Placebos Are Getting More Effective 349
Wired is reporting that the well-known "placebo effect" seems to be increasing as time goes on. Fewer and fewer medications are actually making it past drug trials since they are unable to show benefits above and beyond a placebo. "It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time."
Shooting themselves in the foot (Score:5, Insightful)
Drug companies should never have started advertising directly to end users.
Why? (Score:1, Insightful)
I suspect it may be because people expect drugs to be more effective now.
Re:WTF (Score:5, Insightful)
Or possible the patent is no longer in effect, so no one bothered to fudge any data this time? Perhaps they were too busy "gathering" data for new drugs?
Re:Human race evolving? (Score:4, Insightful)
2. It's very likely nothing to do with our brains, and a lot to do with more rigorous testing.
I don't buy the 'more rigorous testing' argument - I think that pre-supposes that testing was not performed diligently in the past. I think the most likely explanation is that the diagnoses were always flawed. Depression, mentioned in the blurb, for example has physical symptoms, but no known physical cause. My hunch is that many of the ailments we have are caused by factors outside the control of drugs, and it is the extent to which taking regular medication alters behaviour that makes a difference. For example, medication that can't be taken with alcohol presents a positive side-effect for heavy drinkers if taken diligently. Any regular activity has the same positive effects as observing a ritual.
Perhaps a larger proportion of ailments today are not the result of an illness? I'd find that easy to believe.
Re:WTF (Score:5, Insightful)
It's not unthinkable that placebos could be having a more pronounced results than they have in the past. In the Prozac example, psychiatry related drugs are especially prone to placebo effects. Given that the average citizen knows a lot more about these drugs than they did 10+ years ago due to ads and the media, they're more likely to believe it'll work for them than people used to.
Changes attitudes towards drugs having an effect on placebos isn't something that should be dismissed offhand like that writer seems to be doing.
Re:WTF (Score:5, Insightful)
It's not anything to do with the placebo, it's that the drugs that are being developed currently don't do anything.
Maybe drug trials are becoming less compromised (Score:4, Insightful)
A lot of people -- like the author of Talking Back to Prozac [psychologytoday.com] -- claim that some drug trials (especially for popular antidepressants) are compromised to the point that getting drugs like Prozac approved required requires a surprising amount of massaging of the data from drug trials just to get to the point where the drug seems to perform better than placebo. This New Scientist article from last year about how antidepressants' effects may have been exaggerated [newscientist.com], has a good definition of a particular form of publication bias [wikipedia.org] that is apparently common:
If that's true, then it's a gambit that would get less and less effective over time. Certainly, drug companies have a very large commercial interest in boosting the apparent effectiveness of their drugs by "enhancing" the results of their trials through selectively ignoring results they don't like. It does sound somewhat conspiracy theory-ish, but it seems like there's increasing evidence. Plus, if it's true that antidepressants are less effective than many doctors believed in the past, that's more evidence that the trials drew incorrect conclusions.
Re:Human race evolving? (Score:2, Insightful)
Re:It could be (Score:2, Insightful)
Bad Science (Score:3, Insightful)
read 'Bad Science' by Ben Goldacre
turns out that the placebo effect is hugely influenced by beliefs. So - if people are in a trial to treat mental illness, then the placebo will be more effective now than it was 20 years ago simply because people on average believe that mental illnesses are treatable.
In a similar vein, Cimetidine (one of the first ulcer drugs) has become much less effective over time. It suffered a dramatic drop in success rate when the new ulcer drug Ranitidine came on to the market. It seems that as doctors stopped thinking of it as the best drug, it became less effective.
No big surprise that placebos are working better in some contexts. It doesn't show that the placebo effect is generally getting stronger though.
Re:WTF (Score:5, Insightful)
Alternately, the deluge of ads could be brain-washing Americans to think, "Without a little purple pill you'll feel bad," such that the illness itself is a nocebo effect, which placebos effectively nullify.
Re:WTF (Score:3, Insightful)
That guy misses the point.
There is an apparent change here, evidenced by the fact that new tests of old drugs are giving poorer relative results while giving similar absolute results.
It may be due to better testing methods. It may be that there was fraud in the earlier tests which has been gradually weeded out. It may be that people in studies are culturally more eager to please and so are (consciously or unconsciously) making larger lifestyle changes when they enter the study. It may be (as stipulated in TFA) an increased confidence in pharmacology leading to a larger impact of those "other less clear and tangible effects" that PalMD nods to. It is not simply representative of the failure of pharma to find worthwhile new drugs - the fact that old drugs wouldn't pass muster puts the lie to that. What is interesting is that standards have implicitly risen, and no one understands why. This is news, this is interesting, and this should be investigated.
Re:WTF (Score:5, Insightful)
The question is not if old drugs would pass modern test but if old drugs still pass old tests. Old drugs not making it pass modern tests can mean just better tests.
Re:WTF (Score:5, Insightful)
Actually no, language is *not* what is defined by the lowest common denominator, if that were the case, then modern science would go out the window as every technical term in every paper completely lost all hope of having intelligible meaning in the anarchy of broken syntax.
