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Old 9th August 2021, 01:20 PM   #41
HansMustermann
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Originally Posted by theprestige View Post
Since all pain is self-reported to begin with, how can you actually know they were in pain in the first place? When it comes to the study of pain, all we have to work with is self-reporting. Might as well ask if the "green" that you see happens to be the same color as the "green" that I see.
Quoth Dara O'Briain, "Science knows it doesn't know everything; otherwise, it'd stop. But just because science doesn't know everything doesn't mean you can fill in the gaps with whatever fairy tale most appeals to you."

Now I'm not saying that the study of pain is at the fairy tale level, but still, it doesn't mean that LACKING better data necessarily makes a line of thinking correct.
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Old 9th August 2021, 01:21 PM   #42
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Originally Posted by WhatRoughBeast View Post
I beg you, don't go there.

You are now talking about qualia, we are deep in Philosophy territory.
We were already deep in philosophy territory when Hans asked how we can use self-reporting as a metric for change in something for which we only have self-reporting to work with. If Hans doesn't want this to degenerate in navel-gazing about the qualia of pain, he needs to get back to practical applications.
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Old 9th August 2021, 01:45 PM   #43
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Originally Posted by Ziggurat View Post
In all the examples you are referring to, there is a distinction between the experience and the underlying thing that is being experienced. And you keep pointing out that the underlying thing being experienced isn't any different, even if the experience is different because people have fooled themselves.

But pain IS the experience. The underlying thing being experienced isn't pain, but physical damage. And yes, we know placebos don't affect physical damage to the body. That doesn't mean they don't affect the experience. If you think it affects the experience, guess what? It does. By definition.



You are being asked to believe that people's perceptions of pain IS the pain, that pain isn't anything else. The proper comparison to all your examples would not be asking people how much pain they suffered, but how badly their body was damaged. And yeah, people won't get that right. But since the challenge we're talking about isn't fixing damage but alleviating pain, then their experience is rightly front and center.
1. No. It goes beyond that. I'm asked to believe that people can actually make an accurate comparison for such a sensory signal / qualia, even though they provably CAN'T do it for any other senses / qualia.

Regardless of what other processing is done along the way, what feedback loops might exist, etc. SOME value / qualia reaches the final destination on the brain. It may be processed to hell and back, it may not reflect the input particularly well any more, but it's still a value at the end of that processing chain. Whether it's pain, sound, the sense of time, or whatever, but it's how they perceive that pain or sound or time or whatever RIGHT NOW.

And we KNOW that people are utter crap at comparing such non-quantized values even to the value from 5 minutes ago. The guy on the HW Central forums who was comparing MP3 sound from different hard drives, was essentially crap at comparing how it sounded 1 minute ago, when he tried listening to the same MP3, on the same computer, on the same sound card, on the same MP3 player software, on the same headphones, just copied to a different hard drive.

Hell, we know that stuff like cognitive dissonance and generally how engrams work can actually CHANGE that memory.

So the same people who are utter crap at comparing the non-quantized qualia for sound, time, lag, and generally EVERYTHING, even to something from 5 minutes ago... I'm supposed to believe that they're 100% accurate at comparing their current pain to the pain from last week, before they were given the placebo pills


2. That is all good and fine, but please explain in simple words why couldn't the exact same reasoning be applied to all the other examples I gave, if we didn't have the means to actually measure that the perception is wrong.

I mean, take sound for example. Let's say we didn't really know much about how the brain figures out the frequencies and all (you only need to go back a couple of centuries for that.) Equally you could say that the music is the experience, there is no objective way to perceive it, the nerves signal both ways, the brain doesn't get the raw frequencies, etc. In fact, I'm sure some "audiophile" out there did the exact same argument when shown on an oscilloscope that his 1000$ wooden volume knob doesn't actually make his stereo reproduce high frequencies better. (And yes, there are people buying just that kind of nonsense and arguing that it makes their music sound better.)

But in fact, we know that the frequencies are already detected and separated at the cochlea, and there are no nerves to tell it to send more of the high frequencies.
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Old 9th August 2021, 01:51 PM   #44
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Originally Posted by HansMustermann View Post
Quoth Dara O'Briain, "Science knows it doesn't know everything; otherwise, it'd stop. But just because science doesn't know everything doesn't mean you can fill in the gaps with whatever fairy tale most appeals to you."

Now I'm not saying that the study of pain is at the fairy tale level, but still, it doesn't mean that LACKING better data necessarily makes a line of thinking correct.
Nobody's talking about it being necessarily correct. We're saying it's the only line of thinking currently available. I'm sure the moment someone comes up with a better metric for pain mitigation that self-reporting, the entire medical community will stand up, clap enthusiastically, then then start using it almost exclusively. In the mean time, "but how do we know if self-reporting is really accurate?" is kind of a pointless waste of time. We know self-reporting has limitations. We know it's not as reliable as some other metrics. It is what it is.
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Old 9th August 2021, 01:52 PM   #45
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Originally Posted by theprestige View Post
We were already deep in philosophy territory when Hans asked how we can use self-reporting as a metric for change in something for which we only have self-reporting to work with. If Hans doesn't want this to degenerate in navel-gazing about the qualia of pain, he needs to get back to practical applications.
So you went into a discussion about subjective pain and generally subjective reporting of how one subjectively feels better after a placebo, expecting it to NOT involve talking about how it's subjective? REALLY?

Well, anyway, if you're not interested in this particular topic, you have a back button up there, you can feel free to use it. I have no duty to keep everything dumbed down to whatever level passes your approval
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Old 9th August 2021, 01:55 PM   #46
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Originally Posted by HansMustermann View Post
1. No. It goes beyond that. I'm asked to believe that people can actually make an accurate comparison for such a sensory signal / qualia, even though they provably CAN'T do it for any other senses / qualia.
No. You're being asked to ACCEPT - or at least ACKNOWLEDGE - that given the nature of pain, self-reporting is the best metric we have, for all its known limitations. [/quote]
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Old 9th August 2021, 02:00 PM   #47
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Originally Posted by theprestige View Post
No. You're being asked to ACCEPT - or at least ACKNOWLEDGE - that given the nature of pain, self-reporting is the best metric we have, for all its known limitations.
Except that is not what was being said, or what such studies generally claim.

