Talk:Sham treatment/Related Articles

Placebo?

Placebo should be counted a subtopic of sham treatment only if every placebo is part of a sham treatment. But since this does not seem to be the case, both placebo and placebo effect belong under related articles. Right, or am I confused? --Larry Sanger 19:14, 9 January 2009 (UTC)

It's not a clear hierarchy. A sham treatment is generally considered a subset of placebo, and there are subleties depending if the use is research or therapeutic. Abstractly, a placebo-controlled clinical trial has the control arm using something that has no expected physiological effect. The ideal trial is double-blinded; not only the patient but the person administering the procedure does not know if he is doing the experimental or the control treatment. The double-blinding allows placebo effect, but prevents observer bias.

That's easy enough if the treatment is a pill. If it's a minimally invasive physical treatment such as acupuncture or therapeutic touch, the person doing the treatment cannot be blinded, because they have to know whether the patient is experimental or control -- they literally cannot act without knowing whether or not to perform a sham treatment or a real one.

Sham treatment, in some cases, carries the additional implication of causing risk but no benefit. That might be approved, in a research protocol, with something minimally invasive, such as joint aspiration under local anesthesia, but no one is going to authorize cracking a chest to do, or not do, heart surgery.

Can there be a role for sham treatment in clinical practice? Look at the articles about the ethics of use of placebo in treatment. That's written with respect to medications, but, hypothetically, I can picture a practitioner of some manipulative technique "laying on hands" with the same ethical intention as the practioner that injects saline with the suggestion it may relieve pain. Howard C. Berkowitz 19:33, 9 January 2009 (UTC)