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Wednesday, May 9, 2012

Placebo Effect: Misinterpreted Study Proves It

Once again, folks, we have a medical study misenterpreted by the so called experts.  They are now said to have proven "inhaling Albuterol helps asthmatic lungs work better, yet patients who get it don't feel much better than those treated with a placebo inhaler."  That's the results of a study, and they have totally blown it.

Thankfully you have me to give you guys an accurate analysis of these study results, because they show something the researchers have completely missed.

Let me put it this way.  Since I started this blog I've been telling you that doctors think that all pulmonary diseases should be treated as asthma.  They think all dyspnea, regardless of the cause, should be treated as asthma.  They think all dyspnea, regardless of the cause, can be treated with albuterol.  

So you have a patient come into the emergency room with dyspnea and wheezing, and the doctor automatically orders up an Albuterol breathing treatment.  Upon your pre and post treatment assessment the patient neither looks better nor worse, yet then you pose the question:  "Do you feel better?"  The answer is almost always a resounding, "Yes!  I do feel better."  Yet you often wonder:  Is the patient accurate?"

My theory has always been that many patients say they feel better when they actually don't.  In fact, many times a patient will say something like, "Yeah, my breathing is better.  My nose isn't as stuffed as it was before the treatment."  Of course then you know the treatment only had a perceived effect.  

A study was done recently and reported in the New England Journal of Medicine that studied the perceived benefits of Albuterol on subjects, half that were given actual Albuterol and half that were given a placebo.  A good review of this study was written by Reuters "Treatment, not medicine, helps asthma patients feel better: study."  

The test was only done on a small sample of 39 mild to moderate asthmatics.  Of those who received Albuterol, 50 percent reported improvement.  Of those who received a placebo, 50 percent reported improvement.

Thus, the researchers conclusion, as the headline to the Reuters post suggests, is that of the placebo effect, whereby just the mere presence of a medical care worker is all that's needed to help asthmatics feel better. They conclude that the presence of a doctor -- or in this case the RT -- is just as beneficial as acupuncture. In this case, the medicine is Palbuterol

Yet I think the researchers have totally blown these results.  I think these results tell a completely different story than the researchers are telling us, and this is not surprising.  I think the conclusion we should be drawing from this study is that patients have no clue whether or not they feel better.  I think these asthmatics only had a perceived benefit from Albuterol.  I think what these results tell us is the patient is unreliable.

This goes back to common asthma wisdom that says that the only true way to determine if an Albuterol nebulizer has improved lung function is to either do a pre and post pulmonary function test or to have the patient use a peak flow meter.  To go by what the patient says isn't enough.

Obviously if you have an asthmatic who is short of breath and the Albuterol provides instant relief in breathing then the patient is going to be accurate when he says, "I feel better."  Yet if the patient's dyspnea and wheezing is caused by a cold, or heart failure, or pneumonia, or kidney failure, or lung cancer, or rickets, the Albuterol will have no effect, and yet the patient will feel the placebo effect. 

As to be expected, the researchers got it all wrong. Yet your humble RT here is once again proven right. I've written before that Albuterol should be renamed Palbuterol because the medicine may not have any effect, but the presence of an RT will.

This is interesting to say the least.  We know that albuterol really does make breathing easier in patients who are having actual bronchospasm.  However, evidence also suggests that giving albuterol to anyone who is short of breath may produce the placebo response.  So now you know why doctors treat all pulmonary diseases as asthma.

Once again the results of a study are misinterpreted.  Thankfully your humble RT is on the job because these study results prove that Albuterol doesn't cure all dyspnea and wheezing.

1 comment:

Christopher Fontes said...

Anyone with serious asthma as a kid can tell you that Albuterol is phoney.