The Placebo Effect: Things Pharma Prefers You Not Worry About

from the here,-take-this-sugar-pill dept

Thu, Sep 3rd 2009 10:10am — Mike Masnick

There's a fascinating article in the latest issue of Wired about the placebo effect and pharmaceutical companies. It's fascinating for a few reasons: First, because it shows the thought process of pharma firms and why "what's best for pharma" is often not what's best for your health (which is a line often trotted out by those who believe in protecting pharma). Second, because it suggests that some (potentially significant) parts of pharmaceutical science -- the stuff we hear over and over again is so important to protect via patents -- is bunk. And, finally, just because it may surprise you to know just how powerful the placebo effect appears to be -- and that it's only getting stronger.

The critical point is that final one. Basically, the placebo effect (the impact had on a patient taking a sugar pill under the false impression that it's medicine) seems to be quite real and, at times, quite powerful and lasting. Even more surprising is that, over time, the placebo effect has only become stronger and stronger.

Now, if pharmaceutical companies were actually interested in your health, then this would be a ripe area of study, well worth exploring to see if the placebo effect could be better understood and somehow harnessed to make people healthy. But, of course, you can't patent a sugar pill, so pharma research dollars have gone into drugs that can be patented.

However, a serious problem has arisen: with the placebo effect getting stronger and stronger, these "wonder drugs" that pharma has been spending millions of dollars "developing" have increasingly been failing clinical trials, because they can't out-perform placebos. The theory behind testing against placebos is that if a drug doesn't outperform the placebo, you have to question what good the actual drug is and why it should be approved. So, if a drug fails to outperform a placebo, then (the thinking goes) the drug is useless. But that's partly based on the idea that the effect of taking a placebo is weak.

This leaves out an important part of the equation: If the placebo is really effective in dealing with certain issues, then why not examine how to utilize that fact to make people healthy? Some in the pharma world have been pushing for this for a long time, and have repeatedly asked the big pharma companies to release their data on clinical trials, in order to better understand the impact of placebos and to see if there's a way to harness their power. But the pharma companies have resisted and don't want to release the data -- in part because they're scared to death of what this all means. If sugar pills are effective, that's a very different business, and the claims of all of the drugs that are on the market would be called into serious question. Instead, they've apparently spent their time writing out detailed marketing plans that convince doctors to prescribe medicine that doesn't work any better than alternatives.

Now, let's be quite clear here: I am not saying that drugs don't do any good. There are plenty of pharmaceuticals that certainly help deal with certain conditions, and there are plenty of people who lead better lives (or are alive at all) solely because of modern medicine. But, these findings about the placebo effect certainly suggest that -- at least in many cases -- rather than dumping chemicals into the human system via a pill, your brain may actually be a lot more effective at concocting the proper chemicals itself.

If we had a healthcare system built on incentives to actually keep people healthy -- rather than just to sell more pills -- this would be the beginning of a very important field of study. Instead, it's been resisted and the data has been hidden away for years.

The incentive system is clearly screwed up. It's based on patents and hoarding information, rather than on actually keeping people as healthy as possible. If you could craft a healthcare system that actually rewards those who keep patients healthy, then perhaps we'd actually know a lot more about the placebo effect and, beyond it, our own brains' ability to produce important, potentially life-saving or life-improving chemicals on its own. In fact, in such a system, the incentives would be less about hoarding information, and more about sharing it, since, through collaboration, it would be more likely that more people could be kept healthier, allowing greater overall profits. The problem today is that the system is based on incentives that are misaligned... and thus, it's a struggle to get anyone to care about the fact that the placebo effect actually seems to help some people.

Update: As pointed out in the comments, Skeptic Magazine recently had an article that provides some more thoughts on placebos.

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Filed Under: economics, healthcare, incentives, patents, pharma, placebo effect

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Thomas (profile), 3 Sep 2009 @ 10:13am

Pharma concern
Primary concern is making money, Next comes destroying any competition by whatever legal means they can come up with. Third is finding ways around government rules. Fourth is avoiding lawsuits. Fifth (or maybe lower) is healing people. Pharmacy companies are not in the business of helping people.
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TheStupidOne, 3 Sep 2009 @ 10:27am

Interesting
I think the good effects of placebos are based in the fact that if you think there is something wrong, there is going to be something wrong. Taking the placebo removes the expectation that things are wrong with you and so you body starts to recover.

