Saturday, May 24, 2014

A Good Witch Doctor Is Never Cheap!

When giving out placebo medicines, the most expensive ones are the ones that work best.
The era of quack medicine never really ended, and it is still going on, to some degree, in most doctor's offices.

If this shocks you, it shouldn't. After all, it was not that long ago that people were bled for various diseases and arsenic was prescribed for syphilis.

The simple truth is that doctor's are in a tough position -- patients demand instant fixes for both real and imagined diseases, and an amazing amount of medicine has nothing to do with ligaments or muscles or infection, and quite a lot to do with the mind.

And so, men and women with medical degrees from Harvard and Johns Hopkins face what I call "The Witch Doctor's Dilemma."

Consider the simplest kind of medical visit to a veterinarian.

A dog presents with a case of limber tail. The visit alone is going to cost the dog owner at least $80, and that's before a single thing has been done. In a case like this, if the vet prescribes a 40 mg dose of over-the-counter Ibuprofen, the dog's owner may not feel he or she is getting their money's worth in veterinary care!

Yet, if this same vet looks carefully at the tail, scrunches up her face, and says "What we seem to have here is a rare condition, found only in certain working dog breeds, and only in very active dogs. This is a temporal, breed-specific, idiopathic, muscular condition, and not the kind most vets see every day. But I have good news: I know what it is, and I have a prescription for a medicine -- Rimadyl -- that is dog-specific and you cannot buy at local pharmacy. The medicine is not cheap, but I am pretty sure it will work."

Well! After that kind of stem-winding (what's it all mean?) most patients are eager to write a check for another $50.00 ("is that all?"), and the vet is only too happy to oblige, knowing that a dog with limber tail is likely to be in again at some point for a prescription refill -- at which time perhaps a round of unnecessary vaccines, blood work, and teeth cleaning can be sold. 

The joker in the deck is the simple truth that faces every witch doctor:  Most minor health care problems fix themselves, or can be fixed with cheap over-the-counter remedies.  In addition, a vast percentage of "cures" and "improvements" are only due to a placebo effect. And here's the kicker: when giving a placebo medicine, the most expensive one works best.

As The New York Times notes:

In marketing, as in medicine, perception can be everything. A higher price can create the impression of higher value, just as a placebo pill can reduce pain.

Now researchers have combined the two effects. A $2.50 placebo, they have found, works better one that costs 10 cents.

The finding may explain the popularity of some high-cost drugs over cheaper alternatives, the authors conclude. It may also help account for patients’ reports that generic drugs are less effective than brand-name ones, though their active ingredients are identical.

The investigators had 82 men and women rate the pain caused by electric shocks applied to their wrist, before and after taking a pill. Half the participants had read that the pill, described as a newly approved prescription pain reliever, was regularly priced at $2.50 per dose. The other half read that it had been discounted to 10 cents. In fact, both were dummy pills.

The pills had a strong placebo effect in both groups. But 85 percent of those using the expensive pills reported significant pain relief, compared with 61 percent on the cheaper pills. The investigators corrected for each person’s individual level of pain tolerance.

The placebo effect is not just about pills; it also has an impact in surgery.  In fact, osteoarthritic knee surgery was found to be no more effective than placebo surgery in which the patient thought surgery had been done, but it had not. In another study, 
Parkinson's sufferers who had holes bored into their skulls in order to receive brain cell implants said they thought they had experienced improvement even when they had not gotten the brain cell implants.

But the placebo effect could not possibly work for dogs, could it?  

It turns out, it could

In a study of canine seizures, dogs given an inert placebo also improved;

Twenty-two of 28 (79%) dogs in the study that received placebo demonstrated a decrease in seizure frequency compared with baseline, and 8 (29%) could be considered responders, with a 50% or greater reduction in seizures.... A positive response to placebo administration, manifesting as a decrease in seizure frequency, can be observed in epileptic dogs. This is of importance when evaluating open label studies in dogs that aim to assess efficacy of antiepileptic drugs, as the reported results might be overstated. Findings from this study highlight the need for more placebo-controlled trials in veterinary medicine.

So what's it mean at PetSmart and out on the World Wide Web?

Well, it means you will always be able to find con men selling homeopathic cures and folks who are willing to say it "sort-of" worked for them.

Of course it's not just homeopathic potions being sold (All Natural! Organic! No GMO!).

We also have the canine equivalent of "Dr. Sanden's Electric Belt for Weak Men" or "Dr. Scott's Electric Corset," only this time it's called a "Thunder Shirt".

Just look at what the "Thunder Shirt" is supposed to work on -- barking, leash pulling, anxiety, reactivity, general fearfulness, and.... (wait for it!)... as a general training tool.


It's a MIRACLE.  

Which is to say, it's NONSENSE.  

There is no magical mechanical here.

This thing is simply a too-tight corset for dogs, and it mostly works by making the dog so uncomfortable it finds it hard to move. Straight jackets and wet sheets are a  very old "cure" for the human equivalent of barking, leash pulling, anxiety, reactivity, general fearfulness, and as a general training tool as well.

Of course, a simple too-tight dog sweater can be had for a few dollars in the off season.  

But if you want a placebo device to work better, you need to CHARGE MORE. This point has been demonstrated by SCIENCE.

And so, with that in mind, I am offering The Most Effective "Thunder-type" Shirt ever:  ones that will cost $500 apiece.  I call my version the Thunder Shit and it is priced by SCIENCE. 

Operators are standing by.


mugwump said...


Donald McCaig said...

Dear Patrick,

I think the thundershirt might be useful in extreme thunderphobo. Common in most shepherding breeds, I've never owned a Border Collie who wasn't thunderphobic to some degree. I know when a storm is approaching by the dogs on the bed, drooling and panting in my face.

