Episode 9: Health Claims

Episode 9: Health Claims

“Making sense of alternative medicine … Conversation with Shepard Siegel … Mind over matter? … Predicting malintent … Like cures like … Conversation with Jimmy Botella … The man is keepin’ me down … Conversation with Ian Frazer … Cluster buster … Uncut conversation with Shepard Siegel … Uncut conversation with Ian Frazer”
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Summaries

  • Episode 9 - Health Claims > Making sense of alternative medicine > Making sense of alternative medicine
  • Episode 9 - Health Claims > Conversation with Shepard Siegel > Conversation with Shepard Siegel
  • Episode 9 - Health Claims > Mind over matter? > Mind over matter?
  • Episode 9 - Health Claims > Like cures like > Like cures like
  • Episode 9 - Health Claims > Conversation with Jimmy Botella > Conversation with Jimmy Botella
  • Episode 9 - Health Claims > The man is keepin' me down > The man is keepin' me down
  • Episode 9 - Health Claims > Conversation with Ian Frazer > Conversation with Ian Frazer
  • Episode 9 - Health Claims > Uncut conversation with Shepard Siegel > Uncut conversation with Shepard Siegel
  • Episode 9 - Health Claims > Uncut conversation with Ian Frazer > Uncut conversation with Ian Frazer

Episode 9 – Health Claims > Making sense of alternative medicine > Making sense of alternative medicine

  • We spoke about why people believe what they’re told and why people see what they expect to see.
  • Again, last week we saw somebody who claims to be able to heal people through touch and put that prayer energy into physical batteries.
  • We’re more interested in why people believe these things, not just debunking a lot of the stuff that’s out there.
  • Last week we also talked about-well, throughout the course, I suppose, we’ve been talking about the power of expectation: how what we see, hear and remember are all shaped by our experiences.
  • When you see what you expect to see, there are limits to that.
  • I can’t, for example, see a unicorn appear in front of me even though I really, really want to.
  • It needs to be a dark room or a noisy sort of environment where you can bend this noisy information to almost contort into the thing that you expect to see.
  • Instead, they’re going to probably cite some experience that they had-or not even that they had-something that their family member had, or a friend had, or even seeing it happen on a television show, or some expert or alleged expert said that it’s going to work.
  • When we were travelling around the MindBodySpirit Festival, a lot of the health claims or the benefits that each of these people were making reference to weren’t things like open wounds or broken limbs or skin disease.
  • They were things like well-being or integration or balance-very vague, ambiguous statements that you can do a really good job at contorting to your expectations, to see what you expect to see.
  • That’s one of the mechanisms that we talked a lot about last week, and it’s really prevalent when it comes to health claims, these very ambiguous statements that people make that you can contort into your expectations.
  • This is a test developed a long time ago where you show people ink blots and you ask the patient what they see in these ink blots.
  • Now a lot of what they see or the claims of these tests seem to be no better than a lot of the claims that people were making at the MindBodySpirit Festival in terms of the scientific rigor for these things.
  • It’s no better than interpreting somebody’s dreams on the basis of what they see in these ink blots.
  • It’s a really nice example of the role of ambiguity and how you can contort your expectations to coincide with what you expect to see when it comes to health claims.
  • The person who didn’t do particularly well in the exam, lots of things were working against him.
  • There are lots of random multiple things happening to push you down.
  • Things will stop going against you and might start moving towards the mean, and you might start feeling better.
  • If you have a treatment at that time, when you’re at your absolute worst, it’s going to appear as though that treatment is the thing that is causing you to get better.

Episode 9 – Health Claims > Conversation with Shepard Siegel > Conversation with Shepard Siegel

