8 ms·

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.

113 points by mcantelon 17y ago

delackner 17y ago
If placebo works by helping the brain decide that we should get better, causing it to release its own defensive chemicals then it stands to reason that other actions might also be able to induce the same response. The mechanisms involved pre-exist the entire concept of "drugs". Maybe the old-time "placebo" was going to the local healer who jumped up and down and proclaimed that you will get better. Derren Brown's videos come to mind, especially his bit on the subway where he convincingly causes a man to become incapable of recalling where he is going, simply by commanding him to not remember. If other people can cause such powerful changes in our brain function, then there should be ways to do it yourself.
- Luc 17y ago
  I wouldn't put it past Derren Brown to have represented that situation on the subway somewhat differently than it actually happened - he is an entertainer after all (his program about faith healing and religious beliefs was amusing). Your point about influence still stands of course. I found 'Meaning, Medicine and the Placebo Effect' to be rather good: http://cambridge.org/catalogue/catalogue.asp?isbn=0521000874 http://cambridge.org/catalogue/catalogue.asp?isbn=0521000874
indiejade 17y ago
Theory: there isn't anything really all that wrong with most people; it's all in their minds, so the placebo works. Watch the evening news on a network and count the number of advertisements you see for prescription drugs. I did this a couple of weeks ago watching the CBS Evening news, a half-hour program, and about 65 percent of the commercials were for pills of some sort: migraine pills, anti-depression pills, pills for seniors, etc. The prescription drug industry in the US has got a slimy underbelly; it goes out of its way to convince people that there's something "wrong" with them, and then falls all over itself attempting to pat itself on the back for "curing" them.
- ars 17y ago
  "Theory: there isn't anything really all that wrong with most people; it's all in their minds, so the placebo works." Nope. Placebos can really and truly cure things. And not just things that are in the mind. For example the immune system is under brain control, and placebos can affect it. Allergies can be cured by placebo, ref: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27460 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27... Lots of things that you would not expect can be cured by placebo. Read some drug trials (or those inserts in drug packages) and notice how in pretty much all cases the placebo group improved relative to the starting point. As I said in a different comment in this thread: most people refuse to believe placebos can work, and say things like what you did "it's all in their head", "there was nothing actually wrong with them". But they really do work.
  - indiejade 17y ago
    For example the immune system is under brain control, and placebos can affect it. Then it would be the act of taking the placebo that cures, not the actual placebo itself. My theory was simply that by taking something with the expectation of a cure, many people can already be on their way to wellness because, as you mentioned, a lot of healing begins within the brain.
  - adrianbg 17y ago
    Especially in the case of pain this makes total sense to me. Pain is just a signal that something is wrong with you. If you believe in some deep way that the problem has been fixed, then there's no reason for your body to keep making you feel pain.
- JimmyL 17y ago
  Pharma advertising is something that always strikes me when I watch US TV feeds. Here in Canada, pharma advertising is very heavily regulated by the Federal government. It can come in essentially two forms. One is the "for sale" form, in which case the ad is limited to the drug name, the amount, and the price - no description of what it's for, or any other information. The other is the "informational" form, in which case the ad can talk about a symptom, like "acid reflux is dangerous - here are some signs", but it can't mention the name of the drug or pharmaceutical company producing it, and it has to talk about alternative non-drug remedies. The net result is that there are very few pharmaceutical ads on TV here, since they have so little value in what they're allowed to say.
JacobAldridge 17y ago
They should just sell the placebo. No FDA issues, and if it does what tests show it does can you imagine the profit margin! On a serious note, I'm enjoying keeping an eye on the US Health Care debate from afar (Australia, to be precise). Anybody think it will result in sustainable change for the better?
- 10ren 17y ago