And yours is a nonsense argument anyway. If some way of measuring things is inaccurate, then yes, it's valid to discuss exactly what is the margin of error, and thus how accurate or inaccurate one can expect the results to be. It's in fact how science works. Not having anything better is not precluding any of that.

So to use your own words, you're being asked to ACCEPT -- or at least ACKNOWLEDGE -- that not all conversations are with you, nor do they have to conform to your level of misunderstanding.
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Old 9th August 2021, 02:19 PM   #48
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Originally Posted by HansMustermann View Post
So you went into a discussion about subjective pain and generally subjective reporting of how one subjectively feels better after a placebo, expecting it to NOT involve talking about how it's subjective? REALLY?
I'm saying the subjectivity is a red herring. Your objection is pointless because there aren't any other options for measuring pain and pain mitigation.

Quote:
Well, anyway, if you're not interested in this particular topic, you have a back button up there, you can feel free to use it. I have no duty to keep everything dumbed down to whatever level passes your approval : p
I'm interested in the topic. I'm fascinated by your idea that we shouldn't measure pain via self-reporting, even though we don't have any better tools, because it's not an ideal tool.

Tell me more. Tell me what you recommend, as far as the study of pain and its treatment goes. Should we just ignore the entire field, because we can't measure it as reliably as you would like? Should we stop prescribing pain medication at all, because who knows if the patient really is feeling pain in the first place? Should we dismiss the patient who asks for a different prescription, since we have no idea if they're right about their current prescription not working?

What is the practical application, for medicine and pain research, of your objection about the reliability of self-reporting pain?

For me, your objection seems like a dead end. The only way we know someone is in pain to begin with is because they claim to be in pain. If you're going to accept the a priori premise that their self-reported claim is true and indicates a legitimate need for treatment, then it seems silly and pointless to question whether their self-reported claim about the efficacy of the treatment is also true.

What exactly is the practical application you are proposing, from the premise that pain is qualia? What practical application could there reasonably be, other than, "qualia is what we have, so qualia is what we're going to work with. Be mindful of its implications, and do the best you can"?
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Old 9th August 2021, 02:26 PM   #49
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Originally Posted by HansMustermann View Post
1. No. It goes beyond that. I'm asked to believe that people can actually make an accurate comparison for such a sensory signal / qualia, even though they provably CAN'T do it for any other senses / qualia.
Again, no. Every disproof you've appealed to is comparing people's senses to something external, and showing that those senses don't accurately represent the objective reality of that external thing.

And yeah, our senses are so mediated that they are not accurate or reliable representations of those external realities at a fine level. But NONE of that is comparable here, because (again) we aren't talking about anything external. EVERYTHING is internal. And pain specifically is entirely within the brain. There is no such thing as pain outside of the brain. Again, the equivalent of all your examples is not whether something reduces pain, but whether something reduces damage. And yeah, people will get that wrong, pretty reliably. But that's not the issue here.

Quote:
2. That is all good and fine, but please explain in simple words why couldn't the exact same reasoning be applied to all the other examples I gave, if we didn't have the means to actually measure that the perception is wrong.
Because in the case of pain, the perception is the thing. In every example you have given, the perception is NOT the thing. In all your examples, we care about something external, and people are using their perception to evaluate it. In the case of pain, ONLY the perception matters, because again, that's what pain is. Pain is perception of damage, but we aren't talking about what treats the damage, only about what alters the perception.
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Old 9th August 2021, 04:16 PM   #50
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Originally Posted by theprestige View Post
I'm saying the subjectivity is a red herring.
It's not if we're discussing the limits and error margin of subjective measurements.

Originally Posted by theprestige View Post
Your objection is pointless because there aren't any other options for measuring pain and pain mitigation.
And again: we still discuss the error bar in any scientific endeavour, even if we don't have better tools. Unless you've slept in school, even if the best tool you have to measure, say, a school level interference experiment is a ruler marked in sixteenths of an inch, you still put some thought into what level of accuracy you have for the measured wavelength. The fact that you don't have a better one doesn't absolve you from that.

And yes, that includes some thought into whether the tools you have are actually adequate for the job. Like if the only tool you have around for measuring heights is a barometer, it may be enough to measure a mountain height, but not enough to measure your house's height.

Or even in subjective stuff, like clinical studies (which is what we're talking about) or sociology or really anything else, it's actually important to know if your results are (A) compensating for other variables and known effects, and (B) statistically significant. The latter basically meaning the probability to be wrong. If all you can do is an imperfect job in those aspects, it is important to be aware of that, rather than pretend that you must ignore the limitations because it's the best you can do.

But basically all you show here is that you don't even understand what's being discussed or why. And you just do your usual thing of going around and complaining that people put way too much thought into this or that, or actually make judgments about this or that, instead of keeping it at whatever level of simplicity and certainty you'd like.

Originally Posted by theprestige View Post
I'm interested in the topic. I'm fascinated by your idea that we shouldn't measure pain via self-reporting, even though we don't have any better tools, because it's not an ideal tool.
And I'm fascinated what kind of confusion of mind makes you think anyone gives a flip about what you want the talks in various threads to be more like. Maybe going around demanding attention in every talk worked with your mommy, but frankly, you should have grown up and out of that by now.
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Old 9th August 2021, 04:45 PM   #51
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Originally Posted by HansMustermann View Post
It's not if we're discussing the limits and error margin of subjective measurements.
Is that what you want to talk about? The error margins on pain reporting? Then go ahead and talk about it. You put a lot of effort into saying this is what you want to talk about, and no effort at all into actually talking about it. Here, for example:

Quote:
And again: we still discuss the error bar in any scientific endeavour, even if we don't have better tools. Unless you've slept in school, even if the best tool you have to measure, say, a school level interference experiment is a ruler marked in sixteenths of an inch, you still put some thought into what level of accuracy you have for the measured wavelength. The fact that you don't have a better one doesn't absolve you from that.

