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Comment by giantg2 | Hacker News Reader

Maybe Emetrol is placebo, but it has worked for me in the past on a couple of occasions. This included 8 hours of vomiting no mater how hard I willed it to stop or other remedies I tried, and it didn't work on the first dose. It didn't seem like placebo to me, but I am grateful it worked either way.

One thing to note that isn't in the article, is that concentration can matter, so comparing one can to a 30ml dose of medication might not be a great comparison (although this still supports for the author's position that phosphoric acid is not added to cola to prevent vomiting).

Is the placebo effect applicable in infants? I would think that infants would not be capable of the understanding that something will make them better, and thus placebo wouldn't apply to them. Unfortunately this paper is pay-walled so we dont have details about the methods used, but the summary seems relevant.

https://www.jpeds.com/article/S0022-3476(51)80084-2/pdf

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> Unfortunately this paper is pay-walled

not when you use sci-hub

https://sci.bban.top/pdf/10.1016/s0022-3476%252851%252980084...

This included 8 hours of vomiting no mater how hard I willed it to stop or other remedies I tried, and it didn't work on the first dose

It seems very plausible that after 8 hours vomiting would stop without intervention.

Why? One could say that about any duration, right?

Totally. And it would be more probable as time goes on, since you couldn’t really go on vomiting for ever (unless the illness was way more serious!)

8 hours seems pretty ‘normal’ from the few times I’ve been ill like this though - would basically feel like ‘most of a day’ or ‘most of a night’.

I think we are thinking of different things. Continuously vomiting every 5-15 minutes for 8 hours to the point of just green bile coming up is pretty serious (dehydration is a huge concern), in my opinion. This sort of vomiting seems to be an uncontrollable involuntary response.

Yes. You would have to have a placebo controlled test to confirm placebo vs "just happens to last 8 hours". This is what placebo controls are for.

I generally agree. The secondary (and more interesting) question is whether placebo effect is applicable to infants. Based on the theory of how placebo works, it seems it might not be. It seems there are no studies on that. At least I couldn't find any.

Placebo mostly just means "good effect unrelated to intended treatment (active substance, surgical procedure etc)". That can include psychological effects of treatment (such as in pain management, depression, heart rate and blood pressure, and a handful of others).

More commonly though, the placebo effect is just natural progression of the disease, errors in data collection (such as patients trying to be helpful and confirming that vague symptoms have somewhat improved), or errors in data analysis (such as lab techs thinking they've seen something in the sample that they expected to see there).

The psychological effects may or may not apply to infants - that's a somewhat separate question. The other effects definitely do - it's perfectly plausible that a lab tech looking for an improvement in an infant's blood sample after treatment "finds" it.

I would consider those other effects to be bias, controlled via some other mechanism like a study being double blind. For example, lab techs shouldn't even know whose sample they're testing, let alone that patient's treatment, whether they're involved in a study, or the expected outcome.

So I do agree these other effects exist, but I don't think they exist under the classification of placebo effect. It's possible one of these is at play in this study.

Yes, whatever the duration, you'll eventually stop vomiting some time after taking the medicine. Sometimes by chance it will seem like a remarkably short time from medicine to cure compared to the duration of the sickness. This is how a lot of ineffective traditional medicines "work". For a cold or nausea, nearly everyone will experience their problem fixing itself after taking the medicine and combined with cultural beliefs, use that to convince themselves that the medicine treated the disease. Just look at the number of people online who credit some (real) medicine with some outcome despite the fact that they have no way of knowing causation. Or young people who say "I don't drink FooBar type of alcohol because it makes me vomit." after one occasion getting plastered and ending up vomiting. It's good old mind-tricks of correlation vs causation.

There's a reason real medicine requires preregistered double blind trials. It's just far too easy to get causation wrong without using rigorous scientific methods.

"Yes, whatever the duration, you'll eventually stop vomiting some time after taking the medicine."

That's a gross oversimplification. You could continue to vomit. You could also die. There are multiple types/causes for vomiting. Not all vomiting simply stops on it's own.

"It's good old mind-tricks of correlation vs causation."

I'd say this is more than just mind tricks. The study shows there's a strong correlation and evident effects, which suggests studies should be done on the cause.

"There's a reason real medicine requires preregistered double blind trials."

Or in this case a grandfathered status (it is a "real" medicine as it is approved for sale). I also think this is, again, only a half truth. Double blind studies tend to provide the strongest evidence, but they are not the only kind of study accepted for drug approval.

Mostly vomiting stops on its own and people don't die. Even when someone dies, it won't break the beliefs of survivors because they don't believe it works 100% of the time anyway. In your case, you even took an ineffective dose of Emetrol but still believed in its effectiveness despite that! How many ineffective doses would it take for you to not credit Emertol with stopping the vomiting?

If there's a scientific study, that might show something better than the giant fail-fest of cultural medical knowledge. I don't know of any human society that hasn't at least historically had a bunch of ineffective medicine that was widely used. Even modern western society probably has some - such as this Emetrol perhaps or wrong results of drug trials. An extreme case is China where normal doctors in hospitals routinely prescribe herbal remedies alongside conventional medicine.

The dosing isn't based on a single dose. Obviously if you vomit it up before the initial dose has time to work, then you need a second dose.

Did you look at the study linked in these comments? Or are you just going to go on and on about cultural medicine and mind tricks?

Apparently placebo works even with dogs: https://pubmed.ncbi.nlm.nih.gov/19912522/ Given that I would not find surprising if it worked for infants too

That's interesting. Yeah, I couldn't find anything about it for infants.

I wouldn't put too much stock in this study you linked. It's a meta analysis of other studies. These other studies were not designed to test placebo effect. The P value also seems quite large to me (.17). Seems to me like any benefit may have been the conventional drugs they were on...

"In each study, the treatment group received the experimental therapeutic intervention in addition to conventional antiepileptic drug treatment, and the control group received a matching placebo in addition to conventional antiepileptic drug treatment."

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