Author Topic: medical fumble in SGS morgue dialogue  (Read 1746 times)

Twiglard

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medical fumble in SGS morgue dialogue
« on: September 26, 2017, 02:16:21 am »
In the medical histories, there's one about Pasquale prescribing placebo to a SGS citizen. Placebo isn't used outside clinical studies -- as a null hypothesis. Please fix it, it looks absurd. Thanks.

PhrygianDominant

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Re: medical fumble in SGS morgue dialogue
« Reply #1 on: September 26, 2017, 05:02:20 pm »
Correct me if I'm wrong, but while it is true that placebo is primarily used in clinical studies and is a bit problematic from an ethical standpoint, that does not mean that it is not used in medical practice. In fact, if I may quote this article -> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211281/:

"In Germany, when asked about the placebo use, 208 general practitioners reported that they used a placebo at least once in their practice; 45% used placebos, such as saline injections and sugar pills, at least once per year and 76% of general practitioners used medical interventions that have pharmacological or physical activity but have no intrinsic effect on the patient's disease or symptoms. The rationale for the use of placebo was to elicit "a psychological effect, followed by the expectation of patients to receive a treatment" "

There are many examples in here, but I chose this one because it specifically mentions the use of pure placebos: saline injections and sugar pills.

Or this one -> http://journals.sagepub.com/doi/abs/10.1177/0163278703026002002

"The authors sent a questionnaire to 772 randomly selected Danish clinicians and asked them about their use of placebo interventions. Sixty-five percent responded. Among the general practitioners, 86% (95% confidence interval 81-91) reported to have used placebo interventions at least once, and 48% (41-55) to have used placebo interventions more than ten times, within the last year. Hospital-based doctors and private specialists reported to have used placebo interventions less frequently (p <.001). The most important reason for the use of placebo interventions was to avoid a confrontation with the patient. Typical placebos were antibiotics for viral infections. Approximately 30% (28-36) of the clinicians believed in an effect of placebo interventions on objective outcomes, and 46% (42-50) found clinical placebo interventions generally ethically acceptable."

Now, whether Pasquale is practicing good or bad medicine in this instance is a matter of debate, but unless I'm missing something here (I am a game developer and not a medical professional after all, and I don't mean that sarcastically) it doesn't seem absurd at all. On a side note, isn't homeopathy as a whole basically just... placebo?

mattu

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Re: medical fumble in SGS morgue dialogue
« Reply #2 on: September 26, 2017, 06:29:47 pm »
I don't think you (PhyriganDominant) are wrong. Never thought it was odd when I've seen it in context. Totally makes sense to me that Pasquale would prescribe a placebo if he thinks it warranted. Underrail isn't a modern western first world society.

Sanger

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Re: medical fumble in SGS morgue dialogue
« Reply #3 on: September 28, 2017, 12:33:34 am »
On a side note, isn't homeopathy as a whole basically just... placebo?

Many people would probably debate that point with you (I'm not one of them ;)), but either way, I suppose, there's is a difference between a doctor prescribing a treatment for which no empirical evidence of efficacy exists and prescribing a treatment that is outright ineffective.

However I don't really see how any of this is relevant to Pasquale's situation in Underrail, as he's trying to practice medicine in a difficult environment with limited resources (as one of the other entries on the same terminal makes clear), and the worst thing that could've happened as a consequence of his use of a placebo would've been the patient returning with the same complaint. If he hadn't made any attempt at diagnosis it might've been more questionable.

PhrygianDominant

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Re: medical fumble in SGS morgue dialogue
« Reply #4 on: September 28, 2017, 07:18:26 pm »
Well, even though Underrail is a post-apocalyptic world where you can also be treated by a man who used to dump people who hadn't yet died down a corpse chute in the Arena, I still felt the need to primarily address the claim that placebo isn't used outside clinical studies in the modern world and that it is therefore absurd to have a character in the game use such treatment on a patient. My post is relevant to Pasquale's situation in the sense that, heck, if placebo is used in real-life medical practice and is apparently used fairly frequently, then its use in Underrail shouldn't be absurd at all. Underrail is not the modern world, sure, but it shares a lot with it, obviously, and relevant examples from real life help believability in my opinion.

Now when it comes to "good" and "bad" medicine that I mentioned, placebo often relies on some kind deception, and that can affect the patient's trust if the patient were to find out he's been deceived; also, there is a difference between prescribing impure placebo such as multivitamins or antibiotics and pure placebo sugar pills or, say, doing sham surgery in more extreme cases, and people might react to that to varying degrees. Furthermore, some consider deception unethical no matter the context, a sentiment that could be shared by Underrail characters as well (more likely by those who work in better conditions than Pasquale, but still).

