Unit 2 Flashcards
Name the factors that can create false impressions of the placebo effect.
Spontaneous Improvement, Fluctuation of Symptoms, Additional Treatment, Conditional Switching of Treatment, Scaling Bias, Irrelevant or Questionable Response Variables, Experimental Subordination, Conditioned Answers, Psychotic Misjudgment, No placebo given, Uncritical reporting, misquotation, false assumptions
What are four questions to ask for evaluating CAM therapies?
Does the therapy have a beneficial effect on any individual disease or disorder?
Does the therapy have any advantage over existing therapies in terms of efficacy, safety, patient preference, cost, and availability?
Is the effect of the therapy a placebo, or is there some specific treatment effect?
What mechanisms underlie the therapy’s action?
Why is it difficult from a scientific perspective to determine the effectiveness of CAM therapies?
The confusing nature of evidence
little medical research
no independent trials
What is the basis of CAM therapies frequently found upon?
Claims of those often involved in the CAM therapy (biased)
impossible rationals
How can one establish a scientific basis of therapy for CAM? Give an example
show that the therapy is effective in a controlled trial and, if possible, that symptoms relate to an objective measure.
An example: if a disorder is caused by hypoglycemia or a yeast infection, then the symptoms should be there when blood sugar is low or when yeast level is high, and the symptoms should disappear when the objective measure is normalized.
What are the two methods to investigate CAM therapies?
Descriptive observation of the therapy and Randomized controlled clinical trials
What is observational research?
An investigator using observational research methodology looks for clues to gain insight into a situation or phenomenon.
How is observational research data collected?
The investigator collects data through observation. At its simplest level the study may involve a mere one case. This is called a case report. Observation of more than one subject is a case series.
How is observational studies conducted?
Subjects can be studied through interviews and surveys.
How are observational study participants selected?
Subjects are selected according to their experience with the phenomenon being explored (known as a convenience sample), but they cannot be considered typical or representative of the whole population.
How can good reliability of the observational study be provided through selection of participants?
If the group of subjects studied is representative of the target population, obtained in a random fashion, then the results may have reasonably good reliability.
What are the pitfalls of observational studies?
bias from practitioner being involved in the therapy for a number of years
Distortion from a single experience due to anecdotal evidence
What are seven factors to consider when examining anecdotal information or case reports?
Natural history of disease Fluctuations in disease Premature follow-up Spontaneous regression Misinterpretation of information Wrong information Simultaneous conventional therapy
What is observational research useful for?
exploring the nature of a particular condition or phenomenon
What is a placebo?
any therapeutic procedure that has an effect on a patient, symptom, or disease without any specific activity for the condition being treated
Why is the placebo effect important when evaluating CAM treatments? Give an example
as practitioners typically interact with their clients in ways that are likely to boost the placebo effect. For example, when a practitioner assures a client who has pain from arthritis that he will gain much relief from the treatment, then there is an excellent chance that the patient will indeed feel some relief, even if the treatment has no actual direct impact on the problem.
What are some of the myths of the placebo response?
One is that there is nothing wrong with placebo responders in the first place, and the second is that a fixed proportion of people, usually around 30 per cent, are placebo responders.
What are some of the explanations for the placebo effect? Give four
physiological mechanisms (where fear or anxiety increase production of adrenaline and noradrenaline, which through feedback inhibition modulates the pain response
classical conditioning (where pairing conditioned and unconditioned stimuli eventually result in the conditioned stimulus eliciting the same response as the unconditioned)
autonomic nervous system activity (which affects neurohormone production such as endorphins
psychological effects such as mental imagery and the behaviour and attitudes of health-care practitioners
Give an example of the placebo effect (hint: it was surgical of mammary gland)
The internal mammary artery ligation was once thought to improve angina. This procedure was standard medical practice until studies revealed that, with both subjective and objective evidence, a sham operation produced the same results.
Explain how therapy with a placebo is not the same as no therapy
The placebo effect may be a consequence of many factors in the therapist-patient relationship, including the psychological state of the patient, the patient’s expectations and convictions in the efficacy of the method of treatment, and the therapist’s biases, attitudes, expectations, and methods of communication
What are RCT’s?
In this method a hypothesis is tested regarding a causal relationship. Any study where subjects are randomized into two or more groups, one of which is the control group
What is a hypothesis?
a supposition that a specific cause produces the observed phenomenon.
What must a hypothesis be?
The hypothesis must be specific and testable by experiments in which all other variables that might also cause the observation are ruled out.
