5 ms·

No it doesnt. Placebo controlled trials show it has no effect. Im surprised at the nhs for this shoddy review.

by cpncrunch 9y ago

linkmotif 9y ago
You mean shitty review?
- durfdurf 9y ago
  i see what you did there
  - eeZah7Ux 9y ago
    HN is not 4chan. (But it's getting there pretty quickly)
- dang 9y ago
  Would you please stop posting unsubstantive comments to HN? We're trying for better than that here, and I'm sorry to see that you've done it before.
elsherbini 9y ago
Here's a randomized trial with placebos that did work. I wasn't able to find one where it didn't work. http://annals.org/aim/article-abstract/2545886/effect-fecal-microbiota-transplantation-recurrence-multiply-recurrent-clostridium-difficile-infection http://annals.org/aim/article-abstract/2545886/effect-fecal-...
- cpncrunch 9y ago
  I submitted on a while back. Will check later if people reverse the downvotes and assume good faith.
  - AndrewDucker 9y ago
    You'll provide evidence for your claims if people down downvote you for making claims without evidence? I'm not terribly impressed by that approach.
    - cpncrunch 9y ago
      In my world people ask politely for refs or search for it themselves, rather than downvoting first (which is saying "your comment isn't worth reading"). I got up out of bed, posted a comment and was going to look for the link later if people asked. (I did a quick search and didn't find it). However, from the comments here, it's pretty clear people aren't interested in the science. Carry on...
  - icebraining 9y ago
    Is this the post you're referring to? "There have been a total of 2 placebo-controlled trials into fecal transplants for C.Diff AFAIK. One showed some benefit over placebo, and the other showed no difference." https://news.ycombinator.com/item?id=10679823#10680173 https://news.ycombinator.com/item?id=10679823#10680173
    - epmaybe 9y ago
      In case people can't read the article as it's behind a paywall, it's not the primary source. However, to summarize the differences, this one study should not be representative of fact, as it very well could be that in the trial that did not show any benefit, patients could have had very aggressive treatment prior to beginning the study, and thus may have already been clinically cured prior to the study actually beginning. I would definitely trust the OPs meta analysis and systematic review of multiple different trials before believing this placebo controlled trial, for a number of reasons: 1. What I already mentioned above regarding the conflicting results of these two placebo controlled trials 2. The studies used in the nhs article are all done for patients that we're currently undergoing treatment for c diff, not after a long treatment time. 3. Meta analyses and systematic reviews are always going to be higher powered statistically speaking. As long as the papers looked at don't stink of publication bias it's a very valid way of looking at all the research done on fecal transplants for c diff.
- cpncrunch 9y ago
  That's the study I was referring to. You'll see that there was no difference between donor and placebo in the NY group.
  - morsch 9y ago
    But there was a difference in the other group, right? Isn't that still relevant? The study's authors certainly seem to think so. I've only read the abstract.
    - cpncrunch 9y ago
      Yes, that group had a 40% placebo rate vs the 90% placebo response of the NY group. However it is a very small group, and only marginally significant. It needs a larger, better designed study (preferably one which objectively measures c.diff infection status before and after), but if one study fails to show a response that's a pretty good indication that the treatment is suspect.
jimrandomh 9y ago
Checking the meta-analysis paper on sci-hub, Fig. 2 has 7 RCTs, all of which found large effect sizes. I think you're simply mistaken. http://sci-hub.bz/http://onlinelibrary.wiley.com/doi/10.1111/apt.14201/full http://sci-hub.bz/http://onlinelibrary.wiley.com/doi/10.1111...
- cpncrunch 9y ago
  I think you didnt read it. It says there were no placebo controlled trials.
  - foobar1234567 9y ago
    "The benefits, risks, burdens, and effectiveness of the new methods should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo or no treatment in studies where no proven prophylactic, or therapeutic methods exist." World Medical Association (WMA) Declaration of Helsinki. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647647/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647647/ for more.
  - rm2889 9y ago
    Are you familiar with c diff? Placebo's don't work. It's dangerous to have placebo controlled trials with this disease. The current standard of care is a course of very strong antibiotics which still leave > 25% chance of recurrence. These antibiotics are most often used as a control group in c diff infections. In general, placebo controlled trials are usually conducted for diseases which don't have an effective standard of care, or for conditions which aren't serious enough to be considered life threatening. For more serious diseases where a standard of care exists (standard of care is usually scientifically discovered but validated by placebo controlled trials), you conduct trials and compare the performance of the new drug/therapy with the existing standard of care as the control group.
    - TheAdamAndChe 9y ago
      Yup. It's like wanting placebo controlled trials for cancer. It would be unethical and ungodly harmful to condemn people to suffering and death just so people could gather data that wouldn't even compare the results to the current best practices.
ipunchghosts 9y ago
Are you thinking of IBS?
- cpncrunch 9y ago
  No, Clostridium difficile (Kelly et al, 2016, as discussed in the comments above).
throwawayfmt 9y ago
Any time someone points out crap science and the placebo effect on HN they get downvoted to hell. I'm not sure if people on HN just don't understand the placebo effect or don't want to, but it's usually best not to mention it here.

