A method for evaluation of laxative habits in human subjects

The (Harry) Gold standard: angina, suggestion and the path to the ‘double blind’ test and clinical pharmacology. Part 2: the path to the ‘double blind’

“…By this time, and after nearly a quarter of a century of effort to shift the evaluation of anti-anginal therapeutics, Gold and his colleagues could seemingly claim victory, if narrowly defined. As they noted, ‘nowadays it is a rare study of coronary vasodilators that does not specify control with placebo and “double blind” evaluation of cardiac pain’ (Greiner et al., 37 p. 244). Yet, as they realised, this was only a partial victory: ‘In other areas of therapeutics, the majority of studies are so poorly designed that their data contain no indication as to the correctness of the conclusion’ (Greiner et al., 37 p. 244).…”

“…As they noted, ‘nowadays it is a rare study of coronary vasodilators that does not specify control with placebo and “double blind” evaluation of cardiac pain’ (Greiner et al., 37 p. 244). Yet, as they realised, this was only a partial victory: ‘In other areas of therapeutics, the majority of studies are so poorly designed that their data contain no indication as to the correctness of the conclusion’ (Greiner et al., 37 p. 244). Gold had his sights set beyond anti-anginals, and Part 3 of this series will examine the relationship between the ‘double-blind’ method and the advent of ‘clinical pharmacology’ more generally from the 1950s onward.…”

The (Harry) Gold standard: angina, suggestion and the path to the ‘double-blind’ test and clinical pharmacology. Part 3: the double blind and the rise of ‘clinical pharmacology’

“…Laxatives are relevant only as a class of drugs sorely in need of the application of pharmacologic principles in their clinical trials. (Greiner et al,53 p. 252) Pointing explicitly to the 'placebo effect, a shorthand way of saying that the patient's psyche induces responses to the doctor's interest and prescriptions', Gold and his colleagues again emphasised that 'the physician's psyche, too, may alter drug response by the unconscious attitudes imparted to the patient before the drug is taken and when the drug effects are being assessed' (Greiner et al, 53 pp. 252-253).…”

“…In 1957, he and his colleagues reported on their double-blinded study of laxatives for constipation. Invoking the image of the epistemically and morally dubious ‘testimonial’, they noted that such humble preparations were chosen for study not for their representing the apogee of clinical or industrial pharmacology, but for being ‘supported by the weakest series of studies’ while representing the largest sales volume of any class of drugs (Greiner et al., 53 p. 244). Finding some laxatives better than placebo, and others not, Gold and colleagues were admittedly less concerned with the consistency of stool than with ensuring the consistency of clinical investigative methodology.…”

Antacids and Laxatives for Symptomatic Relief in the Elderly

“…Often, the psychological component at the onset of constipation is ignored. One double‐blind study of 20 patients with chronic constipation found that placebo resulted in improvement in 14 patients 10 . A discussion of psychological problems or stressful situations may prove the only treatment necessary.…”