s Not just smoke and mirrors: placebo’s place in modern medicine | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

read more
open full screen

Recent Comments

Click here to read...

News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

read more
open full screen

Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

read more
open full screen

Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

read more
open full screen

The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

read more
open full screen

‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

read more
open full screen

Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

read more
open full screen

Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

read more
open full screen

Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

read more
open full screen

I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

read more
open full screen

Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

read more
open full screen

Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

read more
open full screen

Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

read more
open full screen

Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

read more
open full screen

Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

read more
open full screen

ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

read more
open full screen

Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

read more
open full screen

Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

read more
open full screen

Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

read more
open full screen

Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

read more
open full screen

Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

read more
open full screen

ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

read more
open full screen

Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

read more
open full screen

Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

read more
open full screen

Not just smoke and mirrors: placebo’s place in modern medicine

Staff Researcher

articles by this author...

Editing and Researching news and stories about Australian and International Pharmacy Issues

Editor's Note: The following article is republished from The Conversation and written by Monika Merkes (the author's details follow).
People who are involved in evidence-base medicine research arbitrarily discount this effect, because it does not fit their view of evidence.
However, the "evidence" shows that placebo is an important part of patient care and many people still use placebos.
I remember a common placebo in the "olden days" was a mix of Syrup of Glycerophosphates with a liberal lacing of SVR, worked wonders for so many patients who seemed to thrive on it.
If this placebo produces so many satisfied patients, why is it denigrated as a "placebo" and why can't the scientists find the evidence in support of placebos?

open this article full screen


Monika Merkes

Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University

Monika MerkesM.Merkes@latrobe.edu.au

Summary

Monika Merkes is a social researcher and policy consultant who has worked in state and local governments, the community sector and academia.

Experience

*Director, Direct Communications and Research 2000 – present

* Senior Research Fellow, La Trobe University 2007 – 2009

Education

*La Trobe University
, Doctor of Philosophy (Public Health), 2004

* La Trobe University
, Master of Health Sciences, 1996

* La Trobe University
, Bachelor of Social Work, 1989

Research Areas

*Public Health And Health Services (1117)
*Public Policy (160510)
* Health Policy (160508)

Despite placebos’ reputation as worthless therapy, many medical practitioners still use them. 

Sbn5s6r8-1328766341

Belief is a powerful medicine but the term “placebo” has negative connotations. In modern evidence-based medicine, treatments considered worthless are described as no better than placebos. But this description belies the real picture.

Placebos are characterised as inert, in contrast to active drugs or other treatments. Yet some argue that there’s a role for placebo interventions in mainstream medicine.

Professor Fabrizio Benedetti, a physician and neurophysiologist from the University of Turin Medical School and National Institute of Neuroscience in Italy, has devoted much of his career to the study of placebo effects. He argues that there’s not a single placebo effect but many. These are based on different mechanisms and occur in different medical conditions and therapeutic interventions.

A placebo effect can be caused by an expectation, and the expectation of relief from pain can reduce anxiety. Expectation can also activate a reward mechanism in the nucleus accumbens and release dopamine. The nucleus accumbens is the region in the brain thought to play an important role in reward and pleasure. In this case, the reward is the treatment itself, that is, the reward is the expectation that in a few minutes you will feel better.

A placebo effect can also be produced through learning. If a particular drug has produced positive effects in the past, replacement with a placebo without the patient’s knowledge is likely to produce a similar effect as the active drug.

Placebo responses can be subconscious, and these are mostly created through classical conditioning. Aspirin, for instance, relieves pain and aspirin tablets usually are white and round. If a person has had experiences of pain relief after taking an aspirin, then any tablet that is white and round could have an analgesic effect. Conditioned placebo responses also work for animals.

 

nostalgifabriken/Flickr

 

A placebo’s effectiveness also depends on its type. Placebo injections appear to be more effective than pills. Very small and large pills are more effective than medium-sized pills. Even the colour of a tablet has an influence. Expensive placebos work better than low-priced ones.

Placebo responses also depend, in part, on the condition being treated. Placebos don’t appear to affect diabetes, for instance, while strong placebo effects can be observed for pain.

Clinical trials are not a good way to study placebo effects, says Professor Benedetti. A placebo effect is a psychobiological phenomenon, expressed in brain activity. To understand what’s going on in the brain when a placebo is given, the person has to be studied in the laboratory.

For this, Professor Benedetti uses a “balanced placebo design” involving four groups. The first group receives a placebo, but is told it’s the active drug. The second group of patients receives a placebo and is told it’s a placebo. The third group receives the active treatment and is told it’s a placebo, while the fourth group receives the active treatment and is told the truth.

Using this and other methods, Professor Benedetti found psychobiological placebo effects not only for pain, but also for the immune system, the endocrine system, the cardiovascular system and Parkinson’s disease. These are unconscious placebo effects based on classical conditioning.

And despite placebos’ reputation as worthless therapy, medical practitioners still use them. A survey of US internists and rheumatologists found that more than half had used placebo treatment in the previous year. In Canada, a survey of physicians and psychiatrists found that one in four prescribed placebos regularly as part of routine clinical practice.

 

tschörda/Flickr

 

The German Medical Association (Bundesärztekammer, BÄK) recently recommended that placebo treatments be used in certain circumstances. The BÄK reminded its members that the placebo effect occurs in all treatment situations and its extent depends on the quality of the doctor-patient relationship. The organisation called for doctors to improve their knowledge of placebo research and use placebos to maximise desirable drug effects, minimise undesirable effects, prevent adverse drug reactions, and use the financial resources of the health system in a more efficient way.

But how can placebo treatments be used ethically and without deception?

The BÄK advised its members that placebo treatments outside of clinical trials are ethically justified in the following circumstances:

  • if there is no current proven (drug) intervention for that particular medical condition;

  • for minor conditions in circumstances where the patient expresses a wish for treatment; and

  • if it seems likely that a placebo treatment will be successful.

Good communication is essential and the patient should be informed of potential benefits and harms of the placebo treatment. The BÄK is now calling for internationally recognised guidelines on the use of placebo treatments.

In the absence of a consensus and international guidelines, Professor Benedetti has this advice about the ritual of the therapeutic act:

“I would say that the take-home message for clinicians, for physicians, for all health professionals is that their words, behaviors, attitudes are very important, and move a lot of molecules in the patient’s brain.”

So a placebo can be more than just a placebo, and mainstream medicine would do well to use its potential for the benefit of patients and the health system.

This article was originally published at The Conversation. Read the original article.

Return to home

Post new comment

The content of this field is kept private and will not be shown publicly.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Lines and paragraphs break automatically.

More information about formatting options

health news headlines provided courtesy of Medical News Today.

Click here to read more...

If any difficulty is found in subscribing, please use the "Contact Us" panel found in the navigation bar with the message "subscribe" and your email address.

Subscribe to our mailing list

Email Format
 

 

  • Copyright (C) 2000-2020 Computachem Services, All Rights Reserved.

Website by Ablecode