  • We spoke about why people believe what they’re told and why people see what they expect to see.
  • Again, last week we saw somebody who claims to be able to heal people through touch and put that prayer energy into physical batteries.
  • We’re more interested in why people believe these things, not just debunking a lot of the stuff that’s out there.
  • Last week we also talked about-well, throughout the course, I suppose, we’ve been talking about the power of expectation: how what we see, hear and remember are all shaped by our experiences.
  • When you see what you expect to see, there are limits to that.
  • I can’t, for example, see a unicorn appear in front of me even though I really, really want to.
  • It needs to be a dark room or a noisy sort of environment where you can bend this noisy information to almost contort into the thing that you expect to see.
  • Instead, they’re going to probably cite some experience that they had-or not even that they had-something that their family member had, or a friend had, or even seeing it happen on a television show, or some expert or alleged expert said that it’s going to work.
  • When we were travelling around the MindBodySpirit Festival, a lot of the health claims or the benefits that each of these people were making reference to weren’t things like open wounds or broken limbs or skin disease.
  • They were things like well-being or integration or balance-very vague, ambiguous statements that you can do a really good job at contorting to your expectations, to see what you expect to see.
  • That’s one of the mechanisms that we talked a lot about last week, and it’s really prevalent when it comes to health claims, these very ambiguous statements that people make that you can contort into your expectations.
  • This is a test developed a long time ago where you show people ink blots and you ask the patient what they see in these ink blots.
  • Now a lot of what they see or the claims of these tests seem to be no better than a lot of the claims that people were making at the MindBodySpirit Festival in terms of the scientific rigor for these things.
  • It’s no better than interpreting somebody’s dreams on the basis of what they see in these ink blots.
  • It’s a really nice example of the role of ambiguity and how you can contort your expectations to coincide with what you expect to see when it comes to health claims.
  • The person who didn’t do particularly well in the exam, lots of things were working against him.
  • There are lots of random multiple things happening to push you down.
  • Things will stop going against you and might start moving towards the mean, and you might start feeling better.
  • If you have a treatment at that time, when you’re at your absolute worst, it’s going to appear as though that treatment is the thing that is causing you to get better.

Episode 9 – Health Claims > Mind over matter? > Mind over matter?

  • If we go back to his example that he provided with appendicitis, so if you’re a patient you’re complaining, “My pelvis hurts,” and you go to the clinic and you see a physician, they’re either going to decide to operate or not on the basis of the information they have in front of them.
  • Essentially you either have appendicitis or you don’t, and the physician’s either going to decide to operate or not.
  • If you in fact have appendicitis and they decide to operate, that’s good.
  • If you have appendicitis and they decide not to operate, that’s pretty severe.
  • You have an inflamed appendix and they decide, “You’re fine. Go home,” you could die if this were serious enough.
  • If you don’t have appendicitis and they decide to operate anyway, that’s also a mistake.
  • That’s where they correctly decide to take out an inflamed appendix.
  • When we’re talking about a response bias, all we’re talking about is a tendency, a bias, a tendency to say, in this case, “Operate.” Now the reason that you would want to err on the side of caution and operate is because of that very severe cost of a miss.
  • You would err on the side of caution, and you might decide to operate.
  • As a result, you might take out the odd healthy appendix but on the same note you’re also going to take out a lot of inflamed appendices.
  • That’s this idea of a response bias and deciding more often to operate than you may ordinarily.
  • Yes, the exact same thing is happening with the placebo effect.
  • You can take a pill that has no active ingredient, a placebo.
  • You can either report feeling better or report not feeling better at all.
  • Now a response bias in this case is just a tendency to report feeling better regardless of whether you took a drug or a placebo.
  • You have to think back with your fallible memory about how you felt before and report whether you felt better or not.
  • I mean, if somebody has a claim about something, if they say this diet is the best thing under the sun or this thing is going to heal you, that’s a claim.
  • All you’re hearing about is that positive-positive cell the number of times that you did the thing, took the diet, did the treatment, and felt better as a result, felt more energetic, whatever.
  • Well, hang on, what about the number of times that i took the treatment and I didn’t feel better? Or if the claim is about someone else, how many times did someone else take the thing and didn’t feel better or more energetic? How many times did they not take anything and they felt better? That’s right.
  • Or better, a placebo-if they took the thing without an active ingredient in it and didn’t feel any better, then that’s also worth knowing.