And yes, that includes some thought into whether the tools you have are actually adequate for the job. Like if the only tool you have around for measuring heights is a barometer, it may be enough to measure a mountain height, but not enough to measure your house's height.

Or even in subjective stuff, like clinical studies (which is what we're talking about) or sociology or really anything else, it's actually important to know if your results are (A) compensating for other variables and known effects, and (B) statistically significant. The latter basically meaning the probability to be wrong. If all you can do is an imperfect job in those aspects, it is important to be aware of that, rather than pretend that you must ignore the limitations because it's the best you can do.

But basically all you show here is that you don't even understand what's being discussed or why. And you just do your usual thing of going around and complaining that people put way too much thought into this or that, or actually make judgments about this or that, instead of keeping it at whatever level of simplicity and certainty you'd like.



And I'm fascinated what kind of confusion of mind makes you think anyone gives a flip about what you want the talks in various threads to be more like. Maybe going around demanding attention in every talk worked with your mommy, but frankly, you should have grown up and out of that by now.
Walk me through it. What's the practical application? Someone comes to you reporting pain qualia. What should you do? Offer them some aspirin? Tell them you'll need to see some error bars? What? If they take the aspirin and report the qualia has subsided, what should you do? Accept their claim? Dismiss their claim? Ask for error bars?
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Old 9th August 2021, 05:03 PM   #52
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Originally Posted by Ziggurat View Post
Pain is perception of damage, but we aren't talking about what treats the damage, only about what alters the perception.
Err.... No, not really. Pain is a signal that comes down a nerve. It can mean damage, or it can mean no damage at all. Not all pain receptors respond to cells dying. In fact some have nothing at all to do with that.

As a trivial example, your thermal pain receptors (nociceptors) are literally responding not just to the death of any cells around, but also to temperature. And your threshold is probably around 44–45 °C in the upper direction if you're an average human, which is well below the level where cells are dying right now. It's more to prevent actual damage than to actually measure damage. But anyway, you can feel that kind of pain without ANY actual damage happening.

They're even "misused" as taste receptors in your mouth. E.g., capsacin literally binds to the the temperature receptors.

Other nociceptors respond literally to pressure. Even if no cell around has actually died, above a certain pressure level, you'll get a pain signal.

Yet other nociceptors (the "silent nociceptors") are only activated when there is an inflammation (including due to cell death) or being stimulated too often or such. Unless the proteins associated with an inflammation are there to activate the receptors that need an inflammation, they just don't trigger. Joints for example contain a LOT of these. So for example the same pressure in the joint might hurt like heck if it's inflamed, but not hurt at all if it's healthy. Again, the reason seems to be more to prevent further damage, than respond to actual damage happening right now.

Yet others respond to chemicals in the tissue, so they work kinda like the taste receptors in the tongue. A lot of those chemicals is how the ones that respond to tissue damage do so (and in fact, there are several receptors for several of these chemicals released when repairing tissue damage) but some respond to specific substances like lactic acid (think: muscle sores) or just to the PH being above or below a limit. Tissue damage may or may not be involved, but sometimes it's more about keeping you from getting to the level that actually destroys tissue, than recording existing tissue death. The lactic acid receptors are the prime example for that: they actually respond to lesser concentrations than would actually kill the muscle cell, to keep you from getting to that level.

Etc.

So essentially the objection that 'yeah, but pain doesn't just mean injury', yeah, that's nothing new.

It's still a signal that comes up a nerve, and gets processed SOMEHOW before becoming a subjective sensation that you have to compare to another subjective sensation. No different from any other, like sound, temperature or whatever. If there are effects skewing the comparisons done for the others, I want to know if they're taken into account for this one too.


Also, yes, I know about the inhibition mechanisms but even those aren't as clear cut mood-over-matter as you seem to think. A LOT of it happens entirely in the spinal cord and really has nothing to do with your mood or stress level, because those nerves don't know anything about that. Yes, some of the suppressive signal comes from above in the form of serotonin, norepinepherine and dopamine, but a lot of it is entirely local in the spinal cord and has nothing to do with those or your mood or stress level.

And even those three have more to do with what you're doing at the moment, rather than what you think about the pill you took three hours ago.

E.g., dopamine has more to do with motivational salience, i.e., more of a "yeah, do that" or most often a "keep doing that" signal, as in whatever you were doing at the moment, than having anything to do with what you think about the pill you took three hours ago. Or really with ANYTHING you were doing three hours ago. As I was saying, it's about regulating what you're doing right now.

So it explains things like that you might notice less pain when you're focused on, say, a computer game, but buggerall to do with whether you think the pills you took this morning are working or not


But anyway, yeah, sure, some processing is involved between a pressure receptor firing in your hip and your brain getting a pain value. But it still gets A value at the end of the day. Is it any better at comparing it with the value from yesterday than for any other signal? Is it compensating for all the other variables involved? Having more variables along the way just means more room for subjective confirmation, rather than making it objective.
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Old 9th August 2021, 05:06 PM   #53
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How do you even put error bars on something like self-reporting pain? "There's an X per cent chance that this person is not experiencing the amount of pain they say they're experiencing." How does that work?
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Old 9th August 2021, 05:20 PM   #54
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Originally Posted by theprestige View Post
Is that what you want to talk about? The error margins on pain reporting? Then go ahead and talk about it. You put a lot of effort into saying this is what you want to talk about, and no effort at all into actually talking about it. Here, for example:



Walk me through it. What's the practical application? Someone comes to you reporting pain qualia. What should you do? Offer them some aspirin? Tell them you'll need to see some error bars? What? If they take the aspirin and report the qualia has subsided, what should you do? Accept their claim? Dismiss their claim? Ask for error bars?
What I'm saying is: that's a fundamentally stupid attitude. A lot of the progress we've done on that topic comes from trying to see how we can do or measure things better.

