Hvorfor i h... defineres homopati som et legemiddel ?

[G]

Ok flott. Men man kan jo få inntrykk fra både folk i denne diskusjonstråden samt den kilden jeg fant på internettet at det er store utfordringer innen skolemedisinen over hva placebo først og fremst er for noe, og samtidig en sånn typisk negativt måte å tenke på. Det bunner jo i verifiserbarhet selvsagt, men det ser også ut til å gå litt på holdninger.
 
Viser til tidligere postet lenke:
https://www.vox.com/science-and-health/2017/6/1/15711814/open-label-placebo-kaptchuk
 
Forsøker meg med en oppsummering av utsnitt derfra:

 

 

In medicine, placebo pills are typically used as a tool to test the effectiveness of real drugs. In a double-blind, placebo-controlled clinical trial, which researchers consider the gold standard for testing a drug’s effects, patients (and the doctors running the trial) don’t know who’s taking the real drug and who’s taking the placebo.

 

Kaptchuk is a bit of an outsider in medicine. “Everyone denigrates the placebo,” he said (repeatedly). “The whole profession is against the placebo effect.” But he’s a cautious scientist, saying it’s much too early for doctors to begin prescribing sugar pills to people for these conditions.

 

The usual definition is that “it’s the effect of an inert pill,” but that’s an oxymoron. An inert pill can’t have an effect. So the whole vocabulary of placebo is problematic.

 

Placebo effects accompany real drugs. Morphine given without a person knowing — surreptitiously, in a IV drip — is 50 percent less effective than when it is given in front of them. That’s the placebo effect.

 

What’s going on in the patient’s [mind] is that the rituals of medicine, the symbols of medicine, and a warm, empathic doctor (in the context of a clinical encounter) activate neurotransmitters in the brain, activates specific quantifiable and relevant brain regions that release these neurotransmitters. And they modulate symptoms.

 

Thinking you’re going to get better is not what makes you better. That’s the mind-cure idea: It doesn’t happen. It’s not the way it is.

 

People think this is about mind over matter. But all my patients are people who have been to many doctors before. They don’t have positive expectations about getting better. They’ve been to 10 doctors already.

 

Medicine has managed to ignore the effects in the placebo arm for a long, long time. The phrase “it’s nothing but a placebo” is a form of denigration, it’s a form of delegitimatization, it’s a way of disparaging whatever is going on.

 

I had been around people on placebos for so many years. And I noticed that people were always worried if they were on placebos. If they got better, the would worry, “Maybe I made it up in my head.”
About five years ago, I said to myself, “I’m really tired about doing research that people say is about deception and tricking people.”
Let’s just try to see if we can be honest, transparent: Is it possible that [the placebo effect] would work giving a placebo pill and telling people the truth? People said I was nuts.

 

We have great drugs, but they don’t often treat symptoms that well. What really bothers people are the symptoms. The symptoms are things they can perceive that are modulated by the brain.

 

It doesn’t work in everyone — that’s clear. And we don’t know what makes it work, exactly. But we do know with double-blind studies with placebo — deceptive studies with placebo — that [neuro]chemicals are activated, regions of the brain are engaged that are specific and relevant — there’s something going on. And I don’t think it’s belief.

 

Another scenario is doctors are routinely giving people drugs they know are not effective. Because they just want to give a patient something because they are being driven nuts. For example, if someone complains of fatigue, and doctors do tests and can’t find anything, they’ll say, “Why don’t you take some vitamins?” They know that’s not going to do anything. So that’s a kind of deception that’s routinely used. That could be a place to use it.

 

No. Doctors, they’re trained like hound dogs to find the root biology. The real problem is that doctors hate the placebo effect. Because that’s what they’ve heard in their training from day one: “It’s nothing but a placebo.”

 

Brian Resnick
I get the sense that the take-home conclusion here is: “The placebo effect is weirder and more potentially useful than we have realized.”

Ted Kaptchuk
It’s disruptive. And what it is disrupting is all the theories about placebo. That this is deeper than, “I think I’m going to get better so I get better.”
This open-label placebo is really just one piece of how we harness placebos clinically. It really shakes the paradigm. You don’t have to give a drug that’s more than placebo; the placebo effect itself is something. And we don’t know if a good [doctor-patient] relationship without that pill would work also. But I don’t think so. I think it’s taking home the pill, and that connection is important.
I would like to see if we can get open label used in practical ways with real patients who are having a real hard time and need more improvement.
That’s a lot of work. We need to do more research. We need to see how long it lasts. We have to find the optimal way of doing it. There’s education of providers who don’t like the idea of giving placebos and are uncomfortable with it. That would be one goal.
I would like to see the bottom line of my research change the art of medicine into the science of medicine. Is there a way to quantify what are usually intangible items concretely into: How does this affect illness or health?

 

 
Tok med hele slutten av intervjuet

Endret 26. mars 2019 av G

[hekomo]

At placebo/nocebo ikke er fullt ut forstått betyr ikke at de ikke har peiling i det hele tatt, eller avviser at det eksisterer.

[G]

Jeg hadde heller ikke det inntrykket før jeg leste artikkelen i innlegget mitt ovenfor. Samt etter å ha sett hva noen i denne diskusjonstråden klarer å få ned med bokstaver. Mulighetene for at det er større holdningsproblemer hos enkelte på dette forumet enn hos legestanden er selvsagt tilstede.

 

Også kommer det vel mye an på måten du hadde spurt en lege, på hvilket svar og hvilken tid vedkommende hadde anledning til å ofre det noen tanker.