Episode 9 – Health Claims > Like cures like > Like cures like

  • It’s based on the idea that “Like cures like” or the Law of Similars.
  • The idea behind “Like cures like” is the assumption that the thing that caused the ailment can actually cure it so a diluted form of poison ivy can stop a skin rash; a diluted form of coffee can stop hyperactivity; red onions can stop your eyes from watering.
  • They gave people information about these fictitious tribes.
  • Participants were told about this tribe that ate wild boar.
  • Then another tribe who ate sea turtles, this tribe that ate sea turtles, were judged to be better swimmers.
  • That’s the “You are what you eat” idea, which is related to another similar claim that natural is better.
  • Many people have the intuition that the things that we eat, if they’re natural, they’re better for you; they’re better for the environment; they’re safer.
  • If you think about it for a second, there are a lot of natural things that aren’t good for you.
  • Jelly fish poison, snake venom, arsenic-they’re all perfectly natural, but they’re not good for you at all.
  • Some perfectly unnatural things-automobiles, indoor plumbing, eyeglasses-these are all unnatural, but they’re really, really useful.
  • I had a chance to talk to Jimmy Botella about this idea, this intuition that we have of natural being better, and here’s what he had to say.

Episode 9 – Health Claims > Conversation with Jimmy Botella > Conversation with Jimmy Botella

  • People have strong beliefs, I think, about whether something is good if it’s natural or bad if it’s unnatural.
  • There’s nothing more natural than an earthquake, and that’s not very good.
  • There’s nothing more natural than malaria, and that’s not good either.
  • Being natural doesn’t mean being good, but today everything, especially on TV, there is this romantic notion that if we put natural on a product, call it a yoghurt or a pair of socks, I’m going to sell more.
  • There are now official signs by the US Government saying-I mean, advertisements saying do not do that because there are huge amounts of cases of listeria by getting the natural milk out of the cow without any kind of manipulation just because of the concept of “Can’t be any better than just out of the cow-drink it.” Thank you.
  • Why do you think we have a propensity towards liking things that are natural? Because it sounds good and it looks good.
  • It’s like artificial things are bad; natural things are good.
  • In general, you like natural means good; artificial means bad. Nothing natural can harm me because it comes from Mother Nature.
  • People wouldn’t buy it because something that can heat up things in ten seconds, that can’t be good, with this myth going around that microwave would make food radioactive and people wouldn’t buy it.
  • What would you say to somebody that says the risks for genetically modified food are just too high? Well, the risk is too high is a perception that I don’t find it justified by science and by facts.
  • We’ve been growing GM food now for a long, long time and there isn’t any reports saying that there’s any bad consequence for human health.
  • By the way, there are plenty of reports that normal foods end up in food poisoning.
  • I just heard today that a couple of Australian citizens have died in Bali out of food poisoning eating in a restaurant.
  • GM food, as a matter of fact, the regulation is so strict that GM food are completely tested of everything, and normal food are not.
  • The risk in GM food is a lot less than in normal, what they call normal food.
  • What do you mean there’s no normal anymore? Well, there is nothing that we eat that is natural anymore.
  • Food has been manipulated for thousands of years for our convenience.
  • If you go to the original foods, they will always be smaller, have a lot less yield per hectare, and the nutrition is going to be a lot less.
  • There is some of the food that’s being sold in the market with this myth that they are better.
  • There are some food that are labelled this or that, that say they are better; they have less residues or they are more natural.
  • I know you’re going to pay twice the price to buy that particular food, and you’re free, and I will respect your decision, but find the facts.

Episode 9 – Health Claims > The man is keepin’ me down > The man is keepin’ me down

  • In the beginning of the course, we asked people a bunch of questions, in episode one, in a section called “About You.” One of the questions in particular we asked was do you think that there are health practices-for example, herbal remedies, spiritual harmony, dietary practices, traditional healing-that aren’t being investigate either because the medicine and drug companies don’t like them or because they don’t fit current scientific theories? Now we had tens of thousands of people respond to this question, and 85 percent of people said, yes, that there are practices, alternative practices, that aren’t being investigated.
  • One is just the information that people are exposed to when deciding whether there is actually something to these treatments.
  • If you think about it in terms of the media, television, movies-most of the exposure we have seems to be that there are definitely effective alternative treatments that aren’t being investigated.
  • The second thing, I think, that might be going on is that you don’t really notice non- occurrences exactly as we heard about in the last episode.
  • If something isn’t effective, if one of these treatments have been tested adequately using traditional evidence-based medicine and it came out negative, you wouldn’t hear about it, would you? You would never see in the headline news about a non-event-the fact that the placebo is no better that the active drug, in this case.
  • You’re not going to hear about those particular treatments, and so they won’t factor into your rating as to whether these things are actually happening or not.
  • Yes, I think the availability heuristic is operating very strongly here.
  • You can find treatments from everything from blood disorders to infectious disease or tobacco, drugs and alcohol dependence.
  • If you look at something like mental health and then depression, here, there are all sorts of alternative therapies that have been tested like acupuncture, light therapy, St. John’s wort, and for each treatment they actually list the experiments and analysis that have been conducted and they-what I like about it is they provide a plain-language summary at the end of each of the articles.
  • I really think it can help with your everyday medical and health decision-making.
  • When we were travelling around the world doing these conversations with people, I was suffering jetlag big time.
  • If you want to know if there’s anything to a lot of these treatments, and people, I think, are going to be very surprised by the sort of things that are included in that database-like you said, from light therapy to herbal remedies to acupuncture and all sorts of things-and you can see whether there is anything to these treatments.