Communication would be damn near impossible if every time I read a text I was not able to refer to a dictionary, but instead had to take a walk outside and poll all the halfwits hanging out the front of the local shopping mall what a given word means in a given context. I can imagine it now:
"Hey fellas, sorry to interrupt your skateboarding and pot smoking, but would you mind telling me what you understand by the word 'pontification'? I do apologize, but I have a term paper in linguistics due in a week and I need to bring my semantics up to date according to the current popular lexicon."
"Language evolves" is not the same as "Uneducated dipshits get to set standards".
Re:Personal Anecdote (Score:5, Insightful)
You haven't read much of the old testament have you?
Re:Shooting themselves in the foot (Score:3, Insightful)
Granted the commerce clause has been pushed to rather ridiculous limits, but corporations have had no small part in pushing it in that direction. They would much rather have one set of regulations to deal with than 50.
Re:Human race evolving? (Score:2, Insightful)
People seem to be able to better use their brains to keep their bodies healthy
Have you gone outside recently and seen the average American (as opposed to person). Healthy and 'brain using' are not attributes I'd apply to them.
Re:Idiocracy (Score:3, Insightful)
Here, you make two unfounded assumptions. First, you assume that you can look up all ingredients and determine for certain whether they work. In real life, however, very few substances have been adequately tested for clinical efficacy. Even for those that have been tested, the literature is often somewhat ambiguous (has it been tested for people just like you, with your specific medical condition?) In the studies described in the Wired article, the compounds being tested are new drugs that might or might not work. Moreover, your assumption that a smart person would look up the ingredient seems questionable. Assuming that you yourself are a smart person, it follows that you would have looked up the ingredients of all of the medications you are taking. Yet you seem surprisingly unaware of the limitations of the medical literature when it comes to obtaining a definitive answer to this kind of question.
You are also assuming that the placebo effect works at the level of conscious knowledge. But not all physiological reactions depend upon conscious knowledge. For example, if you are used to hearing a dinner bell just before the meal is served, you will salivate when you hear the bell--even if you happen to know for a fact that dinner is not being served tonight.
Re:WTF (Score:1, Insightful)
Placebo is no longer a scientific expression, it's common usage by the laymen. Psychologists used to talk about jealousy and envy with a great distinction as well, but those blurred together thanks to the masses and are common usage as well. I agree that Webster did a good job compiling the language, but it's still just a compilation, not a rulebook.
The focus of my earlier comment was against people who corrected the teachers in class all the time, slowing down the lecture and contributing nothing to the actual topic. Sadly, my efforts at reprimanding someone for going off topic like this has caused a further departure. I suppose attacking "grammar nazis" on slashdot is asking for the flambebait brand though.
BTW, I read your username as MrNazi at first, which I found absolutely hilarious.
Re:WTF (Score:4, Insightful)
That sill doesn't explain why placebos are now nearly twice as effective as ~1990, but this paragraph from the article might be a factor:
Because if you have an imaginary concocted ailment like restless leg syndrome or hyperactivity, then the imaginary effects of a sugar pill are going to work well to alleviate the imaginary symptoms of the imaginary disease.
Pharmaceutical companies define disease these days. They advertise diseases and they push doctors to prescribe their poisonous ineffective chemicals to treat the advertised diseases.
You could probably find a correlation between the number of advertised diseases like restless leg syndrome and this so called "placebo effect".
Re:WTF (Score:3, Insightful)
Communication would be damn near impossible if every time I read a text I was not able to refer to a dictionary, but instead had to take a walk outside and poll all the halfwits hanging out the front of the local shopping mall what a given word means in a given context. I can imagine it now
How do you think a word enters a dictionary - and why do you think its meaning changes over time?
There is another way of building a dictionary:
handing the work over to an often acutely nationalist academic elite whose working pace is glacial.
The Académie has completed eight editions of the [Dictionnaire de l'Académie française,] which were published in 1694, 1718, 1740, 1762, 1798, 1835, 1878, and 1935. The 8th edition of 1935 contained approximately 35,000 words.
The Académie continues work on the ninth edition, begun in 1986, of which the first volume (A to Enzyme) was published in 1992, and the second (Éocène to Mappemonde) in 2000.The finalized ninth edition is expected to contain more than 15,000 new words.
Re:Maybe drug trials are becoming less compromised (Score:1, Insightful)
The whole point of the file-drawer problem is that it isn't a conspiracy - it's just an 'emergent property' of the way we currently do science, and it occurs without researchers being aware of it.
If I chose to do 20 clinical trials, and only published the one that turned out significant, this wouldn't be the file-drawer effect, but plain and simple fraud.
Re:WTF (Score:1, Insightful)
I would like to know why sugar is considered an "inert" substance and so is associated with being a reliable placebo. I don't care if our diets have a lot in it already. Sugar is known to be immunosuppressive and to also stimulate the release of serotonin in the brain.