As for why the placebo effect is getting stronger ... simple explanation is that society thinks we are getting sicker. We all see information about "super bugs", cancers, bioterrorism, toxic everything, and stories about cell phones giving you cancer in the news constantly. Society is feeding the idea that you are very likely to be seriously ill and the more you believe it the sicker you get.

http://en.wikipedia.org/wiki/Mass_hysteria

Of course not everything is in your head, and perhaps part of the placebo effect is that the expectation of healing reduces the stress on your body enabling your body to better fight the real disease

Side Note:
I hope everybody has seen that pfizer has been fined 2.4 Billion (with a B) for it's marketing of unapproved drugs and inappropriate kickbacks to doctors. Sad thing is that 2.4B probably won't even make them behave because they more than likely made more than that by ignoring the law.
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Mike Masnick (profile), 3 Sep 2009 @ 10:34am

Re: Pharma concern
Pharmacy companies are not in the business of helping people.

Indeed. Nor should they necessarily be in the business of healing people from the kindness of their hearts... but from a policy perspective the gov't often seems to act as if they are. And that's where the problems come in.
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ChurchHatesTucker (profile), 3 Sep 2009 @ 10:42am

Frak sugar pills
I'm going to patent High-Fructose Corn Syrup Pills.
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:Lobo Santo (profile), 3 Sep 2009 @ 10:49am

Re: Pharma concern
Hey, if you're not part of the solution; there's good money to be made in prolonging the problem.
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Chris (profile), 3 Sep 2009 @ 10:51am

Placebo getting stronger
I'd argue that the placebo effect has gotten "stronger" precisely *because* the drug companies are spending so much on r&d. Their increasingly visible, huge investments, combined with more prevalent and "amazing" drugs (like Viagra, etc.) has increased people's faith that the new, expensive drugs are more effective.

I think pharma may be shooting themselves in the foot by doing such a "good" job.
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Steve Silberman, 3 Sep 2009 @ 10:54am

Thanks
Thanks for such a thoughtful post on my article, Michael. I really appreciate it.

TheStupidOne, I suggest you read the piece. You're on an interesting track, but the issues in play are more subtle, involving everything from the definition of mental illness, to the cultural dynamics of clinical trials offshore, to the parts of the brain engaged by certain disorders, to the power of direct-to-consumer advertising. You might enjoy it.
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Mgoodfel, 3 Sep 2009 @ 11:11am

placebos aren't magic
The placebo effect is due to release of chemicals in the brain, as mentioned in the article. It's been ignored because we don't know how to make the brain release those chemicals other than by fooling people into thinking they've received an effective treatment.

At some point, perhaps we can control this release, or duplicate these chemicals and get a medicine that's effective regardless of what people believe.

It's not a reason to give up on the idea of drugs and just switch to meditation or something.
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ignorethispost, 3 Sep 2009 @ 11:12am

I wonder...
Has anyone ever made a killcebo? One that does harm? "hey Honey, have a vitamin... Remember that time you cheated on me?" Then you give em the "antidote" and as soon as they start to recover, tell em it was MORE killcebo.
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Jrosen (profile), 3 Sep 2009 @ 11:14am

Stupid double standards
First, is yes, pharma companies, really don't give much of a damn about actually HELPING people. But then that's old news.

Second, what I find funny, and usual double-standards, or just directed stupidity, is how prevalent placebos and such are, and yet, hypnotism (ie, guided suggestion) is pronounced false, dangerous, and so forth by those same doctors. Proscribing a placebo is literally a form of hypnosis, as it is nothing but suggestion that 'hey, this will help'
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John Doe, 3 Sep 2009 @ 11:17am

Much illness is mental...
The placebo works because much illness today is mental. No, I am not talking about mental illness. What I am saying is the illness is "in our head". Take fibromyalgia, I believe it is really depression. If they would treat the depression, they might actually cure people. Instead, they just create new painkillers. I think that the medical establishment knows this but there is no money in the cure.
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David (profile), 3 Sep 2009 @ 11:24am

Re: Frak sugar pills
I've found that they don't work as well as real sugar pills, though.
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New Mexico Mark, 3 Sep 2009 @ 11:25am

Placebo effect alternative theories
Thought provoking article!

Of course, you didn't even consider that maybe the quality of sugar pills has been improving through the years. It's just part of the ISO 9000 process.

Or maybe all the placebos for the next century were manufactured thirty years ago and like a fine wine they are just improving with age in some warehouse. I may put up a few bottles in the cellar myself just in case.
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David (profile), 3 Sep 2009 @ 11:28am

Re: I wonder...
There is a nocebo effect, which is a bad side effect to an otherwise inert dummy drug. Wikipedia: http://en.wikipedia.org/wiki/Nocebo
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Ryan, 3 Sep 2009 @ 11:29am

Re: Re: Pharma concern
Exactly. There's so many complaints about pharma and the like trying to make money as opposed to healing people, but that's just spinning your wheels. The problem lies in the fact that the system does not offer incentives that align healing people with making money.

