Why Are Placebos Getting More Effective?
Wired Magazine reports that drug companies' are facing a new obstacle in clinical trials: over the past few decades, the placebo response has gotten stronger. Some drugs, like Prozac, would have had trouble getting FDA approval if their effectiveness against placebos were as insignificant as tests now show.
Pharmaceutical companies see the strengthening of the placebo response as a crisis because it makes getting new drugs approved all the more difficult.
The effect is most dramatic with drugs targeting the central nervous system, such as antidepressants, anxiolytics, and pain relievers. The ailments that these drugs treat have "turned out to be particularly susceptible to the placebo effect."
One theory behind the stronger placebo is that clinical trials take place in an environment of exceptional, one-on-one health care, the kind patients don't typically get from their own doctors. This personal attention has a therapeutic effect, encouraging a placebo response.
To find out the exact cause, drug companies are now working with the National Institute of Health (NIH).
In typically secretive industry fashion, the existence of the project itself is being kept under wraps. NIH staffers are willing to talk about it only anonymously, concerned about offending the companies paying for it.
But the placebo "crisis" is one that deserves quote marks. Drug companies want to reduce the placebo response in order to make its products look better. But the fact that patients can reap huge benefits from sugar pills should be taken as good news, not bad. It means that finding relief from chronic pain, insomnia, and certain forms of depression need not come from a drug linked to serious side effects - rather, it suggests that the solution to many ills may reside within the human mind.
Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why [Wired Magazine]
(Photo: BitterScripts)
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Comments:
Yeah, I was already thinking when I read the title:
"Why are placebos getting more effective? Probably because more people aren't really physically sick."
I didn't RTA, but after spending years (and millions) brainwashing the public about the magic of pill-popping, big pharma should hardly be surprised to see that conditioning backfire.
I say it's because we're now pretty well-medicated via our drinking water. It's like free antidepressants.
Perhaps, it isn't the placebo effect at all. Big Pharma hand picked the studies that justified SSRIs and the like. Now that they are budget conscious like the rest of the world, that don't perform as many studies. The result is they cannot cherry pick any more. How do you handle that issue? You make up a new syndrome and call it the increasing placebo effect instead of the reality syndrome.
First you get the sugar, then you get the power, then you get the women.
As long as they don't get dry mouth, constipation, abdominal pain, dizziness, drowsiness, headaches, nausea, anal seepage, skin ulcers, high blood pressure, low blood pressure, difficulty in blood clotting when cut, frequent urination, night sweats, depressed sexual desire, loss of appetite, bouts of sadness, increased sensitivity to light, itching in the groin area, decreased semen, difficulty concentrating, increased joint pain, increased heart rate, decreased lung capacity, or similar symptoms, who cares?
Big pharma has proven over the last 15 or 20 years that they'll market the shit out of anything whether there's a disease to support it.
I'm all about increased standards of testing in clinical trials to determine whether these medicines are effective. They just need to stop inventing disorders and spending billions of dollars trying to coax people into taking them.
"One theory behind the stronger placebo is that clinical trials take place in an environment of exceptional, one-on-one health care, the kind patients don't typically get from their own doctors. This personal attention has a therapeutic effect, encouraging a placebo response."
Or perhaps therapy should be a more widely available (and less expensive) option. Sometimes people just need an ear, a bit of guidance and some reassurance.
@sixseeds:
Agreed. There seems to be a pill for everything. While there are legitimate illnesses out there, it's frightening that there are so many pills available.
Has anyone ever tested one placebo against another placebo? Honest question here.
Is this for all diseases, or primarily for ones likely to be overdiagnosed?
If it applies to drugs for, say, cancer or AIDS, then we might as well give the placebos a fancy name and add them to the treatment regiment. Change the name every few years to keep people guessing. There are many fancy ways to name a sugar pill that are still chemically accurate, not to mention all the possible ways to brand it.
Next, add a third group to the trial: placebo AND the actual drug. Keeping things double blind would be tricky, though.
