- Papineau’s point is that the need for evidence-based medicine – and the consequent need for blind trials – cannot justify deceiving patients.
- This deception may not be bare-faced lying, but can be being “economical with the truth” – ie. not making things 100% explicit or clear – or simply taking advantage of the less-than-clear-headed state worried patients are in when they report a problem.
- The case in question – shoulder arthroscopy with or without further surgical intervention – is complicated by two factors:- |ii|
- The so-called “placebo” still involves a surgical procedure to open up the shoulder to introduce the “scope”.
- The “placebo” isn’t straightforwardly so as it includes “flushing out the joint”, but doesn’t include further – and preliminary – procedures to shave off bits of bone, etc. So, the patient may not consider it a placebo, and it wasn’t labeled as such on the information sheet.
- So, the patients may have thought they had a 2/3 chance of treatment rather than only 1/3 (and may have thought of themselves as having 100% chance of serious treatment where they have intervention, rather than only 50%).
- There’s a dilemma here. Blind trials need to be done, but can’t be unless people volunteer. So, they need to be induced – or at least not frightened off.
- The article doesn’t say whether there was any inducement to take part in the trial – maybe simply a chance to “jump the queue” might be enough. I can’t remember whether people were told which of the “interventionist” groups they were in, though those in the control group would know!
Text Colour Conventions (see disclaimer)
- Blue: Text by me; © Theo Todman, 2019
- Mauve: Text by correspondent(s) or other author(s); © the author(s)