Unfortunately I’m going to cite the contents of a long, three-page story in this blog entry. Fortunately, it’s an absolutely awesome story about the curious history, convoluted present and hopeful future of the placebo effect. Even if it takes you a while to read, it’s worth reading — it takes you from the origin of placebos (salt water instead of morphine during World War 2) through to modern day drug trials, where placebos are beating pharmaceutical drugs such as anti-pain meds or anti-depressants.
It’s crazy stuff — really bat-shit crazy. The story doesn’t really go into the why, as we don’t know the answer yet — it’s amazing enough that a group has finally been formed to look into it (pharmaceutical companies, the ones with all the money when it comes to research, obviously want the placebo response to just… go away. ASAP.) – Since the beginning, the placebo has been Big Pharma’s number one enemy. To pass drug trials a new product has to beat out the placebo effect by a significant margin. In the olden days, this was apparently quite easy.
Today… well, the expert that the story focuses on, William Potter, goes as far to say that in during modern-day tests, Prozac is being beaten-out by placebos, and thus would never make it to market, if it had been invented today. The story actually begins with a story about Merck, a big pharmaceutical company: they’re testing a new anti-depressant (MK-869), and they just can’t seem to beat the placebo effect. Both the drug and the placebo effect had an equal success rate! The placebo effect is so strong at the moment that very few drugs are making it through testing and into the greedy, self-medicating hands of the public.
It’s definitely a weird one that needs to be sussed out. It’s sad that it has been ignored for so long because the body’s self-healing functions are the enemy of pharmacology. Pharmacology’s sole purpose is to dominate the central nervous system, not to aid or assist it in its curative powers. What has caused the increased placebo response? Now this is the funny bit: in realising that placebo response is different, depending on where you are in the world, Big Pharma is actually going to other countries where the placebo effect is weaker, to get their drugs approved.
It would seem that the placebo response is based on culture, society. It’s long been known that we have more faith in the trustworthy, the responsible, the professional. If I tell you I’m going to fix your computer, you’re relieved and walk away happy. If I tell you I’m going to remove your tooth, you’re going to adversely react, scream, run away — and rightfully so!
The story seems to surmise that it’s the pharmaceutical’s massive marketing campaigns that have pushed up the power of the placebo. We’re surrounded by so many reports and surveys and commercials that tell us of the efficacy of anti-depressants that we will them to work: if it works for him, it will work for me — of course, the funny bit is that most drugs have side-effects, and the placebo does not… so with placebo tests we’re told that we’re taking Prozac, our body expects it to work… and so it works. Without any of the side-effects.
And it turns out that doctors have long been prescribing placebos to patients! This one might shock you a little. If you’re on anti-depressants right now… you might actually not be on them. Doctors have long known the power of confidence and good bed-side manner. Doctors often prescribe under-powered doses to patients and tell them that it will work. And, unsurprisingly, it works — with all the potency of actual, drug-based medication. Awesome.
We can walk away from this story with two great things under our belt: a) we’ll be seeing more research into the placebo effect and the body’s self-healing powers. We’re not talking about the body’s ability to fix physical damage, but when it comes to biological imbalance, brain chemistry and ‘rewiring’, we’re capable of a lot more than we think — and b) don’t stop believing in medication. It is your belief in the power of anti-depressants that make them work, not the chemical compound itself.
If that’s not food for thought… I don’t know what is.
Ed Adams
Nov 4, 2009
I almost wrote a book on this exact subject when I was in my 20′s. It’s really amazing to think about the way we are created.
Sara Strand
Nov 4, 2009
But having drugs readily is so much more fun.
I mean, having two kids was GREAT, because then I got oxycodone and percocet (one for each birth). Those were super. I didn’t feel a damn thing, slept great and had some really fantastic dreams. As a side effect, I also can’t really tell you what the first 6 weeks of each child’s life was like because you know- I was like sleeping and stuff. And having really bizarre dreams of trolls mowing my lawn and stealing apples. I totally recommend it. 
HAHA!!
Hezabelle
Nov 4, 2009
“It is your belief in the power of anti-depressants that make them work, not the chemical compound itself.”
To me this implies that depression is not a chemical imbalance but rather something you can fix on your own,and I think it’s a huge generalization of the information presented. It is just completely perpetuating the ongoing stereotypes of depression that make it impossible anyone who suffers from depression to receive the kind of social support they need. If people could truly just “think” themselves through depression don’t you think they would? Depression is the result of chemical imbalance in the brain that for many people HAS to be regulated by medication for the rest of their lives, in order for them to lead “normal” lives. You can compare it to diabetes, in that way. Diabetes doesn’t go away because you think more positively either.