@TinkishDelight: +1. Suddenly it's like everyday stress is something that requires a pill to cope with. A lot of people don't realize that there are obvious mental skills required to get through life that are not terribly difficult to work through or gain through one-on-one care or counseling. That doesn't mean there aren't a few total nut jobs out there, but I'm curious just how many people are on medications for anxiety who really just need better life skills and coping mechanisms.
Does the FDA withhold approval if a drug isn't proven to work? I thought they would only do that if the drug is shown to be harmful.
@TinkishDelight: Seriously. Though I also wonder--did the drug trials not provide this formerly, or do we respond to that more than we used to?
I'm not exactly sure if this makes any sense. When you run a clinical trial, you expect to see the following response in a person who gets the drug:
placebo effect + drug effect
In a placebo patient (in the control group), you expect to see
placebo effect
but no drug effect. My point is EVERYONE included in the experiment has a placebo effect.
In the end, a statistician will basically just say, take the mean of the treated group (meanDrug) and the mean of the control group that received the placebo (meanControl), and then examine
meanDrug - meanControl = approximate drug effect
This is the quantity that is generally of interest, and it should not be affected by the size of the placebo effect. It sounds to me like the drug companies just have products that may not be as effective as they thought they were.
(If the placebo effect tends to affect some people wildly and others much less so, then this could affect the test conclusions.)
...the biggest problem with the placebo effect, especially as it relates to quackery like acupuncture, aromatherapy, homeopathy, etc. is that it will cause the patient to believe that they are getting an effective treatment - which they are not - and stop seeking a real remedy for their problem.
In the case of real clinical trials like this, it is of course exceedingly important to see that the drug's effect is notably better than the placebo effect, because that shows that the drug is effective.
...but a notion like this from the article:
"It means that finding relief from chronic pain, insomnia, and certain forms of depression need not come from a drug linked to serious side effects - rather, it suggests that the solution to many ills may reside within the human mind."
...is a scary thing to say, because of the aforementioned issues with believing you have an effective remedy when in fact you don't, and your condition goes on untreated.
Or perhaps we're just more inclined to believe in the efficacy of a pill when we grow up in an environment where such pills are expected to work. Before the first trial of Prozac, there were few other options for handling depression and other mental illnesses.
Explaining to someone that there was a pill that could help would be an entirely new concept for most people. Therefore their expectations are low. Now people have higher expectations from their drugs as so many have proven to be so effective.
We expect more from our drugs, therefore we get more out of our placebos.
@sixseeds: Brainwashing? You know, there are many diseases out there being treated/cured by "Big Pharma", to use your weasel word. Would you consider my ADHD some invention of some industry?
@acvicari: Placebos relieve symptoms, but usually don't "cure". NOT treating a disease like cancer/AIDS would not be ethical.
I heard at the town hall meeting that the Obama plan would only pay for placebos.
And also for death paneling for doctor's offices.
Thanks a lot, NIH. (shaking fist in the air)
@GitEmSteveDave_GlassMeatClocks: The weird thing about ADHD (I have it, too,) is that it's usually the condition that people claim is made up, not the cure. That is, they may not think ADHD exists, but they sure as shit believe the pills do something.
On more than one occasion I've had people claim that people with ADHD are just pretending so that they can score legal speed. Yeah, cause what every parent really wants is to score little Suzie some crank.
I think anti-psychotic pills would have a pretty high placebo effect. Especially things like Prozac/Zoloft, which I think are mostly bull when prescribed anyway.
As long as they don't get dry mouth, constipation, abdominal pain, dizziness, drowsiness, headaches, nausea, anal seepage, skin ulcers, high blood pressure, low blood pressure, difficulty in blood clotting when cut, frequent urination, night sweats, depressed sexual desire, loss of appetite, bouts of sadness, increased sensitivity to light, itching in the groin area, decreased semen, difficulty concentrating, increased joint pain, increased heart rate, decreased lung capacity, or similar symptoms, who cares?
Wow, that sounds like my typical hangover.
I been telling people for years its "all in their heads" and they scoff at me.
I'm going to start linking this article when I say it now :D
@hellinmyeyes: Yep. When my mother got divorced from the jerk who cheated on her with an 18 year old, her doctor put her on Paxil, which made her sleep pretty much all the time (no joke). I finally convinvced her that in a situation like that, you're supposed to be depressed, it's normal, and you need to get past it, not spend six month unconscious.
