Drugs are getting more effective - including placebos

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.

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Assumption number one was that if a trial were managed correctly, a medication would perform as well or badly in a Phoenix hospital as in a Bangalore clinic. Potter discovered, however, that geographic location alone could determine whether a drug bested placebo or crossed the futility boundary. By the late '90s, for example, the classic antianxiety drug diazepam (also known as Valium) was still beating placebo in France and Belgium. But when the drug was tested in the US, it was likely to fail. Conversely, Prozac performed better in America than it did in western Europe and South Africa. It was an unsettling prospect: FDA approval could hinge on where the company chose to conduct a trial.

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Shaihulud said:

Valium is a super strong drug though, how could it be due to a placebo effect?

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Onionsoilder said:

Well, it looks like a lot of drugs on the market might not be doing anything at all.

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It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.

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Perfection said:

I wonder if placebo effects could be ethically used by the medical community to treat patients.

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Snorrius said:

The idea of article is not that drugs are doing nothing - it is that placebo became stronger, that is the riddle.

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Perfection said:

I wonder if placebo effects could be ethically used by the medical community to treat patients.

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Shaihulud said:

Valium is a super strong drug though, how could it be due to a placebo effect?

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Onionsoilder said:

We always knew about how some peopl...sychotherapy instead of Prozac, for examples.

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Dragonlord said:

They already are. Every day, by, I'm guessing, every GP.

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augurey said:

Doctors already do it.

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Post excerpt said:

The placebo “effect” is just that—an effect observed because of a particular situation. It does not show that there is some special benefit to sugar pills, but that when we observe people, we can measure changes that are not always due to our intended intervention. It is not possible to create strong or weak placebos, since the placebo effect is a measure of poorly defined effects and of chance alone. It is what it is.

The author of the Wired article doesn’t get it in a very profound way. I’ll give you a few laughable examples.

The fact that taking a faux drug can powerfully improve some people’s health–the so-called placebo effect–has long been considered an embarrassment to the serious practice of pharmacology.

Really? That’s not even wrong. Clinical pharmacology research depends on placebo controls to make sense of the data. The fact that certain data is affected in placebo groups does not, for example, mean everything we understand about the cytochrome P450 system is wrong.

He asserts that more and more drug studies are crapping out due to the placebo effect:

It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.

No, it’s not like that at all. Perhaps the studies are just that well done, or maybe the drugs being developed suck, or maybe companies are studying more candidate drugs and screening for efficacy. Just about any explanation that doesn’t involve aliens is better than “placebo is getting stronger”.

He goes on to talk about how placebo has become a crisis of the industry, but I have another explanation: it’s not “placebo” that’s the problem. If drugs in testing cannot outperform placebo, then the researches have done a good job of testing the drugs honestly. If the researchers are failing to develop drugs that beat placebo and the company’s bottom line is suffering, it’s not the fault of the sugar pill. Sometimes it’s either difficult or impossible to develop an effective medication. Failure is inevitable. It’s how science works. If the CEOs don’t like it, they have to either make up the data, or find a new business model.

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