Drugs: Sophisticated Placebos?

Pharmaceutical companies have been grappling with the placebo effect since the 1950s, when its surprising powers were discovered. As long as a patient is under the assumption that he or she is receiving a drug, a sugar pill or saline injection can alleviate illness and cure disease—sometimes, with close to the same level of efficacy as the actual drug. The science behind the placebo is shaky, and there are studies being conducted, but what seems to be of more concern to scientists is the placebo’s detriment to drug trials. Martin Enserink, in Science, discussed in his report on the placebo the recent failure of a new drug by Merck, MK-869, an antidepressant.

            When Merck reviewed the data from a clinical trial, it was found that the patients who had received the placebo had shown nearly the same level of improvement as those on the actual drug. The placebo effect wiped out the rationale for the new drug (Enserink). Placebo effects end some drug trials entirely and drive up costs for others because of the need to have more patient subjects. For psychological illnesses, such as depression, anxiety, and even pain, the response to placebos is incredibly high—typically, 35% of patients on a placebo show improvement, while 65% of patients taking the actual drug improve. Pharmaceutical companies see placebos as a plague, a reason for lost profits—placebos are “probably the most common reason for depression studies to fail” (Enserink). 

            Placebos are the menace of the pharmaceutical industry, but if their effect did not negatively affect sales and stock, science would be much more focused on the causes for the neurological and psychological effects placebos have. Some psychiatrists and psychologists even go so far as to challenge the scientific basis for antidepressants and other psychological drugs. Irving Kirsch, PhD of University of Connecticut leads the controversy.

            Kirsch’s argument is that antidepressants are little more than a placebo with side-effects. The impressive effect that placebos have suggests that it comprises a large part of the efficacy of antidepressants, and in 1998, Kirsch analyzed nineteen trials to prove his hypothesis. His study revealed that a placebo effect accounts for 75% of an antidepressant’s success in the treating depression (McManamay). The results stirred up tremendous controversy and debate, but Kirsch did not stop there; he then argued that the remaining 25% of the drug effect is probably just a “disguised placebo effect” (Enserink). It is easy for a patient to see through the double-blind procedure when he or she is given an inert placebo, as the real antidepressants all have side effects. If a patient notes the side effects, he or she can often be sure they received the actual drug, and will consequently exhibit greater improvement. Patients in the control group who do not note a side effect will not show as much improvement because they are not sure they received the drug.

            Many ethicists have questioned whether or not the use of a placebo control group in drug trials is ethical, because even though the patients who partake in the study are notified that they may receive a placebo, the drug may end up being more beneficial for their condition than the placebo. With such dramatic statistics that point to placebo’s effectiveness, however, placebo trials can’t be removed. Furthermore, trials should be done specifically to test and determine what causes the placebo effect, and how it can be used for maximum benefit in medicine.

            “The study of the placebo effect, at its core, is the study of how the context of beliefs and values shape brain processes related to perception and emotion and, ultimately, mental and physical health.” Neuroscientists studying the placebo effect have concluded that ‘subjective’ constructs such as expectation have a very distinct and identifiable physiological bases, which modulate even internal homeostatic processes. The placebo effect is a “psychobiological phenomenon,” and can have very dramatic physical and biological effects (Benedetti). For example, consuming a placebo believed to be an opiate can release endogenous opiods which will bond with the proper receptors and treat the pain. The same kind of effect could be seen in other conditions, there just isn’t the science to prove it—yet.

Works Cited

1) Enserink, Martin. "Can the Placebo be the Cure?" Science 284.5412 (1999): 238-240. Web. <www.sciencemag.org>.

2) McManamay, John. "Clinical Trials - What the Drug Companies Don't Report." McMan's Depression and Bipolar Web. 12 Feb 2008. McMan, Web. 10 Dec 2009. <http://www.mcmanweb.com/clinical_trials.html>.

3) Benedetti, Fabrizio, Helen S. Mayberg, Tor D. Wager, Christian S. Stohler, and John-Kar Zubieta. “Neurobiological Mechanisms of the Placebo Effect.” The Journal of Neuroscience 24.45.10390 (2005). Web. <http://www.jneurosci.org/cgi/content/full/25/45/10390>