Episode 9 – Health Claims > Conversation with Ian Frazer > Conversation with Ian Frazer

  • Do you have any thoughts about what drives people who don’t want to vaccinate their children?
  • Well, one very simple consideration is that if we don’t have any polio in this country—we
  • don’t in Australia; we haven’t had polio in this country for many years—then why should
  • my child have a vaccine to protect them against a disease which doesn’t exist in this country?
  • After all, the vaccine has a very slight risk associated with it, and there is no risk of
  • the disease. What people of course forget is that their children, when they grow up,
  • are likely to go off to parts of the world where the infection still does exist, and
  • it’s a bit late to get the vaccine after you’ve already got the infection. That’s one reason.
  • It’s this, “Well, it’s not really a problem anymore.”
  • In the old days, people used to rush to get vaccines. The polio vaccine was fought for
  • when it first became available in the 1950s in the United States because there was an
  • epidemic of polio every second year. People died. People became paralyzed. Everybody knew
  • what polio was. Now the next generation of mothers and fathers don’t actually see polio
  • anymore, so they don’t see a risk.
  • Sure.
  • There’s a second group that say, “Okay, well, if everybody else is vaccinated, I don’t need
  • to get my kid vaccinated.” Of course, that’s quite correct because if there’s no way of
  • the infection spreading—for example, if everybody is vaccinated against measles except
  • me, I’m fine—but what they forget is that if only 99 out of every 100 people are vaccinated
  • against measles, that’s still enough to allow an epidemic to occur because every one person
  • that gets infected will infect potentially a hundred others. If 99 are protected, they
  • won’t get it, but the other one will and will pass the infection on, so all the people who are not immunized will be at risk.
  • Right.
  • That’s the second reason, which is not a particularly good one, but you can understand why people
  • think that, especially for infections which are not as infectious as measles. Measles
  • is incredibly infectious, but most infections are not that infectious.
  • The third reason why people think that is that they’ve listened to somebody who’s had
  • supposedly an adverse reaction to the vaccine. They’re persuaded by their neighbors saying,
  • “When my kid got it, then he had convulsions afterwards.” No, that’s a rare complication
  • of measles vaccine, for example. Quite often, the febrile convulsions turn out to be occurring
  • with or without the vaccine, but the story gets around: Mrs. Smith’s daughter got into
  • real trouble after vaccination, and wouldn’t it be better just not to be vaccinated?
  • Right.
  • Those people are persuaded very rapidly when an epidemic of the infection occurs—for
  • example, the whooping cough epidemics we’ve had recently—that their kids should really
  • ought to be vaccinated, but it takes the infection to do it.
  • Then there’s a small group of people who basically just have a set of disbeliefs about how the
  • world works. They don’t believe in the infectious nature of disease, for example. They have
  • an animistic approach to why people get disease. It’s punishment from God or it’s against my
  • religion or whatever. They just have these fixed beliefs, and, by and large, they stay fixed.
  • Yes. You’ve mentioned that one of the reasons that people tend not to immunize their children
  • is, like you said, there isn’t polio in the country. If there was, well, obviously, people
  • would be flocking to be vaccinated. Can you paint a picture as to what some of these things
  • look like—polio and measles and so on—for people who aren’t inclined?
  • Yes, measles is, in most people’s minds, dismissed as just a spotty skin disease. For many people
  • who get measles, that’s all it is, but 1 in 1,000 will get a serious internal complication
  • and 1 in 100,000 will be left with major brain damage as a result of measles infection, so
  • that measles, if you’re the unlucky one, is not a trivial disease. In fact, more people
  • die worldwide of measles than of any other infection apart from diarrheal disease. It’s
  • quite a significant problem, particularly for young kids. Indeed, that’s why we push
  • to get kids vaccinated as early as possible in the developing world because the risk of
  • measles killing you is greatest when you’re between the ages of zero and two.
  • Polio, well, for 99 people out of 100, polio is a diarrheal illness which goes away after
