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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."
You keep saying that word, I do not think it means what you think it means.
There are plenty of other reasons for this to be occurring. Better testing procedures among them.
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Drug companies should never have started advertising directly to end users.
It seems to me that placebos aren't getting better at fixing people, just that statisticians are becoming more efficient at modifying the numbers. Soon they will rule the universe.
Here's an excellent rebuttal to this article by Peter Lipson on the Science Based Medicine blog: Science Based Medicine: Placebo Is Not What You Think It Is
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.
1. Of course we're still evolving and always will.
2. It's very likely nothing to do with our brains, and a lot to do with more rigorous testing.
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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.
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.
Soon, the only drug we will need in Placebo(tm). This is to be expected since it has appeared in more clinical trials for more ailments than any other drug in history.
"His name was James Damore."
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.
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?!
how long until
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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You've got to be kidding me. Which do you think is the most likely explanation. 1, we're all becoming regenerative super-mutants. 2, psychosomatic illnesses are increasing. In other words, people cause stomach aches and heartburn and fast heartbeats and migraines and everything else there is out there to treat and then when they're convinced that they're taking something to help it, tada, it goes away.
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ADHD is not kids acting like kids, it's kids acting like hyperactive goldfishes. There have been abuses in diagnosis, but the condition itself exists. The earliest humans were, in fact, scavengers, were not contemporary with saber toothed tigers and hunting/gathering was a group activity that requires fairly little time in the day compared to the workload of settled civilizations, besides the fact that most of the food needs come from trapping, fishing, light hunt (unless you have a party of 50, you ain't going for mastodon) and plants. So get off your ignorant high horse, abuse of diagnosis =/= the disease doesn't exist.
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.
Placebo also has the most side effects of any drug on record.
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.
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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.
Note that the only actual evidence for a more robust placebo effect referred to in the article is two studies looking at antidepressants. There are also a couple of anecdotes (from companies looking for a scapegoat for their failure) about Parkinson's and Crohn's, but that's hardly evidence.
It would be interesting if there was data for conditions that can be assessed objectively.
The article needed to be about two paragraphs and could certainly have stood to lose all the gushing about how powerful and neglected the placebo effect is. On the bright side, I see Wired is hiring people with no photography or design experience to generate their figures.
You haven't read much of the old testament have you?
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The earliest humans were, in fact, scavengers, were not contemporary with saber toothed tigers
I do not think that is correct. Smilodon went extinct only 10,000 years ago. I believe humans driving them to extinction is still one of the popular theories.
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.
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.
Argh. The laws of science be a harsh mistress.
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.
You haven't read much of the old testament have you?
That wasn't a "side effect".
The truth is that all men having power ought to be mistrusted. James Madison
They usually develop symptoms of depression and paranoia, but we've got a pill for that...
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.
I want to mod you as both flamebait and insightful at the same time.
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.
Build a man a fire, he's warm for one night. Set him on fire, and he's warm for the rest of his life.
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.