It appears that a lot of participants on Hacker News are interested in the role of placebos in treatment trials. I have some recommendations for background articles on the use of placebos in clinical trials and the pitfalls sometimes encountered in interpreting results from such trials. The articles are all by expert authors who practice frequently writing on this topic for general readers.
August 2009 "The Rise of Placebo Medicine" by Steven Novella, M.D.
There are many more good articles about placebos and how they are used in clinical trials on the site where these articles come from. The issue the blogger whose post is kindly submitted here seems so upset about is simply an issue of making a placebo (sham) treatment indistinguishable from the treatment under investigation, so that doctors and patients are properly "blinded" during the trial. Another comment already posted here on HN has pointed out that the FDA does oversee what ingredients are put into placebos, whether or not those detailed ingredients are published in a peer-reviewed research study. The blogger's concerns are legitimate, but not proportionate to the actual problem.
Disclosure: I have been a subject of FDA-regulated medical trials. I was very impressed by thoroughness of data collection in those trials, and by my inability to distinguish whether I was receiving placebo or genuine medicine in one of those trials. My oldest son, now a hacker for a start-up, had work experience while in college at a medical device company, and he was impressed that every line of computer code he wrote during his summer job was reviewed line-by-line by FDA computer scientists as part of the review process for the medical device he worked on.
The purpose of the FDA is quite different from that of a journal; why would you expect the information needed for each to perform its function to be the same? Among other issues, how much time to you expect a journal reviewer to spend vetting a study, compared to the amount of effort that the FDA spends reviewing the same study?
Because how can you have peer review of a study if an essential and complicated part of the study is not published. If only the pharmaceutical company and the FDA review placebo technique, then the study has not really been peer reviewed and placebo techniques are a mysterious black box.
Is placebo design actually complicated? Other posts have indicated that you just have the manufacturer of the drug leave the active ingredient out of the normal formulation (so that all fillers, etc. are identical). If this is an important but well-understood aspect of study design (and ultimately vetted by the FDA), then a reviewer's time is better spent looking at the novel or error-prone aspects of the study.
Is there any evidence that poor placebo design is a problem in practice, or is this a theoretical concern?
There is probably not much evidence because that which would constitute evidence is held effectively in secret. There is no way for the scientific community to look for flaws in methodology. Flaws in research methodologies are often found, sometimes years later, so it's to be expected that at least some placebos are making studies inaccurate perhaps dangerously so, and it's also to be expected that we will never know which studies are compromised since the data is not published publicly.
Yes, placebo design is extremely complicated and often involves active ingredients intended to simulate side effects and treatment experience without treatment effects.
There is quite a bit written in the comments here.
For instance, it would be quite easy for a company to fake efficacy accidentally or intentionally by using a placebo that inhibited natural healing or even made the treated condition worse. The control group would fare worse than the treated group, and the drug could advance toward the market. There is a massive economic incentive for this sort of cheating, and I don't think we can presume pharmaceutical companies are above economic incentives.
August 2009 "The Rise of Placebo Medicine" by Steven Novella, M.D.
http://www.sciencebasedmedicine.org/index.php/the-rise-of-pl...
December 2010 "Placebo Effects without Deception? Well, Not Exactly" by David Gorski, M.D.
http://www.sciencebasedmedicine.org/index.php/placebo-effect...
January 2013 "Is acupuncture as effective as antidepressants? Part 2. Blinding readers who try to get an answer" by James Coyne, Ph.D.
http://www.sciencebasedmedicine.org/index.php/is-acupuncture...
There are many more good articles about placebos and how they are used in clinical trials on the site where these articles come from. The issue the blogger whose post is kindly submitted here seems so upset about is simply an issue of making a placebo (sham) treatment indistinguishable from the treatment under investigation, so that doctors and patients are properly "blinded" during the trial. Another comment already posted here on HN has pointed out that the FDA does oversee what ingredients are put into placebos, whether or not those detailed ingredients are published in a peer-reviewed research study. The blogger's concerns are legitimate, but not proportionate to the actual problem.
Disclosure: I have been a subject of FDA-regulated medical trials. I was very impressed by thoroughness of data collection in those trials, and by my inability to distinguish whether I was receiving placebo or genuine medicine in one of those trials. My oldest son, now a hacker for a start-up, had work experience while in college at a medical device company, and he was impressed that every line of computer code he wrote during his summer job was reviewed line-by-line by FDA computer scientists as part of the review process for the medical device he worked on.