E.g., that you have Ibuprofen (which btw, celebrates its 50 year anniversary this year) as an alternative, yeah, that comes from trying to find a safer alternative to aspirin. Which included coming up with such stuff as using a radioactive form of the drugs they were testing in lab rats, to see where it ends up in the body. Such as whether it accumulates in the liver.

The fact that now you can also use it as an anti-inflammatory came from people actually trying to figure what it does to the tissue, rather than "just take one and tell me if you feel better." The actions of prostaglandins in mediating and regulating inflammation wouldn't even be known until a decade later, and yeah, it came about because people were trying hard to measure more than before. Including seeing exactly with what of your body's chemistry it actually interacts.

And that was only the start. Currently there is actually a lot of computational research in simulating protein interactions, to develop new analgesics, by knowing what you want them to bind with and what you don't want them to bind with. A lot of it boiling down to something that binds with certain opioid receptors (those in the actual pain receptors), but not with the other receptors that traditional opioids bind with.

THAT is what comes out of looking at what actual signals are involved and affected, rather than keeping it at your favourite level of "derp, just take an aspirin."
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Old 9th August 2021, 05:24 PM   #55
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Originally Posted by theprestige View Post
How do you even put error bars on something like self-reporting pain? "There's an X per cent chance that this person is not experiencing the amount of pain they say they're experiencing." How does that work?
Well, you can start by looking at what amount of error do you see in other subjective things, that you can measure. E.g., how many people say they hear more bass with headphones A than headphones B, when they're actually the same labelled differently, but you told them that B is the extra-bass version. Does the percentage of people reporting placebo effects exceed that, and by how much?
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Old 9th August 2021, 05:44 PM   #56
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Originally Posted by HansMustermann View Post
Well, you can start by looking at what amount of error do you see in other subjective things, that you can measure. E.g., how many people say they hear more bass with headphones A than headphones B, when they're actually the same labelled differently. Does the percentage of people reporting placebo effects exceed that, and by how much?
But pain is qualia. Unlike your audio channel test, there's no objective standard to measure against.

And you can't just say that X% of people misreport their audio channel, so X% are probably misreporting placebo effects on pain. What would misreporting their pain even mean? They're lying about how much pain they're experiencing? They're mistaken about how much pain they're experiencing? That makes no sense.

"You say you're imagining less pain, but there's an X% chance that the pain you're imagining is actually more pain."
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Old 9th August 2021, 06:10 PM   #57
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People do lie all the time about all kinds of things, you know?

I just told you why they have to randomize polls, for example. If you ask ANY yes/no question without randomizing it, we KNOW there'll be a skew towards "yes". You could ask a random group A to answer "should we continue the war" and a group B "should we stop the war" and you'll find that the numbers aren't mirrored. In fact if you add the percentage of "yes" in group A to the "yes" percentage for group B (which should mirror the "no" option in group A), you get over 100% every time. That's why you don't do either in an actual poll, but rather randomize whether someone gets the question in the positive or negative form.

There's also a KNOWN effect where if there's any hint that one option is more acceptable or normal for any reason whatsoever, you get a skew towards it. That's why serious polling companies actually put a lot of effort into making it as neutral sounding as humanly possible.

And it's not just about experiences they've been told about in advance, so some kind of confirmation bias or placebo effect could actually affect the actual experience when it happens. If you ask people what they thought about Angela Merkel's speech about the floods last month, again, you see the above effects. They didn't know they'll be polled when they actually had the experience. So your question phrasing can't have affected the ACTUAL experience they had at the time, without involving time travel. But if you ask them about it after a week, provably you get more "yes" if you ask "did you approve of AM's speech" than "no" if you ask "did you disapprove of AM's speech".

So dunno, considering that as far as we know it applies to EVERYTHING, do you see any reason why only for pain, nah, people totally wouldn't skew the numbers similarly?
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Old 9th August 2021, 06:36 PM   #58
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Originally Posted by HansMustermann View Post
Well, you can start by looking at what amount of error do you see in other subjective things, that you can measure. E.g., how many people say they hear more bass with headphones A than headphones B, when they're actually the same labelled differently, but you told them that B is the extra-bass version. Does the percentage of people reporting placebo effects exceed that, and by how much?

The problem with pain perception and measurement is understood. Maybe one day, we’ll have more objective measurements but I kinda doubt it. Some people, due to genetic quirks or other factors, have high pain tolerance or don’t feel pain when they really should. I don’t see how some kind of normalized pain measurement standard can be developed. “Patient reports 8/10 on the Pain Scale but the Mustermann Test says it is actually a 2 . . . they must be lying.” That’s not something I can envision happening.

I think it’s far more likely we will gain a greater understanding of the psychological factors at play and take a multifaceted approach to pain management.
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Old 9th August 2021, 06:48 PM   #59
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I'm keeping an eye out and will post any additional articles if and when Mike puts them up on the site.
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Old 9th August 2021, 11:09 PM   #60
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Originally Posted by xjx388 View Post
The problem with pain perception and measurement is understood. Maybe one day, we’ll have more objective measurements but I kinda doubt it. Some people, due to genetic quirks or other factors, have high pain tolerance or don’t feel pain when they really should. I don’t see how some kind of normalized pain measurement standard can be developed. “Patient reports 8/10 on the Pain Scale but the Mustermann Test says it is actually a 2 . . . they must be lying.” That’s not something I can envision happening.
At the level of one patient? No. But I think one should be aware of the factors that skew the aggregate results when talking about a group statistic where the whole point is whether something actually works.

