from the here,-take-this-sugar-pill dept
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.
Filed Under: economics, healthcare, incentives, patents, pharma, placebo effect