Mind

Mind and popular culture: Placebo effect increasing? Big pharma not exactly delighted

Spread the love

This very interesting article by Steve Silberman in Wired (“Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why,” 08.24.09) notes

True, many test subjects treated with the medication felt their hopelessness and anxiety lift. But so did nearly the same number who took a placebo, a look-alike pill made of milk sugar or another inert substance given to groups of volunteers in clinical trials to gauge how much more effective the real drug is by comparison. 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.

Ultimately, Merck’s foray into the antidepressant market failed. In subsequent tests, MK-869 turned out to be no more effective than a placebo. In the jargon of the industry, the trials crossed the futility boundary.

MK-869 wasn’t the only highly anticipated medical breakthrough to be undone in recent years by the placebo effect. From 2001 to 2006, the percentage of new 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. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.

More:

After decades in the jungles of fringe science, the placebo effect has become the elephant in the boardroom.

Although longish, this article is indispensable in understanding the damage that materialism and mechanism has done to medicine. The placebo effect should never have been either a problem or an embarrassment. It only became so because of a need to pretend that the patient’s mind does not matter, because mind is an illusion created by the buzz of neurons in the brain and causes nothing. It is increasing only because its potent effects are ignored.

Well, they are paying for their mistake now.

The good news is that a new approach is developing, one that harnesses both the placebo response and pharmaceuticals. As Silberman says,

The placebo response doesn’t care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That’s potent medicine.

Of course, that means that your mind exists and is doing the heavy lifting. But so? If you’re better, you’re better. You want to complain about that? Save it for when you are sick and not getting better. That happens too.

Go here for the rest.

See also:

Mario Beauregard on “The Neuroscience of Spirituality”

Big mystery [not!]: Why you feel sick when doctors tell you you are

Can ideas be reduced to purely material causes?

Neuroscience: Where does it hurt? How?

Finally, an idea! Wow, a real idea. But wait, wait

Brain: If a pill did not cause all your problems, chance are a pill will not fix them all either

Health can sometimes be fun, free, and painless: The placebo effect gets its own Web site

Placebo effect: Your mind’s role in your health

Mind and medicine: Did your doctor just prescribe you a quarter teaspoon of coloured sugar?

Beauregard and O’Leary on the Dennis Prager show: A partial transcript

If you do not take your sugar pill placebo are you more likely to die?

10 Replies to “Mind and popular culture: Placebo effect increasing? Big pharma not exactly delighted

  1. 1
    Graham says:

    I think O’Learys point is that the placebo effect can only be the product of an (immaterial) mind, but why should it ? Why cant the brain be influenced by the sight/taste/feel of a sugar pill & generate some physical response that makes us feel better ?

  2. 2
    Lenoxus says:

    One decent argument for the existence of the effect is the health management system idea — that many of the body’s methods for dealing with illness, such as nausea, are drastic and involve extreme costs; therefore, if the body is “told” by the central governor that it’s going to get better, such methods won’t be used. (Admittedly, this doesn’t cover every known case of the placebo effect at work.)

    Of course, in an area like depression, it should be no surprise that the placebo effect works — “thinking” that you are going to “feel” better easily becomes “feeling better”. (Not to trivialize the more extreme forms of depression, of course.)

    On a side note, I believe the headline was misleading, as I saw no evidence given that the effect is “increasing”. (I could be mistaken.)

  3. 3
    Graham says:

    To Lenoxus,
    Very recent research (I dont have the link) has shown that the placebo effect is real, and measurable, though short lived. I dont think anyone is surprised that the effect exists.

    I agree with your final note that the effect need not be increasing. Drugs have always been tested against placebos before approval, so any change in the success rate of drug trials could be related to the placebo effect, or to any other factor (more stringent standards, more sophisticated formulae, etc).

    O’Leary seems to suggest the placebo effect is all a great big surprise.

  4. 4
    Mark Frank says:

    I don’t understand this argument at all. The placebo effect has been established for decades and, as Graham points out, is completely compatible with a materialist view of mind.

  5. 5
    Lenoxus says:

    In one of the linked Mindful Hack posts, O’Leary writes:

    It is only a big mystery if you think that the mind is an illusion generated by the dance of neurons in the brain and has no causal power.

    Indeed, if we thought the mind had “no causal power”, the effect would be a mystery. In fact, our abilities to move, breathe, and communicate would be mysteries.

  6. 6
    Lenoxus says:

    Oh, I just looked at the linked article that explains how the effect is increasing. Weird. (What’s even weirder is that ID totally predicted it!)

    One possibility given in the article is that the volume or effectiveness of drug advertising may be increasing, hence making more people believe more strongly in the effectiveness of medication. (Consider how much more socially acceptable it is now to take antidepressants, he said anecdotally.)

    Something to keep in mind about pain is that, neurologically, it is no more “real” than its absence — outside of the mind, nothing the body experiences is “inherently” painful. (Nocireception is not caused by paper cuts but by the neurological response to paper cuts.) That the effect would work with pain, in particular, makes perfect sense — if the brain is told that it needn’t worry about some apparent harm to the body, it will shut off the costly procedure of nocireception.

  7. 7
    O'Leary says:

    Lenoxus, I am glad you looked at the linked article. It is very informative.

    In my view, the vast increase worldwide in communications means that people “know” – via information (which is in itself immaterial) communicated to them by a variety of means, including word of mouth – what they should expect to happen. And therefore it happens at a much higher rate than otherwise. As a matter of fact, just enrolling in a study will, in itself, alleviate symptoms in many prospective research subjects. This is called the “Hawthorne effect.”

    That is one of the bases of non-materialist neuroscience. Treating the brain as a machine or the mind as an illusion simply reduces our understanding of what is happening.

    As the article notes, one problem for pharmaceutical companies is finding populationswho genuinely do not know what to expect.

  8. 8
    Learned Hand says:

    That is one of the bases of non-materialist neuroscience. Treating the brain as a machine or the mind as an illusion simply reduces our understanding of what is happening.

    I don’t see any argument here about how the non-materialist perspective enhances our understanding of the placebo effect. Every part of the effect is just as sensible under the materialist framework, Lenoxus notes.

  9. 9
    allanius says:

    Uh…the reasons why the placebo effect is “increasing” aren’t very esoteric. First, pharma companies are no longer able to quietly shelve the studies that don’t come out right. If all the studies in SSRIs are taken into account, placebo overcomes statistical difference in the end. These drugs were never the panacea that an adoring press made them out to be. They just seemed that way because all we saw were the most flattering trial results.

    The second reason is that a lot of drugs are making it into Phase 2 and even Phase 3 testing that really shouldn’t be there. Drug companies are more willing to roll the dice on marginal compounds because the cupboards are bare.

    Finally, the burden of proof is much higher today. When I first started in the industry, you could obtain FDA approval based on a couple of Phase 3 studies in less than 100 patients. The guidelines for proving statistical significance have become far more rigorous today, which means that a lot of drugs that might have made it in the past won’t make it any more.

  10. 10
    Learned Hand says:

    Finally, the burden of proof is much higher today. When I first started in the industry, you could obtain FDA approval based on a couple of Phase 3 studies in less than 100 patients. The guidelines for proving statistical significance have become far more rigorous today, which means that a lot of drugs that might have made it in the past won’t make it any more.

    Why is that?

Leave a Reply