Religious rituals in healthcare

[Gaest]

Humoring the thought, why would we need to vet rituals or the people performing them, and how?  If we're going to legitimize witchdoctory, how could we vet that?  Make sure the person is a legitimate shaman?  Is that a requirement for the "treatment" to work?

My idea about a vetting process controlled by medical professionals is actually to avoid crossing the boundary between science and junk-science.
If doctors should recommend any rituals - including religious ones - as a part of a medical treatment, then you obviously want a process to make sure that a given ritual is good at creating placebo effects (and not nocebo effects). You also want a process to make sure that the one who performs the ritual - if there is one - meets relevant criteria.

[BrianSoddingBoru4]

Try it this way. You're in average health, when you're suddenly stricken with a life-threatening condition (could be an injury, could be a disease, it doesn't matter, really). This isn't something you can shrug off or treat with maple syrup - you must get medical attention or you will die, full stop.

In the short time left before you absolutely, positively must have medical care, you have to make a choice. One option is to be looked after by the best doctors, nurses and technicians available, all of whom had extensive experience treating exactly your condition with a success rate of more than 95%. You will be whisked away, instanter to a top-notch medical facility, where these amazingly talented people, assisted by the best medical equipment available, will do everything in their power to cure you. But they assure you that neither they, nor anyone else, with either pray for you nor provide you with any religious ritual.

Your second option is to be looked after by second-rate (but still very good) medicos, whose experience, training, dedication, facilities and equipment have given them a success rate of 80% in treating your condition. But all these personnel inform you that then entire hospital staff will send intercessory prayers on your behalf to the deity of your choice, and will arrange any religious ritual that you feel comfortable with.

Now choose: a 95% chance of staying alive without religious flummery, or an 80% chance with it. tick...tick...tick...

Boru

[robvalue]

Boru: Interesting.

My intuition tells me that you'd mostly be filtering people based on how zealous they are. The hardcore would go with the prayer, and the "moderates" would abandon it.

[Minimalist]

The hardcore would go with the prayer,

Good way to rid ourselves of them, eh?

[brewer]

Boru: Interesting.

My intuition tells me that you'd mostly be filtering people based on how zealous they are. The hardcore would go with the prayer, and the "moderates" would abandon it.

Not just zealous, feeble minded have to be included. (is that all theists?)

And then, what to we do with the coma, stroke, unconscious,........... that can't tell the medical staff their belief or amount of belief? If they are satanists and you go christian are they now just fucked?

And lets not even get into the schizophrenic with a "god delusion". They should be healing themselves!

[Gaest]

Well, my idea with this thread is to argue that interventions that cause placebo effects can be/become legitimate medical treatments. Some rituals - including religious ones - can on that basis be a potent part of treatment for some conditions.

bold mine

There is no direct cause/effect that is measurable and repeatable from person to person. I find the thought offensive.

First of all, sorry for the late reply.

While I'm pretty sure you are wrong here, it did strike a nerve.
I already hinted at the problem in the intro post - "Of course more research is needed - partly because not everyone responds equally to placebo effects (...)" - and obviously it goes beyond variations in effect from person to person.
How would you reliably be able to create and recreate a placebo response in a given person, and what traits/states (genetically, psychologically or neurologically) would you look for to assess whether said person would have a significant placebo response?
As far as I can see we are heading in that direction though.

Support for my claims - since that is good form:

 
“Results are heterogeneous, but imply that predictors are rather not found among “classic” trait personality variables (such as extraversion or neuroticism) or emotional response dispositions (such as anxiety). Instead, they are more on the side of cognitive constructs such as self-efficacy, locus of control, and “emotionalized” contingency expectations. From a theoretical perspective, this is intuitive, considering how closely related these concepts are to expectancy (Bandura, 1977). Expectancy is considered a major PR mechanism (Finniss et al., 2010; Enck et al., 2013).
 
Specifically, promising variables are goal-seeking, self-efficacy, self-esteem, locus of control, and optimism; desire for control and restraint; fun and sensation seeking, and neuroticism; participants’ sex (or possibly gender); the val158met-polymorphism; suggestibility, beliefs in expecta- tion biases, body consciousness and baseline symptom severity.
 
These findings suggest that individuals’ neuro-chemistry, as measured by neuroimaging methods, can in part explain individual differences in placebo responses. However, as this is a relatively new domain of research with a limited number of studies, the area would benefit from independent replication of these findings.”
 
