

That's a good point. This discovery raises a lot of difficult questions that will have to be navigated with nuance. --Wikiman2718 (talk) 00:01, 10 October 2019 (UTC)

The correct distinction is certainly between objectively testable and subjective outcomes, if there is no objectively demonstrated outcome then I would say there is no empirical evidence of effect. Guy (help!) 15:23, 10 October 2019 (UTC)

The correct distinction is between verifiability and truth. If there are no WP:MEDRS sources supporting a conclusion, than we cannot. If there are, we go ahead. I am tired of debating truth with people who go around in circles. I want to improve the article. --Wikiman2718 (talk) 15:33, 10 October 2019 (UTC)

What's verifiable is that the studies showing effects, show effects on self-reported measures of subjective symptoms, consistent with the "effect" being due to bias and human error. What's also verifiable is that a large amount of the "research" that attempts to prove otherwise, is conducted by people with a vested interest in pseudoscientific treatments, most notably Ted Kaptchuk and acupuncture. Guy (help!) 15:40, 10 October 2019 (UTC)

Ted Kaptchuk did not author any of those fourteen reviews. The WP:MEDRS sources study objective outcomes. --Wikiman2718 (talk) 15:50, 10 October 2019 (UTC)

Now go back and read what I actually wrote. Example: your second source is based on 5 studies, of which all but one are co-authored by Kaptchuk. Guy (help!) 16:02, 10 October 2019 (UTC)

The medical community does not seem to have a problem with his research. But if you do, go ahead and leave that source out. One down, thirteen to go. --Wikiman2718 (talk) 16:05, 10 October 2019 (UTC)

As a side note: This article reports that Ted Kaptchuk hasn't practiced acupuncture for 28 years and says he does not believe in it. Anywikiuser (talk) 11:04, 22 October 2019 (UTC)