  • a couple of days, but for 1 in 100 people, it leads to paralysis maybe of a leg or an
  • arm. If you’re really unlucky, it paralyses your vocal muscles and of course the paralysis
  • is permanent because the nerves that work these muscles are destroyed by the virus.
  • That’s why people used to end up on respirators for the whole of their lives because they
  • were basically left unable to breathe for themselves.
  • Another vaccine that I’ve been involved with of course is the vaccine for cervical cancer.
  • Again, the virus that causes the cancer for 98 people out of 100, it’s a trivial infection;
  • they never know they’ve had it, but for the 2 percent of people who get persisting infection,
  • they can go on and get a cancer which will kill them. If it’s not detected early enough,
  • it’s a lethal infection. In fact, papillomavirus kills more people worldwide. Quarter of a
  • million people worldwide die every year as a result of papillomavirus infection. That’s
  • a very significant burden. It’s the ninth commonest cause of infectious disease death.
  • Wow. One of the issues that we’re dealing with in the course is the idea of cancer clusters.
  • These are quite common. We even had a case, I think, in 2006 in Brisbane. Have you had
  • much experience? Do you know the phenomenon or why they tend to pop up?
  • When I sat on the International Agency for Cancer Research’s Scientific Advisory Board
  • for a few years, this was one of the topics that used to come up regularly. It related
  • to use of mobile phones. It related to stuff being discharged from factories.
  • Some cancer clusters are very real. Environmental pollutants can produce a cancer cluster. Sometimes
  • those cancer clusters are the first evidence of the particular chemical that can cause
  • a cancer. Minamata disease, for example, is an example where toxic pollution produced
  • a whole suite of cancers, and then the Bhopal disaster as well where there was a release
  • of methyl cyanate, I think it was, into the environment, and that produced a whole cluster of cancers.
  • Most of the clusters that people are worried about—that mobile phone tower, this particular
  • power station—there are half a dozen cancers or ten cancers in the community, and somebody
  • says that’s a cluster—what they forget is that rare events occur rarely, but they do
  • occur. If you’ve got a population of seven billion and you’re sensitized to looking for
  • clusters, you’ll find them. You’ll find them with just the probability that you would expect
  • if it’s all random. In other words, a statistical analysis plus a close look to see if it really
  • is a cluster because quite commonly what you find is they say, “Well, we’ve got six cancers,”
  • but it turns out that they’re all quite different and they’re not really a cluster of anything.
  • They’re just six people who were unfortunate to get a disease. It’s partly statistics and
  • partly common sense. You just have to remember that people do get struck by lightning every
  • now and then. Cancer clusters are in the sort of struck-by-lightning or one-in-a-million chance, but it does happen.
  • The title of the course is “The Science of Everyday Thinking.” Given your career, given
  • your experience in vaccination and immunology and so on, what advice do you have for the
  • students, the 60,000 to 80,000 students who are taking the course, to improve their everyday thinking?
  • I think that basically the more educated people are, the more likely they are to make correct
  • decisions about things. You can never have too much education. Even if you’re not going
  • to be a scientist, if you’re not going to go out there and do experiments, understanding
  • the scientific process—the fact that you can make a hypothesis, or call it a guess,
  • if you like, then test it, and then at the end of the testing be reasonably confident
  • about whether about whether your guess was correct or not—that is the basis for making
  • decisions about things. That’s the message that I would always leave people with so that
  • even if they don’t do the experiments, they should be aware that when data are gathered
  • through experimentation, it is actually testing an idea and it can be falsified. You can get
  • an answer that says your hypothesis was wrong.
  • The alternative is straight guesswork. Don’t bother doing the experiment. Let’s just say
  • I’m right, and then you get an answer. That’s not an uncommon approach to things, but it
  • does lead to some very interesting mistakes.
  • I think that the important thing is to say that wherever possible, test a hypothesis.
  • My name is Ian. I think about infections.

