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Are Placebos Really Sugar Pills?

asserttrue.blogspot.com

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Re: Are Placebos Really Sugar Pills?

#21

Post by abtinf »

Having worked in the pharma industry, this article is complete bullshit.

For double and triple blind (the third blind comes from not even the pharma company knowing the blinding details until after the trial) placebo design is an extraordinarily complex undertaking. A placebo must match the drug in physical appearance, taste, texture, density, state (liquid/solid/gas), and anticipated side effects. Any material difference in any of these categories renders the trial completely and totally meaningless, because at a minimum it unblinds the doctors on the ground.

Pointing out a few random oversights out of the thousands of clinical trials that occur every year is not proof of evil on the part of pharma; it is a testament to the care that goes into their design. It represents a defect rate virtually unmatched in any other industry.

But sure, go ahead and advocate irresponsible alarmism over a non-issue, as if though drug trials aren't already expensive enough, retarding scientific progress and costing millions of lives from drugs that would have been otherwise developed.

Re: Are Placebos Really Sugar Pills?

#22

Post by joshuacc »

wiredfool wrote: post #15
newishuser wrote: post #4

What this article leads me to think is that we need to legally protect the word placebo. It seems grossly misleading to use the word placebo to describe non biologically inert ingredients. To do so is to lie and nothing more.

Just look for homeopathic remedies then. Guaranteed not to have any active ingredients.

That's not strictly true. Homeopathic remedies do often include small amounts of alcohol or sugar.

Re: Are Placebos Really Sugar Pills?

#23

Post by pygy_ »

cooldeal wrote: post #3

Aren't the side effects mimicked so that participants won't see the lack of them and then know that they're taking the placebo which will defeat the double blind study? For example, if you're testing fish oil, you wouldn't use a sugar pill since it's easy to know what you're taking by looking at it. You would use something like olive oil.

Indeed. It is well known that SSRIs studies were biased because of this, because SSRIs have a lot of early side effects, which break the blinding. Knowing that you're in the treatment branch increases the placebo effect.

That being said, the opacity of the manufacture process is concerning.

Studies with active placebos should have a third branch with inert placebos, to assess the incidence of side effects.

Re: Are Placebos Really Sugar Pills?

#24

Post by refurb »

This seems like a ridiculous blog post.

Only 6% of clinical studies list what their placebo was, so the conclusion from that is that there is a concerted effort by drug companies to unscrupulously modified the outcomes of their studies by choosing biologically active placebos. That's a bit of a stretch.

Typically what is done for a study is that drug company will manufacture the drug for the study in tablet form, complete with fillers and binders (inert ingredients used to make the pill). Then they will manufacture the same tablet without the active ingredient. The drug has to be identical in shape and color or else the study isn't really blinded, physicians could tell that patients were getting two different drug. That's the reason why drug companies make their own placebos.

Also, the example of using olive oil instead of clofibrate has two possible explanations: 1) clofibrate is soluble in olive oil so they likely gave one set of patients clofibrate +olive oil and the other just olive oil (negating the effect of olive oil) OR the study was just poorly done (yes it happens) and it would be obviously to anyone familiar with clinical trials (including the people at the FDA).

I could go on, but it doesn't really seem necessary. The article speaks for itself.

Re: Are Placebos Really Sugar Pills?

#25

Post by trotsky »

Florin_Andrei wrote: post #6
acchow wrote: post #2

As an aside, sugars aren't biologically inert either.

So, is there anything that could be said to be biologically inert in any and every scenario?

A quote from the press release about the paper the OP cites:

But, according to the paper's author, Beatrice Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego School of Medicine, this standard has a fundamental problem, "there isn't anything actually known to be physiologically inert."

http://www.sciencedaily.com/releases/2010/10/101018174335.ht...

Re: Are Placebos Really Sugar Pills?

#26

Post by pleiotrope »

cooldeal wrote: post #3

Aren't the side effects mimicked so that participants won't see the lack of them and then know that they're taking the placebo which will defeat the double blind study? For example, if you're testing fish oil, you wouldn't use a sugar pill since it's easy to know what you're taking by looking at it. You would use something like olive oil.

I think you're correct. The example given in the linked article mentions dry mouth, but it's arguably important in double-blind studies to have both the controls and test groups develop similar side effects, to prevent both the patient and the administering physician from determining which is the placebo group. I don't think it's entirely due to nefarious motives from the drug company.

Re: Are Placebos Really Sugar Pills?

#27

Post by CodeMage »

abtinf wrote: post #21

Having worked in the pharma industry, this article is complete bullshit. For double and triple blind (the third blind comes from not even the pharma company knowing the blinding details until after the trial) placebo design is an extraordinarily complex undertaking. A placebo must match the drug in physical appearance, taste, texture, density, state (liquid/solid/gas), and anticipated side effects. Any material diffe…

I encourage you to post that in the comments on the blog itself. There are already comments saying "thank you for this" and "placebos should be regulated" and whatnot. Maybe I'm overly optimistic, but I believe it would be useful to have your comment close to the article text (instead of having to scroll down) to provide balance.

Re: Are Placebos Really Sugar Pills?

#28

Post by hellerbarde »

abtinf wrote: post #21

Having worked in the pharma industry, this article is complete bullshit. For double and triple blind (the third blind comes from not even the pharma company knowing the blinding details until after the trial) placebo design is an extraordinarily complex undertaking. A placebo must match the drug in physical appearance, taste, texture, density, state (liquid/solid/gas), and anticipated side effects. Any material diffe…

I was about to write something similar. Thanks for formulating it so eloquently. I think it's this part that trips up some people:

> [...] at a minimum it unblinds the doctors on the ground.

It's very important that the person administering the drug/monitoring the patient can not tell the difference.

Re: Are Placebos Really Sugar Pills?

#29

Post by jpablo »

abtinf wrote: post #21

Having worked in the pharma industry, this article is complete bullshit. For double and triple blind (the third blind comes from not even the pharma company knowing the blinding details until after the trial) placebo design is an extraordinarily complex undertaking. A placebo must match the drug in physical appearance, taste, texture, density, state (liquid/solid/gas), and anticipated side effects. Any material diffe…

Of course we can't know who is telling the truth since ingredients on placebos are not disclosed. That's the part I think is the meat of the issue.

Re: Are Placebos Really Sugar Pills?

#30

Post by pygy_ »

abtinf wrote: post #21

Having worked in the pharma industry, this article is complete bullshit. For double and triple blind (the third blind comes from not even the pharma company knowing the blinding details until after the trial) placebo design is an extraordinarily complex undertaking. A placebo must match the drug in physical appearance, taste, texture, density, state (liquid/solid/gas), and anticipated side effects. Any material diffe…

Who controls the integrity of placebos?
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