So many markets are regulated on the obviously faulty assumption that if we can just get the right CEOs in the power, the right regulators doing oversight, the right politicians dictating terms, that the system will be fine. This will never happen, and it's pointless to blame individuals for specific failures when the problem is systemic.

True healthcare reform will come when monetary incentives require serving the consumers, and the government gets out of the market to allow for as much unrestricted competition as possible.
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ChurchHatesTucker (profile), 3 Sep 2009 @ 11:32am

Re: Re: Frak sugar pills
Dammit. We've got to ban the import of those Mexican Sugar Pills...
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BC, 3 Sep 2009 @ 11:32am

The Placebo Effect in Skeptic Magazine
The latest issue of Skeptic Magazine has an interesting article about the placebo effect. It's also available online- http://www.skeptic.com/eskeptic/09-05-20
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Nathania Johnson, 3 Sep 2009 @ 11:34am

I'm usually wary of "anti-pharma" talk, but this is one of the smartest pieces I've ever read on the matter.

The truth is that there is a strong body-mind connection. And it baffles me as to why insurance companies do not cover mental health benefits 100%. It would probably decrease their overall costs by a great margin!
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Yogi, 3 Sep 2009 @ 11:45am

Health care that works
I remember seeing a documentary about Chinese traditional doctors that used to work in the villages.

They got paid to keep people healthy - if one their healthy clients got sick - they wouldn't get paid.

It's really that simple.
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Chuck Norris' Enemy (deceased) (profile), 3 Sep 2009 @ 11:47am

Re:
It would probably decrease their overall costs by a great margin!
And their profit.
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Free Capitalist (profile), 3 Sep 2009 @ 11:48am

Re: placebos aren't magic
At some point, perhaps we can control this release, or duplicate these chemicals and get a medicine that's effective regardless of what people believe.

This is a curious proposition. I don't want to get all hippy-dippy, but the more I consider the placebo effect, the more I think our purely chemical approach to health is somewhat flawed.

At this point, I doubt that our simply reproducing chemicals and injecting them into a body will have a universally positive effect on any condition. For one the proportion of chemicals produced by the human brain and the quantity probably vary too much from individual to individual to even be correlated to a given disease with our current clinical methods.

These I'm guessing that in your case where the patient's *belief is is not buying into the potential for healing taking place, complete healing will likely never take place. If we could gague belief (and unfortunately, a Q&A form will not suffice), I would bet that patients who had at least *some belief, or hope (or faith) that they were receiving an effective remedy would show the most positive results in a clinical trial set up (other than the mythical belief gague) just the way we do things now.

Oddly, my doctor shares similar opinions on the healing *process. Forunately for me, he is also quite adept at chemistry.

Maybe it is a good time to take up meditation or yoga or something along with the regimine of anti-anxiety medications. Being receptive to (and having hope or faith for) healing does seem to correlate to healing in clinical studies (based only on circumstantial evidence only, however).
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PRMan, 3 Sep 2009 @ 11:50am

Re: Re: I wonder...
Ah, but sometimes this is intended and designed into the test.

When Monsanto Corporation was trying to get Nutrasweet approved, they put MSG into the placebo and then reported the same level of reports of harmful effects as the "placebo".

The problem is that Nutrasweet is very chemically similar to MSG and causes cross-effects in many of the same people.

So the "inert" placebo was anything but. It was carefully designed to hide the effects.

Then, after approving aspartame/Nutrasweet, all the FDA execs went to work at Monsanto for huge salaries.
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Josh (profile), 3 Sep 2009 @ 11:52am

Re: Placebo getting stronger
Agree.

You can't watch a show on standard primetime TV without being bombarded with 3 or more ads about the latest drugs that solve problems X, Y and Z. Magazines have a pharma ad every few pages (sometimes spanning multiple pages because they have so much fine print).

Tell people that they *NEED* this thing enough and they start thinking they do (even if they don't). It has worked for religions, governments, consumer goods, and anything else you can think of for millennia.
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ChrisB (profile), 3 Sep 2009 @ 11:58am

Unethical
The big problem with placebos is they require deception to work. Therefore, it is unethical for a doctor to prescribe them.
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Josh (profile), 3 Sep 2009 @ 12:05pm

Re: Stupid double standards
What you call a double-standard is not. Measuring the effectiveness of hypnosis is much more difficult than measuring the placebo effect. Placebo effects are most frequently measured in double-blind studies of other drugs where neither the doctors directly interacting with the patients nor the patients themselves know whether they are receiving the real drug or a placebo.

