Waiit - "You have a mind-shattering headache. [..] What do you reach for? " - isn't this where you're supposed or even required to ask the pharmacist? You know, the person who has the years-long training to know drug effects, limitations and interactions with other drugs?

I'd say yes but the last time I was truly sick (flu) my roommate went to the store and asked the pharmacist what to give me and came back home with a bunch of homeopathic sugar pills. My trust in other humans is pretty low for this sort of stuff.

That's pretty awful. On the flipside, here in Montreal I've been very impressed with my local pharmacists at the nearby chain drugstore. They pay attention to drug interactions to the extent of flagging a risk the doctor missed but in retrospect admitted is valid, give me a consult every time I get a new medicine, remember things well enough that I was once asked how my wife was doing with her own recovery from something, and so on.

I used to live in the US and I'm certainly not used to that either. I wish that kind of great pharmacist care were more widespread as a norm.

For some reason, people seem to have evolved to consider nicotine products (for instance) more opposed to the abstract mission of a drugstore than homeopathic products.

I have never smoked or vaped or anything, but it's the homeopathic OTC meds that viscerally upset me, that they should be allowed on the shelves.

Isn't there a social benefit in letting the 10% (or whatever) of people that believe in them get a safe and effective placebo, for many conditions where that's all that's needed?

I see belief in the "placebo effect" as a mind virus. Because it is not just a justification for lying to patients, but entails medical people lying to themselves.

I get tired trying to explain, and if I'm not convincing anyone, maybe it's me who doesn't understand...but, I feel like the key is to ask yourself, if the placebo effect is something that you can scientifically demonstrate, how would you arrange a control group?

Failure to identify a reason for an apparent effect cannot be turned into proof that "nothing" has an effect. It's just a mental short circuit that people get trapped in.

> if the placebo effect is something that you can scientifically demonstrate, how would you arrange a control group?

Easy, just don't give the control group any medicine. Give the other group a placebo. If outcomes are better for the second group, it's evidence that placebos work, just as clearly as the usual trial provides evidence that medicines work.

That's sad

In many countries the pharmacist is a doctor and they are there to handle simple cases. Thailand, Singapore, Malaysia all seem this way. VS the USA (and Japan?) where all the pharmacist does is handout the medicine some other doctor prescribed.

Yes, for headaches no one wants to read a meta-analysis, they just want to buy something quickly and feel slightly better.

On the other hand, for depression medication, they don't want their doctor to look at an online tool and choose the most effective antidepressant. They want their doctor to look at THEM and say "hmm, we'll try you on X but if it doesn't help with the intrusive thoughts we'll maybe switch it out to Y and up the dosage of Z". Or they want to tell the doctor what they think they want to be prescribed. They are paying big bucks to see a psychiatrist. Most of them are not on a self-optimization trip, they just want to feel better, and also feel like someone takes an interest in how they are getting on. Using a snazzy tool would probably lead to the patient being less satisfied with the doctor's service, even if they have slightly better outcomes by whatever questionable metric is in the study.

Also, the author completely missed the fact that different people react differently to different treatments.

It's basically akin to looking at Google Analytics and trying to predict what your next website visitor will do. You'll have an idea of what someone's going to do, but you can't perfectly predict it.

Also, people feel differently about different treatments, for particular reasons. If your mom always took one brand of Tylenol when she had a cold, taking it might reassure you more than the theoretically optimal painkiller. Customers were quite happy to pay more for the exact same Ibuprofen labelled with 'Back Pain' or 'Period Pain', because they felt it worked.

If you think about it, the author's desire to choose 'the scientifically proven to be the most effective' is just another example of such a superstition. If you could convince him that a particular medication was the winner in the meta-analysis, he would probably objectively feel better, even if it wasn't actually true.

> most people when they have a headache and know that most painkillers on the market will result in about the same degree of relief

I've not had this experience. For me, Ibuprofen works, aspirin and acetaminophen have zero noticeable affect. It's been that way my entire life. The other two might have some affect on fever? (no idea) but none on pain, at least for me.

Then for you, a meta-analysis would be even more useless, as your own experience is much more valuable.