After all, that's the whole POINT of comparing it to placebo in other clinical trials. You don't know if ONE specific test subject you use to test if the new antibiotic pill worked really has a better immune system than average, or had a remission for other reasons, and the point isn't to diagnose that for that one patient in the first place. But you know that x% in the control group recovered while taking just pure lactic acid pills, and you compare if the y% for your actual antibiotic is higher than that. You know that the results are skewed by x% so you subtract that percent from your actual results.

Originally Posted by xjx388 View Post
I think it’s far more likely we will gain a greater understanding of the psychological factors at play and take a multifaceted approach to pain management.
Here's to hope.
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Old 10th August 2021, 07:29 AM   #61
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Originally Posted by HansMustermann View Post
Err.... No, not really. Pain is a signal that comes down a nerve.
No, it isn't. The signal coming down the nerve is just a signal. It isn't pain until after it's been processed by the brain. And the only access we have to it after it's been processed is what people report. There is nothing else. There cannot be anything else until we invent mind reading.

Quote:
But anyway, yeah, sure, some processing is involved between a pressure receptor firing in your hip and your brain getting a pain value. But it still gets A value at the end of the day. Is it any better at comparing it with the value from yesterday than for any other signal?
Yes. Because again, what we care about is the subjective experience, NOT some objective external reality. People's unreliability in correlating their subjective experience to objective external reality doesn't matter when it's the subjective experience we care about and not that external reality.
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Old 11th August 2021, 02:43 AM   #62
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I guess I'm not explaining my point well enough. Let's try more structured and concise.

The problem isn't "pain is an experience". The problem is that the following are 4 very different things:

1. the experience,

2. the MEMORY of an unquantifiable, undescribable experience

3. the ability to COMPARE memories of such unquantifiable, undescribable experiences

4. how you REPORT such

Even going "pain is the experience" doesn't cover #2, #3 and #4 at all.

And the fact that we're crap at #2, #3 and #4 is well proven by now.

E.g., since theprestige brought up colours, that will do nicely to illustrate #3. Because there are actual studies that show that if you don't actually have a different word for different hues, i.e., you can't remember them that way, you absolutely suck at telling whether the colour you remember is the same as the colour in front of you now. As in, if you go to some people who have no different word for "orange", they just call it "red", and you show them an orange card and a range card, sure, everyone will say it's not the same colour. It's a different shade of red, obviously. But if you show them an orange thing today, and tomorrow you show them a red card and ask them if it was this colour, most will say, yeah, it was exactly that colour.

And that doesn't just go for tribes who lack such words. In the very modern western world, virtually everyone who doesn't know burgundy as a separate colour, makes the same confusion between burgundy (#800020) and red (#800000). In fact, a lot pretty much feel like #800020 is THE natural red, a lot more so than the actual #800000 red. Yeah, they can tell it's a different qualia if they see both right now, but they suck at comparing it to the qualia they remember from yesterday, if they can't put a different name on it.

E.g., your memory of a subjective sensation being unreliable and changeable depending on what you want to believe, is the whole POINT of the classic cognitive dissonance experiments. You know, the one where where you have to turn a knob by one degree every X minutes, or to turn pegs in a peg board for an hour, or such. Yeah, boredom is the experience too, there is no quantifiable value, bla, bla, bla. But if at the end of the day,

1. my experience may be that I was bored out of my skull, but

2. how I REMEMBER it after the cognitive dissonance kicked in might be that, actually, it wasn't too bad

And if we add what we know about reporting other things,

4. how I REPORT it may be that it was actually a nice and educational experience, e.g., if I get the impression that that's what the guy polling me wants to hear, or that's what the other group members are reporting, or any of the other KNOWN factors that distort such reports.

So you can stop hammering on "but the pain is the experience." Again, that covers #1. It does NOT cover #2, #3 or #4 AT ALL.
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Old 11th August 2021, 03:34 AM   #63
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Originally Posted by xjx388 View Post
...snip...

I think it’s far more likely we will gain a greater understanding of the psychological factors at play and take a multifaceted approach to pain management.
That's been happening in the English NHS for quite some time, started up in Liverpool a few decades back now. It's now recognised that chronic pain shouldn't only be treated with medicine and surgery, often it is as much about helping someone live a good life, with their pain and finding a balance between treatments and quality of life.

I know from discussions here regarding treatment of chronic pain that the USA's medical system (as a generalisation) is quite behind the curve on this.
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Old 11th August 2021, 04:51 AM   #64
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Old 11th August 2021, 05:32 AM   #65
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Originally Posted by HansMustermann View Post
I guess I'm not explaining my point well enough. Let's try more structured and concise.

The problem isn't "pain is an experience". The problem is that the following are 4 very different things:

1. the experience,

2. the MEMORY of an unquantifiable, undescribable experience

3. the ability to COMPARE memories of such unquantifiable, undescribable experiences

4. how you REPORT such

Even going "pain is the experience" doesn't cover #2, #3 and #4 at all.

And the fact that we're crap at #2, #3 and #4 is well proven by now.

E.g., since theprestige brought up colours, that will do nicely to illustrate #3. Because there are actual studies that show that if you don't actually have a different word for different hues, i.e., you can't remember them that way, you absolutely suck at telling whether the colour you remember is the same as the colour in front of you now. As in, if you go to some people who have no different word for "orange", they just call it "red", and you show them an orange card and a range card, sure, everyone will say it's not the same colour. It's a different shade of red, obviously. But if you show them an orange thing today, and tomorrow you show them a red card and ask them if it was this colour, most will say, yeah, it was exactly that colour.

And that doesn't just go for tribes who lack such words. In the very modern western world, virtually everyone who doesn't know burgundy as a separate colour, makes the same confusion between burgundy (#800020) and red (#800000). In fact, a lot pretty much feel like #800020 is THE natural red, a lot more so than the actual #800000 red. Yeah, they can tell it's a different qualia if they see both right now, but they suck at comparing it to the qualia they remember from yesterday, if they can't put a different name on it.