  Coca cola. Coke was initially sold as a medication. In the 80's, blind trials showed that people preferred the taste of Pepsi - but when they knew the brand, they preferred Coke. Coca cola executives were so worried by this that they launched "New Coke" which was more like Pepsi, and people preferred it in blind tests. But it failed utterly, and the original Coke itself continued to be popular, as it has been to this day. See the "Rx for Success" side bar on page 2. The last two items are branding and clever names.
  - dgordon 17y ago
    Also, what tastes good in a single sip for a blind taste-test can be different from what tastes good when you drink a glass of it. I think Malcolm Gladwell talked about this in Blink.
- andreyf 17y ago
  Anybody think it will result in sustainable change for the better? As someone who is keeping an eye from up-close, hahahahahaha! Sustainable change for the better. Good one. Let me sum up American politics for you: we have the best PR in the world. This means that with enough money, you can convince people that your brand will cure them even if you're selling sugar pills. That's why American pharmaceuticals spend more on marketing than R&D. It also means you can convince people to hate socialized medicine, even if they're recipients of medicare/medicaid. Hence, in America, the only time something gets done is when a group with lots of money/power gets even more money/power out of it. The good news is that there are a lot of conflicting powerful interests. Car manufacturers and many banks, for example, have a lot to gain from a public option for healthcare - the former hopes to lower expenses for their retirees (huge expense for them). The latter hopes to stop mortgage foreclosures tied to medical expenses. The bad news is that often, the way to optimizing for powerful interests isn't very close to optimizing for the interests of the public at large.
patio11 17y ago
My take away from this is that, in addition to checklists, one low-cost intervention to improve healthcare would be to have the doctor spend a few minutes chatting the patient up and expressing cheery optimism about their prognosis. If the doctor's time is too valuable, find some unemployed psych grad with good people skills and put him in a lab coat.
- akkartik 17y ago
  But keep it super hush hush. If the populace grows uncertainty about whether it's getting the drug, the placebo effect may turn against the patient.
- Alex3917 17y ago
  Occam's razor suggests that Wired's explanation is complete bullshit. Let me give a far simpler explanation that would explain all the phenomena mentioned in the article: We are seeing a rise in physical health problems due to increasing social isolation and other mental health risk factors. As we replace the community barbeques with family grills we're losing more than a fun weekend activity, we're losing something that's evolved over hundreds of thousands of years to keep us mentally healthy. And more and more, scientists are learning that mental health is one of the greatest predictors (if not the greatest) of physical well being. Why do you think ~50% of college students experience clinical depression? I'm sure that stress, poor diet, lack of sleep, and excessive alcohol consumption are all contributing factors, but at the end of the day these poor lifestyle "choices" aren't really choices at all; rather, they're triggered by specific design decisions made at the institutional and societal level. Placebos aren't working better because people have more faith in medicine, they're working better because of the Hawthorne effect; people feel like they have someone who cares about them. That's why the effectiveness is radically different across populations, depending on the social environment, even though we're all exposed to the same media.
  - tierack 17y ago
    To be blunt: citations needed. The article not only talks about conditions that are clearly mental (depression) and ones that are arguably mentally related (IBS), but also ones that you'd have a hard time attributing to "lifestyle 'choices' that aren't really choices at all" (Parkinson's). > Placebos aren't working better because people have more faith in medicine, they're working better because of the Hawthorne effect The article talks about both effects and more (placebos working less well for conditions that are locally under-diagnosed, for example). The article presents a rich collection of causes for the rise of the placebo effect instead of a single cause. And I think Occam, who could appreciate the complexity of the brain and see that they've got data, would agree that it couldn't be as simple as you suggest. (Also, across populations we don't all get exposed to the same media. Something tells me that there aren't constant erectile dysfunction commercials in Bangalore.)
blhack 17y ago
