Unethical informed consent caused by overlooking poorly measured nocebo effects

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients

Broadband in rural and remote areas: the impact of Scottish policy initiatives

The ability to participate in the Internet-based economy that is emerging requires access to broadband. However, in many countries, 'digital divides' occur, with those in geographically remote and rural areas being particularly disadvantaged. Through focusing on rural and remote Scotland, the paper identifies three different categories of policy initiatives that have been adopted and their interaction with broader UK and industry wide developments. Whilst these initiatives have encouraged the adoption of broadband, it is argued that UK initiatives are creating a new series of challenges to the adoption of broadband

Positive messages may reduce patient pain: A meta-analysis

Introduction Current treatments for pain have limited benefits and worrying side effects. Some studies suggest that pain is reduced when clinicians deliver positive messages. However, the effects of positive messages are heterogeneous and have not been subject to meta-analysis. We aimed to estimate the efficacy of positive messages for pain reduction. Methods We included randomized trials of the effects of positive messages in a subset of the studies included in a recent systematic review of context factors for treating pain. Several electronic databases were searched. Reference lists of relevant studies were also searched. Two authors independently undertook study selection, data extraction, risk of bias assessment, and analyses. Our primary outcome measures were differences in patient- or observer-reported pain between groups who were given positive messages and those who were not. Results Of the 16 randomized trials (1703 patients) that met the inclusion criteria, 12 trials had sufficient data for meta-analysis. The pooled standardized effect size was −0.31 (95% confidence interval [CI] −0.61 to −0.01, p = 0.04, I2 = 82%). The effect size remained positive but not statistically significant after we excluded studies considered to have a high risk of bias (standard effect size −0.17, 95% CI −0.54 to 0.19, P = 0.36, I2 = 84%). Conclusion Care of patients with chronic or acute pain may be enhanced when clinicians deliver positive messages about possible clinical outcomes. However, we have identified several limitations of the present study that suggest caution when interpreting the results. We recommend further high-quality studies to confirm (or falsify) our result. FUNDING Alexander Mebius research has been funded through the ERC grant "Philosophy of Pharmacology: Safety, Statistical Standards, and Evidence Amalgamation" (GA: 639276

Me ei tea, kas enamik ravimeetodeid toimib, ja veel vähem teame, kas need põhjustavad kahju, on väidetud uues uuringus*

Eesti Arst 2022; 101(9):521–52

Why include humanities in medical studies: comment

Five reasons why teaching medical humanities in medical schools improves student performance, enhances wellbeing, and ameliorates patient outcomes

Looking Through a Paradox an Environmental History of Two Mormon Communities

Nature is both powerfully attractive and powerfully repellent, 1 describes the Western Paradox as it was first described by Donald Worster in his Under the Western Skies: The West has been an American symbol of independence, equality and self-preservation from its earliest day, but that freedom had a price. The scarcity of water in the arid West shackled these free spirited adventurers as they became slaves to canals, dams and irrigation ditches.2 Their natural spirit seemed to be defied by the world of technology and machines, which they sought to leave behind by coming West. Yet, by coming to the arid West, the need for water to merely survive grew severe, and with it, grew a need to efficiently use limited water resources. Out of this need, evolved an increasing use of technology to obtain water resources effectively, as well as innovations of new technology. When this happened, those free-spirited adventurers found themselves becoming caught in the capitalistic and dependant world, that they had dreamt of leaving behind, and transforming into victims of Worster\u27s Paradox.

Problematic placebos in physical therapy trials

The placebo controlled, randomised controlled trial is widely recognised as the gold standard design for providing evidence in health care. Yet controversies surrounding placebos persist, which include issues regarding ethics, legality, mechanisms, and even whether there should be such a thing as placebo at all. Here, we intend to highlight some of the difficulties in the design and use of placebo controls within physical therapy trials. Unlike placebo tablets, which can be constructed simply by removing the active or‘characteristic’ingredient, physical therapy treatments are often more complex, with many active features that cannot be easily separated. Based on the challenges of isolating the characteristic feature(s) of treatments, we explore the problem with constructing placebos in trials of physical therapies, drawing on philosophy of science as a basis for defining what a placebo is and is not. After pointing out common problems, we outline potential solutions using alternative designs that allow trials to remain rigorous, while at the same time avoiding the pitfalls introduced when using inadequate placebos

Transitioning from the Reflection-Based Safety Literacy Classroom to the Worksite: The Student Experience

Reflection-based safety literacy is a form of education that builds bridges between the classroom and the workplace. This paper explores how experiences shared in the classroom create connections between health and safety learning material and its application in personal and professional lives. The exploration of the student experience showed that students transferred course themes to the work environment more effectively when sharing the experience with a colleague and created personal connection to the content through application and reflection between learning sessions. Instructor and student stories demonstrated that a variety of experiences in implementing and interpreting the material resulted in a meaningful context for the student experience. These themes provide insight into the value of reflection and dialogue as tools to enhance health and safety curriculum. La formation à la sécurité basée sur la réflexion est une forme d’éducation qui érige des ponts entre les salles de classe et les milieux de travail. Cet article explore la mesure dans laquelle le partage d’expériences en classe crée des liens entre le matériel pédagogique portant sur la santé et la sécurité d’une part et son application dans la vie personnelle et professionnelle d’autre part. L’étude de l’expérience des étudiants a révélé que ceux-ci transféraient plus efficacement au milieu de travail les savoirs acquis en classe quand ils partageaient l’expérience avec un collègue et qu’ils créaient des liens personnels avec le contenu par l’application et la réflexion entre les cours. Les récits des enseignants et des étudiants ont démontré que diverses expériences portant sur la mise en pratique et l’interprétation du matériel ont créé un contexte significatif pour l’apprentissage. Ces thèmes offrent un aperçu de la valeur de la réflexion et du dialogue en tant qu’outils pour améliorer le programme d’éducation à la santé et à la sécurité. Mots clés : éducation en matière de santé et sécurité au travail; apprentissage basé sur la réflexion; diversité; narration