Placebo: The next blockbuster?

An article in the Lancet advocates the use of placebos for active treatment, according to MedPage Today (Placebos Advocated as Active Treatments).

Finniss and colleagues reviewed the literature on the placebo effect, which suggests that it is far more complicated than many people think.

It is more than just taking a pill that patients think is, or could be, an active drug. The act of receiving a pill brings a whole “psychosocial context” into play, according to Finniss and colleagues: it includes not only the patient’s desires and expectations but also those of the clinician; their past experiences; and their interaction with each other and with their physical and social environment,” they wrote.

“The placebo is inert but the psychosocial context is not,” the researchers asserted.

The authors acknowledge potential ethical issues, but advocate the use of non-deceptive practices in prescribing and administering placebos.

Placebos can be helpful for treatment but they can also be harmful in new drug development. In particular, when people who respond to placebos participate as subjects, it can seem as though a drug isn’t effective when in fact it is. If drug companies can find ways to eliminate placebo responders from trials then the robustness of those trials will increase and more drugs will make it to market.

If those same companies are particularly clever, they’ll find ways to maximize the placebo response in the treatment arm while minimizing it in the control, thus making non-effective drugs seem to work. That may be hard to do in a double-blind study but I wouldn’t call it impossible.

February 22, 2010

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