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Placebos Are Getting More Effective 349

Posted by ScuttleMonkey
from the time-to-start-treating-with-placebos dept.
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."
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Placebos Are Getting More Effective

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  • Believing (Score:3, Interesting)

    by gmuslera (3436) on Monday September 07, 2009 @12:10PM (#29341083) Homepage Journal
    If we are easier to be convinced that that junk in fact is medicine and will heal us (and in a so strong way that it will even work), in what other fields are we swallowing "placebos" giving us the feeling that they work?

    The biggest problem is that if well our brain could control somewhat our body, i.e. lowering pain, in other fields reality could be strongly against what our brain feels. Unfortunately the only example that comes to my mind right now is the "safest operating system on earth", signal that im accepting all the other placebos.
  • Re:WTF (Score:5, Interesting)

    by bistromath007 (1253428) on Monday September 07, 2009 @12:11PM (#29341105)
    That guy seems to be ignoring the fact that the placebo effect, being partly psychosomatic, is something that by nature will cloud the results of testing psychiatric drugs as people become more trusting of their effectiveness in general.
  • by Anonymous Coward on Monday September 07, 2009 @12:13PM (#29341133)

    People are more and more diagnosed with depression. A high placebo effect in treating depression is, in my uneducated opinion, at least partially indicative of over-diagnosis. While in the past only the truly sick were diagnosed as depressed, today perhaps some of the patients aren't really that depressed, and thus can be treated with placebo/happy thoughts. To what degree is depression caused by "wrong" behavioral and mental patterns, and to what degree is it born of a chemical imbalance? Of course, they may cause each other, but I do believe that some depression cases are not that deep-seated. If it's a deep, recurring or continuous depression, then use real drugs that changes brain chemistry and how the brain functions. If it's not that bad, a pep talk and placebo just might push the brain towards solving it's own imbalances.

    Oh, and I am/was depressed. Yes, I did use medication, Zoloft to be precise.

  • by Anonymous Coward on Monday September 07, 2009 @12:13PM (#29341143)
    Patients entering a trial are not the same as they use to be. This is because patients actually have a choice in entering a trial or not.

    Let's look at multiple sclerosis for example. When the initial medications were tested (betaseron, refib, copaxone) the majority of patients entering the trials did not have the option to go onto approved therapies and there only hope of therapy was to enter a trial. Now, as a physician, if I have a patient who is at higher risk of progressing from multiple sclerosis, I can offer than 5 approved therapies before they have to consider entering a trial to get an "experimental therapy" or ending up in the placebo group.

    Having not participated in trials for antidepressants, I suspect patients with more severe depression are being placed on approved therapies and more mild depressed patients are being placed into trials. Antidepressants have always been shown to have a more robust response (at least as measured by the non-linear systems used) to severe depression than more mild depression.

  • by T Murphy (1054674) on Monday September 07, 2009 @12:16PM (#29341165) Journal
    I know some, if not all, Western European countries prohibit advertisement of prescription drugs. I would be curious if testing a group of Americans and a group of Europeans will give different strength placebo effects. I suppose other reasons for this are more likely than advertisement, but I would nevertheless like to see this be proved the reason (through an unbiased source of course).
  • Re:WTF (Score:1, Interesting)

    by characterZer0 (138196) on Monday September 07, 2009 @12:19PM (#29341191)

    Huh. I read that and found out that placebo means exactly what I thought it meant.

    And that Wired articles are exactly as poor as I thought they were.

  • by JamesP (688957) on Monday September 07, 2009 @12:25PM (#29341267)

    Is anyone testing these drugs being used on the tests??

    Let's retest 'drug whose patent has expired' to see if it still works the same, so maybe when they find out it doesn't, hey, what about this new one?!

  • Re:WTF (Score:5, Interesting)

    by commodore64_love (1445365) on Monday September 07, 2009 @12:48PM (#29341541) Journal

    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:

    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: "Is it time with your children? Is it a good book curled up on the couch? Is it your favorite television show? Is it a little purple pill that helps you get rid of acid reflux?" By evoking such uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response.

    The frequent ads from the companies are effectively brain-washing Americans to think, "All you need is a little purple pill to feel good," and so the mere act of swallowing that pill, even if it's just sugar, becomes twice as effective as previously.

  • Re:WTF (Score:5, Interesting)

    by Firethorn (177587) on Monday September 07, 2009 @12:50PM (#29341571) Homepage Journal

    It's not anything to do with the placebo, it's that the drugs that are being developed currently don't do anything.

    Did you read about how some of the older drugs wouldn't have made it past the trials today?

