placebos are becoming more effective

From 2001 to 2006, the percentage of new [pharmaceutical] products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against 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. ….

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

The roots of the placebo problem can be traced to a lie told by an Army nurse during World War II as Allied forces stormed the beaches of southern Italy. The nurse was assisting an anesthetist named Henry Beecher, who was tending to US troops under heavy German bombardment. When the morphine supply ran low, the nurse assured a wounded soldier that he was getting a shot of potent painkiller, though her syringe contained only salt water. Amazingly, the bogus injection relieved the soldier’s agony and prevented the onset of shock.

Returning to his post at Harvard after the war, Beecher became one of the nation’s leading medical reformers. Inspired by the nurse’s healing act of deception, he launched a crusade to promote a method of testing new medicines to find out whether they were truly effective. ….

By 1962, … Beecher’s double-blind, placebo-controlled, randomized clinical trial—or RCT—was enshrined as the gold standard of the emerging pharmaceutical industry. ….

Beecher’s prescription helped cure the medical establishment of outright quackery, but it had an insidious side effect. By casting placebo as the villain in RCTs, he ended up stigmatizing one of his most important discoveries. The fact that even dummy capsules can kick-start the body’s recovery engine became a problem for drug developers to overcome, rather than a phenomenon that could guide doctors toward a better understanding of the healing process and how to drive it most effectively.

Steve Silberman, “Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why”, Wired Magazine, September 2009.

This article is fascinating, and well worth reading. It is a superb addendum to Merrill Goozner’s 2004 book on Big Pharma. After years of ignoring the effect of placebos, Merck, Lilly, Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi-Aventis, Johnson & Johnson, and other major firms are now funding a massive data-gathering effort called the Placebo Response Drug Trials Survey. It is now clear that response to placebo is a physiological phenomenon, not—as previously thought—a psychological trait related to neurosis and gullibility of patients.

It is possible that—because of mass advertising and because of the increased effectiveness of real drugs—people have more faith in all types of pills. Pharmaceutical companies then are victims of their own success.

I don’t understand, though, how Big Pharma will be able to profit from a study of placebos. Perhaps they don’t expect to, which would explain why they are co-operating, rather than working secretively and independently.

Steve Silberman ia a contributing editor at Wired Magazine. HT to Tyler Cowen at Marginal Revolution.


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