Sunday, September 06, 2009

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

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.
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. THe placebo effect 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:

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?


Big mystery: Why you feel sick when doctors tell you you are

Of New Scientist's Michael Brooks's 13 things that don't make sense, the thirteenth was the nocebo effect (02 September 2009).

In Latin, "nocebo" means "I will harm." It is the opposite of "placebo" which means "I will please." Practically, just as placebo means that the patient gets better because he has been told he will, nocebo means that a patient gets worse precisely because medics have predicted pain, debility, or death.

It was easy to dismiss accounts of voodoo death, but Brooks recounts the following case:
In the 1970s, for example, doctors diagnosed a man with end-stage liver cancer, and told him he had just a few months to live. Though the patient died in the predicted time, an autopsy showed the doctors had been mistaken. There was a tiny tumour, but it had not spread. It seemed the doctors' prognosis had been a death curse.
I am not clear why that doesn't make sense. A person who is informed by a credible source that he will die could surely have a heart attack or allow a chronic condition to overtake him. The placebo effect works very well indeed, so we should expect its evil twin to do likewise.

It is only a b ig mystery if you think that the mind is an illusion generated by the dance of neurons in the brain and has no causal power. Otherwise, the sense of mystery is completely absent.

Interestingly, the Criminal Code of Canada says two relevant things: After denying that deaths supposedly caused by “the influence of the mind alone” (= witchcraft, the "evil eye", etc.) are culpable homicide, the Code nonetheless adds this rider: “This section does not apply where a person causes the death of a child or sick person by willfully frightening him” (sec. 228). Now, the doctors mentioned in Brooks's account are not in the dock for this, because they honestly believed what they told that man. But should they have told him the news in that way?

I once interviewed a radiologist whose key job was "bad news from radiology." I asked her how she coped. She said, basically, my patients are usually in considerable pain and have been sick for a long time, and they know something is very wrong. Her method was, before telling them the results, to set up a further treatment plan. The plan usually amounted to palliative care. But, she said, they are never left alone, never abandoned. She seemed a wise lady to me.

And I think that, with her approach, if a patient's diagnosis turns out to be wrong, he won't deteriorate rapidly or die any time soon, so a new diagnosis will be sought. And the nocebo effect will be out looking for a job.

More on the nocebo effect at The Mindful Hack:

Evolutionary psychology: Misunderstanding superstition

Commentator Dinesh D'Souza on The Spiritual Brain: Including stuff he didn't know (No way is that his fault. The medical and parmaceutical community finds all these topics very difficult, and they discuss them only reluctantly.)

Prayer studies: From one-way skepticism, deliver us

Faith as one ofthe healing arts