    I think this might have to do with the FDA's mailed fist choking off anything to do with 'snake oil' for years - we've raised generations that expect medications to be safe and effective, and therefore they are, by golly(placebo effect).

  • by frieko (855745) on Monday September 07, 2009 @12:50PM (#29341573)
    Is that you, Tom Cruise? Things can go wrong in your body and they don't need a cause. You don't need to smoke to get cancer. Same thing with depression. You can bring depression upon yourself, for example with stress, but it's often just a genetic hormone deficiency. My depression hit suddenly, and I tried everything to cure it, over the course of two years. Eating different, fish oil, more vacation, rigorous exercise, more religion, less religion. Nothing worked. Still woke up at 3am wanting to kill myself. On a regular basis.

    Went on Lexapro and I've been totally fine ever since.
  • On the Flip Side (Score:3, Interesting)

    by RootWind (993172) on Monday September 07, 2009 @12:51PM (#29341589)
    Placebo also has the most side effects of any drug on record.
  • Re:WTF (Score:5, Interesting)

    by bondsbw (888959) on Monday September 07, 2009 @12:52PM (#29341597)

    The placebo affect can also be caused by pride. "I paid $300 for these pills, they work so much better than the generics!" It's the same reason that I can buy an expensive computer/phone/car with the same features as your off-brand, but still act like it's much better.

    But I'm sure that has little to do with testing where you don't have to pay... just saying, in general.

  • Re:Idiocracy (Score:3, Interesting)

    by ceoyoyo (59147) on Monday September 07, 2009 @12:58PM (#29341689)

    No, that's how some American physician got the idea that the placebo effect was something you had to control for in a drug study. I realize the article makes it sound like the concept of placebos originated in WWII but it's simply not true.

    Surgeons in Napoleonic times were well aware that their patients responded better if their medication tasted as badly as possible (and preferably produced other effects, like severe diarrhoea). Ships carried various substances specifically to make the surgeon's preparations taste bad.

    The concept of the sugar pill is even older than that.

  • Re:WTF (Score:5, Interesting)

    by dgatwood (11270) on Monday September 07, 2009 @01:10PM (#29341847) Journal

    Actually, when it comes to psychiatric drugs, they often do. In many cases, it's all in your head, so to speak. If you can convince yourself that a medication is working for such things, you will get better, and if you convince yourself that it isn't working, you will stay the same or get worse, whether you're taking a drug that tries to fix the underlying chemical imbalance or not. Why? Because ultimately your brain is controlling the regulation of those neurotransmitters. It can compensate for any "fix" the drugs make, and can similarly correct its own regulation if you convince it that the levels should be improving. Indeed, in the field of psychiatric drugs, it would actually be surprising if such a strong placebo effect did not occur, assuming that people generally believe that psychiatric drugs are effective.

    Unfortunately, too many doctors, including psychiatrists, are too eager to prescribe a pill rather than taking the time to get to the root of the problem and fix what's really wrong. The good news is that prescribing a placebo may be just as effective for many of their less serious patients, but without the harmful side effects.... :-)

  • Re:WTF (Score:5, Interesting)

    by gadget junkie (618542) <gbponz@libero.it> on Monday September 07, 2009 @01:17PM (#29341931) Journal

    It's not anything to do with the placebo, it's that the drugs that are being developed currently don't do anything.

    Did you read about how some of the older drugs wouldn't have made it past the trials today?

    I think this might have to do with the FDA's mailed fist choking off anything to do with 'snake oil' for years - we've raised generations that expect medications to be safe and effective, and therefore they are, by golly(placebo effect).

    I love it. Gullibility by design (TM), the new prescription. The disturbing part of the equation is that price is part of the effect, so I'd expect that a 50$ pill could have a bigger placebo effect than a 5$ pill of identical composition, provided that the patients know it.

  • Re:WTF (Score:2, Interesting)

    by Anonymous Coward on Monday September 07, 2009 @01:21PM (#29341987)

    You keep saying that word, I do not think it means what you think it means. [scienceblogs.com]

    There are plenty of other reasons for this to be occurring. Better testing procedures among them.

    Perhaps the real reason efficacy of trial drugs has declined is Big Pharma is trying to treat conditions that aren't actual problems? "Over-active bladder syndrome" comes to mind immediately -- stop drinking caffeine, only drink water when you're thirsty, problem solved.

    As the above URL observes:
    "Failure is inevitable. It's how science works. If the CEOs don't like it, they have to either make up the data, or find a new business model."

    I think the CEOs have done exactly that. It's pronounced "advertise directly to the US public."