Hypnotism requires the patient to be aware they are being hypnotized and the doctor to actually perform it. Pretty difficult to do a real *double-blind* study of hypnosis when the patients and doctors both know who is being hypnotized.

Now, I do not doubt that hypnosis can be effective for some mental illnesses, just as deep relaxation and other stress relief methods are. But you just try setting up a real study with adequate control groups to measure it definitively.
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Anonymous Coward, 3 Sep 2009 @ 12:06pm

Re: Much illness is mental...
I am convinced that aspartame (aka Nutrasweet and Equal) are the source of many of the modern problems of chronic fatigue syndrome, fibromyalgia and morbid obesity, all conditions which are now common, usually among young women under the age of forty. We were the first generation to grow up with cans of Diet Coke sweetened with aspartame in our hands, and we're the ones exhibiting most of these bizarre health conditions.
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DS, 3 Sep 2009 @ 12:07pm

What?

So "Big Pharma", you know, the companies that actually have to do medical testing (which includes the chance of something being a placebo effect) is afraid?

Shouldn't this article be about the scammers out there who do not have any studies (or at least badly done ones) about their products? Say Homeopathic scammers, the Airborne crowd, or the Asian footpad sellers?

At least "Big Pharma" has empirical evidence to show a product works (or in what percentage of the population it should work), and not a schoolteacher who feels better after taking some fizzy vitamins.
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Jason (profile), 3 Sep 2009 @ 12:09pm

Re: Re: Frak sugar pills
Sure they do, just run some more tests, and you'll see that I'm right.
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Ryan, 3 Sep 2009 @ 12:14pm

Re: Unethical
Nobody here is suggesting that doctors just start prescribing sugar pills for all maladies, but to engage in research so that we might understand the effect and replicate it on demand.

Your statement seems pretty black-and-white, however. I want my doctor to hold my best interests at hand and keep me healthy to the best of his ability. I don't see why a white lie is inherently unethical. The Hippocratic Oath states:

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

Doesn't look like that precludes effective placebos to me...
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Dark Helmet (profile), 3 Sep 2009 @ 12:26pm

Re: Re: Much illness is mental...
"I am convinced that aspartame (aka Nutrasweet and Equal) are the source of many of the modern problems"

Ah, one of my favorite topics. But you forgot several chronic illnesses linked to aspartame as well, most notable being several forms of cancer and autism.
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Beta, 3 Sep 2009 @ 12:26pm

"...if a drug fails to outperform a placebo, then (the thinking goes) the drug is useless. But that's partly based on the idea that the effect of taking a placebo is weak.

I disagree. Strong or weak, the "placebo effect" gives power to both pills, not just the placebo. So if the drug can't do better than the sugar pill, which is cheaper, then it's useless.

I've heard of research on the placebo effect that shows that it works even if the subject knows it's a placebo. If that turns out to be true, then there's something more than faith involved. Maybe the body is conditioned to rally when it swallows a pill, or maybe it's something about receiving care from another human being...
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Anonymous Coward, 3 Sep 2009 @ 12:28pm

I love to see when ignorant people talk about the things they do not understand - makes an entertaining reading :)

If you believe tha placebo effect will heal you, use a sugar pill next time you have a hangover; don't touch that Tylenol!
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KeillRandor (profile), 3 Sep 2009 @ 12:31pm

Healthcare...
The biggest problem with making health care into an industry, (as the US has, and in so doing, has affected every other country), is that the best healthcare system is one that's NEVER USED.

In other words - having the best health care, and making a profit, are actually ideally incompatible.

With that in mind, along with the fact that health care HAS to treat everyone for lots of things equally - (since the minority can and WILL cause problems for the majority) - healthcare is actually one of the best systems designed for a socialist program - but only if it's done properly, and preferably from the ground up, without any interference - unfortunately, of course, such a scenario doesn't, and will probably never, exist.
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Dark Helmet (profile), 3 Sep 2009 @ 12:31pm

Re: Re: Re: Much illness is mental...
Additional aspartame information:

Martindales Pharmacopoeia tells you that aspartame 'is converted by hydrolysis into 3 products in the gastro-intestinal tract, aspartic acid, methanol (a poison) and phenylalanine, a chemical known to cause severe mental retardation known as phenylketonuria'.

As taken from www.medicalnewstoday.com

Thanks Donnie Rumsfeld and Searl! You guys are the best.