She stopped taking the pills, developed a social life again, and has been just fine ever since. :)
I realize some people really do need to be medicated, but not all people do. *rolleyes*
@cmp179: Yes. There are three phases of clinical trials a drug has to pass in order to be considered both safe AND effective for approval by the FDA. At my last job I was working for a bio-tech company that almost went bankrupt because a drug they had invested years and millions in R&D had inconsistent results in clinical trials. The results for a new drug mentioned in the article is a BIG DEAL.
@dubgee: @GitEmSteveDave_GlassMeatClocks: Awww, shheeit. Looks like we're not going to avoid the whole "is ADHD a real or a made up disease" debate, are we.
I sure do love having people tell me an issue I struggled with my entire life is just made up by "the man!"
*backs away slowly*
@cmp179: I lost my comment, but yes, as Orv said both safe AND effective. They go through three phases of clinical trials and results like the ones in the article above would undoubtedly lead to the new drug not passing.
@The_IT_Crone: Sorry to be all nitpicky, but Prozac and Zoloft are not anti-psychotics. Antipsychotics are used to treat psychosis-- things like schizophrenia and delusional disorder. Zoloft and Prozac are antidepressants, used to treat depression.
Psychosis is wayyyy different from depression.
@JennQPublic: Exactly. There is huge difference between situational depression and an actual chemical imbalance. IMO unless the person is a risk to their self or to others, drugs should not be a treatment for situational. And actually even if it is an imbalance I think that therapy is still necessary for recovery and coping.
Unfortunately the way the system is set up, you can get 90 days worth of Prozac for $15 but have to shell out upwards of $200 a week for a decent psychologist.
Some placebos are lactose pills. I suppose they're hoping to give the lactose intolerant the runs/stomach cramps to simulate a "reaction" and make the medication seem real?
@aloria: I've "suffered" with it my whole life. And if people want to think I wanted all those hours of detention and fights with my parents, then they need help. It wasn't until I was an adult that I was properly diagnosed and people noticed the change. Heck, people could even tell days I took my meds and days I forgot.
@GitEmSteveDave_GlassMeatClocks:
Don't worry, that probably comes from the "other" city's tap water. You know, the one that has the nuclear power plant...
@tbbx: I've been thinking about install death panels on my house. I heard that they increase your R value. If you combine it with red paint, you rarely get any reaver attacks.
@YouDidWhatNow?: How is chronic pain "untreated" if it doesn't hurt anymore? How is insomnia "untreated" if you now fall asleep. Yes, for things like cancer, etc, not feeling symptoms != disease cured, but when the symptom _is_ the disease, then what's the problem if a placebo cures it?
Perhaps the should do a clinical study where one group gets a placebo while another group gets a placebo. That should get to the bottom of things.
@GitEmSteveDave_GlassMeatClocks: Same here-- I didn't get diagnosed until I was 23; didn't start taking treatment for it until earlier this year. People can definitely tell the difference when I'm on or off my meds. I can, too-- I like to write down my list of tasks I performed at work. Untreated, my list was 5 or 6 things a day. Treated, my list is more like 10-15.
I really don't mind the fact that people are skeptical of "new" conditions, but I really wish they wouldn't make their personal crusade to convince me that my symptoms don't really exist. Seriously, I would give an appendage of your choice for them not to. But they do, and my trying to help myself be better is not hurting you or society or baby Jesus, so just leave me the hell alone.
Keeping things double blind would be tricky, though.
Not to mention terribly unethical. Doctors and patients have to be informed about treatment. Experiments are a special case where the parties understand they may be in a control group.
Gotta love some of the condescending comments about anti-depressants coming from people who have never had to deal with major clinical depression or any other mental disorders. The brain is an organ. It malfunctions. If someone's heart starts beating irregularly and they needed medication for it people wouldn't bat an eye. But for some reason when the brain malfunctions people say "it's all in your head just get over it". All these armchair psychiatrists need to get over-themselves.
Or, maybe the patients just needed more sugar in their diet.