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On the previous idea, [farble] commented that doctors tend to consider it highly unethical to prescribe a placebo knowingly, which presumably meant that it was considered immoral to provide a treatment while believing that it would not have a physically-based (let's not quibble about the mind-body problem
here) therapeutic mechanism. I choose to misunderstand this anno in what i hope is a creative way.
Suppose it really is considered unethical to prescribe anything with a placebo effect. That means you should evolve a strategy to prevent the patient know they're being treated. Possible methods of delivery are relatively straightforward and come to mind quite easily: break into their bedroom at night and apply local anaesthetic to an easily-ignored part of their body, then inject them with a drug; wait until they leave shopping unattended and put something in their jam; add a bronchodilator to an asthmatic's air-con; put something in their personal tap water (as opposed to fluoride or stuff that's pharmacologically active but in it by mistake); kidnap and drug them before conducting keyhole surgery on them if they're particularly unobservant; infect mosquitos with attenuated yellow fever viruses. That last bit presumably wouldn't work. Just generally surreptitiously treat people for conditions they have without them knowing it.
This would overcome the problem of concordance but introduces a second problem - they need to be spied on a lot to work out how they might be ill. Fortunately, nowadays this is fairly straightforward what with our CCTV cameras and loyalty cards. Hence you monitor their lifestyles that way, make an educated guess about what might be wrong with them (maybe they look overweight or out of breath on the screen or are buying a lot of heart-disease inducing food in their favourite supermarket), put the info together with their medical records and proceed accordingly.
There are minor ethical problems of lack of informed consent, the fact that you're just guessing what's wrong with people, you don't know enough about them to treat them effectively and you have to spy on them a lot (though probably no more than they are spied on already), but it would at least overcome the problem of knowingly prescribing a placebo.
Taurine
http://en.wikipedia.org/wiki/Taurine
[spidermother, Dec 16 2012]
Minority Report
http://www.imdb.com...81689/?ref_=nv_sr_1
Pre-emption ... but similar. [8th of 7, Sep 01 2014]
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This would make for an interesting novel. |
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OK, I choose to misinterpret this further and
suggest someone write an apology for Big Brother
(in the literary sense) - describing a world wherin
everyone in the professional classes are employed
by the government to invasively look out for one
another's problems. So Winston Smythe might
come into work oneday and turn on his
government viewscreen and start watching the
movements of his next-door neighbours, learning
that they have problems x,y or z - and figuring out
ways to solve them in as unobtrusive a way as
possible. Meanwhile he goes through an internal
bout of restlessness brought on by the developing
presentation of a set of symptoms suggestive of
bowel cancer, and is variously pleased, neutral or
irritated by apparently unexplained changes in his
local circumstances (raw meats disappear from his
fridge, and are replaced with whole-grain porridge,
and fibrous fresh vegetables) He begins to wonder
whether there is someone from "The Party" (in
this narrative, "The Party" really is more an
ongoing celebration, than totalitarian political
movement) who is watching over him, or whether
it's a combination of luck, forgetfulness and/or
some supernatural embodiment of kindness that
is providing him sustenance. |
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We later discover Winston's back story that out of
the darkness of the
recession in the early stages of the 21st Century,
and the ensuing global conflict, small groups of
tightly knit survivalists - linked globally by a still
functioning internet - developed a lovely sharing,
looking after-each-other culture that somehow
managed to plug all the tricky gaps that usually
form and spoil these types of arrangements - the
year is 2084, and everything turned out nice again. |
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bad idea. bad! no pastry. |
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I would disagree that //doctors tend to consider it
highly unethical to prescribe a placebo
knowingly//. |
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I am pretty certain that doctors often prescribe
drugs knowing that they *may* have no significant
pharmacological effect, but that their placebo
effect will be beneficial. |
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For example, doctors will prescribe oral
rehydration stuff for kids with diarrhoea, even
though they know that in most cases a few glasses
of flat Coke will work just as well. |
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Their patients do feel better faster on Dioralyte
(or whatever) than on flat Coke, and most doctors
know there is no clinical reason for this. |
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Another angle would be to take it in a direction where the ethics start to conflict in subtle but meaningful ways; perhaps it would be something like an Asimov short story. Oh [calum], you listening? |
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Another way to do this is to make it mandatory for everyone to attend clinic once a day, and to be aenethsetised there once a week, and to be given a bottle of white pills to be taken with every meal. Then , as in your idea, no-one will know whether they are being treated or not. It could be like Confession where you have to tell the doc what is wrong with you even if you are fine. However it is not so exciting because of the lack of spies. |
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I half-remember either a clinical trial or a collection
of anecdotal evidence from GPs where they found
that genuine medicines prescribed with phrases such
as "I don't think this'll help but it's worth a try" were
markedly less effective than similar prescriptions
given with phrases such as "This is great and it
should clear things up." |
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I think it's clear that this is an intentionally bad idea and it's not particularly subtle either. One problem with intentionally bad ideas is that they're too self-conscious, i think. I need to work on making my ideas worse without being aware that they're bad, which is a kind of meditative activity and i may in fact have achieved this already in ignorance. |
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[MB], that quote is from [farble], and [zen_tom], that's just excellent! I also want to point out that initially Coke was marketed for its alleged medicinal benefits. Also, yes, that kind of thing happens and apparently there's a hierarchy of effectiveness too, with placebo surgery at the top. |
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[Pocmloc], the trouble with that is they'd be aware of the possibility. |
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The next logical step in this idea is therefore
to reintroduce the cocaine into Coca-Cola … |
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Interestingly, Red Bull doesn't really make any drinks. The company rather re-brands (with some changes) Krating Daeng, a pre-existing Thai drink. |
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This was discussed on Gruen Planet, as an example of a company and brand that doesn't actually manufacture anything, just markets and distributes. |
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Also interestingly, "A review published in 2008 found no documented reports of negative or positive health effects associated with the amount of taurine used in energy drinks, including Red Bull." It seems to be a placebo. |
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It doesn't seem to be a stimulant; rather, it's an ordinary component of foods and the human body (link). |
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I suspect that they deliberately don't make _any_ claims, and let the consumer assume that it is a stimulant (or whatever). |
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but if the placebo is given out free, who will pay for it? |
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Everyone. That's the beauty of a National Health Service that's free at
the point of use. Since everybody pays (via taxes) whether they're sick
or not, it is perfectly logical that everybody should be treated (whether
they want it or not). |
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A novel about a Secret Health Service has possibilities. |
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/but if the placebo is given out free, who will pay for it?/ |
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I had a dream last night I was talking to people from the remote past, and telling them that we had almost beaten polio, then clarifying that we had almost eliminated it as a disease - but not yet. |
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The proposed idea is already done routinely as a basis for most public health endeavors - for example water purification, sanitary sewers, fluoridation, vaccination etc. THat stuff works whether you believe or not. Having people believe helps them go along with it as a society and get it done - the failure to eradicate polio being a great example of that. |
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//you should evolve a strategy to prevent the patient
know they're being treated// The NHS already does
this. |
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