Monday, August 31, 2009

Take two placebos and call me in the morning.

This story has little or nothing to do with politics, but I guess we can say it is health care related. I just found it so interesting I had to post it here.

Most people are familiar with the "placebo effect." A patient who believes they are being treated for an ailment can show improvement or be cured even if the treatment consists of sugar pills. This is the hurdle pharmaceutical companies must clear when testing a new drug. To be proven effective, a drug must be shown to be more effective than a placebo. Apparently that hurdle is getting higher.

Steve Silberman reports in Wired that placebos are statistically getting stronger and more effective:
"Last November, a new type of gene therapy for Parkinson's disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn's disease, an intestinal ailment, citing an "unusually high" response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.

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.

It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger."
This is a problem for Big Pharma, who are spending millions designing drugs that are not as effective as the astonishing curative power of belief in a sugar pill. Silberman described the effect in a CNBC interview on Monday:

With billions at stake, drug companies are apparently tinkering with a pill's color, shape, name and labeling in the hope of building a better, more effective um... placebo. Again from the article:
"The most important ingredient in any placebo is the doctor's bedside manner, but according to research, the color of a tablet can boost the effectiveness even of genuine meds—or help convince a patient that a placebo is a potent remedy."

"Reality is that which, when you stop believing in it, doesn’t go away." - Philip K. Dick

x-posted at Donklephant.

Divided and Balanced.™
Now that is fair.


Wellescent Health Forums said...

I can only imagine how frustrating this must be to pharmaceutical companies that spend so much effort when the baseline of comparison they are using to measure effectiveness is changing underneath them.

On the flip side, it certainly points to the degree to which mental well-being affects our ability to be healthy.

mw said...

True enough. One other interesting element raised in the article, was the possibility that with their big increase in advertising in recent years - Big Pharma may be responsible for the phenomena. The notion is that advertising is so pervasive and effective that it has psychologically prepared people to expect and believe that anything can be cured with a pill.