
Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. - helium
http://www.wired.com/print/medtech/drugs/magazine/17-09/ff_placebo_effect
======
KirinDave
As I've said before, this article is incredibly wrong and quite misleading. If
you ever wanted evidence that most Americans do not understand how medicines
are developed or what the Placebo Effect is, this article (and the responses
here) serve as ample evidence.

For a more rigorous refutation by a trained professional, please read:
<http://www.sciencebasedmedicine.org/?p=1248>

I'll pull the zinger quote from the article above for you:

>No, it’s not like that at all. Perhaps the studies are just that well done,
or maybe the drugs being developed suck, or maybe companies are studying more
candidate drugs and screening for efficacy. Just about any explanation that
doesn’t involve aliens is better than “placebo is getting stronger”.

~~~
lliiffee
It is really _so_ ridiculous to think that there is some drug such that:

* The drug provides a modest health improvement.

* That health improvement happens to be smaller than the health improvement do to the placebo effect?

I don't know what the typical magnitude of the placebo effect is. If it is
substantial, then actually working, actually helpful drugs might be being
denied to people. The very mechanisms for the placebo effect he hypothesizes
(e.g. people taking care of their health when on a study) certainly seem like
they might vary with our culture...

~~~
KirinDave
All I can say is, you do not know what the Placebo effect is. You don't
understand why you cannot use it as a therapeutic invention. You do not
understand why most drugs benefit from the placebo effect already.

Please, pleasepleaseplease go and read up on what it actually is.

~~~
lliiffee
Woah there tiger-- where do you get that I am suggesting using the placebo as
a therapeutic invention!? (If it makes any difference, I meant to type "due
to" rather than "do to"). I am suggesting that the following situation might
exist:

1) Drug A is 5% effective

2) Placebo is 10% effective

3) No one ever gets the benefits of drug A, since its benefits are masked
during trial.

~~~
icey
A placebo gets used to determine the margin of error for a particular test.
The drug being tested must show significant improvements over the placebo's
measurements in order to prove that it is effective.

If your theoretical Drug A performs worse than the placebo, then the
effectiveness that it had should be considered to be within the margin of
error, and therefore not better than taking nothing at all.

~~~
lliiffee
Well... But since placebos can't be used therapeutically, and Drug A can,
doesn't that make it better than nothing?

~~~
icey
If the drug can't outperform the placebo, then it doesn't make it better than
nothing because you're adding chemistry to your body without any assurance
that it's going to actually _do_ anything.

~~~
lliiffee
But "the placebo" is not a static thing. If we designed experiments
differently, the placebo effect might be able to be reduced (say to 3%), in
which case drug A would now beat it.

------
hachiya
I would speculate that when placebos appear to work, it is primarily because
they don't do anything, besides possibly providing some increased hope to the
patient, allowing the body to work without the "side" effects of drugs. The
human body naturally tries to heal itself to the best of its ability.

Here's a very interesting example of placebos being administered on a routine
basis, for years.

    
    
      Natural Hygiene, as it is today, can be traced back to Dr Isaac
      Jennings (of Oberlin, Ohio, USA) who, after practising medicine for 20
      years, began to ask questions when, during a fever outbreak in the
      summer of 1815, a patient who rested, drank water and did nothing,
      recovered in absolute record time compared to patients who had been
      medicated. Based on this, Dr Jennings noted similar results with many
      other patients.
    
      He then went on to treat many patients with what must have been one
      of the first placebo (dummy pill) treatments. In 1822 he gave up
      medical pills, plasters, powders and potions and treated patients with
      pills made from bread and vegetable-coloured water for the next 20
      years. This he only did to keep the patients’ confidence in him. He
      would then advise his patients to correct their lifestyle and diet to
      a more natural approach. He then practised for a further 20 years the
      "do nothing mode of treating disease." He wrote three books, "Medicine
      Reform" (1847), "Philosophy of Human Life" (1852) and "Tree of Life"
      (1867).
    
      Natural hygiene was often referred to at this stage as Orthopathy
      meaning TRUE or RIGHT AFFECTION or BEHAVIOUR.
    
      Dr Jennings had a great influence upon Dr R T Trall, who went on to
      do more for the hygiene movement than any man, next to Dr Herbert
      Shelton.

<http://www.mary-anns.com/Natural%20Hygiene.htm>

I've read this account on other sites as well. The Jennings story can be
verified by other sources online. His deliberate use of placebo for so many
years is fascinating.

More information here on Jennings:
<http://naturalhygienesociety.org/past2.html>

~~~
david927
_I would speculate that when placebos appear to work, it is primarily because
they don't do anything_

I like your argument but, amazingly, there's some research that seems to
indicate that placebos affect a _physical_ change. In cases where heroin was
used as a pain killer, a placebo could be blocked using the same chemical that
blocks the effect of heroin.