The problem is the depression (clinical depression) is one of the most horrifyingly over-diagnosed diseases on the face of the planet. EVERYONE gets depressed. If people didn't, we'd be living in Utopia. When you hand some person who is having a crappy day a pill and say something like "this is full of magic chemicals that are going to make you feel better", their outlook on life improves, and they aren't depressed anymore! Clinical depression is different. Clinical depression is as much a real disease as anything else, and it cannot be treated with a placebo any more than a broken leg can. Real depression is not a psychological problem, it is a neurochemical one... Clinical depression does not even always manifest itself as feeling sad or anxious. It can present itself as bad memory, poor focus, decreased creativity...These things, while psychologicacl problems, have neurological causes. Yes, being sad does as well, but being sad is as easy to "cure" as being hungry. This is why the placebo worked.
- randallsquared 17y ago
  You seem to believe placebos do not affect actual medical problems. It's interesting in this regard that in placebo trials vs a gastric acid reducer (to treat ulcers), 48% of those taking a placebo improved, while 76% of those taking the real drug improved. The interesting part is that it's now known that ulcers are not caused by gastric acid, but by bacteria, so even the "real" drug here worked via placebo effect, but it did work for most patients. Edit: source: http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ulcers http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ul...
  - yummyfajitas 17y ago
    That's probably due to the "leaky placebo" effect: if the placebo does something to you (e.g., gives you a headache, or other side effect), it makes you think it is really working.
- ars 17y ago
  That's what the drug companies want people to think. But it's not actually true. Even the type of depression you are talking about responds to placebos. And it responds very well to therapy, but barely at all to drugs - except that the drugs work well as placebos. It is a real condition - don't get me wrong, I'm not saying it isn't. It's just that the drugs don't do as much as people think they do. Most people when they first hear about placebos flatly refuse to believe they work as well as they do. But they do.
clofresh 17y ago
The unsung hero in all this is the analytics data they used to debunk widely held assumptions about the placebo effect in clinical trials. Nothing like cold, hard data to inflict some cognitive dissonance on some "experts".
ghshephard 17y ago
This is an incredibly interesting article - one of the more effective ways of healing the body is to engage the brain to heal it for you. Placebo Effects, in many cases, are as powerful as the effects of the drug. Previously, the Pharma industry took this as in indication their drug's weren't effective. The central thesis of this article isn't that the drugs are ineffective, it's that the Placebo effect is a real, and sometimes _very_ effective mechanism for healing people. From the article: "one way that placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual."
datums 17y ago
The book predictably irrational discusses the placebo effect on surgery. http://www.predictablyirrational.com/pdfs/Placebo1.pdf http://www.predictablyirrational.com/pdfs/Placebo1.pdf Very interesting results.
jsz0 17y ago
It's probably directly related to the number of people regularly taking medication for other conditions. More people have more faith in magic pills to solve all their problems. We have become a heavily medicated society.
olefoo 17y ago
I have a theory as to why Placebos are getting _more_ effective; which is the real curiosity of this article. Television. If as a child, you watch 10,000 hours of commercials telling you how effective drugs are. Is it any wonder that you are convinced enough that your body actually makes it true, even if you got the Obecal P instead of the real deal.
- lanaer 17y ago
  http://www.slash7.com/articles/2009/8/25/oh-yeah-there-s-a-sugar-pill-for-that http://www.slash7.com/articles/2009/8/25/oh-yeah-there-s-a-s...
gruseom 17y ago
It's been shown that antidepressants are no better clinically than placebos. The drug companies simply suppressed the trials that didn't yield the results they wanted and cherry-picked the ones that did in order to get FDA approval. This all came out a couple of years ago when a long-running Freedom of Information Act suit forced them to release all the trials. http://www.guardian.co.uk/society/2008/feb/26/mentalhealth.medicalresearch http://www.guardian.co.uk/society/2008/feb/26/mentalhealth.m... Edit: I just remembered that I posted about this to HN back when the study came out: http://news.ycombinator.com/item?id=123575 http://news.ycombinator.com/item?id=123575. A commenter pointed out that the study was limited to SSRIs, the most widely used antidepressants.
gruseom 17y ago
Fascinating article. But they didn't mention the obvious economic reason why placebo effects have been shunned or suppressed: placebos are free. If the pharmaceutical industry gets clever about finding ways to make money off the placebo effect, as opposed to getting more devious about pushing drugs into people, that seems to me a good thing.