No it doesnt. Placebo controlled trials show it has no effect. Im surprised at the nhs for this shoddy review.

linkmotif 9y ago

You mean shitty review?

durfdurf 9y ago
i see what you did there
- eeZah7Ux 9y ago
  HN is not 4chan. (But it's getting there pretty quickly)
dang 9y ago
Would you please stop posting unsubstantive comments to HN? We're trying for better than that here, and I'm sorry to see that you've done it before.

elsherbini 9y ago

Here's a randomized trial with placebos that did work. I wasn't able to find one where it didn't work. http://annals.org/aim/article-abstract/2545886/effect-fecal-microbiota-transplantation-recurrence-multiply-recurrent-clostridium-difficile-infection http://annals.org/aim/article-abstract/2545886/effect-fecal-...

cpncrunch 9y ago
I submitted on a while back. Will check later if people reverse the downvotes and assume good faith.
- AndrewDucker 9y ago
  You'll provide evidence for your claims if people down downvote you for making claims without evidence? I'm not terribly impressed by that approach.
  - cpncrunch 9y ago
    In my world people ask politely for refs or search for it themselves, rather than downvoting first (which is saying "your comment isn't worth reading"). I got up out of bed, posted a comment and was going to look for the link later if people asked. (I did a quick search and didn't find it). However, from the comments here, it's pretty clear people aren't interested in the science. Carry on...
- icebraining 9y ago
  Is this the post you're referring to? "There have been a total of 2 placebo-controlled trials into fecal transplants for C.Diff AFAIK. One showed some benefit over placebo, and the other showed no difference." https://news.ycombinator.com/item?id=10679823#10680173 https://news.ycombinator.com/item?id=10679823#10680173
  - epmaybe 9y ago
    In case people can't read the article as it's behind a paywall, it's not the primary source. However, to summarize the differences, this one study should not be representative of fact, as it very well could be that in the trial that did not show any benefit, patients could have had very aggressive treatment prior to beginning the study, and thus may have already been clinically cured prior to the study actually beginning. I would definitely trust the OPs meta analysis and systematic review of multiple different trials before believing this placebo controlled trial, for a number of reasons: 1. What I already mentioned above regarding the conflicting results of these two placebo controlled trials 2. The studies used in the nhs article are all done for patients that we're currently undergoing treatment for c diff, not after a long treatment time. 3. Meta analyses and systematic reviews are always going to be higher powered statistically speaking. As long as the papers looked at don't stink of publication bias it's a very valid way of looking at all the research done on fecal transplants for c diff.
cpncrunch 9y ago
That's the study I was referring to. You'll see that there was no difference between donor and placebo in the NY group.
- morsch 9y ago
  But there was a difference in the other group, right? Isn't that still relevant? The study's authors certainly seem to think so. I've only read the abstract.
  - cpncrunch 9y ago
    Yes, that group had a 40% placebo rate vs the 90% placebo response of the NY group. However it is a very small group, and only marginally significant. It needs a larger, better designed study (preferably one which objectively measures c.diff infection status before and after), but if one study fails to show a response that's a pretty good indication that the treatment is suspect.

jimrandomh 9y ago

Checking the meta-analysis paper on sci-hub, Fig. 2 has 7 RCTs, all of which found large effect sizes. I think you're simply mistaken. http://sci-hub.bz/http://onlinelibrary.wiley.com/doi/10.1111/apt.14201/full http://sci-hub.bz/http://onlinelibrary.wiley.com/doi/10.1111...

cpncrunch 9y ago
I think you didnt read it. It says there were no placebo controlled trials.
- foobar1234567 9y ago
  "The benefits, risks, burdens, and effectiveness of the new methods should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo or no treatment in studies where no proven prophylactic, or therapeutic methods exist." World Medical Association (WMA) Declaration of Helsinki. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647647/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647647/ for more.
- rm2889 9y ago
  Are you familiar with c diff? Placebo's don't work. It's dangerous to have placebo controlled trials with this disease. The current standard of care is a course of very strong antibiotics which still leave > 25% chance of recurrence. These antibiotics are most often used as a control group in c diff infections. In general, placebo controlled trials are usually conducted for diseases which don't have an effective standard of care, or for conditions which aren't serious enough to be considered life threatening. For more serious diseases where a standard of care exists (standard of care is usually scientifically discovered but validated by placebo controlled trials), you conduct trials and compare the performance of the new drug/therapy with the existing standard of care as the control group.
  - TheAdamAndChe 9y ago
    Yup. It's like wanting placebo controlled trials for cancer. It would be unethical and ungodly harmful to condemn people to suffering and death just so people could gather data that wouldn't even compare the results to the current best practices.

ipunchghosts 9y ago

Are you thinking of IBS?

cpncrunch 9y ago
No, Clostridium difficile (Kelly et al, 2016, as discussed in the comments above).

throwawayfmt 9y ago

Any time someone points out crap science and the placebo effect on HN they get downvoted to hell. I'm not sure if people on HN just don't understand the placebo effect or don't want to, but it's usually best not to mention it here.