Episode 9 – Health Claims > Uncut conversation with Shepard Siegel > Uncut conversation with Shepard Siegel

  • Are there any other examples from our everyday life where that happens? If you expect to take a drug, you make responses that prepare you for a drug, just like you make responses in anticipation for food that prepares you for food.
  • How does that mechanism work? What do you mean you’re expecting, and how do you know what to expect from a drug? Well, if you’re in an environment in which-let’s take a common example of somebody who has a cocktail in the evening when they come home from work.
  • That’s because the usual cues for the alcohol that cause them to prepare for the alcohol are not present in the afternoon because they haven’t normally drunk at that time; whereas, in the evening they are present, so the effect of the drug is more pronounced if you don’t prepare for it than if you do prepare for it.
  • That’s been seen with many effects of many drugs.
  • How can I get more drunk? It’s the same amount of the drug, but it has a completely different effect.
  • Well, if you take a drug, any drug, what it does is engenders responses that attenuate the effect of the drug in order to keep you in a normal homeostatic state.
  • If the drug causes your blood vessel diameter to increase, for example, there’ll be sympathetic activity that cause the blood pressure diameter to decrease.
  • If the drug causes your heart rate to increase, the increased heart rate will initiate homeostatic responses that decrease heart rate.
  • A drug is certainly a-it can be a major physiological insult, and the reason why you don’t die when you get the drug is because the perturbations that are produced by the drug induce responses that counter the effects of these internal disturbances.
  • If you do inject too much of a drug, you’ll die.
  • The interesting fact about overdoses of many drugs, and especially heroin, is that these very drug-experienced and presumably very drug-tolerant individuals die after receiving a dose of the drug that would not be expected to kill them.
  • You could document, for example, that many people buy a drug from a common drug supply, from a common supplier, and they all inject about the same amount of the drug, and only one individual will suffer the overdose.
  • The others not only don’t suffer an overdose, but don’t see anything particularly unusual about the drug on that occasion.
  • You can find instances in which an individual died after self-administering a dose of the drug that you can demonstrate was a smaller dose than they survived the previous day.
  • It’s a peculiar idiosyncratic reaction to the drug that’s suffered by the victim.
  • The reason why it occurs is because they don’t make the compensatory response in anticipation of the drug.
  • Why wouldn’t they make the compensatory response in anticipation of the drug? It’s because on the occasion of the overdose they get the drug in unusual circumstances.
  • This has certainly been demonstrated in several experiments with animals concerning overdose to heroin, pentobarbital, and alcohol in that the drug-experienced rat or mouse that gets the drug in an environment other than that previously paired with the drug is likely to suffer an overdose.
  • Of course you can’t do the experiments with people that you can do with animals, but there are many, many case reports of individuals who suffer an overdose when they take the drug in circumstances for them which are unusual, and that would be expected if they don’t make the drug preparatory response.
  • If you’re admitted to a hospital, you’re going to survive the overdose because you’re given a drug called an opiate antagonist that displaces the opiate molecule from its site of action in the brain, and so you survive, and so you can question the individual about their drug use on the occasion of the overdose.
  • What they looked at in this Spanish hospital were people who were admitted for heroin overdose and survived, and they could question them about the-what the circumstances the drug administration were in the occasion of the overdose.
