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Placebo response growing over time - but only in America

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What effect? (Score: 1)

by fishybell@pipedot.org on 2015-10-27 18:46 (#RSHX)

"The data suggest that longer and larger trials are associated with bigger placebo responses,"
So, really it's not about a greater placebo effect in the US, but longer trials that change the placebo response. This isn't surprising considering how many drugs take several weeks to have any effect at all. The subject assumes that the drug is working better the longer they are on it, regardless of if its a placebo or not. This should not make it "harder for pharmaceutical companies to prove that the drug being tested is more effective than treatment with a placebo" as suggested in the summary, but the normal response to a longer trial.

The FDA's standards for response above placebo are very, very low. They are already looking into changing the rules to exclude drugs that solve the same problem that aren't just "above placebo," but "above what's available." (google "fda comparative effectiveness"). It should be harder to make new drugs that solve the same problem as existing ones: if it's not better, why should people have to pay higher prices for it (new drugs get new patents)?

Re: What effect? (Score: 1)

by evilviper@pipedot.org on 2015-10-28 10:01 (#RVJ9)

So, really it's not about a greater placebo effect in the US, but longer trials that change the placebo response.
No, it definitely IS about the placebo effect. Longer trials are only one of several possible explanations as to why the effect is significant in the US. An alternative theory as to the cause is the "direct-to-consumer advertising for drugs - allowed only in the United States and New Zealand".

A third option is that this study may simply be wrong: "I don't think that controlling the placebo response will increase the number of successful trials. What drug companies have to do is to find more effective drugs." -Fabrizio Benedetti, who studies placebo responses at the University of Turin, Italy.

http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511
The FDA's standards for response above placebo are very, very low.
"more than 90% of potential drugs for treatment of neuropathic and cancer pain have failed at advanced phases of clinical trials"
It should be harder to make new drugs that solve the same problem as existing ones: if it's not better, why should people have to pay higher prices for it (new drugs get new patents)?
While new drugs get new patents, the old drugs remain just as cheap. If you don't have a good reason to use the newer one... don't!

But new drugs are still important. Some people have bad reactions to components of certain drugs, but do fine with others. Different drugs have different side effects. The effectiveness of new drug may be significantly better than the existing drug on specific stages of illness (e.g. diagnosis too late-stage for the cheaper medication to be effective). Of all the problems that exist in pharmaceuticals, too-many good & effective drugs isn't one of significant concern.

History

2015-10-28 10:01
N
So, really it's not about a greater placebo effect in the US, but longer trials that change the placebo response.
No, it definitely IS about the placebo effect. Longer trials are only one of several possible explanations as to why the effect is significant in the US. An alternative theory as to the cause is the "direct-to-consumer advertising for drugs —- allowed only in the United States and New Zealand".

A third option is that this study may simply be wrong: "I don’'t think that controlling the placebo response will increase the number of successful trials. What drug companies have to do is to find more effective drugs." -Fabrizio Benedetti, who studies placebo responses at the University of Turin, Italy.

http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511
The FDA's standards for response above placebo are very, very low.
"more than 90% of potential drugs for treatment of neuropathic and cancer pain have failed at advanced phases of clinical trials"
It should be harder to make new drugs that solve the same problem as existing ones: if it's not better, why should people have to pay higher prices for it (new drugs get new patents)?
While new drugs get new patents, the old drugs remain just as cheap. If you don't have a good reason to use the newer one... don't!

But new drugs are still important. Some people have bad reactions to components of certain drugs, but do fine with others. Different drugs have different side effects. The effectiveness of new drug may be significantly better than the existing drug on specific stages of illness (e.g. diagnosis too late-stage for the cheaper medication to be effective). Of all the problems that exist in pharmaceuticals, too-many good & effective drugs isn't one of significant concern.

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