Re: About Placebo...
真的很用功 馬上把這麼新的東西拿出來
不過我完全同意這篇的看法
※ 引述《daze (一期一會)》之銘言：
: Placebo似乎沒有想像中那麼大的效果。
: 我翻到 Cochrane Library 的一篇Review：
: 《Placebo interventions for all clinical conditions》
: （http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
: CD003974/frame.html 縮址：http://0rz.tw/LUu02 ）
: Plain language summary
: Placebo treatments for all clinical conditions
: It has been widely believed that placebo (dummy) treatments (for example
: sugar tablets) are associated with substantial effects on a wide range of
: health problems. However, this belief is not based on evidence from
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
: randomised trials that use a placebo treatment for one group of people, while
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
: another group receives no treatment. The effect of placebo treatments was
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
: studied by reviewing more than 150 such trials covering many types of
: healthcare problems. Placebo treatments caused no major health benefits,
: although they possibly had a small effect on outcomes reported by patients,
: for example pain.
: 這篇Review對156個Study做meta-analysis。
: 這些Study的共通點是，有"給Placebo的組"與"完全沒給藥的組"，並且是RCT的。
你說得很正確 這篇論文比較了placebo跟完全沒給藥的差別
結果證實完全沒給藥跟只給安慰劑沒有顯著差別（少數幾個分類有顯著 但是比bias小）
所以顯然完全不給藥就跟給安慰劑的效果一樣好
這點我完全認同 而且在他做研究之前我本來就是這樣相信的
給安慰劑跟完全不鳥他本來就應該沒什麼差異才對
這跟我之前說得安慰劑效應大概在六七成 本身並沒有衝突
因為安慰劑效應是指病人健康有進步就算
這篇文章是比較兩種的差別 本來就是不太一樣的事情
容我多補充一點
我認為安慰劑效應有可能是心理或社會的因素影響而來 （安慰劑有效的機制不明）
病人主觀的心理因素會因為跟「什麼也不做」對照而因此得到不支持的看法
但是病人離開致病的環境、接近醫院的心理影響
還有社會環境的因素 都還無法靠這兩者的對照而得到肯證或否證
: （具體的標準：
: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The
: Cochrane Library Issue 4, 2002), MEDLINE (1966 to 2002), EMBASE (1980 to 2002),
: Biological Abstracts (1986 to 2002), and PsycLIT (1887 to 2002). We contacted
: experts on placebo research, and read references in the included trials.
: We included randomised placebo trials with a no-treatment control group
: investigating any health problem.
: ）
: 結果：
: We found no statistically significant pooled effect of placebo in 38 studies
: with binary outcomes (4284 patients), relative risk 0.95 (95% confidence
: interval (CI) 0.89 to 1.01). The pooled relative risk for patient-reported
: outcomes was 0.95 (95% CI 0.88 to 1.03) and for observer-reported outcomes
: 0.91 (95% CI 0.81 to 1.03). There was heterogeneity (P=0.01) but the funnel
: plot was symmetrical. There was no statistically significant effect of
: placebo interventions in the four clinical conditions investigated in three
: trials or more: pain, nausea, smoking, and depression, but confidence
: intervals were wide.
: We found an overall effect of placebo treatments in 118 trials with
: continuous outcomes (7453 patients), standardised mean difference (SMD) -0.24
: (95% CI -0.31 to -0.17). The SMD for patient-reported outcomes was -0.30 (95%
: CI -0.38 to -0.21), whereas no statistically significant effect was found for
: observer-reported outcomes, SMD -0.10 (95% CI -0.20 to -0.01). There was
: heterogeneity (P<0.001) and large variability in funnel plot results even for
: big trials. There was an apparent effect of placebo interventions on pain
: (SMD -0.25 (95% CI -0.35 to-0.16)), and phobia (SMD -0.63 (95% CI -1.17 to
: -0.08)); but also a substantial risk of bias. There was no statistically
: significant effect of placebo interventions in eight other clinical
: conditions investigated in three trials or more: nausea, smoking, depression,
: overweight, asthma, hypertension, insomnia and anxiety, but confidence
: intervals were wide.
: Authors' conclusions：
: There was no evidence that placebo interventions in general have clinically
: important effects. A possible small effect on continuous patient-reported
: outcomes, especially pain, could not be clearly distinguished from bias.
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※ 編輯: Oikeiosis 來自: 118.231.78.38 (03/26 03:37)
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