Horing, B., Weimer, K., Muth, E. R., & Enck, P. (2014). Prediction of placebo responses: A systematic review of the literature. Frontiers in Psychology, 5, 1079. doi:10.3389/fpsyg.2014.01079
 
 
“Genetic variation is another important factor that may influence (and help predict) placebo effects. While the study of the genes that influence the placebo effect (Hall et al., 2015), is only just emerging, its potential to improve our understanding of the mechanisms underlying the placebo effect is promising. Importantly, greater understanding of how different genes influence the placebo effect may eventually allow researchers and clinicians to tailor treatment settings to individuals in order to maximize their treatment outcomes via the placebo effect.”

Colagiuri, B., Schenk, L. A., Kessler, M. D., Dorsey, S. G., & Colloca, L. (2015). The placebo effect: From concepts to genes. Neuroscience, 307, 171-190. doi:http://dx.doi.org.ez.statsbiblioteket.dk:2048/10.1016/j.neuroscience.2015.08.017
 
 
“These findings demonstrate the potential of combining resting state connectivity and genetic information to predict placebo effect. In the same study, personality was also found to represent a possible predictor. In another recent study (Hashmi et al. 2014), it was found that the efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia in older patients with knee Osteoarthritis.
 
Taking together, resting state functional connectivity holds the potential to predict placebo response. Nevertheless, we have to interpret the above results with caution, and independent replication of these studies is needed before we can draw solid conclusions.”
 
Kong, J. & Benedetti F. Placebo and Nocebo Effects: An Introduction to Psychological and Biological Mechanisms – in F. Benedetti et al. (eds.), Placebo, Handbook of Experimental Pharmacology 225 pp 12, Springer-Verlag Berlin Heidelberg 2014, DOI 10.1007/978-3-662-44519-8_1

It will never be considered legitimate medicine.

Hmm... Do you have anything to support this claim?

I find the thought offensive.

Erh... sounds like a you thing.

---

Try it this way.  You're in average health, when you're suddenly stricken with a life-threatening condition (could be an injury, could be a disease, it doesn't matter, really).  This isn't something you can shrug off or treat with maple syrup - you must get medical attention or you will die, full stop.

In the short time left before you absolutely, positively must have medical care, you have to make a choice.  One option is to be looked after by the best doctors, nurses and technicians available, all of whom had extensive experience treating exactly your condition with a success rate of more than 95%.  You will be whisked away, instanter to a top-notch medical facility, where these amazingly talented people, assisted by the best medical equipment available, will do everything in their power to cure you.  But they assure you that neither they, nor anyone else, with either pray for you nor provide you with any religious ritual.

Your second option is to be looked after by second-rate (but still very good) medicos, whose experience, training, dedication, facilities and equipment have given them a success rate of 80% in treating your condition.  But all these personnel inform you that then entire hospital staff will send intercessory prayers on your behalf to the deity of your choice, and will arrange any religious ritual that you feel comfortable with.

Now choose: a 95% chance of staying alive without religious flummery, or an 80% chance with it. tick...tick...tick...

Boru

I would generally prefer a hospital that does not utilize intercessory prayer, but I'm not completely sure what your point is in relation to what has been said in the thread so far?

[brewer]

It will never be considered legitimate medicine.

Hmm... Do you have anything to support this claim?

I find the thought offensive.

Erh... sounds like a you thing.

Support? Medical school education. More than just reading articles looking for any kind of support that use of placebo effect by medical practitioners should be considered legitimate. Since you seem to like reading:

http://www.livescience.com/51421-should-...thics.html

Got no idea what the "Erh" comment means. Care to communicate better?

Edit: more reading for you: https://sciencebasedmedicine.org/placebo...omeopathy/

[Mr Greene]

It's fine for the passengers to pray on a plane, when the pilot stars praying it's time to panic.

[robvalue]

I'd say that healthcare as a whole should be purely secular. If the staff want to go pray for people in private during their breaks, then they can fill their boots.

I don't think I'd have a problem with a religious figure coming to visit a patient on their request in the hospital, as long as it didn't inconvenience anyone else or compromise the care in any way. Of course, this should mean that any religion would be permissible, or none at all.

I think the biggest problem is staff assuming a patient wants religious interference without request. That's just preaching and is unprofessional.

[Gaest]

Support? Medical school education.

Care to elaborate on this argument from authority?

More than just reading articles looking for any kind of support that use of placebo effect by medical practitioners should be considered legitimate.

