I think this part is a bit too strong, which corrupts one of the main points of the whole post:
The other contribution comes from the get-better-anyway effect. This is a statistical artefact and it provides no benefit whatsoever to patients.
It’s not called the stay-the-same-anyway effect, it’s called the get-better-anyway effect. The patient who reports lower pain a week later actually is in less pain. Health isn’t repeated draws from an urn: if you crack a rock one day it won’t regress to the mean. It’ll stay cracked. That people heal is not a statistical artefact.
That is, I agree much more with the O’Connell quote (emphasis mine):
If this finding is supported by future studies it might suggest that we can’t even claim victory through the non-specific effects of our interventions such as care, attention and placebo. People enrolled in trials for back pain may improve whatever you do. This is probably explained by the fact that patients enrol in a trial when their pain is at its worst which raises the murky spectre of regression to the mean and the beautiful phenomenon of natural recovery.
Regression to the mean plays a part, especially for chronic variable conditions like lower back pain or depression, but even there natural recovery plays a huge part (otherwise the condition would be a degenerative one).
It’s not called the stay-the-same-anyway effect, it’s called the get-better-anyway effect.
I agree, but here I am (uncharacteristically :-/) inclined to the charitable reading and treat “it” in “it provides no benefit whatsoever” as referencing placebo.
I would also think of regression to the mean (in this context) as an observable manifestation of “natural recovery” and not oppose them.
I think the structure of the paragraph is pretty clear (differentiating sentence, name A, explain A, name B, explain B, compare A and B), and the rest of the article matches my interpretation.
I would also think of regression to the mean (in this context) as an observable manifestation of “natural recovery” and not oppose them.
Yes, one could say that natural recovery is the mechanism by which regression to the mean works.
The chief thing I’m objecting to is the idea that the regression is in some way illusory or nonexistent. In the discussion of the NSLBP, for example, DC claims “none of the treatments work” when I think the result is the opposite, that “all of the treatments work.” Now, DC and I agree on the right course of treatment (do nothing) for the same reason (why spend more to get the same effect as doing nothing?), but we disagree on the presentation. Instead of “treatment” vs “no treatment,” both of which are equally ineffective, cast it as “natural recovery plus treatment” vs. “natural recovery alone,” both of which are equally effective.
Here you might get into an object level vs. meta level debate. I argue that one should talk up doing nothing instead of talking down treatments that are no better than doing nothing, because it will be hard to convince the man on the street reasoning by post hoc ergo propter hoc that his attempts did not actually lead to recovery, but if convinced to try doing nothing then the same fallacy will, when doing nothing turns out to work, cause him to gain trust in doing nothing. One could respond that the important point is not that he get the object level question right, but that he avoid fallacious reasoning.
cast it as “natural recovery plus treatment” vs. “natural recovery alone,” both of which are equally effective
That naturally leads to the effect of treatment being zero which is conventionally called “the treatment does not work”.
When you have some baseline process and some zero-effect interventions on top of it, I think it’s misleading to say that all these interventions work.
I argue that one should talk up doing nothing instead of talking down treatments that are no better than doing nothing
These, of course, are not mutually exclusive. Besides, you need to do something to counteract the proponents of the no-effect treatments—such people exist (typically they are paid for providing these treatments) and if you just ignore them they will dominate the debate.
I think this part is a bit too strong, which corrupts one of the main points of the whole post:
It’s not called the stay-the-same-anyway effect, it’s called the get-better-anyway effect. The patient who reports lower pain a week later actually is in less pain. Health isn’t repeated draws from an urn: if you crack a rock one day it won’t regress to the mean. It’ll stay cracked. That people heal is not a statistical artefact.
That is, I agree much more with the O’Connell quote (emphasis mine):
Regression to the mean plays a part, especially for chronic variable conditions like lower back pain or depression, but even there natural recovery plays a huge part (otherwise the condition would be a degenerative one).
I agree, but here I am (uncharacteristically :-/) inclined to the charitable reading and treat “it” in “it provides no benefit whatsoever” as referencing placebo.
I would also think of regression to the mean (in this context) as an observable manifestation of “natural recovery” and not oppose them.
I think the structure of the paragraph is pretty clear (differentiating sentence, name A, explain A, name B, explain B, compare A and B), and the rest of the article matches my interpretation.
Yes, one could say that natural recovery is the mechanism by which regression to the mean works.
The chief thing I’m objecting to is the idea that the regression is in some way illusory or nonexistent. In the discussion of the NSLBP, for example, DC claims “none of the treatments work” when I think the result is the opposite, that “all of the treatments work.” Now, DC and I agree on the right course of treatment (do nothing) for the same reason (why spend more to get the same effect as doing nothing?), but we disagree on the presentation. Instead of “treatment” vs “no treatment,” both of which are equally ineffective, cast it as “natural recovery plus treatment” vs. “natural recovery alone,” both of which are equally effective.
Here you might get into an object level vs. meta level debate. I argue that one should talk up doing nothing instead of talking down treatments that are no better than doing nothing, because it will be hard to convince the man on the street reasoning by post hoc ergo propter hoc that his attempts did not actually lead to recovery, but if convinced to try doing nothing then the same fallacy will, when doing nothing turns out to work, cause him to gain trust in doing nothing. One could respond that the important point is not that he get the object level question right, but that he avoid fallacious reasoning.
That naturally leads to the effect of treatment being zero which is conventionally called “the treatment does not work”.
When you have some baseline process and some zero-effect interventions on top of it, I think it’s misleading to say that all these interventions work.
These, of course, are not mutually exclusive. Besides, you need to do something to counteract the proponents of the no-effect treatments—such people exist (typically they are paid for providing these treatments) and if you just ignore them they will dominate the debate.