Btw, guess at what temperature aspartame breaks down into free methanol (poison), aspartic acid, and phenylalanine? 86 degrees.

Yay! It's in food and drink and our core body temp. is 98.6 degrees! Sweet(ener)!
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John Doe, 3 Sep 2009 @ 12:34pm

Re: Re: Re: Much illness is mental...
I knew I didn't like that stuff for a reason, besides taste that is. I am not a fan of man made substitutes for natural foods. I am a firm believer in all things in moderation. Stick with the natural stuff in moderation. On that note, ever notice that when people eat the fake stuff they eat a lot of it?
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Sean, 3 Sep 2009 @ 1:02pm

Re: Pharma concern
Is taking pills for the rest of your life a "cure"? No it is really just managing symptoms. Yes big pharma mostly cares about $$$$$$$.
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Sean, 3 Sep 2009 @ 1:06pm

Side Effects
Has anyone listened to the commercials from big pharma? Like an allergy pill with side effects like headache, runny nose, watery eyes, etc. Sometimes the side effects are worse than what it treats.

Then there is the doctors that you go to when you experience side effects from a medication and want to give you more medicine to combat the side effects rather than try a different medication.
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Ryan, 3 Sep 2009 @ 1:12pm

Re: Healthcare...
The biggest problem with making health care into an industry, (as the US has, and in so doing, has affected every other country), is that the best healthcare system is one that's NEVER USED.

In other words - having the best health care, and making a profit, are actually ideally incompatible.

Obviously, but if it were never used then there would be no need for health care providers. Unfortunately, it IS used...so for those of us that need to pay others to heal us, how do we ideally determine who gets our money? Why, those that provide the best value by giving the best long-term care at the cheapest cost. Sure, a company with no competition would be better served to provide worse care at higher cost, just as a television provider would be better off making quickly-broken televisions that cost $20,000 a pop. Why don't they? Competition.

With that in mind, along with the fact that health care HAS to treat everyone for lots of things equally

...why? There are a limited number of resources to go around, which are distributed in the same manner as anything else. Some people have more ability to pay than others, and everyone has different preferences for how they value quality-of-life and optimality of care.

One of the problems with socialist care is that there is no individual incentive for efficiency. All of a sudden, it costs more to provide the same level of health outcome -- it's like the tragedy of the commons. Another is that, like anything socialist, there's very little incentive for providers to innovate or otherwise invest in progress for the benefit of the public.

The biggest problem with the health care industry is that its cartelized. Thanks to government regulations, licenses, and restrictions(patents among them), it is not in the best interest of pharmaceutical companies, insurance providers, etc. to provide optimal value because there are no better ones to come along and steal their market share.
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haskins69 (profile), 3 Sep 2009 @ 1:47pm

Re: Re: Pharma concern
simply when medician started Dr. , drug makers , ect...
where there TO HELP , as a matter of fact dr. swear to only help and do no harm
it seems to me that if you make stuff you should make money
fair enough?
but also you should offer the best product .......period
not the one you make more on , but works less well
and that's what these drug companys do
its all about money , not health care as they portay them selfs
if it was about heath care they [drug companys] look for the best drug's , treatment , ect...they don't

I think we as a socity should call in all drug company records and have them looked over by indepndent researchers

if you do I'll bet you not only find its about money , but that you"ll find they have/or know of cures for most illnesses

but we'll never know because if its about just money then lets be honest..........there is NO MONEY IN CURES

the money is in treating and mantaining your illness or basicly.....sell you 1 pill , cure's you make a couple hundered or sell you a life time of pills for thousands and thousands of dollars never curing you just mantaining you so your still sick but feel better while taking the pill but get sick if you quit so you take their crap for life giving them a lifetime amount of money

and the best scam they run is this pill has these side effects so you gotta take this pill to.......forever

I don't trust drug companys or any politition thats protecting them............and will be voting against any that vote the way of big drugs come next election

same goes for those who stand up for the insurance company's
I'll vote them out

republicans are you listening....your 30 yr old jobs are at stake
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Dark Helmet (profile), 3 Sep 2009 @ 1:52pm

Re: Re: Re: Pharma concern
"there is NO MONEY IN CURES"

That's been true for a long time, but there is one possibility that has been brought about by genetic and pharma engineering that could make cures extremely profitable:

If you are continusouly creating diseases to be cured.
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Mike L, 3 Sep 2009 @ 2:41pm