E.g., your memory of a subjective sensation being unreliable and changeable depending on what you want to believe, is the whole POINT of the classic cognitive dissonance experiments. You know, the one where where you have to turn a knob by one degree every X minutes, or to turn pegs in a peg board for an hour, or such. Yeah, boredom is the experience too, there is no quantifiable value, bla, bla, bla. But if at the end of the day,

1. my experience may be that I was bored out of my skull, but

2. how I REMEMBER it after the cognitive dissonance kicked in might be that, actually, it wasn't too bad

And if we add what we know about reporting other things,

4. how I REPORT it may be that it was actually a nice and educational experience, e.g., if I get the impression that that's what the guy polling me wants to hear, or that's what the other group members are reporting, or any of the other KNOWN factors that distort such reports.

So you can stop hammering on "but the pain is the experience." Again, that covers #1. It does NOT cover #2, #3 or #4 AT ALL.
So what's the practical application for the diagnosis and treatment of pain? What's the practical application of all this, for the study and measurement of pain? What do you recommend?
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Old 11th August 2021, 05:46 AM   #66
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Originally Posted by theprestige View Post
So what's the practical application for the diagnosis and treatment of pain? What's the practical application of all this, for the study and measurement of pain? What do you recommend?
As I've already told you: compare it to the known effects before deciding that all the difference is placebo actually working.

Besides, you're still in the wrong thread if you want it to be at the 'pragmatic' hillbilly level of "Offer them some aspirin." (As per your message #51.) We're talking about stuff like determining whether to offer them an aspirin, a placebo, or surgery. You'd think that surgery is invasive enough to kinda be important to know the real effect of all three. But at any rate, when we're talking about a study, we're already past the level of being 'pragmatic' and just trying to "Offer them some aspirin."
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Old 11th August 2021, 05:51 AM   #67
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BTW, not that it would matter anyway. I'm still not impressed by your relentless pursue of trying to stop people from thinking too much about this or that, or god forbid, touch topics that were also at some point touched by philosophy. I can talk about whatever the hell I want, whether it has immediate practical applications or not, and I don't need the approval from you or any other internet non-intellectual that's bothered by it.

Yes, there are lots of topics that lack any immediate pragmatic application. Especially in the science forum.

E.g., GR frame dragging is utterly devoid of any pragmatic applications at the moment. Other than in one experiment where we had to build special probes to even detect it at all, it's orders of magnitude lower than the margin of error for just about anything we can observe up there. We still can and did discuss it in its own thread.

E.g., Hawking Radiation is even more useless at the moment from a pragmatic point of view. We haven't even ever detected it. I mean even for frame dragging we have that one experiment that actually observed it, for Hawking Radiation we have exactly none. We literally can't build anything based on that knowledge, not even a special probe to detect it, and we can't use it to explain anything we've observed up there. But guess what? We can still talk about it.

Etc.

And if people discussing things that may not pass your immediate pragmatism criterion bothers you, that's your problem, not everyone else's.

Really, you have a back button up there. If any discussion is getting too philosophical for you, you can use it.
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Old 11th August 2021, 10:48 AM   #68
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Originally Posted by xjx388 View Post
That implies that the placebo is doing “something.”
It says no such thing. It is just a recognition of the fact that humans are prone to suggestion. They can even be talked into feeling sick (the "nocebo" effect).

Of course, nobody will admit to being prone to suggestion so a lot of skeptics will deny that the placebo effect exists.
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Old 11th August 2021, 10:54 AM   #69
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Originally Posted by arthwollipot View Post
Undoubtedly. But it's also, as I said, uncontrolled variables. It's also the idea that you take a pill when the pain is worst, but because you take it when it's at the top of the bell curve, as it were. The pain goes down not because of the intervention, but because it was going to go down anyway.

This and a host of other factors contribute to the "powerful placebo" effect.
Er .. paracetamol is not a placebo. It is an actual pain inhibitor. If you are going to deny that there is anything such as a real pain blocker then you will lose all credibility.
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Old 11th August 2021, 11:12 AM   #70
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Originally Posted by HansMustermann View Post
I guess I'm not explaining my point well enough. Let's try more structured and concise.

The problem isn't "pain is an experience". The problem is that the following are 4 very different things:

1. the experience,

2. the MEMORY of an unquantifiable, undescribable experience

3. the ability to COMPARE memories of such unquantifiable, undescribable experiences

4. how you REPORT such

Even going "pain is the experience" doesn't cover #2, #3 and #4 at all.

And the fact that we're crap at #2, #3 and #4 is well proven by now.
Why do you think we're bad about #3 and #4? As far as I can tell, the problems with #3 and #4 are all actually problems with #1 (ie, our experience of something isn't an accurate reflection of what we're experiencing). Seriously, how do you test whether someone is bad at reporting their experience? You can only do so by comparing what they report to the external thing. And yeah, that's not accurate. But you cannot conclude that they're bad at reporting their experience, because you cannot distinguish between the experience and the report. You actually have no reason to conclude that their reporting is wrong but their experience is accurate. And everything we know suggests that the problem is at #1, NOT at #4.

And the problems with #2 are avoidable.
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Old 11th August 2021, 11:19 AM   #71
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Originally Posted by HansMustermann View Post
BTW, not that it would matter anyway. I'm still not impressed by your relentless pursue of trying to stop people from thinking too much about this or that, or god forbid, touch topics that were also at some point touched by philosophy. I can talk about whatever the hell I want, whether it has immediate practical applications or not, and I don't need the approval from you or any other internet non-intellectual that's bothered by it.
LOL. I'm not trying to get you to stop thinking about it. I just happen to disagree with your thinking on the subject.

You're more than welcome to wax as philosophical as you like about self-reporting not being an ideal measure of qualia. It still won't change the fact that when it comes to pain management qualia is all we have, and self-reporting is the only available tool.

And it still won't change the fact that I think you're wrong about calibrating qualia reporting to other reporting that has an objective reference.