And lastly - homeopathy. :D You are right about what you wrote, Sanger, but the thing I was aiming at when I mentioned it was that, considering the lack of evidence for any therapeutic efficacy of homeopathic medicine and that any positive effects, if and when they occur, are thus merely the result of a placebo; one can from a practical standpoint only treat it as, well, placebo (at best), regardless of intentions. Granted, there are some problems with that, and maybe I should have left homeopathy out of this, for many (heh) reasons. But it's there now, so that's that.

I hope that clears up a few things. :) No tl;dr, sorry.
« Last Edit: September 28, 2017, 07:33:49 pm by PhrygianDominant »

Fenix

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Re: medical fumble in SGS morgue dialogue
« Reply #5 on: October 04, 2017, 10:40:24 am »
On a side note, isn't homeopathy as a whole basically just... placebo?
With such placebo effectiveness I have different question - isn't official medicine a placebo effect too?

PhrygianDominant

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Re: medical fumble in SGS morgue dialogue
« Reply #6 on: October 05, 2017, 05:42:58 pm »
On a side note, isn't homeopathy as a whole basically just... placebo?
With such placebo effectiveness I have different question - isn't official medicine a placebo effect too?

If I'm understanding your question correctly, then the answer is no. Modern medicine is effective at treating health conditions, whereas homeopathy is not.

Fenix

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Re: medical fumble in SGS morgue dialogue
« Reply #7 on: October 05, 2017, 11:16:35 pm »
Well, if modern medcine has effeciveness of 80% - which I fairly doubt, then half of it come from placebo effect.
As for homeopathy, it cure things that actual medcine has troubles to cure.

Sanger

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Re: medical fumble in SGS morgue dialogue
« Reply #8 on: October 06, 2017, 01:16:44 am »
Whoops, here we go!

PhrygianDominant

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Re: medical fumble in SGS morgue dialogue
« Reply #9 on: October 06, 2017, 04:39:25 pm »
Whoops, here we go!

:D

Quote from: Fenix
As for homeopathy, it cure things that actual medcine has troubles to cure.

Can you give me an example?

Twiglard

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Re: medical fumble in SGS morgue dialogue
« Reply #10 on: October 07, 2017, 04:31:43 am »
Correct me if I'm wrong, but while it is true that placebo is primarily used in clinical studies and is a bit problematic from an ethical standpoint, that does not mean that it is not used in medical practice. In fact, if I may quote this article -> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211281/:

"In Germany, when asked about the placebo use, 208 general practitioners reported that they used a placebo at least once in their practice; 45% used placebos, such as saline injections and sugar pills, at least once per year and 76% of general practitioners used medical interventions that have pharmacological or physical activity but have no intrinsic effect on the patient's disease or symptoms. The rationale for the use of placebo was to elicit "a psychological effect, followed by the expectation of patients to receive a treatment" "

"The authors sent a questionnaire to 772 randomly selected Danish clinicians [...] Approximately 30% (28-36) of the clinicians believed in an effect of placebo interventions on objective outcomes, and 46% (42-50) found clinical placebo interventions generally ethically acceptable."

It's very scary from an ethical perspective. I can understand doctors lying to people with advanced cases of dementia et al. But the general idea is that doctors don't lie to patients and are upfront with them over the course of treatment. This is what I heard from multiple direct sources and it's my own scarce experience as well.

GP's are another can of worms though. Anecdotally, I have a family member having been prescribed heavily addictive stuff as a sleep aid. Then it got worse.

Now, whether Pasquale is practicing good or bad medicine in this instance is a matter of debate, but unless I'm missing something here (I am a game developer and not a medical professional after all, and I don't mean that sarcastically) it doesn't seem absurd at all.

It's in direct violation of medical ethics. Probably. This poster thinks so. There's no Pasquale second-guessing himself about his decision or anything.

But then again, Pasquale is a GP so it makes sense.

On a side note, isn't homeopathy as a whole basically just... placebo?
Sometimes their stuff gets contaminated accidentally and then it gets real "therapeutic". It's not in ICD. It's like L. Ron Hubbard, except not as bad.

Your linking to the abstracts is elucidating, thanks for that.
« Last Edit: October 07, 2017, 04:47:55 am by Twiglard »