RE: changing culture is very hard
Misaligned incentive system. Totally agree. How do you go from a culturallty-embeded incentive "system" of putting money ahead of all else to one that does not. Money is way too important in this culture and the culture reinforces it everywhere. This is a culture where insurance companies advertize and tell people to "never admit" you were at fault and this is seen as perfectly reasonable and acceptable by the populace. What about the fact that so many people who are in an accident will sue just because they can -- always for some cash. These are not "bad" people. They are our uncles, brothers, etc. Greed is not really human nature as we like to believe in this culture. Go to other cultures. Like all things, greed can be cultivated. Ecocentrism is human nature. And this is expressed differently in different cultures and people. This can be expressed as valuing "class," civilized behaviors, intelligence, philosophical depth, money/materials, etc.
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nasch (profile), 3 Sep 2009 @ 3:29pm

Re: Re: Re: I wonder...
Then that wasn't a nocebo, was it?
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nasch (profile), 3 Sep 2009 @ 3:32pm

Re: Re: Re: Re: Much illness is mental...
I am not a fan of man made substitutes for natural foods.

Except Funyuns, I assume. ;-)
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Ryan D, 3 Sep 2009 @ 4:02pm

Re: placebos aren't magic
Why do they have to "make" peoples brains release those chemicals, why not treat people with a fake pill for $5.00 instead of a pill that works less for $150.00?
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CrushU, 3 Sep 2009 @ 4:55pm

Re: Re: Stupid double standards
"Hypnotism requires the patient to be aware they are being hypnotized and the doctor to actually perform it. Pretty difficult to do a real *double-blind* study of hypnosis when the patients and doctors both know who is being hypnotized."

Just like for Acupuncture, the way you do a double-blind trial is simple: Have two groups of patients and practitioners. Have all the practitioners taught by the same actual acupuncturist/hypnotist, but one group taught the wrong way and one group taught the right way, telling both groups they're learning it the right way. Have the two groups of practitioners Practice (always amusing that doctors are just practicing... when will they actually perform?) on their groups of patients, and see if the Actual treatment does better.

BTW, my opinion is that acupuncture does SOMETHING beyond just the placebo effect. I recall seeing a study where they observed brain images while undergoing the acupuncture... The one I recalled was a point in the foot triggering a part of the brain related to sight. More amazing is that that was actually what the point was labelled as in the acupuncturist's technique.

It's also documented that the pressure points and the lines they lie along are electromagnetically special in the body. (Most points have a neutral field associated with them, and the lines correspond to the magnetic field lines our bodies have. Nerves use electricity, and electricity affects magnetic fields.)
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..., 3 Sep 2009 @ 6:22pm

and in related news
For all you out there that still think big pharma has your best interests in mind

Pfizer to pay record $2.3B penalty for drug promos

http://finance.yahoo.com/news/Pfizer-to-pay-record-23B-apf-1176280604.html?x=0
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Blamer, 3 Sep 2009 @ 6:23pm

PUNCHING ABOVE YOUR WEIGHT
"Placebo effect getting stronger and stronger"

So people are becoming increasingly convinced that medicine works.

That optimism seems justified to me. We're beyond VOODOO. The results of scientific progress are evident all around us. We see a PILL and we infer trials, statistics, and scientific rigor. It hooks in psychologically to the importance we place on REALITY and TRUTH.

"if a drug fails to outperform a placebo, then (the thinking goes) the drug is useless"

Not useless. Just no better than a placebo. And it turns out MR. PLACEBO IS A SUPER HEAVY-WEIGHT!

They're also sneaky. We're so highly influenced by subtleties that we need carefully designed DOUBLE-BLIND TRIALS to sort the tricks from the treatments. Witch-doctors use this phenomenon to their advantage and so do medical advertisements, which is MORALLY QUESTIONABLE at best.

"why not examine how to utilize that fact to make people healthy?"

ETHICS. Lying to people about the pills they're taking and charging them impressive amounts definitely works, however it flies in the face of reality and truth. The ends DOES NOT justify the means.
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nasch (profile), 3 Sep 2009 @ 8:06pm

Re: Side Effects
One thing to keep in mind is that if anyone reports any symptoms of anything during a trial, they have to report that as a side effect. So even if it had nothing to do with the drug, it goes into the warnings (if I understand correctly).
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Bizaro Anonymous Coward, 4 Sep 2009 @ 7:10am

Re:
Are you claiming to be an expert in the field ?
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Anonymous Coward, 4 Sep 2009 @ 7:11am

Re: Side Effects
My favorite side effect is "oily discharge"
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..., 4 Sep 2009 @ 7:14am

Could it be that
The methods of testing have changed over the years such that placebo seems to have become more potent ?
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Scote, 4 Sep 2009 @ 7:26am

"However, a serious problem has arisen: with the placebo effect getting stronger and stronger,

FALSE.

