A fascinating article from Wired magazine (http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect) addresses the curious problem that the placebo effect seems to be increasing in clinical trials and has torpedoed the launch of several new medications. Any new drug coming to market needs to demonstrate significant efficacy compared to a “dummy” pill, or placebo. Recently new “blockbuster” medications ranging from anti-depressants, to Parkinson medications, to medications for Crohn’s disease have been shown to be effective, but not as effective as placebo, so have had to be pulled. Even Prozac, the work horse of mood enhancers, has not shown effectiveness compared to placebo in recent clinical studies.
The NIH and Big Pharma alike are (finally) looking into the science of placebos, though Big Pharma is reluctant to pay for the studies (natch.)
“Ironically, Big Pharma’s attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. 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.”
I actually had the opportunity to speak to the author of this article on a recent radio call-in talk show to discuss how the keen attention paid to placebo effect in acupuncture research is glaringly absent from surgery research. Surgeries are often compared to other surgeries or conservative treatment, but rarely are “sham” surgeries performed. see posts http://ksparrowmd.blogspot.com/2009/08/another-popular-back-procedure-found-to.html and http://ksparrowmd.blogspot.com/2009/04/believing-in-treatments-that-dont-work.html
He reminded me of the open heart procedure called Mammary Artery Ligation which had finally been debunked. But that is one of very few surgical procedures that have been subjected to any sort of even handed scrutiny. I would add that open heart surgery has to be one of the most powerful, ritualistic procedures performed in medicine and must have extremely powerful placebo properties.
My interest in this topic is because of my involvement in acupuncture research, but I also am interested in therapies that don’t fit the medical model and are therefore unexplained. The Western Medical Model is phenomenally valuable, but it does have its limits and there is a tyranny of the mechanistically rational when it comes to alternatives. I also think that the placebo effect is the ultimate testament to the power of “mind-body” medicine. I think it is high time that it should be studied and hopefully harnessed, not ridiculed.
I, personally, have no interest in handing out placebos for a living, but studying what is happening physiologically interests me no end.
I happened on another article from Wired about the effectivenes of sham acupuncture for back pain. http://www.wired.com/wiredscience/2007/09/for-back-pain-e/ Even sham acupuncture worked better than physical therapy or medications, as the NHS in Britain is now acting on.