I'm not saying you need to stop having all these ideas I disagree with. I am saying that I reserve the right to disagree with them whenever you bring them up.
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Old 11th August 2021, 11:23 AM   #72
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Originally Posted by Ziggurat View Post
Why do you think we're bad about #3 and #4? As far as I can tell, the problems with #3 and #4 are all actually problems with #1 (ie, our experience of something isn't an accurate reflection of what we're experiencing). Seriously, how do you test whether someone is bad at reporting their experience? You can only do so by comparing what they report to the external thing. And yeah, that's not accurate. But you cannot conclude that they're bad at reporting their experience, because you cannot distinguish between the experience and the report. You actually have no reason to conclude that their reporting is wrong but their experience is accurate. And everything we know suggests that the problem is at #1, NOT at #4.

And the problems with #2 are avoidable.
"I feel like my head is being crushed in a vise! I need some pain relief!"

"Good news! Independent and objective observations confirm there is no vise anywhere near your head, let alone crushing it! So you don't really need any pain relief after all!"
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Old 11th August 2021, 11:28 AM   #73
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Because we have studies, instead of just rationalizing how we want really hard to believe that those aren't factors.

That's actually where that being able to use an external stimulus comes in handy. Because we can also make sure first that looking at #FF8C00 ("darkorange" as the HTML name goes) is a different qualia than looking at #FF0000 (pure red.) You know, instead of just believing really really hard that if they later confuse the two, it means they had the same subjective experience for both. We can do the scientific thing and engineer the test to first make sure that no, they don't. That was the first part of that study that I mentioned. If you show them the first one on a card, and half a minute later the second one, they can very much tell that it's a different colour. Their subjective experience of it is NOT the same. And you can repeat it as often as you like, and confirm every time, no, they don't experience dark orange as the same as pure red.

It's only when you show them the first today, and the second a day later, that a lot of people who lack different words for both (i.e., they can't remember it as "I saw the orange card yesterday" because they lack the word "orange") start saying that yeah, you showed them the same colour yesterday.

I.e., again, it's not about their qualia / subjective experience RIGHT NOW, nor about the difference between that and the objective value of the stimulus. What matters is that it's two different qualia that we can cause, and yes, they're different qualia. We can test that no it's not the same qualia. It's only the MEMORY of that qualia that turns out to be very mutable, when people are asked to COMPARE anything against it.


Edit: or let's take something without a measurable external stimulus, if that's tripping you up that hard. Let's take the classic cognitive dissonance experiments. The whole point is that you can debrief someone right after they had to turn pegs for an hour, and then ask them about it again after a week, and after being paid 1$ to convince someone else that it's a fun job. And a week later they'll say something completely different than right afterward. One or the other report could be an accurate description of exactly how boring it was, but BOTH can't be true, because they describe a different experience. That memory has changed. That's the whole POINT of those cognitive dissonance experiments.
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Old 11th August 2021, 11:35 AM   #74
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Originally Posted by theprestige View Post
"I feel like my head is being crushed in a vise! I need some pain relief!"

"Good news! Independent and objective observations confirm there is no vise anywhere near your head, let alone crushing it! So you don't really need any pain relief after all!"
Which again just shows that you're in the wrong thread for your usual 'pragmatic anti-intellectual' schtick. Because if you had read what it's about, it does include stuff like, yes, a study about whether it doesn't work just as well to give someone placebo instead of actual pain relief or instead of surgery. I.e., exactly deciding that yeah, exactly, according to some independent and objective study, some people won't get pain relief after all.

Not to mention that if we're talking about studies, then inherently everyone in the control group, yeah, didn't get any actual pain relief. That's what having a control group, and reporting in the test conclusions that the cure used in the other group worked better than placebo, mean.

So your complaint is... what? That a discussion is actually on topic? Or WTH?
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Old 11th August 2021, 12:11 PM   #75
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Originally Posted by HansMustermann View Post
@Ziggurat
Because we have studies
Studies of what? I've seen studies that show we're bad at remembering things. I've seen studies that show we're bad at differentiating things. I've seen studies that show we're bad at reporting objective external realities.

I have never seen a study that shows we cannot report accurately our own subjective experiences. I don't think there are any such studies.

Quote:
That's actually where that being able to use an external stimulus comes in handy. Because we can also make sure first that looking at #FF8C00 ("darkorange" as the HTML name goes) is a different qualia than looking at #FF0000 (pure red.) You know, instead of just believing really really hard that if they later confuse the two, it means they had the same subjective experience for both. We can do the scientific thing and engineer the test to first make sure that no, they don't. That was the first part of that study that I mentioned. If you show them the first one on a card, and half a minute later the second one, they can very much tell that it's a different colour. Their subjective experience of it is NOT the same. And you can repeat it as often as you like, and confirm every time, no, they don't experience dark orange as the same as pure red.

It's only when you show them the first today, and the second a day later, that a lot of people who lack different words for both (i.e., they can't remember it as "I saw the orange card yesterday" because they lack the word "orange") start saying that yeah, you showed them the same colour yesterday.
No. You have actually misunderstood something subtle but very important here. What's going on here in the two cases are not the same experience just separated by time. By showing someone two different shades of red, you have given them a different subjective experience than showing them one shade of red. The contrast between the two will make them experience the two shades differently.

It's sort of like the color brown. There's no such thing as brown light, it doesn't exist. Brown is just dark orange, but to experience that as brown and not as orange, you have to be seeing other brighter things which tell you that it's dark. If there's nothing else to compare it to, then brown IS just orange. That contrast is part of the experience. You can even demonstrate this yourself. On your phone or on a tablet, in a well lit room, load up an image that's solid brown. Then take it into a completely pitch-black room, and look at it again. It's orange. Why does it turn from brown to orange? Because in a pitch black room, you have nothing brighter to compare it to to tell you that it's dark.