  • Re:WTF (Score:5, Interesting)

    by Darkness404 (1287218) on Monday September 07, 2009 @01:23PM (#29342011)
    Exactly. The human brain doesn't want to be ripped off. The same reason why people swear that baseball hotdogs taste so much better, when they are more or less just the same things that you can buy at every grocery store the only difference is that you aren't paying $3+ per hotdog.
  • Re:WTF (Score:5, Interesting)

    by smaddox (928261) on Monday September 07, 2009 @01:38PM (#29342123)

    I know you were moded Funny, but I think there could be some bit of truth to your statement.

    Especially when the drugs are meant to treat depression, this could be part of the effect. We have record levels of depression in this country. Could part of that be due to pharmaceutical advertising?

  • Re:WTF (Score:3, Interesting)

    by Anonymous Coward on Monday September 07, 2009 @02:38PM (#29342687)

    The frequent ads from the companies are effectively brain-washing Americans to think, "All you need is a little purple pill to feel good," and so the mere act of swallowing that pill, even if it's just sugar, becomes twice as effective as previously.

    There is a flip side to this study-

    The rise of the "effectiveness" of placebo's might simply indicate a rise in purely psychosomatic, and/or mis-diagnosed "illnesses"... therefore the data would end up looking like the placebo's are more effective when in fact it is simply that more people are either thinking they are sick, or being told they are sick, when they are in all reality, healthy. So of course an actual working drug would have little more effect than a placebo... because there isn't anything to cure in the first place.

  • by RatPh!nk (216977) <ratpH1nk@gM[ ].com ['ail' in gap]> on Monday September 07, 2009 @02:44PM (#29342749)
    If anything the diagnostic criteria for some illness have been loosened, if not in print then in practice (depression, ADD, Bipolar, various allergies). Some "ailments" weren't really considered that big of a deal 20-30 years ago, or were at least considered rare (Restless Leg Syndrome, Premenstrual dysphoric disorder, fibromyalgia). Perhaps, and I say this more to be devil's advocate, we are treating people with symptoms, or not, of diseases that they don't have, or don't really exists in the manner we think they exist. At least in terms of treatment. As such, the treatment is wrong (either by lack of disease or bad targeting), and of course would be expected to be no better than placebo.
  • Re:WTF (Score:1, Interesting)

    by Anonymous Coward on Monday September 07, 2009 @02:48PM (#29342789)

    Hey, I had over-active bladder syndrome as a kid. I never drank coffee, only drank water when I was thirsty, and was never allowed to drink soda or anything like that. At times I would pee, go back to the living room, and have to pee again 5 minutes later.

  • Re:Believing (Score:3, Interesting)

    by lawpoop (604919) on Monday September 07, 2009 @02:48PM (#29342797) Homepage Journal

    [I]n what other fields are we swallowing "placebos" giving us the feeling that they work?

    One of the big ones is surgery for pain - especially back pain. The thing is, you don't want to have people go through the risks of surgery just to open them up and do nothing and have them as a control group. Also, if you did open a person up and not perform the surgery, any doctor looking at the X-rays could immediately tell that the procedure was not performed, so no double-blind studies. So, a lot of surgical procedures are not exposed to the gold standard of scientific medicine, the double-blind control group study.

  • Re:Or not. (Score:4, Interesting)

    by JohnFluxx (413620) on Monday September 07, 2009 @03:23PM (#29343091)

    Urgh, what a crappy article. He dismisses the well-documented placebo effect - out of ignorance presumably.

  • by ChameleonDave (1041178) on Tuesday September 08, 2009 @12:46AM (#29347169) Homepage

    Your post partly just repeats what I said was the purpose of placebo, and partly expresses an overly narrow view of the matter.

    The scienceblogs.com article equated placebo with control, and I am extricating them. You are wrong to say the only meaningful drug test is drug versus placebo.

    Interesting data have also been gleaned from situations where people receive treatment but don't know it. Their outcomes can then be compared with people who receive treatment and know it, people who don't receive treatment but think they are, and people who know they're not getting treatment. There is no need to do these experiments at different times or in different places.

  • Re:WTF (Score:3, Interesting)

    by SoupGuru (723634) on Tuesday September 08, 2009 @12:43PM (#29353033)
    A dictionary is a catalog of language that's in use. It is not a reflection of what is proper.

    I remember the day my world came crashing down and I realized Webster's was basically useless. It was when I was gently trying to explain to someone that pronouncing "ask" as "ax" has no bearing on reality - for God's sake, it's a three letter word, how could you ever confuse the order of letters?! So I pulled down Webster's to prove my point:

    Main Entry: ask
    Pronunciation: \'ask, 'ask; dialect 'aks\

    Fuck.

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