  • They also had people admitted to the hospital for any of a variety of reasons that people get admitted to the hospital: fights on the street, automobile accidents, other traumatic events having nothing to do with drug use.
  • The people that were admitted for heroin overdose tended to take the drug in unusual circumstances.
  • The people with about the same blood levels of opiate who were admitted to the hospital but didn’t suffer an opiate overdose, and so were tolerant to the drug, were-they took it in their usual place on that occasion.
  • If you’re engaging in this sort of behavior, you might be about to take the same physical amount of a drug, if you’re in a new environment or a new situation, then it’s going to affect you differently.
  • Is there any lab-based evidence for the difference you were talking about between experiencing a drug in one situation versus another? Yes.
  • I’ll describe the heroin experiment to you: there are a large number of rats that were prepared with intravenous cannula-that is, they could be administered a drug through a vein without actually piercing the skin with a hypodermic needle all the time.
  • What’s the explanation for that? If you are in an environment that you previously have not gotten heroin, you don’t make the conditional homeostatic response that’s going to attenuate the effect of the drug.
  • You, on some particular occasion, get decaffeinated coffee when you normally get caffeinated coffee, it should have a soporific effect because you would prepare for the activating effects of the caffeine and there would be no caffeine there, and you would have a conditioned response, which would be sleepiness.
  • Can you tell me about the placebo effect? What is it? The placebo effect is interesting, both historically and its mechanisms.
  • The placebo effect really was publicized as a result of a paper, I think in 1955, by somebody named Beecher, called “The Powerful Placebo.” He didn’t do any new research, but he evaluated existing literature, and he showed that for a variety of treatment modalities, about a third of the-for a variety of different disease states, about a third of the people that don’t get treated get better.
  • If the treatment is a drug, a placebo can be something that looks like the drug but doesn’t contain the active ingredient.
  • How does the placebo effect work? What’s the mechanism that allows you to somehow have a physiological reaction even though there is no active drug or substance? Well, when you say have a physiological reaction, the placebo effect is based on the patient’s report of them feeling better, and that’s to be distinguished from a physiological reaction.
  • Let me tell you about an interesting study that was done recently where patients who had asthma had a-there’s a drug that’s effective called Albuterol.
  • If you give half your patients-well, they gave a third of the patients nothing, a third of the patients an Albuterol inhaler, and a third of the patients a placebo inhaler that didn’t have the active drug in it.
  • If the patient says they feel better, that’s usually taken as evidence of the placebo effect, but often if you measure whether they get better, and if you have some physiological index like respiratory parameters, then you’ll find that there is no placebo effect.
  • The patient is in pain and gets a drug or gets a substance, which the physician assures the patient will alleviate the pain.
  • It’s been pointed out since at least in 1990s: in order to really demonstrate a placebo effect, you need at least a three-arm study where one group gets the drug; one group gets a placebo; and a third group gets no treatment, and you have to find the difference between the placebo group and the no treatment group in order to assert a placebo effect.
  • You’re saying you need to look at the effect of the drug, and then of a placebo, and then of the no treatment.
  • I thought-that’s surprising to me because my intuition or my common understanding of the placebo effect was that if there is nothing active and you get better, then it was a placebo effectbut you’re saying that’s not necessarilythe case.