- eru 17y ago
  Homeopathy anyone?
torpor 17y ago
A person is responsible for their own mental condition. Period. That is what this placebo situation demonstrates, more than anything. YOU are responsible for YOUR condition.
- warfangle 17y ago
  I'll be sure to tell that to the homeless dude who digs through my garbage every night and has heated arguments with the fire hydrant..
  - torpor 17y ago
    Tell him. If he doesn't /take/ responsibility, it doesn't change the fact that his life is his own and whatever he is experiencing, belongs to him alone.
ahoyhere 17y ago
Well, the US govt took the prohibitions off drug advertising in the mid-90s and now it's a >6 billion-a-year industry. Just the ads and promotions, that is. All those ads say that pills work for all range of problems (even imaginary ones that the drug makers made up to sell more pills - such as pre-menstrual dysphoric disorder, to sell renamed Prozac and renew their patent). Those ads weren't there before. The ads still aren't shown in Europe, where the real drugs are beating the placebo effect (the article mentions trials in France and Italy where diazepam wins; in the US, diazepam fails against the placebo). Drug advertising is simply not legal in most parts of the EU. They don't think that has something to do with it? Ads affect belief - maybe nobody says "Oh, well now I believe xyz will cure me," because they pretend to be immune to advertising, but if you're surrounding by messaging that pill = cure, you are going to eventually believe it as it is absorbed as cultural knowledge. Just like low-fat = healthy has become a "fact" that "everyone knows." I was shocked that the article barely even made a nod to this, and didn't follow it to the its conclusion. I think it's hilarious that the drug co's went along thinking that they won big with that repeal of consumer protection laws, and that their own exploitation of known human weakness is causing their drugs to be less effective than sugar pills.
David 17y ago
My question: why do the pharms think this is bad news for them? The placebo effect requires belief that the placebo is fixing the problem. Studies are double-blind so that the patient does have that belief. Without the expectation of being cured, there is no improvement. For the placebo effect to be a significant influence in general health, the public needs to be convinced that it is receiving a legitimate fix. The best way to show people it's a real cure? Give them a real cure, and tell them all about how it works. The need for chemical compounds that change some aspect of body chemistry will not decrease because of the placebo effect; instead, these compounds become the placebo. It's another, more effective layer of manipulation. But despite my wording, I see no problem with it. It might technically be a giant fraud, if the power of healing lies with the buyer all along. But if it happened in finance, who would complain? "Company convinces clients they have more money; buying power mysteriously increases" doesn't sound all that fraudulent to me. Essentially, it's business as usual for pharms. Develop compounds that may or may not work, tell everyone they work, sell them, produce actual results. What's all the fuss about?
jasonkester 17y ago
I've always thought you could make a killing on the late night infomercial market, selling "Placebo" to people. Think of all the research out there on the well-documented Placebo Effect. Now you can benefit from this safe, effective, miracle cure. Order now and we'll throw in a second bottle of Placebo free of charge! Considering the things that stupid people fall for, this would seem guaranteed to work.
- deleted 17y ago
  [deleted]
- run4yourlives 17y ago
  They already do that, it's called a q-ray bracelet I think.
electromagnetic 17y ago
IMO it's quite a simple explanation. You only have to watch 5 minutes of US advertising (I'm from the UK and living in Canada) to think you should have something wrong with you. If you think you should have something wrong with you for long enough, you will, it's called hypochondria and there's long been the suggestion of prescribing placebos to them until they're capable of getting access to a psychologist or psychiatrist. You get the problem that when pills cure everything and you're sick and not on a pill, you worry. This makes you feel worse, which makes you sicker. The sugar pill not only has a placebo effect, but it also stops you worrying so really its having two effects opposed to the usual one we've classically seen. When stress is the leading form of disease in the western world, you're going to have to remove stressed people from the drug tests to get impartial results. It just happens to suck that most sick people are stressed out. I guess they'll have to give a placebo to the test and control group to relieve stress and then give a second to the control group pretending its actual medicine.