Sara Strand
Nov 4, 2009
Well I think that there is a big difference in someone who is chronically depressed (my sister in law, for example) and someone who is depressed because I am in a shitty set of circumstances (me, for example). Now my SIL and I were both on anti-depressants and they help her to a point, but she still feels like crap everyday- and is on medication for lots of other things as well. Now me on the other hand, took them for almost 2 years and really didn’t feel any different. My life still sucks, the circumstances are all the same, I just felt numb and foggy; therefore, I am not able to really think through things to fix what is going on. Yes, depression can be a serious thing, but I think that most people don’t understand that depression also is brought on by things that you are able to change around you, but maybe are too lazy or ignorant to do that. And I’m totally lazy so I know that about myself. But perhaps we should be more concerned with small kids being on meds for ADD/ADHD and the whole other whack load of behavior issues when you know, maybe people could just parent. And not give your kid everything they want all of the time. Limit TV/videogames and crap like that. But again, it’s easier to give you kids whatever rather than deal with issues.
sebastian
Nov 4, 2009
I wasn’t aware that diabetes was a brain imbalance? Something to do with the liver or pancreas or something?
I’m not a doctor (not that doctors know much more on this topic either), but I would say the evidence is pretty damning, on the restorative power of our own body?
It could easily be that some people are not really depressed (or whatever affliction is being tested) — and so of course they get better with the placebo. That IS the other option — that the number of depressed people is actually far smaller than is being medicated. That would certainly make sense too.
As for those with ‘real’ imbalances… surely you’re aware of your own ability to change your brain chemistry? Psyching yourself up? Watching a scary movie? Exercising?
The sad thing is, we don’t know enough about the brain (or whatever’s causing the placebo effect) to make scientific decisions. But the placebo effect is different all over the world, it would seem, and not just for victims of depression. And that would suggest that we’re more involved with our own wellbeing than Big Pharma would like us to believe.
Ed — I think you have a few little oddities/secrets about your past that may come out eventually…!
Jack
Nov 4, 2009
Interesting, but I’ve read about this subject before now (‘Bad Science’ by Ben Goldacre is a handy place to start). I work for an extremely large pharma company that makes drugs for bi-polar/depression/mania (amongst others) etc, and it can be interesting to see how well-researched and well-conducted double blind clinical trials turn out.
However, there are a few points that I think people are often not aware of. Firstly, that the placebo vs compound trial is generally considered unethical in today’s world. If there is a glimmer of hope that a compound can help, then it should be used in all test subjects. Instead, compounds in development are tested against their next best rival on the market in similar dosage sizes and frequencies. Efficacy is therefore benchmarked and scored against existing known solutions, though compliance from the patient can skew the findings of course (amongst many other variables).
Secondly, that article doesn’t really offer me the satisfaction that would let me place reliance on it, mainly because there are no proper references to the sources used. I am not questioning it, rather slightly sceptical, because media and pharma are both equally guilty for being quite selective with how they choose to cut and extrapolate data from sources – though Homeopaths are the absolute worst for this (a story for another day).
The placebo effect is not new; however, I am extremely disappointed that the article didn’t broach the ‘regression to mean’ concept at all. (I double checked by searching with my browser Ctrl-F). There isn’t enough time spent on researching this aspect of the effect of placebos, and regression to mean is a relatively decent explanation behind the way people respond to placebos and is something we can all relate to. An easy example is a bad knee. You take a knock playing soccer and it feels more painful after a few days. After a week, it’s still quite sore – more so than on the day of the incident. You go to the doctor as it is really sore now, and he or she prescribes a method of treatment (NSAIDS/exercise/rest) and your knee recovers back to full strength. The treatment may have no bearing on the knee recovering, rather your knee was at the peak of pain and couldn’t get any worse, thus any perceived ‘treatment’ would have a positive impact on the knee naturally healing itself (with or without assistance). There’s more to it, but you get the idea.
Another point to consider is the animal testing side of things. To the best of my knowledge, animals are largely unaffected by the placebo effect, and by law (in Europe and US), drugs are REQUIRED to be tested on animals before humans. (Let me reiterate that to anyone who is anti-animal testing: EU Law [can't remember which US body stipulates, probably FDA] stipulates this requirement, NOT the companies that perform the testing) Therefore, positive effects must be shown to a degree to justify the testing on a human subject and the regulatory bodies must also be satisfied with these findings too.
