Heroes Not Zombies

Here’s an interesting piece of news about the placebo effect – it’s getting stronger!

In an article on the BBC’s website, William Kremer explores the discovery that in RCTs (Randomised Controlled Trials) of drugs where drugs are compared to placebos, the size of the response to the placebos seems to be getting larger, making it harder for drug companies to demonstrate significant benefits of their drugs to the licensing authorities.

The article has a bit of a limited view of placebo, in my opinion, because the writer seems to focus exclusively on the idea that a placebo makes someone “feel better” – which implies that they aren’t “really better”. In fact, others have described the placebo effect as the “self-healing effect” because it involves the biological mechanisms of healing. In relation to pain studies, imaging has shown that the parts of the brain which are active in response to pain are stimulated both by pain killing drugs and placebos. I think we lose something by dismissing the placebo effect as a trick, or as something unreal.

As best I can see it does involve the imagination, and that is referred to in the article towards the end where they mention some of Ted Kaptchuk’s work.

But the part which really struck me in this article came in the discussion about how to minimise the placebo effect in drug trials –

There is also a drive to lower, through discussions with patients, their expectations of taking part in a trial. What is the best way to do that? “We tell them the truth,” says Dr Nathaniel Katz, the president of Analgesic Solutions, a consultancy that helps drug companies avoid trial failures.

“Telling the truth” means reminding patients that they are part of a trial for a drug that may not work, and which they may not even be given. “Even if it works,” Katz says, “it only works for about a third to a half of patients – that’s as good as it gets these days.”

Did you notice that sentence? –

“Even if it works,” Katz says, “it only works for about a third to a half of patients – that’s as good as it gets these days.”

How often does that fact slip right past patients and doctors? The way some people talk about “proven” or “evidence based” drugs, you’d think they “just work” – as in work every time for every person – wouldn’t you?

But we all know that isn’t true.