113 points by mcantelon 17y ago

If placebo works by helping the brain decide that we should get better, causing it to release its own defensive chemicals then it stands to reason that other actions might also be able to induce the same response. The mechanisms involved pre-exist the entire concept of "drugs". Maybe the old-time "placebo" was going to the local healer who jumped up and down and proclaimed that you will get better. Derren Brown's videos come to mind, especially his bit on the subway where he convincingly causes a man to become incapable of recalling where he is going, simply by commanding him to not remember. If other people can cause such powerful changes in our brain function, then there should be ways to do it yourself.

Luc 17y ago
I wouldn't put it past Derren Brown to have represented that situation on the subway somewhat differently than it actually happened - he is an entertainer after all (his program about faith healing and religious beliefs was amusing). Your point about influence still stands of course. I found 'Meaning, Medicine and the Placebo Effect' to be rather good: http://cambridge.org/catalogue/catalogue.asp?isbn=0521000874 http://cambridge.org/catalogue/catalogue.asp?isbn=0521000874

indiejade 17y ago

Theory: there isn't anything really all that wrong with most people; it's all in their minds, so the placebo works. Watch the evening news on a network and count the number of advertisements you see for prescription drugs. I did this a couple of weeks ago watching the CBS Evening news, a half-hour program, and about 65 percent of the commercials were for pills of some sort: migraine pills, anti-depression pills, pills for seniors, etc. The prescription drug industry in the US has got a slimy underbelly; it goes out of its way to convince people that there's something "wrong" with them, and then falls all over itself attempting to pat itself on the back for "curing" them.

ars 17y ago
"Theory: there isn't anything really all that wrong with most people; it's all in their minds, so the placebo works." Nope. Placebos can really and truly cure things. And not just things that are in the mind. For example the immune system is under brain control, and placebos can affect it. Allergies can be cured by placebo, ref: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27460 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27... Lots of things that you would not expect can be cured by placebo. Read some drug trials (or those inserts in drug packages) and notice how in pretty much all cases the placebo group improved relative to the starting point. As I said in a different comment in this thread: most people refuse to believe placebos can work, and say things like what you did "it's all in their head", "there was nothing actually wrong with them". But they really do work.
- indiejade 17y ago
  For example the immune system is under brain control, and placebos can affect it. Then it would be the act of taking the placebo that cures, not the actual placebo itself. My theory was simply that by taking something with the expectation of a cure, many people can already be on their way to wellness because, as you mentioned, a lot of healing begins within the brain.
- adrianbg 17y ago
  Especially in the case of pain this makes total sense to me. Pain is just a signal that something is wrong with you. If you believe in some deep way that the problem has been fixed, then there's no reason for your body to keep making you feel pain.
JimmyL 17y ago
Pharma advertising is something that always strikes me when I watch US TV feeds. Here in Canada, pharma advertising is very heavily regulated by the Federal government. It can come in essentially two forms. One is the "for sale" form, in which case the ad is limited to the drug name, the amount, and the price - no description of what it's for, or any other information. The other is the "informational" form, in which case the ad can talk about a symptom, like "acid reflux is dangerous - here are some signs", but it can't mention the name of the drug or pharmaceutical company producing it, and it has to talk about alternative non-drug remedies. The net result is that there are very few pharmaceutical ads on TV here, since they have so little value in what they're allowed to say.

JacobAldridge 17y ago

They should just sell the placebo. No FDA issues, and if it does what tests show it does can you imagine the profit margin! On a serious note, I'm enjoying keeping an eye on the US Health Care debate from afar (Australia, to be precise). Anybody think it will result in sustainable change for the better?

