La gradación del efecto placebo. Un estudio N=1, doble ciego, con belladona homeopática 30C / Grading the placebo effect. A N=1, double blind study with homeopathic belladonna 30C

El concepto ‘placebo’ se ha convertido de una caja de sastre para efectos no comprendidos a una categoría científica de efectos no-específicos pero contrastables. Este cambio paradigmático convirtió el placebo en un elemento objeto de investigación clínica en condiciones controladas. Un resultado intrigante de las investigaciones recientes es que se perfilan diferentes categorías o clases de placebo según su grado de eficacia y la supuesta procedencia de esta influencia. Los resultados del presente estudio indican una diferente influencia entre un placebo neutro y un placebo homeopático, con lo cual parece confirmarse una necesaria diferenciación entre tipos de placebo (AU)

A controlled trial of glycopyrronium and l-hyoscyamine in the long-term treatment of duodenal ulcer.

A controlled single-blind trial has been carried out to determine the value of long-term anticholinergic therapy in duodenal ulcer. Of 106 male patients with symptomatic and radiologically proven duodenal ulcer admitted to the trial, 91 completed the study. Patients were divided randomly into three groups. They received either glycopyrronium, or 1-hyoscyamine in a sustained-release form, or inert tablets for one year. Progress was judged on the basis of frequency and severity of symptoms, monthly assessments by patients, antacid consumption, and radiology. By all criteria, glycopyrronium and 1-hyoscyamine were not significantly superior to placebo. Symptomatic improvement, both subjective and objective, occurred in approximately 80% of all patients during the year of observation; there was no significant difference between the groups.

Gastric acid secretion in patients with duodenal ulcer treated for one year with anticholinergic drugs.

Ninety patients with duodenal ulcer, divided randomly into three groups, were treated continuously for one year with either glycopyrronium, 1-hyoscyamine (as a sustained-release preparation) or inert tablets. Dosage with active tablets was so adjusted that the patient experienced definite but tolerable side-effects. Basal and maximal gastric acid secretion were measured immediately before and one week after cessation of treatment. There was no significant change in the means of these measurements in patients who received placebo or 1-hyoscyamine. In those given glycopyrronium, mean basal output was significantly increased. Mean maximal acid output in this group fell, but not significantly.Individual measurements of maximal acid output showed quite marked fluctuations in all groups. It is concluded that spontaneous changes in parietal cell mass may occur in patients with duodenal ulcer, and that prolonged anticholinergic therapy does not reduce parietal cell mass.