I know of dogs who've (accidently) hung themselves in storms and several who, despite knowledgeable owners eventually had to be put down.

It is an adaptation of Temple Grandon's "squeeze machine" a device which presses like a hug but w/o personal involvement.

Does it work? Some owners of thunderphobic dogs swear by it.

Is there anything else that works?

Not that I know of.

Donald McCaig

PBurns said...

Animals raised permanently outside do not seem to have astraphobia -- fear of storms.

Look at your sheep, or the local cattle for example -- no stampedes.

Ditto for wild bears, wolves, fox, coyotes, etc. These animals have learned to shelter and wait out the rain, but they are not panicked by it or by lightning. Ditto for zoo animals.

What is different? I think one of the main things is that domestic dogs (some breeds more than others) take a lot of their cues from humans.

What do we humans do when it rains?

We run away for shelter!

Does that feel like FEAR to a dog?

I bet it does!

Instead of running inside when it begins to rain, we probably should do is the opposite --- go out into it and act as if everything is perfectly normal (which it is). Use rain as an excuse to teach simple tricks for terrific treats. It's impossible to hold too many ideas in the brain at the same time, and "food for old tricks" is pretty good stuff, especially if that particular game first starts with simple rain and then moves to rain with thunder.

Squeeze machines are very different than what we see here with Thunder Shirts. For one thing, you are not supposed to live in them - they are for a few minutes, not hours or days, or weeks. For another, they are for the brain-damaged. Dogs that are fear-phobic are not brain damaged -- they are simply dogs that have too little positive experience from loud noises and which may also be reacting to changes in barometric pressure and/or very, very mild static electricity, and/or cues from humans. As a general rule, however, it is simply noise. Dogs that are thunder-phobic also tend to be phobic to fire crackers and massive distant banging from construction or fracking operations.

It's worth mentioning that Temple Grandin no longer uses a squeeze machine -- she simply hugs people as you or I might do. As an adult, she has assimilated and normalized most of her fears.

What to do? A "Thunder Shirt" might work for a lap dog for thunder alone. But running out after your border collies to put them into a too tight shirts, one at a time, might be a great deal harder on you and them than simply calling them into the barn, turning them into a stall, and turning on a little Jethro Tull music so they have less to see and heart. My storm-reactive Jack Russell goes into his stone dog house and burrows into the hay. Seems to work for him!

Astraphobia in humans is dealt with by exposing folks to the phobia in a slow but persistent and repetitive way so that the fear is normalized away. With dogs, one way to start might be to have a thin metal "lightning sound" sheet (a big aluminum sheet from HomeDepot will do) that can be rattled to call the dogs for food. Not too many animals fear the dinner bell! Animals are normally terrified of gun shots, but in the West during elk season, a lot of grizzlies have come to associate gun shots with gut piles, and so the crack of a .50 is now called a "Grizzly Dinner Bell." Operant conditioning at its finest! Could the same work for a metal rattle sheet? I suspect so.

Donald McCaig said...

Dear Patrick,
There've been all sorts of ineffective counter-conditioning/desensitation attempts against thunderphobia which isn't quite the same thing as astraphobia. Storms bother my dogs less than approaching storms.

As far as the notion that animals reared outdoors don't get it - I invite you to try to keep my two 120 pound sheepdogs out of the house when a big storm approaches.

Moderate cases are annoying but manageable. I've never had a sheepdog who'd quit working in thunder but I've had many who didn't work as well. In an extreme case - remember I've known dogs who had to be put down for this - I'd put a thundershirt on the dog for a few hours. Might work. Can't hurt.

Donald McCaig

PBurns said...

I didn't say your dogs don't get it -- clearly do. But how about your sheep or the local cattle?

Animals are animals -- they are mostly the same **except in the ways they are not**.

If we agree that dogs get this phobia, but sheep and cattle do not, then what is it about the dog?

I would aver, that it **may** be that the dogs looks to humans for cues much more than any other type of animal. And some BREEDS of dogs and individual dogs clearly look for cues from people far more than others (I bet we agree on that).

People run away when it rains.

Could that spark the fear?

Here's a question for you -- one I honestly do not have the answer for. Did the old guard dogs that spent their entire lives out on the range without any house nearby run for the hills when lightning and thunder came? Is this a phenomenon you heard a lot about from Basque herders or the folks on long drives of cattle and sheep in the U.S. and Australia and rural Scotland? If so, you would think there would be a pretty deep literature bank to draw from. But is there?

Or is this (perhaps?) a phenomenon of modern man and modern dogs in a modern world where rain is a cause to run?

Serious question, as I do not know. Yes, the issue with dogs is different, but it's not because of their physique, I would argue, but their mind. And the phenomenon seems to be most pronounced (I think) in those dogs that look to humans for guidance.

Donald McCaig said...

Dear Patrick,
There is no (0) literature about farm/ranch/spanish guard dog behaviors. There are some sketchy 19th century reports from travelers. There are modern scientific effectiveness studies (high/ breed unimportant).

I don't know how range guard dogs react to thunder.

I do know sheepdogs learn thunderphobia from one another "What's Shep so afraid of?" but since we humans are more annoyed by storms than frightened of them, I doubt they pick it up from us.

All my dogs startle to gunfire or fireworks and if a neighbor is sighting in, their response is identical to their reaction to storms.

Sheepdogs (and guard dogs for that matter) have hyperkeen hearing. Reports may be painful(?) which escalates to fear of any/all rain/hail storms (they are indifferent to snow and sleet storms unless ((rarely)) they're accompanied by thunder ((which argues by the way against your 'pick it up from humans theory' because we're far more concerned about snow storms than rain storms)).

Whew. Some sentence, huh?

Donald McCaig