10ren 17y ago
Coca cola. Coke was initially sold as a medication. In the 80's, blind trials showed that people preferred the taste of Pepsi - but when they knew the brand, they preferred Coke. Coca cola executives were so worried by this that they launched "New Coke" which was more like Pepsi, and people preferred it in blind tests. But it failed utterly, and the original Coke itself continued to be popular, as it has been to this day. See the "Rx for Success" side bar on page 2. The last two items are branding and clever names.
- dgordon 17y ago
  Also, what tastes good in a single sip for a blind taste-test can be different from what tastes good when you drink a glass of it. I think Malcolm Gladwell talked about this in Blink.
andreyf 17y ago
Anybody think it will result in sustainable change for the better? As someone who is keeping an eye from up-close, hahahahahaha! Sustainable change for the better. Good one. Let me sum up American politics for you: we have the best PR in the world. This means that with enough money, you can convince people that your brand will cure them even if you're selling sugar pills. That's why American pharmaceuticals spend more on marketing than R&D. It also means you can convince people to hate socialized medicine, even if they're recipients of medicare/medicaid. Hence, in America, the only time something gets done is when a group with lots of money/power gets even more money/power out of it. The good news is that there are a lot of conflicting powerful interests. Car manufacturers and many banks, for example, have a lot to gain from a public option for healthcare - the former hopes to lower expenses for their retirees (huge expense for them). The latter hopes to stop mortgage foreclosures tied to medical expenses. The bad news is that often, the way to optimizing for powerful interests isn't very close to optimizing for the interests of the public at large.

patio11 17y ago

My take away from this is that, in addition to checklists, one low-cost intervention to improve healthcare would be to have the doctor spend a few minutes chatting the patient up and expressing cheery optimism about their prognosis. If the doctor's time is too valuable, find some unemployed psych grad with good people skills and put him in a lab coat.

akkartik 17y ago
But keep it super hush hush. If the populace grows uncertainty about whether it's getting the drug, the placebo effect may turn against the patient.
Alex3917 17y ago
Occam's razor suggests that Wired's explanation is complete bullshit. Let me give a far simpler explanation that would explain all the phenomena mentioned in the article: We are seeing a rise in physical health problems due to increasing social isolation and other mental health risk factors. As we replace the community barbeques with family grills we're losing more than a fun weekend activity, we're losing something that's evolved over hundreds of thousands of years to keep us mentally healthy. And more and more, scientists are learning that mental health is one of the greatest predictors (if not the greatest) of physical well being. Why do you think ~50% of college students experience clinical depression? I'm sure that stress, poor diet, lack of sleep, and excessive alcohol consumption are all contributing factors, but at the end of the day these poor lifestyle "choices" aren't really choices at all; rather, they're triggered by specific design decisions made at the institutional and societal level. Placebos aren't working better because people have more faith in medicine, they're working better because of the Hawthorne effect; people feel like they have someone who cares about them. That's why the effectiveness is radically different across populations, depending on the social environment, even though we're all exposed to the same media.
- tierack 17y ago
  To be blunt: citations needed. The article not only talks about conditions that are clearly mental (depression) and ones that are arguably mentally related (IBS), but also ones that you'd have a hard time attributing to "lifestyle 'choices' that aren't really choices at all" (Parkinson's). > Placebos aren't working better because people have more faith in medicine, they're working better because of the Hawthorne effect The article talks about both effects and more (placebos working less well for conditions that are locally under-diagnosed, for example). The article presents a rich collection of causes for the rise of the placebo effect instead of a single cause. And I think Occam, who could appreciate the complexity of the brain and see that they've got data, would agree that it couldn't be as simple as you suggest. (Also, across populations we don't all get exposed to the same media. Something tells me that there aren't constant erectile dysfunction commercials in Bangalore.)

blhack 17y ago

The problem is the depression (clinical depression) is one of the most horrifyingly over-diagnosed diseases on the face of the planet. EVERYONE gets depressed. If people didn't, we'd be living in Utopia. When you hand some person who is having a crappy day a pill and say something like "this is full of magic chemicals that are going to make you feel better", their outlook on life improves, and they aren't depressed anymore! Clinical depression is different. Clinical depression is as much a real disease as anything else, and it cannot be treated with a placebo any more than a broken leg can. Real depression is not a psychological problem, it is a neurochemical one... Clinical depression does not even always manifest itself as feeling sad or anxious. It can present itself as bad memory, poor focus, decreased creativity...These things, while psychologicacl problems, have neurological causes. Yes, being sad does as well, but being sad is as easy to "cure" as being hungry. This is why the placebo worked.

