5 ms·
He doesn't simply call for active placebos to be outlawed. He lists several problems with the current system and then says: FDA needs to review its policies on
by ahoyhere 14y ago
He doesn't simply call for active placebos to be outlawed. He lists several problems with the current system and then says:
FDA needs to review its policies on placebos and either outlaw "active placebos" or rigorously define acceptable conditions for their use.
That's like saying "The US Govt either needs to outlaw medicines OR rigorously define acceptable conditions for their use." Which is not a statement most reasonable people would disagree with… hence the FDA. Everybody would obviously choose the second measure. It's a classic persuasion technique: give an extreme choice so the other choice will seem more reasonable. It gets attention. Nobody is going to outlaw active placebos.
As for overtly implying drug companies manipulate their results, he had a small handful of examples and one of them is a counter example where the drug company looks to be undermining its own results by using a too-good placebo (olive oil) that made its drug look useless.
Finally he raises the question: If you kick people out of the study when they improve on placebo, are you still actually testing against placebo?
How can you know, if the trials don't document what's in the placebo, and the FDA doesn't regulate it?
- tptacek 14y agoI'm not sure we read the same article. The one I read said, and this is the whole graf: FDA needs to review its policies on placebos and either outlaw "active placebos" or rigorously define acceptable conditions for their use. That seems like a profoundly ignorant argument. The article doesn't account for the need to blind studies. Why does it come across as credible to you?
- koide 14y agoWhy do blind studies need the regulation on active placebos to be non rigorous?
- tptacek 14y agoWho are you arguing with? Surely not me. But the case you're making isn't the case the blog post made. The blog post suggests, with varying levels of overtness, that there is something shady about active placebos.
- koide 14y agoI'm talking about the quote you used on your comment. That quote by itself does not sound particularly outrageous or ignorant. You should have chosen a different line to illustrate how shady the author thinks active placebos are.
- tptacek 14y agoOutlawing active placebos might be a reasonable course of action?
- nitrogen 14y agoThe blog post author may have used the idea of outlawing active placebos as a "door in the face" to make regulating them seem more palatable. At the least, it seems koide is interpreting the second suggestion as having more weight, while you are focusing on the first.
- koide 14y agoI take the sentence to mean "If there are no rigorous controls in place on active placebos, they should be outlawed" which doesn't sound unreasonable.
- tptacek 14y agoIt's totally unreasonable; it would be saying "because we don't trust the FDA, we should unblind drug trials".
- derefr 14y agoPeople threaten people with things that they themselves would find horrible, in order to incentivize the other party, all the time. The US budget sequestration, for example: a bunch of spending cuts none of us wanted, created with the intention of making us pick spending cuts we did want instead so that it wouldn't happen. The idea behind this statement is similar: if the FDA actually pre-commits to a policy saying "either we're going to figure out a huge set of requirements for publishing placebo composition data [huge hassle for us, honestly] or, if we haven't done that by January 2015, no more active placebos"--well, suddenly the drug companies are breathing down the FDA's neck to get those requirements drafted so they can comply with them before it's too late.
- sethev 14y agoHow can you know, if the trials don't document what's in the placebo, and the FDA doesn't regulate it? But these are accusations made by a man who admits he had never heard of active placebos until a few days ago. He's reading reports that are summaries of the trials and apparently concluding that since the summary doesn't include the ingredients of the placebo then they're undocumented and not regulated by the FDA. How does he know that?