Humans are suggestible when in front of a GP/doctor. We are a society self-obsessed with self-diagnosis (everyone does it, no point denying) and doctors are in turn loathed to believe the symptoms, when someone has already decided on their ailment, to rattle off the listed symptoms like a script. It’s not exactly unfair to assume that a good proportion of mental (and physical for that matter) conditions perhaps don’t really exist and themselves, are all in the mind. Not to mention huge numbers of cases of depression going mis-diagnosed and resulting in bi-polar/mania disorders (which have quite high suicide rates, incidentally).
Regarding doctors prescribing placebos in place of real products, I would have to question this in the real world and outside of a control-group. Firstly, if you pay for your prescription and get beta-carotene, it’s technically fraudulent activity. Secondly, it’s totally unethical in every way, shape and form, however you look at it.
I could go on, but I don’t want to take over your blog, but I would happily continue the discussion another time!
To sum up, the article is certainly admirable. It does show that the brain is a powerful tool and can be quite deceiving to each and every one of us, but sadly for me, it lacks statistical and empirical evidence to convince me that it was researched in a sufficient manner, as it overlooks some already well-documented and studied research.
Jack
Nov 4, 2009
Oh and Sebastian – diabetes is indeed a pancreatic problem, but people lump Type I and Type II together incorrectly. It creates an overall poor understanding of the condition as a result.
Type I is what you see when people ‘shoot up’. The body doesn’t make enough insulin. [insulin deficiency]
Type II is where the insulin in the blood is not used correctly by the body (insulin allows glucose to be absorbed by cells). This type of diabetes means that people have too much glucose in their body, which is the far more common variant of diabetes. [insulin resistance]
Hezabelle
Nov 4, 2009
I wasn’t saying that diabetes was a brain thing. I was saying that depression is a disease, like diabetes, that people have to learn to live with and often CAN’T live without medication. It may be easier for you to understand that someone with diabetes is sick and it’s not their fault. But apparently someone will depression could miraculously be better if they wanted to be?
It doesn’t work that way.
carissajaded
Nov 4, 2009
Very interesting! I know placebos work. I am a slight hypochondriac, and if fear can actually make me sick, then I would think placebos could make me better….
But my question is, if the doctors start giving out placebos, is it fair for consumers to have to spend the same amount of money on them as real meds?
Hannah-Lane
Nov 4, 2009
I always thought the placebo effect was interesting. The mind is a tricky thing…and the power of suggestion is equally baffling to me.
on a related note: I used to watch A Baby Story on TLC all the time and it amazed me the women who “don’t believe” in things like morning sickness or giving into the pain of child birth. There was one on the other day about a woman who used hypnosis to have a relatively “painless” experience (until she had to have a c-section)…It’s really amazing what your mind can do in regards to pain.
I also wonder a lot about all natural remedies and holistics medicine. Do the natural remedies work because we believe they will or do they actually work? the connections of the mind to health certaintly are interesting!
sebastian
Nov 4, 2009
I’ll have to get you in to do some actual guest blogging, as opposed to ‘sub-blogging’ in the comments…!
I agree that it’s totally impossible to scientifically conclude anything from the story — I mean, it is just that, a story. Not a report, or ‘findings’. And it’s a fun story, an interesting story, a story that makes us think!
There are many, many variables that aren’t covered (and thus not cited). Apparently he was even fired for writing that (if you read the comments) — no idea if that’s true or not…!
But it’s good that the placebo effect is having attention drawn to it. For too long (I think) it’s been about trying to control our brain/nervous system, rather than help it along.
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Hez — not sure if I follow your logic. a) How do you know which people are really-diseased-depressed, and which are just… depressed? The thing is, we don’t understand the brain. We don’t really understand what causes most of our mental maladies.
We do understand what causes diabetes though, and thus we can medicate it.
I mean, before anti-depressants, would you be extolling the virtues of lobotomies?
Just because *A* solution exists, does it mean it’s the right one? Do medications such as anti-depressants ACTUALLY work, or is it entirely the placebo effect at work? That’s the point of this story — to make us think about that particular truth (or not).
Re: the ethicality of prescribing placebos. Good question. But people go to ‘gurus’ all the time for questionable healing, right? Should a medical doctor be any different? If a placebo is known to work for most problems of the nervous system… why should doctors not dispense it?
Holistic/natural remedies are coming under a lot of fire at the moment Hannah. I think we’ll be seeing a lot of info on these particular topics in the next few years. We’re finally starting to take more of an interest in the causes of problems, rather than just scatter-gun approaches of morphine and other psychoactive drugs.