randallsquared 17y ago
You seem to believe placebos do not affect actual medical problems. It's interesting in this regard that in placebo trials vs a gastric acid reducer (to treat ulcers), 48% of those taking a placebo improved, while 76% of those taking the real drug improved. The interesting part is that it's now known that ulcers are not caused by gastric acid, but by bacteria, so even the "real" drug here worked via placebo effect, but it did work for most patients. Edit: source: http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ulcers http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ul...
- yummyfajitas 17y ago
  That's probably due to the "leaky placebo" effect: if the placebo does something to you (e.g., gives you a headache, or other side effect), it makes you think it is really working.
ars 17y ago
That's what the drug companies want people to think. But it's not actually true. Even the type of depression you are talking about responds to placebos. And it responds very well to therapy, but barely at all to drugs - except that the drugs work well as placebos. It is a real condition - don't get me wrong, I'm not saying it isn't. It's just that the drugs don't do as much as people think they do. Most people when they first hear about placebos flatly refuse to believe they work as well as they do. But they do.

clofresh 17y ago

The unsung hero in all this is the analytics data they used to debunk widely held assumptions about the placebo effect in clinical trials. Nothing like cold, hard data to inflict some cognitive dissonance on some "experts".

ghshephard 17y ago

This is an incredibly interesting article - one of the more effective ways of healing the body is to engage the brain to heal it for you. Placebo Effects, in many cases, are as powerful as the effects of the drug. Previously, the Pharma industry took this as in indication their drug's weren't effective. The central thesis of this article isn't that the drugs are ineffective, it's that the Placebo effect is a real, and sometimes _very_ effective mechanism for healing people. From the article: "one way that placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual."

datums 17y ago

The book predictably irrational discusses the placebo effect on surgery. http://www.predictablyirrational.com/pdfs/Placebo1.pdf http://www.predictablyirrational.com/pdfs/Placebo1.pdf Very interesting results.

jsz0 17y ago

It's probably directly related to the number of people regularly taking medication for other conditions. More people have more faith in magic pills to solve all their problems. We have become a heavily medicated society.

olefoo 17y ago

I have a theory as to why Placebos are getting _more_ effective; which is the real curiosity of this article. Television. If as a child, you watch 10,000 hours of commercials telling you how effective drugs are. Is it any wonder that you are convinced enough that your body actually makes it true, even if you got the Obecal P instead of the real deal.

lanaer 17y ago
http://www.slash7.com/articles/2009/8/25/oh-yeah-there-s-a-sugar-pill-for-that http://www.slash7.com/articles/2009/8/25/oh-yeah-there-s-a-s...

gruseom 17y ago

It's been shown that antidepressants are no better clinically than placebos. The drug companies simply suppressed the trials that didn't yield the results they wanted and cherry-picked the ones that did in order to get FDA approval. This all came out a couple of years ago when a long-running Freedom of Information Act suit forced them to release all the trials. http://www.guardian.co.uk/society/2008/feb/26/mentalhealth.medicalresearch http://www.guardian.co.uk/society/2008/feb/26/mentalhealth.m... Edit: I just remembered that I posted about this to HN back when the study came out: http://news.ycombinator.com/item?id=123575 http://news.ycombinator.com/item?id=123575. A commenter pointed out that the study was limited to SSRIs, the most widely used antidepressants.

gruseom 17y ago

Fascinating article. But they didn't mention the obvious economic reason why placebo effects have been shunned or suppressed: placebos are free. If the pharmaceutical industry gets clever about finding ways to make money off the placebo effect, as opposed to getting more devious about pushing drugs into people, that seems to me a good thing.

