Uncle Don's Notebook
[Graphic: Inkwell
labeled VITRIOL © John Holden]

Uncle Don's Notebook

27 Aug 2001

Each of us needs a notebook in which to jot down those flashes of insight, one-liners, bad jokes, Nobel-prize-worthy ideas, and provocative tidbits and scraps read or heard. This is mine.

This document is the natural successor to my regular column Scraps From The Editor's Wastebasket in The Vector, published from 1976 to 1991.

Entries are stacked in reverse order, with the most recent ones first, so readers won't have to wade through old ones to get to the new ones. Occasionally they will be collected and archived.

Input and suggestions are welcome at dsimanek@lhup.edu.

It's been a while [August, 2001] The new millenium is nearly upon us, and I realize that I've been neglecting these Scraps for a while. Well, my lame excuse is that I've been busy. I've just shipped off the manuscript of our new book Science Askew to our publisher The Institute of Physics Publishing. It's expected to appear in October 2001. The book is a collection of science humor, and is illustrated by John C. Holden who has done drawings for my web pages and for my old publication THE VECTOR. You can find a description of the book on my science humor page.

Then I've also been doing web housekeeping, purging dead links, updating documents, and adding new ones. My front page is now faster loading, and navigation has been improved. I've put into practice some of the new things I've learned about HTML during the last few years.

Placebos medically ineffective! [July 2001] The news has brought some astounding revelations these days. A new medical study of studies has concluded that placebos aren't medically effective! Well, duh!

Why is this of interest? Well, placebos have been long been used in clinical studies simply because they were assumed to be medically ineffective. The symbolic example of a placebo is the classic "sugar pill", but there are also placebo non-drug therapies, and even placebo surgery (an incision without the real operation). Lately some of the new-age gurus have been suggesting that doctors ought to prescribe placebos and use placebo therapies, for if the patient thinks they are medical treatments, they may do some people some good. That was the motivation of this study. But the study found that only in the case of some kinds of pain, maybe, this "placebo effect" might be of some benefit for some people some of the time.

Clinical studies usually include a "null" or "control" group which gets only a placebo and another group which gets the supposedly effective treatment. It's long been known that some of those who get only the placebo do indeed show (or report) improvement in whatever ailed them. In a properly designed double-blind study niether the participants nor the doctors administering the treatments know which group is which, to ensure equality of variables affecting the participants and equality in evaluating their condition before, during and after the treatment.

So why do some who get only placebos improve? Some 30% do in many kinds of illness. Several reasons come to mind: Many ailments improve without treatment. Many ailments improve for a while, then recur. Some ailments are largely in the mind, and merely being part of a study can make a person forget the ailment for a while, especially if the person imagines that he or she is getting the "real" treatment.

Even some cancers "go away" without treatment, according to older studies. These days few cancer cases go untreated. Some cancers are misdiagnosed, and some cases of spontaneous remission do apparently occur, for reasons not yet known. This sort of thing provides purveyors of quack treatments sufficient testimonials for their advertisements.

I've said for some while that clinical medical studies should include three groups, one which gets the treatment being tested, a placebo group, and a truly "null" group which gets no treatment at all. Only then will we get a handle on what's really going on, and learn just how many of those getting the real treatment are actually benefiting from it. Other studies have concluded that up to 1/3 of the apparent effectiveness of well established drugs is not due to the drug or treatment. I assume the same applies to non-drug therapies, such as acupuncture and chiroquackery.

Opinions expressed here are those of Donald Simanek. Any similarity to policy of Lock Haven University of Pennsylvania or opinions of its administrators is highly unlikely, and surely coincidental. Any words of wisdom or universal truths found herein are unintentional and should be brought to our attention so corrective action may be taken.

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