Okay. So what are the problems with the articles I quoted? Did I misrepresent them? Or are there something significant wrong with them?


With regards to the two blogposts you gave: I pulled out the suff that seemed most relevant, but if there's anything else in there you want me to comment on you'll have to quote it.

Edit: more reading for you: https://sciencebasedmedicine.org/placebo...omeopathy/

(…)Smith then raises the ethical appropriateness of a key component of successful placebo use: in order for placebos to work, patients must believe something that is untrue

Not necessarily. Studies have showed that open-labeled placebos can have a significant effect as well.

“Although Maxalt was superior to placebo under each type of information, we were surprised that the efficacy of Maxalt mislabeled as placebo was not significantly better than the efficacy of placebo mislabeled as Maxalt. We were also surprised to find that open-label placebo treatment induced pain relief as compared with the worsening of pain during the untreated attack. A therapeutic benefit of open-label placebo versus no treatment was also recently reported for patients with irritable bowel syndrome in a randomized controlled study (8) and in a pilot study in depression (9).
(…)
Because our study used deception, its applicability to routine clinical care is limited, and the present findings are essentially a proof of concept. It would be important to expand our findings with experimental manipulations of expectancy considered ethical in clinical practice.
(…)
In conclusion, positive information about active medication contributes to successful treatment of episodic migraine. Medication and information (which presumably influences expectancies) may be equally critical for pain relief. The benefits of placebo persist even if placebo treatment is honestly described. Whether treatment involves medication or placebo, our study clearly shows that the information provided to patients and the predictable ritual of pill taking are important components of care (21). Further research is warranted to investigate the application of our findings to clinical practice and research design.”

Kam-Hansen, S., Jakubowski, M., Kelley, J. M., Kirsch, I., Hoaglin, D. C., Kaptchuk, T. J., et al. (2014). Altered placebo and drug labeling changes the outcome of episodic migraine attacks. Science Translational Medicine, 6(218), 218ra5-218ra5. doi:10.1126/scitranslmed.3006175

Obviously there is still a long way, but there are studies with results entertaining the possibility of ethically using placebos in treatment.

But what about placebo use by health professionals? While routine use of placebos wouldn’t be considered ethically acceptable, Smith notes that reinforcing the efficacy of a conventional medication, in a way that could enhance potential placebo effects, is acceptable. This is a routine part of the pharmacist’s dialogue with patients – understanding and addressing concerns, summarizing therapeutic effects, and managing overall treatment expectations. It can be done in a non-deceptive way that should maximize the non-specific effects.

Perhaps there may yet emerge a framework where placebos can be ethically (and judiciously) justified. Homeopathy isn’t it.

So following your source here: Maybe placebo can be a legitimate part of medicine.

Since you seem to like reading:

http://www.livescience.com/51421-should-...thics.html

But then, the tide turned, again, with a study published in The New England Journal of Medicine in 2001 by Dutch researchers, who found that most placebo studies were methodologically flawed. With a rub to Beecher, their paper was playfully titled "Is the Placebo Powerless?"


Kaptchuk has claimed in previous interviews to have learned much from the Dutch study and has since collaborated with one of the Dutch authors.

First of all, the researchers are obviously Danish – with Hróbjartsson probably having some kind of Icelandic or Faeroese origin. Not that it’s important, but it doesn’t exactly instill confidence in his claims...

The weird part here is that Wanjek follows that up with a “Kaptchuk has claimed”, and then he doesn’t go through any of the points of criticism and doesn’t investigate whether Kaptchuk has learned from them and included it in his later studies and articles.

Nevertheless, there are many critics of using placebos in medical care. In a 2011 article in The Atlantic, in reaction to a study that Kaptchuk conducted on asthma, retired family physician Harriet Hall said, "Asthma can be fatal. If the patient's lung function is getting worse, but a placebo makes them feel better, they might delay treatment until it is too late."

While Harriet Hall might have a point, this is not so much a general criticism as a pretty specific one… And there are varying severities of asthma – speaking as one who had problems with asthma as a kid, but was never in danger of dying.

But critics argue that placebo effects tend to be small, temporary and inconsistent, and that they have little proven positive effect on disease outcome, which should be the ultimate goal.

Which critics and what arguments? Again we're not given a lot of information. IMO this article is a bit underwhelming when it comes to arguing against what I have brought up in this thread…

Got no idea what the "Erh" comment means. Care to communicate better?

Yes, it was meant as a softer version of “meh”.