eru 17y ago
Homeopathy anyone?

torpor 17y ago

A person is responsible for their own mental condition. Period. That is what this placebo situation demonstrates, more than anything. YOU are responsible for YOUR condition.

warfangle 17y ago
I'll be sure to tell that to the homeless dude who digs through my garbage every night and has heated arguments with the fire hydrant..
- torpor 17y ago
  Tell him. If he doesn't /take/ responsibility, it doesn't change the fact that his life is his own and whatever he is experiencing, belongs to him alone.

ahoyhere 17y ago

Well, the US govt took the prohibitions off drug advertising in the mid-90s and now it's a >6 billion-a-year industry. Just the ads and promotions, that is. All those ads say that pills work for all range of problems (even imaginary ones that the drug makers made up to sell more pills - such as pre-menstrual dysphoric disorder, to sell renamed Prozac and renew their patent). Those ads weren't there before. The ads still aren't shown in Europe, where the real drugs are beating the placebo effect (the article mentions trials in France and Italy where diazepam wins; in the US, diazepam fails against the placebo). Drug advertising is simply not legal in most parts of the EU. They don't think that has something to do with it? Ads affect belief - maybe nobody says "Oh, well now I believe xyz will cure me," because they pretend to be immune to advertising, but if you're surrounding by messaging that pill = cure, you are going to eventually believe it as it is absorbed as cultural knowledge. Just like low-fat = healthy has become a "fact" that "everyone knows." I was shocked that the article barely even made a nod to this, and didn't follow it to the its conclusion. I think it's hilarious that the drug co's went along thinking that they won big with that repeal of consumer protection laws, and that their own exploitation of known human weakness is causing their drugs to be less effective than sugar pills.

David 17y ago

My question: why do the pharms think this is bad news for them? The placebo effect requires belief that the placebo is fixing the problem. Studies are double-blind so that the patient does have that belief. Without the expectation of being cured, there is no improvement. For the placebo effect to be a significant influence in general health, the public needs to be convinced that it is receiving a legitimate fix. The best way to show people it's a real cure? Give them a real cure, and tell them all about how it works. The need for chemical compounds that change some aspect of body chemistry will not decrease because of the placebo effect; instead, these compounds become the placebo. It's another, more effective layer of manipulation. But despite my wording, I see no problem with it. It might technically be a giant fraud, if the power of healing lies with the buyer all along. But if it happened in finance, who would complain? "Company convinces clients they have more money; buying power mysteriously increases" doesn't sound all that fraudulent to me. Essentially, it's business as usual for pharms. Develop compounds that may or may not work, tell everyone they work, sell them, produce actual results. What's all the fuss about?

jasonkester 17y ago

I've always thought you could make a killing on the late night infomercial market, selling "Placebo" to people. Think of all the research out there on the well-documented Placebo Effect. Now you can benefit from this safe, effective, miracle cure. Order now and we'll throw in a second bottle of Placebo free of charge! Considering the things that stupid people fall for, this would seem guaranteed to work.

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run4yourlives 17y ago
They already do that, it's called a q-ray bracelet I think.

electromagnetic 17y ago

IMO it's quite a simple explanation. You only have to watch 5 minutes of US advertising (I'm from the UK and living in Canada) to think you should have something wrong with you. If you think you should have something wrong with you for long enough, you will, it's called hypochondria and there's long been the suggestion of prescribing placebos to them until they're capable of getting access to a psychologist or psychiatrist. You get the problem that when pills cure everything and you're sick and not on a pill, you worry. This makes you feel worse, which makes you sicker. The sugar pill not only has a placebo effect, but it also stops you worrying so really its having two effects opposed to the usual one we've classically seen. When stress is the leading form of disease in the western world, you're going to have to remove stressed people from the drug tests to get impartial results. It just happens to suck that most sick people are stressed out. I guess they'll have to give a placebo to the test and control group to relieve stress and then give a second to the control group pretending its actual medicine.