Here's more: <http://www.newscientist.com/article/dn7892>

~~~
rms
And as a further consequence -- real naloxone blocks the effects of placebo
morphine.

<http://news.ycombinator.com/item?id=567913>

------
msluyter
Perhaps researchers are finding the placebo effect more successfully due to a
sort of meta-placebo effect. They're expecting to observe it, so they do... ;)

------
yummyfajitas
My theory concerning the increasing placebo effect is pharmaceutical
advertising. We are increasingly hearing the message "pill X will cure problem
Y"; this primes us for the placebo effect.

Just one of the positive effects of drug ads.

------
lbrandy
When I read this article, I got hung up on the part about the scientists
studying the biochemical pathways of the placebo effect. How interesting. It
saddens me to think he doesn't get much funding.

And then I had this thought: What if he developed a pill that caused an
artificial biochemical release of the chemicals responsible for the placebo
response. A non-placebo that triggers a placebo response in your body. Hmmmm.
How would you even a test such a pill?

------
jonsen
I just wonder if it would help some patients, if you could buy placebos. I
mean branded placebos: "This is the placebo used in trial x and y and shown to
have positive effect on z and w".

~~~
ugh
That might be an ethical way to sell placebos (homeopathy is at the moment
demonstrating the unethical one) — I just don't know whether it would be as
effective. Are placebos also effective when you know fully well that you take
nothing more than a sugar pill? I don't think so.

~~~
jonsen
You know you are taking a sugar pill with a demonstrated effect. That might do
it.

How would you do a trial for that? Placebo placebo?

~~~
charltones
There have been trials of placebos against placebos. That's how it has been
established that more placebos are more effective than fewer and also how the
shape and colour of the tablets relates to their effectiveness. If you want
some references on this, look up Bad Science by Ben Goldacre. It's a good
read, btw.

------
ivank
Previously <http://news.ycombinator.com/item?id=783912>

~~~
tokenadult
Yes, here the duplicate detector for this older article was beat by submitting
the print version, which opened a printer dialog on my computer.

------
pchristensen
[http://blogs.wnyc.org/radiolab/2009/12/28/placebo-
rebroadcas...](http://blogs.wnyc.org/radiolab/2009/12/28/placebo-rebroadcast/)

Very good episode of RadioLab about the same topic.

------
paylesworth
I've not had a chance to read the article yet, will do so if I get a chance
over lunchtime. However, the posting reminded me of an Radiolab story I
listened to over the weekend that explores this topic as well and had some
good observations about the power of mind over matter.

[http://blogs.wnyc.org/radiolab/2009/12/28/placebo-
rebroadcas...](http://blogs.wnyc.org/radiolab/2009/12/28/placebo-rebroadcast/)

------
ytinas
I wonder if people think placebos are magically "getting more effective"
because people in the US are actually taking way more drugs today than they
actually need to? Out of all my friends back home in the states almost _all_
of them are on some kind of prescription for something. One couple pays over
$2k per month for medication! Is all this _really_ necessary? In this couple's
case, some of the drugs are apparently only needed to counter the effects of
some of the others.

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mynameishere
_By the late '90s, for example, the classic antianxiety drug diazepam (also
known as Valium) was still beating placebo in France and Belgium. But when the
drug was tested in the US, it was likely to fail._

?

Really? Does this pass the smell test? I've never taken Valium [1], but I'm
pretty sure its effects are strong and clear, to the point of creating serious
addictions.

[1] On second thought, I probably have, as a pre-op, and yes the effects were
obvious and unlikely to be replicated by a sugar pill.

~~~
CalmQuiet
What does "it was likely to fail" mean. But it didn't. ...witness, yes,
countless addicts. I've worked professionally (as biofeedback therapist) with
scores of users of valium (and its cousins), and the withdrawal can be
tricky/agonizing.

------
Entlin
Maybe it's the added sugar in the placebos that makes them so effective?

------
johnaspden
I stopped reading this half way down. Is there anything in the article except
blether?

The first half seemed to be saying 'Drugs companies do tests against placebos.
Merck is short of drugs.' Can someone who took the trouble to plough through
it summarise the second half?

~~~
gvb
If you read long enough (sigh, I gotta get a life), you will find the article
has the likely answers to the question.

"But why would the placebo effect seem to be getting stronger worldwide? Part
of the answer may be found in the drug industry's own success in marketing its
products.

[...]

"Potential trial volunteers in the US have been deluged with ads for
prescription medications since 1997, when the FDA amended its policy on
direct-to-consumer advertising. The secret of running an effective campaign,
Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating
a particular brand-name medication with other aspects of life that promote
peace of mind. [...] By evoking [...] uplifting associations, researchers say,
the ads set up the kind of expectations that induce a formidable placebo
response."

It also speculates that cultural differences (including the consequences of
"outsourcing" testing) influence the placebo effect, and that psychiatric
drugs are especially susceptible to the placebo effect ("...[a challenge] is
to accurately define the nature of mental illness")

Lots of self-hoisting on petards going on in the drug business, otherwise
known as the Law of Unintended Consequences.
<http://en.wikipedia.org/wiki/Unintended_consequence>

~~~
johnaspden
Cool, thanks!

