I'd like to share another perspective on these results from a post by someone on another forum. Hopefully the mods won't mind. I'm a mod on the forum from which this came. I know the author won't mind me borrowing his quote. To put some of his comments in perspective, this is from a forum for people with spinal cord injuries and he's discussing people who have neuropathic pain from their injury.
Every medical student, at least the ones I know, has been taught that almost any study of benefit in a ratio of 60:40 is suspect and probably doesn't prove much. The reason is the so called placebo effect.
This doesn't keep drug companies from promoting sales based on this sixty/forty ratio, but real drugs with real effectiveness tend to come in at a higher rate.
You don't get any better than Harvard and Deaconess. Yet, they recently reported a study of irritable bowel where pills labeled placebo, given to patients who were told it was a placebo, had "adequate symptom relief". Even the investigators found it hard to believe.
The piece was published in PloS One, a journal not in the first tier, but gaining some popularity. Significantly, it is published by the Harvard Center for Alternative Medicine. Politicians funded and instructed NIH to establish a center for Alternative Medicine. I am not knocking anything at NIH, but it traces its roots to political influence. I am not aware that NIH is in the habit of turning down money, but from what is reported, it seems the idea for such large funding came from politically minded individuals, presumably with a strong belief Alternative Medicine is being ignored.
So what do we make of this 60:40 study of irritable bowel? First of all, why irritiable bowel, which is a symptom based diagnosis? Excess serotonin has been theorized as a generative cause. Never confirmed. Traditionally, it is diagnosed by the lactulose hydrogen breath test, which suposedly showed small intestinal bacterial overgrowth, although Vanner's article at Gut. 2010 Nov 26 showed this fancy test doesn't diagnose bacterial overgrowth. So we have a nebulous entity to begin with. Why not use placebo in strep throat, psoriasis, male pattern baldness, or atrial fibrillation, where there is something we can measure? So, what is IBS and how is symptom relief measured.? What is a number which represents "adequate symptom relief" What symptoms, subjective or objective, is the study based on. Finally, where are the biopsy, or chemical studies to confirm the data.
Predictably, this study has given new impetus to the mind/body crew, who tend to see anything anyone else has as largely psychosomatic.
I only ask this. Why would a spinal cord injured victim, who is entitled to plenty of validation just because people can see they cannot walk, resort to some fantastic story of unendurable pain, which is almost never validated. Do SCI people have an aversion to validation. Not likely.
Why would any sane person who is paralyzed, claim his/her pain is much more disabling and much harder to endure than the lack of mobility. Anything they are going to get, they are going to get because they cannot get around.
Why is it possible to create an animal model for central pain merely by a little cord injury? Why do these animals attempt to chew off the affected limb to get rid of the pain.
Having spent hard time in a review of journal articles with a master statistician, it soon became obvious that nearly all articles are plagued by statistical weakness. The samples are not random. There were confounding factors. The sample was too small, etc. etc. There is no objective measure of severity nor is there an objective measure of relief in IBS.
In such illnesses, there is a certain tendency to ignore what the patient is saying. It is time for capsaicin injection again, to beat back those who fall for the mind/body idea in severe pain of central origin.
Central Pain patients need this like Custer needed more Indians. When will people learn that sixty/forty is just not good enough.
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