Take a few pills and fake it

An excellent article in Wired article points out a rather complicated trend: Placebo effects seem to be increasing. Placebo effect vary with location of trial, observers, and involvement: Pain killers work less well for Alzheimer patients because they can’t anticipate the treatment and mobilize their dopamine, for instance.

In other words, the placebo effect is real, physical and not self-delusion. If that is the case, it can be used in hybrid healing strategies. All well and good – so why is it rising? One reason may be the geographic expansion of trials:

The contractors that manage trials for Big Pharma have moved aggressively into Africa, India, China, and the former Soviet Union. In these places, however, cultural dynamics can boost the placebo response in other ways. Doctors in these countries are paid to fill up trial rosters quickly, which may motivate them to recruit patients with milder forms of illness that yield more readily to placebo treatment. Furthermore, a patient’s hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America," says psychiatrist Arif Khan, principal investigator in hundreds of trials for companies like Pfizer and Bristol-Myers Squibb. "It’s basically luxury care."

Another reason – which I think is a challenge to pharma in general – is that we are beginning to exhaust the one-factor solution maladies. Most illnesses with clear symptoms and known causes are now fixed, and what remains are those that are complicated, either because the symptoms are the same as many other things, or because they are caused by interactions between many factors and it is very difficult to establish causality. (Much like, in the airline industry, plane crashes tend to be caused by complicated, multi-factor coincidences rather than banal errors, which have largely disappeared.)

The answer lies in better control of experiments (e.g., drug administration without the patient knowing it) and in massive and collaborative data analysis, as the industry now seems to be moving towards. And, perhaps, in the recognition that health care provision is an exercise not only in having the requisite tools and techniques, but also knowing how to combine them so that the sum is bigger than the parts.

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