geoffrey modest medical blogs

  A recent systematic review and meta-analysis evaluated the placebo  response and adverse event rates in treatments for gastroparesis (see placebo response rate in gastroparesis ClinGastroHep2023 in dropbox, or  doi.org/10.1016/j.cgh.2022.09.033 )     Details : -- the medical literature was reviewed through August 2022 to identify RCTs comparing active drug with placebo in patients with gastroparesis -- placebo response rates were assessed for at least one of nausea, vomiting, abdominal pain, bloating, or fullness (typical gastroparesis symptoms), as well as for adverse events. -- 22 articles reported on the placebo response rates, with a total of 1011 patients -- Primary outcome: magnitude of the placebo response as well as adverse events associated with placebo (i.e. the nocebo effect: adverse events associated with the belief that the placebo will cause harm)   Results : -- overall pooled placebo response rate: 29.3% (23.7%-35.2%) ...

A recent summary article reviewed both placebo and nocebo effects, reflecting  respectively   increases in beneficial or harmful results (s ee  placebo nocebo review nejm2020  in   dropbox , or DOI: 10.1056/NEJMra1907805 ). These placebo/nocebo effects occur in clinical trials (specifically comparing an active agent with placebo), informing patients about medical treatments, and public health campaigns Details: -- placebo effects can be associated with the release of various hormones including endogenous opioids, endocannabinoids, dopamine, oxytocin, and vasopressin.      -- these effects seem to be specific: for example the placebo effect in patients with Parkinson’s disease seems to b e specific to dopamine release, though dopamine release is not associated with placebo effects on acute or chronic pain       -- patients subjected to experimental pain had benefit from the potent opioid remifentanil; but those p...

The New York Times had a recent opinion piece written by Dr. Haider Warraich, a cardiologist, highlighting the increasing threat of fake medical news (see https://www.nytimes.com/2018/12/16/opinion/statin-side-effects-cancer.html ). Thanks to Dr. Dickey Jones for bringing this article to my attention. Details: -- he highlights a woman who had a heart attack , likely related to a very high cholesterol level. He prescribed a statin but she never picked it up because of scary things she read on the Internet -- he mentions a 2009 study looking at YouTube videos related to immunization, finding that though 48% of the videos were positive vs 32% negative (i.e. contradicting the known medical knowledge about immunizations), the negative videos had a significantly higher number of ratings (86% vs 63%), and were rated significantly higher (4.4 vs 3.5 stars out of a maximum of 5 ). And public service announcements were the least likely to be rated and have th...

in the new york times yesterday, there was a good analysis of the " nocebo  effect"--people on placebo in various studies who have significant side-effects. can be up to the 40% range.  an example of a patient who attempted suicide by taking an overdose of meds, which, unbeknownst to him, was placebo -- and his blood pressure dropped!! other studies suggest that when provider describes potential side-effects of a new med, there is a greater likelihood of the patient developing that side-effect.  see: http://www.nytimes.com/2012/ 08/12/opinion/sunday/beware- the- nocebo -effect.html?_r=1 in my practice, i mention common side-effects but more in a dismissive way (like, "although some people may develop some inflammation of the liver when on a statin, it is really unlikely, i have seen it rarely in the many patients i have on statins, and i will monitor you closely just in case"), especially if i think the med in question is really important for the patient. h...