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Howick, J., Thomas R, F., Mebius, A., Bishop, F., van Osch, M., van Dulmen, S., . . . Mistiaen, P. (2016). Positive "framing" as a powerful medication for pain: A meta-analysis of randomized trials. European Journal of Integrative Medicine, 8, 57-59
Open this publication in new window or tab >>Positive "framing" as a powerful medication for pain: A meta-analysis of randomized trials
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2016 (English)In: European Journal of Integrative Medicine, ISSN 1876-3820, E-ISSN 1876-3839, Vol. 8, p. 57-59Article in journal (Refereed) Published
Abstract [en]

Introduction: A growing body of evidence suggests that positive framing–inducing positive expectations about the outcome of treatments can reduce pain symptoms. However there is no pooled estimate of the effect size of positive framing for treating pain. Such an estimate is useful to understand the extent to which positive expectations can enhance usual care.

Methods: We extracted data from a recent systematic review of interventions that modified all "context factors" (including but not limited to) inducing positive expectations) in adults suffering from pain. The systematic review concluded that positive expectations were effective, but did not pool the results so no effect size was provided. Two authors independently extracted data from the studies and conducted the analysis. Our primary outcome was patient self-reported pain.

Results: 10 randomized trials were eligible for meta-analysis. In the trials with continuous outcomes the standardized effect size was −0.39 (95% confidence interval −0.68 to −0.10, p = 0.009, I2 = 79%), suggesting reduced pain on average in groups in which positive expectations were induced. The effect size was similar in magnitude but was not statistically significant when we excluded studies deemed to have a high risk of bias (standard effect size −0.31, 95% CI −0.65 to 0.02, p = 0.07, I2 = 77%).

Conclusion: The effect of inducing positive expectations is comparable to the effects of some pharmacological drugs. However many of the studies had a high risk of bias, and heterogeneity was significant. Future research is warranted including investigating ways to implement this evidence into patient care in an ethical way.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Clinical Medicine
Research subject
Philosophy; Medical Technology
Identifiers
urn:nbn:se:kth:diva-192638 (URN)10.1016/j.eujim.2016.08.136 (DOI)
Funder
EU, European Research Council, 639276
Note

QC 20160930

Available from: 2016-09-16 Created: 2016-09-16 Last updated: 2017-11-21Bibliographically approved
Howick, J. & Mebius, A. (2016). Randomized trials and observational studies: the current philosophical controversy. In: Schramme, Thomas and Steven Edwards (Ed.), Handbook of the Philosophy of Medicine: (pp. 873-886). Springer
Open this publication in new window or tab >>Randomized trials and observational studies: the current philosophical controversy
2016 (English)In: Handbook of the Philosophy of Medicine / [ed] Schramme, Thomas and Steven Edwards, Springer, 2016, p. 873-886Chapter in book (Refereed)
Abstract [en]

The supposed superiority of randomized over non-randomized studies is used to justify claims about therapeutic effectiveness of medical interventions and also inclusion criteria for many systematic reviews of therapeutic interventions. However, the view that randomized trials provide better evidence has been challenged by philosophers of science. In addition, empirical evidence for average differences between randomized trials and observational studies (which we would expect if one method were superior) has proven difficult to find. This chapter reviews the controversy surrounding the relative merits of randomized trials and observational studies. It is concluded that while (well-conducted) observational can often provide the same level of evidential support as randomized trials, merits of (well-conducted) randomized trials warrant claims about their superiority, especially where results from the two methods are contradictory.

Place, publisher, year, edition, pages
Springer, 2016
National Category
Philosophy Health Care Service and Management, Health Policy and Services and Health Economy Medical Ethics
Research subject
Philosophy
Identifiers
urn:nbn:se:kth:diva-161234 (URN)2-s2.0-85042842139 (Scopus ID)978-94-017-8687-4 (ISBN)
Note

QC 20150311

Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2018-03-15Bibliographically approved
Howick, J., Fanshawe, T. R., Mebius, A., Heneghan, C. J., Bishop, F., Little, P., . . . Roberts, N. W. (2015). Effects of changing practitioner empathy and patient expectations in healthcare consultations. Cochrane Database of Systematic Reviews
Open this publication in new window or tab >>Effects of changing practitioner empathy and patient expectations in healthcare consultations
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2015 (English)In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493XArticle in journal (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keywords
positive expectations, positive framing, expectations, communication, pain, patient-practitioner communication, placebo
National Category
Philosophy Clinical Medicine Health Sciences
Research subject
Philosophy; Medical Technology; Technology and Health; Applied Medical Technology
Identifiers
urn:nbn:se:kth:diva-176496 (URN)10.1002/14651858.CD011934 (DOI)2-s2.0-85041832147 (Scopus ID)
Funder
EU, European Research Council, 639276NIH (National Institute of Health)
Note

QC 20151214

Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2017-12-01Bibliographically approved
Howick, J., Ashley, G. K. & Mebius, A. (2015). Philosophy of Evidence-Based Medicine. In: Duncan Pritchard (Ed.), Oxford Bibliographies in Philosophy: . Oxford University Press
Open this publication in new window or tab >>Philosophy of Evidence-Based Medicine
2015 (English)In: Oxford Bibliographies in Philosophy / [ed] Duncan Pritchard, Oxford University Press, 2015Chapter in book (Refereed)
Abstract [en]

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM.

Place, publisher, year, edition, pages
Oxford University Press, 2015
National Category
Philosophy Medical Ethics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:kth:diva-162119 (URN)10.1093/obo/9780195396577-0253 (DOI)
Note

QC 20150323

Available from: 2015-03-22 Created: 2015-03-22 Last updated: 2017-04-10Bibliographically approved
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0280-7206

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