Don't get your medical advice from Wired.

"Frequent readers of skeptical and medical blogs will spot the first problem: the insanely nonsensical claim that "placebos are getting better". This not only "begs the question," but actually betrays a fundamental misapprehension of the concept."

http://scienceblogs.com/whitecoatunderground/2009/09/placebo_is_not_what_you_think.php

More more science based information on placebos, check

http://www.sciencebasedmedicine.org/?s=placebo
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Ryan, 4 Sep 2009 @ 8:24am

Re:
Scote,

Only that first link appears to be directly relevant, and the blogger there seems to misunderstand the placebo effect. He continually derides it as if supposedly the sugar itself is causing positive effects, which is not the effect at all. It is not the sugar in a placebo(or anything related to the placebo itself) that causes the body to fight back, but the brain's belief that it will.
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Scote, 4 Sep 2009 @ 9:20am

@Ryan,

If you think Science Based Medicine contributor Peter Lipson doesn't what placebo effect is then you have a problem. He never suggests, nor does he think, that "sugar" cases placebo effect and for you to suggest so indicates a profound misreading of his post, especially since it is incredibly simplistic of you to think that placebo effect is limited to placebo **pills**. The errors in your post confirm the commonality of severe misunderstandings about the nature of placebo effect in clinical testing.
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Anonymous Coward, 4 Sep 2009 @ 9:45am

Yeah, that would work well. Lie to the patients and tell them you are giving them a drug that will cure them, tell them its a brand new drug and really works.

How do you think the government will view that? If people know they are getting a placebo, it won't work.

Drug companies are in the business of making drugs. Why would you think anything other than that? They are a part of healthcare, but you seem to insist that they should spend money on other parts of healthcare.

Oh, and drug companies in all their advertising do in fact mention placebos. And when they report clinical trial data, they do in fact report the placebo information.
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Dark Helmet (profile), 4 Sep 2009 @ 10:13am

Re:
"Yeah, that would work well. Lie to the patients and tell them you are giving them a drug that will cure them, tell them its a brand new drug and really works."

Seriously? Are you in Healthcare? And do you know the history and current state of Healthcare in this country?

If not, I would encourage you read up both on how the Rockefeller family got its start (selling petroleum as a cancer cure, similar to what you stated above) and also how much of modern medicine, from education of doctors to pharma to insurance, is dominated by that family.

http://en.wikipedia.org/wiki/William_Avery_Rockefeller
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Mike Masnick (profile), 4 Sep 2009 @ 11:33am

Re:
Scote,

I think that the scienceblogs post is wrong -- though I do read that site on occassion and normally think it's great. He's read way too much into the Wired article and is pretending it say stuff it doesn't. No one is saying that the Placebo itself has an impact (which is what he seems up in arms about). But they're just saying it's worth figuring out *why* those who take a placebo do seem to do better in certain circumstances. Everyone agrees that a placebo, by itself, does nothing. The Wired article is just pointing out that it would be worth finding out why.
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Scote, 4 Sep 2009 @ 12:12pm

I think you are right that the article explores the effect of placebos and has some interesting details, but it also reported "It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger." Which is what PalMD specifically takes issue with.

And the article is also somewhat wrong to say "The roots of the placebo problem can be traced to a lie told by an Army nurse during World War II as Allied forces stormed the beaches of southern Italy." Perhaps the "problem" can be traced to that incident but placebo treatments have been used as long as people have been trying to heal others. Any drug or treatment that has no efficacy greater than a placebo is a placebo--which 2.5 billion dollars spent at the NIH has shown so called "Alternative Medicine" to be.

So what can be said is that the placebo effect, the differential between a placebo treatment and an actual treatment with a pharmacological effect, was discovered in WWII, but placebo treatments date back thousands of years.

Also, placebo effect isn't just a sugar pill, water injection, sham acupuncture vs. experimental treatment, placebo effect is the sum of all things that are different from the control group and treatment group (hopefully as identical as possible), differences that are often hard to pin down 100%, which is why we have control groups.