And, maybe it depends on what you are testing for whether this "inert" sugar is affecting the outcome. For example, if you are testing treatments for treating cold symptoms, it is possible that the sugar pill suppresses the immune system, thus making the cold medication look good by comparison. On the other hand, when testing treatment for a psychiatric condition, perhaps sugar actually is having a positive effect in the brain. In that case, psychologically as well as chemically, with sugar are also giving a "reward" to the brain for taking the pill, so we must also assume that the brain has nothing to do with health if we trust sugar as an inert baseline.
Our scientists and culture tend to have tunnel-vision and assume that something as supposedly harmless as a sugar pill could be considered inert chemically with respect to a very specific chemical process in the body. But in general sugar is not inert and it can in fact affect the systems being tested, thus I suggest it makes a lousy placebo that can distort data on medical treatments depending on what is being tested.
wtf indeed.
Re:WTF (Score:5, Insightful)
Re:WTF (Score:0, Insightful)
What?
What?
When someone says "No shit, Sherlock" they are calling you Sherlock Holmes sarcastically. Sarcasm means you aren't actually Sherlock Holmes! It's a suggestion that you are not very clever and are saying something obvious, unlike Sherlock Holmes.
I don't think you're very clever, Sherlock.
Re:WTF (Score:4, Insightful)
The rise of the "effectiveness" of placebo's might simply indicate a rise in purely psychosomatic, and/or mis-diagnosed "illnesses"...
The great thing about this, in a properly controlled double blind test is that it doesn't matter. The real pill gets the same psychological boost as the placebo. Both pills have the same base line. Now the difference between the two pills is due to the differences in the active ingredients.
This all sounds like total bullshit by pharmacological companies to escape from some cheating they were doing back in the 1990s or something.
Re:WTF (Score:3, Insightful)
If you went and read a blog post by a skateboarding pot smoker, you most likely WOULD have to use ubandictionary.com or similar to understand it.
There's a good chance he would need to do the same to read various texts written by you.
Both of you could read the majority of each others' written works anyway. This is your dreaded "lowest common denominator" at work. If it bothers you, perhaps you should make more effort to keep up with the new terms continually entering common parlance.
Yes, this is how language works. Now get off my damn lawn.
Re:WTF (Score:2, Insightful)
> are certainly not the most trustworthy guys around.
I think it's the people diagnosing psychological illness. At this point it's difficult to name a psychological illness that isn't diagnosed, and medication prescribed for it, several orders of magnitude more frequently today than fifty years ago. *Some* of that is because greater awareness allows more real cases to be diagnosed. But I think a *lot* of it is just so much bunk, a weird sociological phenomenon, a sort of hypochondria at the societal level.
Autism, for instance, is not even slightly difficult to recognize when there's a real case, but diagnosis is up, way up. We supposedly have several cases of it where I live, in Galion (a city of some twelve thousand people); I've met a couple of these kids: they are quite obviously not autistic at all. In fact, in one case I sincerely doubt the boy has any significant psychiatric disorder at all (beyond the usual "mom and dad never spend any time with me, so I'm going to act up and see if that gets me some attention" that plagues the entire Western world these days; this is not something a drug can cure).
Bipolar disorder, clinical depression, ADHD, you name it: if it's a psychological disorder for which the normal treatment is to prescribe medication, diagnosis is up, and in a lot of cases the medication doesn't seem to work. I'll tell you why the psych meds aren't doing anything: it's because a lot of those people don't need the meds. There's nothing chemically wrong with their brains.
Here's just one example scenario that you can actually *see* happening if you pay attention. The parents ignore the kid most of the time, plop him in front of a television and expect him to entertain himself, so he acts up. When he acts up at school, the teachers call in the shrink, and he tells the parents that the child has a problem. Nobody wants to blame the parenting, because that's a good way to incur the wrath of lawsuits. So the parents take the kid to a specialist, and he hazards a diagnosis and prescribes some pills. Yeah, maybe that'll fix the problem. Or not.
It's not just kids, either. Adults are being overdiagnosed with psychiatric issues as well.
I'm not saying there aren't people with real psychiatric problems that *can* be helped by medication. There are. There always have been. (Well, the meds weren't always around, but the conditions were.) But what I am saying is that a lot of people are being incorrectly diagnosed with these problems.
I suppose the pharma companies might bear some of the blame for this, if their advertising gives people the wrong idea, but I think there's more going on than that. I believe it's a symptom of something much deeper in our society: we have got to the point where we expect all of our issues to be solved simply and easily, and we frequently aren't willing to invest personal effort. We just want to go to a doctor and have him tell us that there's a name for our problem and a standard treatment, something easy we can do, like take a pill once a day, and then we won't have to actually struggle with our issues.
I've read the article (Score:3, Insightful)
I see a fundamental issue with the central storyline, which is that drug companies are seeing a stronger placebo response in drug trials. But drug trials are not designed to measure the placebo response; they are designed to measure the drug against the placebo. It would be like comparing 100 different scales for accuracy, and then going back into the data set to try to discover any differences in the standard weights that were used. A placebo can either be a control or an effect; you can't run one experiment and then treat it both ways. Based on your article it sounds like this is what the drug companies are trying to do though.