Bibliographic record
Abstract
Dear Editor: The April issue of The CJP included 3 papers on the use of placebos in psychiatric research.1-3 Reading these excellent papers reminded us of past studies of our research group on addictions. One of our conclusions was that belonging to the placebo group in a trial for the treatment of alcohol dependence was persistently beneficial. In subsequent projects, we matched these subjects with others treated in several specialized institutions by the usual psychosocial approaches. Outcome measures, repeated every 6 months, showed that these more intensive treatments were slightly superior to our placebo groups, significantly in some areas, not in others.4 More far-reaching conclusions were offered by a multisite study conducted by the US National Institute of Alcoholism and Alcohol Abuse. The Combined Pharmacotherapies and Behavioural Interventions Study compared 2 medications (naltrexone and acamprosate), behavioural intervention, and a placebo group.5 Improvement in all 9 cells remained important up to the end of the follow-up period: the placebo was inferior to naltrexone but superior to the behavioural-psychosocial approach. The latter, elaborated by a group of the best American specialists, combined the most evidence-based approaches in up to 20 hours of intervention over 4 months. Any treatment implies imaginary (for example, self-image) and symbolic (for example, relational) components, and they are exclusively present in the placebo groups. A physicist can spend years quantifying the vibrations from the instruments of a symphonic orchestra, without pretending to explain the esthetic emotion produced. Similarly, clinical research is a branch of science, but in spite of all efforts it remains a unique combination of art and science, allowing some imaginary and symbolic components to enter the scene as uninvited guests, and our placebo groups belong to this category. Understandably, many clinical researchers and pharmaceutical companies tend to neglect this paradigm shift specific to human research. When the magnitude of the placebo effects reaches such dimensions as the ones discussed above, they deserve deeper reflection about their meaning and their implications for ethical, evidence-based treatment. The CJP and the authors of these articles deserve our thanks for this introduction. References 1. Kirsch I. The use of placebos in clinical trials and clinical practice. Can J Psychiatry. 2011;56(4):191-192. 2. Shorter E. A brief history of placebos and clinical trials in psychiatry. Can J Psychiatry. 2011;56(4):193-197. 3. Raz A, Campbell N, Guindi D, et al. Placebos in clinical practice: comparing attitudes, beliefs, and patterns of use between academic psychiatrists and nonpsychiatrists. Can J Psychiatry. 2011;56(4):198-208. 4. Redko C, Legault L, Brown TG, et al. Comment evaluer les modes de pratique ? Deux experiences quebecoises d'evaluation a long terme du traitement de la toxicomanie. In: Landry M, Guyon L, Brochu S. Impact du traitement en alcoolisme et toxicomanie. Laval (QC): Presses de l'Universite Laval; 2001. p 1-15. 5. Anton R, O'Malley S, Ciraulo D, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence. JAMA. 2006;295( 17):2003-2017. Maurice Dongier, MD, FRCPC Thomas G Brown, PhD Montreal, Quebec REPLY Understanding Placebo Science: A Word About Deception Dear Editor: In their commentary, Dr Dongier and Dr Brown discuss additional findings that speak to the magnitude of placebo effects; meanwhile, survey data and media reports begin to unveil the use of placebos in clinical settings. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.059 | 0.220 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.017 |
| Scholarly communication | 0.011 | 0.021 |
| Open science | 0.007 | 0.005 |
| Research integrity | 0.035 | 0.072 |
| Insufficient payload (model declined to judge) | 0.010 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".