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Placebos Are Getting More Effective
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."
Drug companies should never have started advertising directly to end users.
Or possible the patent is no longer in effect, so no one bothered to fudge any data this time?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?
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.
The article seems to be fully of quibbles about simplifications or unscientific use of language rather than the overall point (which it finally gets to in the final paragraph).
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.
It's not anything to do with the placebo, it's that the drugs that are being developed currently don't do anything.
Gentlemen! You can't fight in here, this is the war room!
A lot of people -- like the author of Talking Back to Prozac -- 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, has a good definition of a particular form of publication bias 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.
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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.
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.
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.
But... the future refused to change.
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".
I hate printers.
You haven't read much of the old testament have you?
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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".
Just callin' it like I see it.
a less sarcastic way to say that would be that confidence in modern medicine is increasing.
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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.
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