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August 09, 2008

Comments

Larry

Andrea:
Great points. And you are right...I need to find out what the typical placebo response is for similar meds. BTW, I just spoke with my Doc on the phone who heard about my blog posting and quipped, "Of course I gave you the placebo!"

andrea

It's hard to say ... given that diarrhea will often resolve itself after a day or two of changed diet, the placebo rate might not be all that strange.

Meds for such are either to help "gel" the stool, or are to eliminate parasites, or to put one's intestinal flora back into normal balance (we all have more bacterial cells than we do our own cells, and most of them are just fine where they are, some even beneficial). If you get foreign bacteria, both your own immune system and your friendly flora will work to get the foreign stuff down to a manageable level. That of course takes time as well.

I would expect that placebo rates differ by the types of treatments. What would probably be useful would be to look at the placebo rates for other medications that are given to treat the same sort of problem in roughly the same manner. Those would give you some idea of whether or not this placebo rate is typical or not.

Placebo rates are important not only to weed out which effects are due to consumer expectations, but also to compare which benefits are simply due to plain ol' getting better.

Both of those confounders are why so many bogus "treatments" and "cures" for ASD and other issues are claimed to work (in addition to various cognitive biases).

The problems with such are many:
* testimonials are not data,
* placebo effects and maturation and cogitive biases are not tested and compared,
* customers spend vast amounts of money on false promises,
* parents don't get past the blame and bargaining stages of grief to learn to accept their children as okay people even with the issues,
* some of the treatments or cures are dangerous in their own rights,
* people search for quick miracle cures instead of relying upon evidence-based methods, sometimes preventing good medical or educational practice from happening.

It's a mess. Sometimes it's horrifying.

So yes, examine the data. But also examine what's not in the data. Know what the possible confounds are. Know that the typical baselines are for the placebos and for the natural resolution of issues. Understand that every medication has side effects, and not all side effects listed are serious issues of concern or even likely. Know that nothing is guaranteed or 100% safe.

Should your doc have given you a placebo? Well, if your problem is due to the ordinary dietary unsettledness and weird schedules that result from travel, then a placebo would work. But if your doc gave you something to sort out your gut flora and you really have a gut flora problem, then I would say the medication is probably a good hedge.

Don't forget to go back if the issue isn't resolved in several days; you don't want to be hosting something parasitic, or be developing some other kind of gut issue that may have been totally unrelated to travel!

But don't worry -- the reason that such events are often "news" is because they are rare. Most of us just get to spend quality time in the bathroom catching up on the heap of mail and newspapers as the ordinary problem runs its course (pun intended).

andrea

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