Sharp Things are the Best Medicine

Rather, they’re the best fake medicine.

This is a mildly entertaining review of placebo responses from migraine trials, looking to compare the effect size of various forms of placebo.  These authors identified 79 studies with appropriate response-to-therapy data for analysis, and evaluated the relative influences of pharmacologic therapy, cognitive-behavioral therapy, and acupuncture or surgery versus their placebo/sham versions.

Sham cognitive-behavioral therapy was ineffective and all the confidence intervals crossed unity.  Pharmacologic placebo was only superior to no treatment at all.  Then, sham acupuncture or surgery was superior to both no treatment and pharmacologic placebo.  Hence, the authors conclude the expectation of benefit is enhanced by the elaborate rituals associated with invasive therapies – and ought to be considered and cautioned against when designing trials that attempt comparisons between invasive and medical therapies.

Or, you could simply use this knowledge for evil – and conduct almost guaranteed-success non-inferiority trials for any manner of medically useless device for provision of symptom relief.

The choice is yours.

“Differential Effectiveness of Placebo Treatments: A Systematic Review of Migraine Prophylaxis”
http://www.ncbi.nlm.nih.gov/pubmed/24126676