The Placebo Gets Stronger

The sugar pill is putting the drug industry in turmoil.

Double-blind study with randomized placebo-controls is the medical gold standard. The FDA won’t put its stamp of approval on a new drug unless the medication has beaten sugar pills in at least two legitimate trials.

But about half of the medications that fail to make it through late-stage trials are losing out to placebos. Even drugs that have been around for years, are failing follow-up tests (one of them is Prozac). Researchers say the problem is not weak medicines but the placebo effect itself. It’s growing stronger.

There’s now a massive effort underway to figure out it’s happening called the Placebo Response Drug Trials Survey.

We already know that the placebo response is related to cultural differences. William Potter of Lilly's neuroscience labs discovered he could predict whether a drug would pass or not based simply on the location of the study. A decade ago, Prozac worked fine in the US but Valium failed. The reverse was true in Europe. The greater the expectation of effectiveness by the patient, the more powerful the placebo’s effect. In countries where volunteers do not have access to the quality of care given during a drug trial, the more likely they are to respond positively to the luxury care coming from American researchers.

Although the most significant ingredient in any placebo is the doctor's bedside manner, even the color of a tablet can boost effectiveness and help to convince a patient that a placebo is really a potent remedy. Doctors have found that calming blue capsules make more effective tranquilizers than fiery red ones.

In each of these cases, the placebo aids recovery by touching the mind's desire and ability to predict the future. We are constantly parsing the reactions of those around to gauge a more accurate estimations of our fate. A doctor’s tone of voice while delivering a diagnosis or the reaction of someone else to the very same medication we ourselves are taking.

Stephen Goforth