Cartoon Introduction to Evidence in Medicine

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Cartoon presentation on anecdotes versus evidence in medicine, placebo effect and herbs are drugs.

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  • This is the placebo effect, and we’re going to talk about that in a bit
  • Welcome to our talk today on Placebo Effects, and why it is important to know what they mean for your health.
  • Many people have heard about placebos, and hear the term “sugar pill”. A lot of the time that more or less describes what are used as placebos. To delve a little deeper, placebos actually are anything that makes the patient think they’re receiving a treatment, but instead receive something that doesn’t therapeutically effect the body. There are even placebo surgeries! The reason placebos are used in medical trials is that if a new drug doesn’t help patients as well as a placebo, then the drug isn’t effective, and will have to be modified or abandoned completely. As we’ll discuss in a moment, expectations are important with placebos. (next slide)
  • Well, its not very straightforward, but it’s basically an improvement of symptoms for a patient when you give them a placebo. Remember, placebos don’t actually effect your body, so why would you feel an improvement in symptoms? You might be wondering why this happens. (next slide)
  • [Give examples…] The placebo effect sounds pretty good right now, but there’s a very important aspect of its use in medicine; the ethics of placebo effects. (next slide)
  • The harm is that it doesn’t actually Make you better; it only Might make you feel better. You need to consider whether that is worth it for yourself and for your family. It can also cost a lot of money, which not everyone can afford for an extended period of time. If you have a serious illness, such as cancer or diabetes, proper treatment can be heavily delayed or altogether neglected, leading to awful outcomes for these patients. If you are interested in seeing specific examples go to www.whatstheharm.net (next slide)
  • Herbs are actually drugs. In fact they are full of drugs.
  • Herbs are actually drugs. In fact they are full of drugs.
  • A drug is just a chemical that brings about a biological change in our body. Many people might think that drugs are chemical or artificial, and that herbs and plants don’t fall into this category. But plants are chemicals, many of which will have effects on your body. Plants are full of drugs!
  • In fact many of our current pharmaceuticals came from plants. Everyone has heard of aspirin. It helps with pain relief and inflammation among other things. It originally was found in willow bark. And Digoxin, a drug which has powerful effects on your heart, originally came from the foxglove plant.
  • Herbal remedies can have side effects, just like any drugs your doctor prescribes you.
  • Cartoon Introduction to Evidence in Medicine

    1. 1. Anecdotes and Evidence: What’s the Difference?
    2. 2. <ul><li>An anecdote is a personal story </li></ul>What is an anecdote anyways? I used to have a lot of back pain, but since I started taking that remedy its been better
    3. 3. <ul><li>Why aren’t stories good evidence? </li></ul><ul><ul><li>Sample Size : One story doesn’t tell you everything </li></ul></ul>Anecdotes aren’t Evidence What you don’t know is… … I would have gotten better on my own … I still have pain, but I feel better because I believe the remedy worked … that the other 99 people who took it didn’t get better at all
    4. 4. <ul><li>Why aren’t stories good evidence? </li></ul><ul><ul><li>Reporting Bias : people tend to report positive effects. </li></ul></ul><ul><ul><li>How many times have you heard this? </li></ul></ul>Anecdotes aren’t Evidence I want to tell you about this home remedy I took that didn’t work at all!!! Hmm not many…
    5. 5. <ul><li>Why aren’t stories good evidence? </li></ul><ul><ul><li>No Control Group : people can feel better if they expect that something is going to make them better </li></ul></ul>Anecdotes aren’t Evidence Guys! I took this sugar pill and it made my back pain go away!
    6. 6. <ul><li>One group of people gets the remedy and the Control Group gets a “sugar pill”, but they don’t know which one they got </li></ul>What is Good Evidence then? I wonder which one I got… REMEDY SUGAR PILL
    7. 7. <ul><li>Having a large Sample Size : The more people that you have the better the evidence that the remedy actually works </li></ul>What is Good Evidence then? REMEDY He might have gotten better on his own, but would all these people have gotten better? SUGAR PILL
    8. 8. <ul><li>Lots of independent experiments that show the same result </li></ul>What is Good Evidence then? Hmmm this experiment shows it works, but there’s 19 experiments showing it doesn’t work…
    9. 9. Sample Size and Error STUDY #1: With Big Sample Sizes, The Remedy has an Effect STUDY #2: With Big Sample Sizes, The Remedy has no Effect - 0 + - 0 + Big Sample Size Small Sample Size Big Sample Size Small Sample Size
    10. 10. Sample Size and Error Effect of smoking on having a premature baby 1 Shah, N and MB Bracken. 2001. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Journal of Nutrition. 2001;131:1032S-1040S. Effect of acupuncture on treating stroke 2 Tang J-L, Zhan S-Y, Ernst E. 1999. Review of randomised controlled trials of traditional Chinese medicine. British Medical Journal 319:160-161. . Decreased Risk Increased Risk Negative Effect Positive Effect
    11. 11. The Placebo Effect
    12. 12. What is a Placebo? <ul><ul><li>A “sugar pill” : Made of something that doesn’t affect the body , like water or sugar . It is used to test if a remedy works better than giving “nothing”. </li></ul></ul>I wonder which one I got… REMEDY SUGAR PILL
    13. 13. What is the Placebo Effect? <ul><ul><li>When people take the sugar pill, they expect that they will feel better and they often DO feel better: this is the Placebo Effect </li></ul></ul>Pills are Medicine. I FEEL BETTER!!!!!! SUGAR PILL
    14. 14. Placebo Effect Examples <ul><ul><li>Your parents giving you chicken soup when you have a cold </li></ul></ul><ul><ul><li>You give a child a kiss on their wound to make it feel better </li></ul></ul>I feel better :)
    15. 15. I like feeling better…. What’s the harm? <ul><ul><li>A remedy that causes a placebo effect doesn’t actually make you better, though you might feel better </li></ul></ul><ul><li>If you have a serious disease (like cancer) you might delay getting treatments and your disease could get worse </li></ul><ul><li>Costs money! $$$$ </li></ul>
    16. 16. Herbs versus Drugs
    17. 17. <ul><li>Herbs are drugs! </li></ul>Herbs are Drugs! What?!!!!! No way….
    18. 18. What is a Drug, Anyway? Drugs?…
    19. 19. What is a Drug, Anyway? <ul><li>A drug is a substance that brings about a biological change in our body </li></ul>Plants are Chemicals that can have effects on your body!
    20. 20. Many of our Pharmaceuticals came from Plants <ul><li>Willow Bark Aspirin </li></ul>Foxglove Digoxin
    21. 21. Pharmaceuticals <ul><li>Known drug  Known effect  Known Amount </li></ul>
    22. 22. Herbal Remedies <ul><li>What’s the Drug?  Effect??  Amount??? </li></ul>
    23. 23. <ul><li>Herbal remedies can have side effects </li></ul><ul><li>They can also interact with your other medications </li></ul><ul><li>So when your doctor asks you what medications you are taking, you should tell him/her about the herbal remedies you are taking too! </li></ul>Herbal Remedies have Side Effects too

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