The unpredictability of the human brain is beating Big Pharma like a drum. If you didn’t see it, let me recite a recent headline for you to provide some context: Next generation antidepressants are failing to beat the placebo effect in 7 out of 10 trials.
How can this be happening? For decades we’ve been led to believe that pharmaceutical companies and their fortunes are well ahead of the bio curve, not three steps behind it. But now we’re finding out that’s never really been true, at least not when it comes to mind meds.
More than ten years ago, the American Psychological Association announced that as much as 50% of improvement experienced by patients taking anti-depressants can be attributed to the placebo effect (based on a study of 3200 depressed subjects). You might consider that big news, but it never really got its due, possibly because the percentage of people using antidepressants at the time was still short of enormous. Between then and now more studies have shown essentially the same thing — except the placebo effect in these studies is becoming ever more pronounced. This 2008 study, for example, blew the lid off the Zoloft bottle by claiming that antidepressants as a class can’t pass the placebo laugh test.
Last month, Wired ran a tremendous piece of reporting, The Pill that Cures Almost Anything, that chronicles the increasingly intense battle between Big Pharma and our brains. In it we learn that the placebo effect was first identified during WWII when a nurse and doctor accidentally gave a wounded soldier on the brink of shock a shot of saline instead of morphine — mysteriously, his pain was relieved and shock averted.
That doctor, Henry Beecher, also happened to be a professor at Harvard, and after the war he returned to Cambridge to follow up on the strange effect he’d stumbled upon. His work triggered a crusade to change testing methods for new drugs, and by 1962 Congress amended the Food, Drug, and Cosmetic Act to include placebo trials for all drugs pending approval.
Turn the page to 2009, and Big Pharma is in a tizzy. Not only are new generation antidepressants failing to beat sugar pills in clinical trials, but old standards like Prozac are nosediving as well. At least part of the reason seems to be that the placebo effect is not one size fits all. Cultural differences, geography, age, and any number of demographic distinctions alter how one or another group reacts to placebos versus drugs. From the Wired article:
New findings tell us that the body’s response to certain types of medication is in constant flux, affected by expectations of treatment, conditioning, beliefs, and social cues.
The bigger reason, however, could be linked to the explosion in antidepressant advertising of the last 10 or so years. When the FDA liberalized its policy on pharmaceutical advertising in 1997, Big Pharma injected billions into the advertising industry to create appealing come ons for mind drugs — and it worked. All of that advertising–telling people that they’ll be happier, lead fuller lives, appreciate their families more–has created a mass-scale expectation of medical mind relief. Uplifting associations correlate strongly with placebo response, and that’s exactly what Big Pharma’s advertising dollars bought.
If that’s true — what irony. It’s altogether possible that the strengthening placebo effect is the result of unprecedented spending to convince people to take more drugs.
Does that necessarily have to leave us with a cynical takeaway, that we’ve been duped and mind meds are useless? Not at all. Many, many people do genuinely benefit from taking antidepressants and similar meds–for some of them the placebo effect may even provide a value-added boost. Criticism aimed at the mass marketing methods of Big Pharma shouldn’t overshadow the fact that a lot of people are feeling better on meds than they ever did before, and doubtless many lives have been saved.
We can find an even more encouraging note to end this on, namely: understanding more about how the placebo effect works may provide insight into how the brain heals itself, and that could revolutionize medicine. Quoting again from the Wired piece:
Ironically, Big Pharma’s attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn’t care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better.