34 comments on “The Rising Placebo Effect&rdquo

1) If you think it works, and it doesn’t matter what the data say, what was the point of the trials?

2) If not working better than placebo is success, then why use something expensive that works no better than placebo? Why not use something cheap? Of course, someone else might think differently (http://www. theonion. com/article/fda-approves-sale-of-prescription-placebo-1606 ).

I’d actually love to try this. My daughter has been having mild stomach aches for a couple months. Doctors think it’s diet related. Wife thinks its Gluten (because… you know… Gluten).

I’d love to have a little placebo pill I could give her “from the doctor”. It would be worth it if it “cures” what I already think is largely in her head.

Some cruel and heartless person will propose that this is evidence that Americans are uniquely hysterical and suggestible. Whereas a cooler inspection suggests only that they are becoming increasingly hysterical and suggestible, which is a plain different thing.

Is there any chance that regression to the mean plays a role? ie, patients tend to enroll in trials when their pain is at its worst (and thus likely to get better)? Or have trials been done comparing placebo to “no intervention”?

Morten G says:

Oh, me me! I have theories galore.

1) Prescription strength painkillers are much more easily available in the US than Europe/Asia. And the people in the placebo group are likely to go take some. Patients lie.

This hypothesis is of course shot down if the clinical trial includes blood tests to ensure that the patients don’t take any other painkillers.

2) US Americans are better entertainers and more charismatic. The US school system includes a bunch of show-and-tell and debate teams and it’s generally in the culture to charm people. The US doctors might just be better at convincing the patients that the placebo is going to work.

3) European / Asian doctors might be better at explaining that while the patient enrols in a trial for an experimental drug, there is a good likelihood that the patient does not receive any of the drug. Or US American patients might have a harder time wrapping their heads around the concept.

Remedies:

Test patients for drugs and medications that might interfere with the outcome.

Perform double-blind head-to-head trials instead of placebo controlled.

Recruit patients on the autism spectrum since they lie less.

Crossover trials so that all patients are both on placebo (or the competition to beat) and the experimental drug.

And it is not completely dumb that a strong placebo effect obscures efficacy. If you get 100% response in both placebo and intervention group then you can’t say if the drug did anything or not. Doesn’t mean that it should be approved. If anything the placebo should be. If you still believe in the drug then you should redesign, resubmit, and redo the trial.

DCRogers says:

Maybe it’s because American doctors *underprescribe* placebos?

“Half of all German doctors prescribe placebos, new study shows”

anonymous says:

Ariely figured this out a long time ago, in a controlled study. The phenomenon is not limited to medicines, though it was demonstrated in a study using pain meds.

Perhaps the driving force for efficacy here is that we have trained our society to expect that new drugs will be astronomically expensive.