The blog sciencebasedmedicine.org frequently comments on the complex issue of placebo effect, including the fact that all or almost all "alternative medicine" is nothing more than placebo medicine doled out by practitioners who don't know that fact to patients who don't know that fact:

http://www.sciencebasedmedicine.org/?p=672
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Gene Cavanaugh, 4 Sep 2009 @ 1:43pm

Pharma and placebo effect
Right on, Mike!
There is another thing - all medicines are poisons, and the effect is hopefully to poison a foreign agent, such as bacteria, more than it poisons healthy tissue (there is a major effort right now to use nanotubes to deliver medicines more accurately to limit the damage to healthy tissue).
So, over a long term, medicines will harm or even kill you - the sulfa drugs I was given to prevent infection killed the beneficial bacteria in my gut - I still haven't fully recovered!
The placebo effect, exercise, healthy diet - not poisons!
Sounds like a good thing, to me!
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Erin M, 4 Sep 2009 @ 4:31pm

I've been chirping the same line since I first found out about the placebo effect. "why isn't this a bigger deal?" There are serious kidney conditions, for example, where placebos out perform drugs and have enduring effects improving health.

This is an excellent example of how profit motive can come into conflict with the public good in serious ways. Because those potent drugs have not only hefty price tags, but generally have side effects that sometimes necessitate a whole new series of drugs to counter.
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loud (profile), 6 Sep 2009 @ 5:35pm

Re: Re: Re: Re: Much illness is mental...
I gotta say, DH, I usually like reading your comments, but your conspiracy side...not so much.

aspartame 'is converted by hydrolysis into 3 products in the gastro-intestinal tract

This is true, however:

Phenylalanine is an essential amino acid (which means it is not produced by the human body and required to be consumed in your diet)...other sources of this terrible chemical: asparagus, chicken, beef, walnuts, cottage cheese, eggs, fish, hummus, meats, milk, soybeans.

Aspartic acid is a non-essential amino acid (which means that the body is able to make its own supply). It is also found in dairy, beef and poultry.

Now, methanol...I'll give you that one, as it is a poison. However, the big debate is how much are you getting from aspartame vs. how much you are getting from other sources. It is the real debate...I will say this: read this article with an open mind: http://recipes.howstuffworks.com/question536.htm I am not going to debate the methanol aspect of aspartame here. If you are going to scare monger against aspartame, you should do it concerning the methanol aspect, because it is the most debatable

And where did you get the retardation thing...seriously? Phenylketonuria is a genetic disorder that's been around way longer than aspartame. And the mental retardation comes from people with phenylketonuria being unable to break down phenylalanine, whether they get it from aspartame or any of the other sources. Aspartame did not cause phenylketonuria. The "Phenylketonurics - contains phenylalanine" warning you see on diet soda cans is a warning specifically to phenylketonurics that the products contains phenylalanine. It is not a warning of the ill effect of aspartame for normal people like you and me.

end rant
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John85851 (profile), 7 Sep 2009 @ 3:10pm

Two things
First: sure Pfizer was fined billions of dollars, but is this really punishment or a "cost of doing business"?

Second, I heard somewhere that some pharma companies were basically making up "diseases" to fit whatever drug they came up with:

Scientist: This drug was supposed to treat headaches, but it only gets the blood flowing in the arms.
Marketing person: Perfect! We'll invent a new disease called No Blood In Your Arms Syndrome or NBIYAS and tell people they should take this pill.

At the risk of offending "sufferers", is "restless leg syndrome" really a "disease" or is it just another description for poor blood circulation?
And is fibromyalgia really a disease? (A lot of people say it's not.) Or is it a way to get your doctor to treat a physical "disease" rather than what it really is: depression, which is a mental illness, which many people think is a scary term.

I'm still waiting for the makers of No-Doze to start running commercials that say "Do you fall asleep at night? Are you tired at 1:00am? If so, you probably have night-time sleepiness syndrome or NTTSS. Take No-Doze to help cure this disease."
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mrmacfoo, 17 Sep 2009 @ 9:48am

Einstein took the two words we humans invented "space" and "time". He said "balls! there isn't one without the other!" he gave us the idea of spacetime. In our everyday language we still haven't caught up yet, we take space and time as separate in most situations because its easy for us.

Humans have also invented the two words "mind" and "body". The placebo effect arises from the fact that the mind and the body are only separated by our language, not by nature.

while you cant cure aids with placebo but taking a pill and getting care from a doctor when you are depressed will of course make you feel better.

As far as the Big Pharma companies go, in order to have survived so far, they have to make money and stop other dudes from making more. its natural evolution. in order to change how they do this we have to change their environment. I like the 'chinese healer who doesn't get paid if his patient gets sick' model.
Problem is every government is sponsored by these companies, they employ millions of people and are really successful at what they do, be that bribing/persuading doctors to sell their products or pouring money into research to develop a new anti-retroviral drug...this is how they have become so successful and they dont want to change the game...
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Axle, 4 Nov 2009 @ 6:59am

Re: Placebo getting stronger
I think you confuse R&D with advertising.
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