So no, our experience of color isn't just about the color itself. It never has been. Contrast is vital to our perception of color, and by removing those two similar colors from each other so far in time, your test loses that contrast. It changes the actual perception of the colors. You are not actually just testing how well people recall their subjective experience. Your example doesn't demonstrate what you think it does.

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Edit: or let's take something without a measurable external stimulus, if that's tripping you up that hard. Let's take the classic cognitive dissonance experiment. The point is that you can debrief someone right after they had to turn pegs for an hour, and then ask them about it again after a week, and after being paid 1$ to convince someone else that it's a fun job. And a week later they'll say something completely different than right afterward. One or the other report could be an accurate description of exactly how boring it was, but BOTH can't be true, because they describe a different experience. That memory has changed. That's the whole POINT of those cognitive dissonance experiments.
Which is relevant to #2, but not to #3 and #4. And #2 is avoidable.

ETA: back to your dark orange/red thing, the memory problem (ie, #2) is probably an even bigger issue than the contrast, though. And again, #2 is avoidable. But our memory is highly compressed information. And how that information is compressed depends a lot on language, since language helps us categorize things and make distinctions which are important. So our memory compresses the representation of colors we see, often in line with with the language we use for colors. So two different colors may get compressed into one color if there's only one word for both. Which, again, is relevant to #2. But it's got jack **** to do with #3 or #4.
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Old 11th August 2021, 12:53 PM   #76
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Well, yes, now you're getting it. Yes, memory is my biggest problem, and:

A. the language IS a very large part of the problem. We have less trouble remembering things differently or as the same if we have some different word or number to remember. It's only when two or more experiences can at best be described as "uh, it was some kind of shade of red" that you have trouble remembering exactly what shade.

and

B. Well, it's not just literal contrast. They're actually also a very different hue, i.e., angle on a colourwheel. (In fact, the hue is the only difference, since both are 100% brightness and 100% saturated. It may bear the code name of "dark orange" in HTML parlance, but actually it's full brightness and full saturation orange.) But in the more general meaning of 'contrasting' two things, yes, you can tell things apart when you can immediately contrast them to one another. Be it colours, sounds, how tall someone looks, or whatever other non-describable non-quantified thing. I called it compare, you seem to call it contrast, but yes, that's the general idea. But insert a day in between and you no longer have that 'contrast'.

BUT

What I'm saying is that we have the same issue for pain.

A. You don't have a different word for how much it hurt last week before you got the placebo saline injection in your shoulder, vs how much it hurts a week later when you have the next appointment to tell the doctor if it helped.

B. Nor do you have the 'contrast'. Sure, if you had to tell if it hurts more or less after I poke you in the shoulder with a finger, you could tell the difference. If it's actually pressure pain on an inflammation, you'll have your contrast right there when I put some extra pressure on it. My point is that if you insert a week in between, yeah, you don't have that 'contrast' any more.


As for #4, yes, that's covered by different studies and such. And indeed the classic cognitive dissonance experiments are all about #2, so they lack the #3 part too. While each of them is well documented, yes, to the best of my knowledge there is no one experiment that illustrates all 4 in one experiment. It would be nice if there was, but we'll just have to do with what we have.
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Old 11th August 2021, 01:50 PM   #77
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Originally Posted by HansMustermann View Post
Well, yes, now you're getting it. Yes, memory is my biggest problem
And that problem can be avoided. You don't need to have people remember in order to test placebos.

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What I'm saying is that we have the same issue for pain.
Except we don't. The problem you refer to with language causes differences to be ignored. Language may make some differences not show up while others still do, but if you find a difference, it wasn't caused by language. So that's not an argument against placebo effects being real.

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As for #4, yes, that's covered by different studies and such.
I don't think it is.
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Old 11th August 2021, 02:47 PM   #78
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Originally Posted by Ziggurat View Post
And that problem can be avoided. You don't need to have people remember in order to test placebos.
I'm listening. How do you propose to test if people are actually feeling less pain than last week, or hell, since yesterday, without relying on them remembering the sensation from last week?
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Old 11th August 2021, 03:07 PM   #79
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Originally Posted by HansMustermann View Post
I'm listening. How do you propose to test if people are actually feeling less pain than last week, or hell, since yesterday, without relying on them remembering the sensation from last week?
That's not the test you run.

You take a bunch of people in pain. You have them rate their pain. You give them a treatment (or no treatment). You wait, say, 1 hour. You ask them again to rate their pain.

One person's answers won't mean much. But with a big sample, you can see whether your interventions made a difference. At no point do you need them to compare pain today to pain from last week. You only ever ask about the pain they are experiencing right now.
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Old 11th August 2021, 03:36 PM   #80
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I'll even grant that it might somewhat work at an hour interval, but that's not the thing we're talking about here. We're talking a placebo for surgery, for Pete's sake. You can't ask people in the group that actually got surgery to put the same kind of strain on a shoulder that just got operated, as they did when it hurt before, to see if it already got better. A shoulder that just got cut up and sewn up during the last hour, yeah, you KNOW it's going to hurt more. (Just the inflammation from tissue being cut and sewn is going to activate any of the sleeper nociceptors that weren't already activated.) Nor, really, could you do that with the placebo group without tipping them off that something isn't adding up.

But even without it involving surgery, a lot of these placebo trials involve comparing stuff across weeks or even months. E.g., in this one https://journals.plos.org/plosbiolog...l.pbio.1002570 one test was the improvement over a 2 WEEKS period, while the second test was over THREE MONTHS. In this one https://bmcmusculoskeletdisord.biome...91-021-04089-9 it's over 4 weeks. Etc. That's quite a bit different from the 1 hour scale you propose, wouldn't you agree?

But generally, even without surgery or even being about pain, the kinds of things that are in placebo trials are not always suited for such immediate comparison. E.g., one such placebo study involved self-reporting how easy it was to fall asleep in patients with insomnia. That's hard to gauge accurately in any case, but more importantly for most people it's going to necessarily mean comparing to something from 24 hours before.
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