[cpncrunch]

It does sound phenomenal, but bear in mind there was no placebo control, so we don't know how much of the effect was due to the placebo effect.

Generally the placebo effect will vary depending on the type of intervention. A very novel and invasive intervention like this will have a high placebo effect. Remember Liberation Therapy?

Given that psychological treatment alone can reduce the fatigue in MS to below that of healthy controls (van Kessel 2008), it's likely that the placebo effect plays a large role. (The placebo effect will also affect pain, weakness and numbness, as the part of the brain that produces fatigue - the anterior cingulate cortex and insular cortex - also produces those symptoms).

[zxv]

Hang on a minute.

Placebo effect does not explain regaining sensation, nor regaining ability walking.

[refurb]

Sure it can. Sensation is a subjective measure by the patient themselves. If the patient takes a drug then you ask if sensation improves, they could certainly say "it feels like it's improving".

And with regards to ability to walk, fatigue is often a major complaint in MS. If the patient takes a drug, "feels better", they may have more energy and do better on a walk test.

There are measure where a placebo effect is unlikely, such as blood tests of biomarkers or physical processes that are easily measurable without having to ask the patient (e.g. plaque buildup on arterial walls).

[King-Aaron]

I think you're vastly and grossly underestimating how multiple sclerosis impacts your nervous system if you think that a placebo effect making you "feel better" will give you the ability to walk again.

It's actually a little stunning, reading your position on this.

[refurb]

It's not my position, it's the FDA's position. Take a look at some of the FDA's comments on other disabling diseases like Duchenne's muscular dystrophy. An improve in an ability to walk (6 minute walk test, 6MWT) is view with skepticism by clinicians.

[jMyles]

For the purposes of clinical trials, are there any conditions that are excluded as possible placebo effects?

[Retric]

Regrowing limbs for an obvious start. Placebo is mostly effective with pain and has minor impacts on other issues.

[patall]

That's exactly the placebo effect. You think that you get a treatment and your body reacts to that

[badsock]

Also MS in particular is famous for misleading results due to spontaneous partial remission unrelated to the treatment.

[rpedela]

Placebo effects don't last 15 years.

[cpncrunch]

They certainly can if the initial illness is psychosomatic. I'm not saying that is the case here, but I've certainly seen people with identical symptoms fully recover from psychological treatments. There does appear to be a certain psychosomatic aspect to MS, given how effective CBT is in treating the fatigue, the fact that it is triggered by stress, and that depression is a major factor in MS (and plaques appear to be correlated to depression rather than to disability).

[rpedela]

I could see that if it was a pill or injection taken periodically over 15 years, but not a single procedure. In general, you have a point but the fact a single procedure has been curative for 15 years suggests with high confidence that there is real effect.

Also claiming that MS is largely psychological is, at best, insulting to MS patients.

[cpncrunch]

>I could see that if it was a pill or injection taken periodically over 15 years, but not a single procedure

This is a pretty involved, and long, procedure. One of the main factors about psychosomatic fatigue/pain illnesses is that the patient gets stuck in a vicious circle where the stress of the illness itself causes further symptoms. Sometimes all that is required is something that breaks the cycle.

>Also claiming that MS is largely psychological is, at best, insulting to MS patients.

First of all, I never said that. I pointed out there there are psychological aspects to it, and argued that there may be some patients diagnosed with MS who have a psychosomatic illness. What % that is, we don't know.

I would also argue that it is very unhelpful for you to have that attitude, and it is a reflection of the bias against psychiatric illness that is so prevalent in society.

It also goes against what we know about how the brain works. It has been pretty conclusively demonstrated by Noakes and others that psychosomatic fatigue is a fundamental part of the human brain, and likely all mammals as well. Saying that psychosomatic symptoms are somehow bad - or imaginary - is fundamentally misrepresenting the science.

Unfortunately this is a very common attitude. I saw last week one of the world's top medical researchers say that changes in mitochondrial activity prove that an illness is not psychosomatic. That statement is, of course, demonstrably false, because cortisol (and therefore stress) reduces mitochondrial activity.

[paulbjensen]

MS is nerve damage caused by the nerve cell's coating (Myelin) being mistaken for a foreign body by the immune system, and attacking it. How would the Placebo effect stop and reverse that nerve damage?

[DanBC]

Placebo would have no effect on that nerve damage.

Some of the symptoms of MS have nothing to do with the nerve damage. Some of the symptoms are real, but not explained by the MS. Those symptoms may be relieved with psychological therapy.

They use CBT for pain in some cancer patients - use of psychological therapy for real symptoms in people with physical illness isn't a bit of woo-peddling. It's giving people in pain some help.

[cpncrunch]

>MS is nerve damage caused by the nerve cell's coating (Myelin) being mistaken for a foreign body by the immune system, and attacking it.

That's the headline theory for MS, but if you look at the actual research you'll see that it's not actually proven. Sensitivity and specificity are 46% and 63% for the McDonald criteria, which is very poor. Plaques in MS are associated with depression, not disease activity in general. Patients with depression (but no MS) show myelin damage and brain plaques as well. The myelin damage may just be a factor of depression.

Sometimes things in medicine aren't quite as settled and proven as you might think. MS is certainly a very good example of this. Unfortunately there is such emotional and intellectual attachment to the idea that MS is neurological and caused by myelin damage that it is next to impossible to change people's minds. (I'm talking about the minds of doctors and researchers, not patients). It's certainly not something I'm interested in doing. I just find it interesting.