Tuesday, March 09, 2010
Via Amit Ghate is an interesting article about a burgeoning area of research that recent problems experienced by the pharmaceutical industry during drug trials have invigorated: Placebo effects have been growing stronger lately, sinking several candidate drugs and even calling into question the effectiveness of established drugs upon reevaluation.
What might be the basis of the placebo/nocebo effect, and how might we take advantage of it?
Further research by [Fabrizio] Benedetti [of the University of Turin] and others showed that the promise of treatment activates areas of the brain involved in weighing the significance of events and the seriousness of threats. "If a fire alarm goes off and you see smoke, you know something bad is going to happen and you get ready to escape," explains Tor Wager, a neuroscientist at Columbia University. "Expectations about pain and pain relief work in a similar way. Placebo treatments tap into this system and orchestrate the responses in your brain and body accordingly."This research is, of course, in addition to making obviously-needed improvements in the clinical trials themselves.
[O]ne way that [a] placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us--such as the tone a doctor uses to deliver a diagnosis--to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual.
Benedetti has helped design a protocol for minimizing volunteers' expectations that he calls "open/hidden." In standard trials, the act of taking a pill or receiving an injection activates the placebo response. In open/hidden trials, drugs and placebos are given to some test subjects in the usual way and to others at random intervals through an IV line controlled by a concealed computer. Drugs that work only when the patient knows they're being administered are placebos themselves.It is interesting how the concept of "placebo" is evolving over time with added knowledge of how the body and mind work and interact. From first denoting a class of sham or merely palliative remedies, to a presumably ineffective stand-in for a real drug, and now perhaps to more of a type of psychological or psychosomatic effect.
P.S. Statistician Nick Barrowman views the idea of a placebo effect with a much-needed jaundiced eye.
Today: Corrected a spelling error.
10-5-11: Added PS.