Episode 9 – Health Claims > Uncut conversation with Ian Frazer > Uncut conversation with Ian Frazer

  • I just wanted to start off by doing a bit of myth-busting on a few of the common immunization myths, for example: is there any evidence, whatsoever, that heavy metals in vaccines cause any sort of difficulties? Is mercury a problem these days? Vaccines nowadays, at least in the developed world, do not have mercury in them anymore.
  • The reality is that the very small amount of mercury that’s present inside the vaccine material in a routine vaccination is far less than you’d actually consume in the course of a normal diet.
  • Well, the reality of course is that it handles all the infections that the vaccines are designed to prevent.
  • The vaccines are much less of a challenge to the immune system than the infections we meet, and yet we still survive all the infections as well.
  • Some of them become commoner because we’re living longer now because we don’t get the infections anymore, but there’s no direct evidence that any particular disease has been attributable to vaccines, with one or two minor exceptions.
  • I mean, some vaccines that were made in great haste deal with infections such as the swine flu vaccine definitely caused rare autoimmune disease.
  • For the vast majority of vaccines, we’ve got so much data now to say that there’s no evidence that these vaccines increase your risk of getting this disease.
  • A vaccine company exists to make vaccines, and because they’re owned by shareholders, they’re expected to turn profit.
  • The cost of developing these vaccines is extraordinarily high.
  • The risk is extraordinarily high, too, because the vast majority of vaccines that are proposed never get out there to the market.
  • Vaccine companies actually got to the stage where they’re pretty well turning around saying, “We’re not going to make vaccines anymore. We can’t make any money off these.” It was only when the American government stepped in and said, “Look. We will indemnify the vaccine companies against any potential claims from problems with the vaccine,” that the vaccine companies were really able to carry on making vaccines.
  • Vaccine companies actually started as philanthropic organizations, by and large.
  • Commonwealth Serum Laboratories was a government organization that makes vaccines in Australia.
  • Most vaccines are very, very safe-one in a million allergic reactions.
  • That’s about the same for almost all the vaccines that we currently give out.
  • In terms of long term risks, the only clearly identified one is that you can get an allergic reaction when you get the vaccine.
  • Some of these are severe-about one in a million people that get a vaccine get an allergic reaction.
  • First of all, you demonstrate, if there is an animal model, that the vaccine will protect against the infection in an animal.
  • Then you do those ranging studies in a small number of healthy volunteers to see how much of the vaccine you need to give to give an immune response that you think will be protective.
  • Then you’d go on to do studies which become increasingly more broad spread. Initially they start focusing on the ideal target group, and you basically compare the vaccine with a placebo and find out whether the vaccine protects.
  • Then eventually you go out and take all comers and immunizing everybody that you would plan to immunize, including people who might’ve had the infection already, people who have recently been ill with other illnesses, and basically try to get this broad picture as possible of how protective the vaccine is, vis-à-vis a placebo and whether there are any groups that are particularly vulnerable risk for complications.
  • Most vaccines turn out to be safe in almost everybody that they’re given to.
  • The one exception is that if you’ve got an already impaired immune system-one in a 100,000 people are born with a significantly impaired immune system-then you’re not likely to want to get a live vaccine because the live vaccine might actually cause the disease you’re trying to prevent if your immune system can’t respond to the vaccine.
  • Yes, on average, 20 years from the time when you start thinking about the vaccine to the point where it’s actually out there as product.
  • Do you have any thoughts about what drives people who don’t want to vaccinate their children? Well, one very simple consideration is that if we don’t have any polio in this country-we don’t in Australia; we haven’t had polio in this country for many years-then why should my child have a vaccine to protect them against a disease which doesn’t exist in this country? After all, the vaccine has a very slight risk associated with it, and there is no risk of the disease.
  • What people of course forget is that their children, when they grow up, are likely to go off to parts of the world where the infection still does exist, and it’s a bit late to get the vaccine after you’ve already got the infection.
  • The polio vaccine was fought for when it first became available in the 1950s in the United States because there was an epidemic of polio every second year.
  • The third reason why people think that is that they’ve listened to somebody who’s had supposedly an adverse reaction to the vaccine.
  • They’re persuaded by their neighbors saying, “When my kid got it, then he had convulsions afterwards.” No, that’s a rare complication of measles vaccine, for example.
  • Quite often, the febrile convulsions turn out to be occurring with or without the vaccine, but the story gets around: Mrs. Smith’s daughter got into real trouble after vaccination, and wouldn’t it be better just not to be vaccinated? Right.
  • One group in particular in the US was looking at one of the-I think it was the cervical cancer vaccine that you developed-and said that people died as a result during the clinical trial.
  • These deaths were assessed by the clinicians who were running the trial as not in any way associated with the vaccine.
  • These vaccines were given to teenage and young women, and teenage and young women occasionally commit suicide; they occasionally are involved in car accidents; and they occasionally have other completely unrelated illnesses.
  • The direct evidence of that is that we’re doing research on the herpes vaccine at the moment, and there had been a bit of media coverage for that, and that results in perhaps in five to ten e-mails per day to me to say, “When will this herpes vaccine be available?” Obviously, everybody is now aware that people are working on a vaccine for herpes.
  • Then of course the story goes global-goes viral, to use the current expression, although that’s not right for a vaccine.
  • The net result is of course that things get out of hand, and what happened as a consequence of that with the cervical cancer vaccine was that India cancelled its entire vaccination program for the single cancer that kills more women than any other in India.
  • In countries where the problem is common and vaccines are there for being newly introduced to get rid of the problem, then simple word of mouth works extraordinarily well.
  • If you come along saying, “We’ve got a vaccine, and it’s safe,” and particularly if that message comes from within the community, from the district nurses or health workers that are known to the people, the vaccine will be accepted.
  • In the developed world and particularly when you’re introducing a new vaccine for something which people haven’t really seen as a problem or don’t think that they’re a particular risk of, then there are two important bits.
  • If the doctor recommends it, if the district nurse recommends it, if the midwife recommends the vaccine, then chances are the mother will accept it.

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