Are Placebos Really Sugar Pills? • Hacker News Board

Re: Are Placebos Really Sugar Pills?

#111

Post by kvb » Wed, Jan 30, 2013, 9:15 PM UTC

guelo wrote: post #98

tokenadult wrote: post #67

It appears that a lot of participants on Hacker News are interested in the role of placebos in treatment trials. I have some recommendations for background articles on the use of placebos in clinical trials and the pitfalls sometimes encountered in interpreting results from such trials. The articles are all by expert authors who practice frequently writing on this topic for general readers. August 2009 "The Rise of P…

It makes no sense that the FDA receives extra information that is not available to peer reviewers. Why would that be?

The purpose of the FDA is quite different from that of a journal; why would you expect the information needed for each to perform its function to be the same? Among other issues, how much time to you expect a journal reviewer to spend vetting a study, compared to the amount of effort that the FDA spends reviewing the same study?

Re: Are Placebos Really Sugar Pills?

#112

Post by nitrogen » Wed, Jan 30, 2013, 9:15 PM UTC

tptacek wrote: post #109

koide wrote: post #108

Earlier quoted context omitted.

I'm talking about the quote you used on your comment. That quote by itself does not sound particularly outrageous or ignorant. You should have chosen a different line to illustrate how shady the author thinks active placebos are.

Outlawing active placebos might be a reasonable course of action?

The blog post author may have used the idea of outlawing active placebos as a "door in the face" to make regulating them seem more palatable. At the least, it seems koide is interpreting the second suggestion as having more weight, while you are focusing on the first.

Re: Are Placebos Really Sugar Pills?

#113

Post by Ingaz » Wed, Jan 30, 2013, 9:21 PM UTC

davidtanner wrote: post #105

Ingaz wrote: post #99

Earlier quoted context omitted.

>>That's a bit of a stretch. Can you imagine an "active placebo" for LSD, THK, methamphetamine (for example) ? "Placebo" must be a potent psychedelic or stimulator itself.

I think that amphetamine has been used as a placebo for LSD in some studies. I've also heard of researchers using threshold doses of the psychedelic as the active placebo. This is probably the best option most of the time.

It's interesting, but amphetamine and LSD are tooo different,

I can imagine amphetamine as placebo for MDMA, but not for LSD.

Re: Are Placebos Really Sugar Pills?

#114

Post by koide » Wed, Jan 30, 2013, 9:28 PM UTC

tptacek wrote: post #109

koide wrote: post #108

Earlier quoted context omitted.

I'm talking about the quote you used on your comment. That quote by itself does not sound particularly outrageous or ignorant. You should have chosen a different line to illustrate how shady the author thinks active placebos are.

Outlawing active placebos might be a reasonable course of action?

I take the sentence to mean "If there are no rigorous controls in place on active placebos, they should be outlawed" which doesn't sound unreasonable.

Re: Are Placebos Really Sugar Pills?

#115

Post by lwat » Wed, Jan 30, 2013, 9:30 PM UTC

oneandoneis2 wrote: post #53

His cited example of a placebo that could skew data is olive oil, which by reducing heart disease would make the drug appear less effective than it might actually be. Pointing out a study where the pharma company might have used a placebo that made their drug harder to approve is hardly in keeping with the insinuation that they're using placebos for "disturbing" ends. Seems more like a case of "throw all the mud and…

Also: The placebo effect is stronger if the placebo used has side effects. Again this works AGAINST drug companies.

Re: Are Placebos Really Sugar Pills?

#116

Post by pbhjpbhj » Wed, Jan 30, 2013, 9:43 PM UTC

pleiotrope wrote: post #26

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.

>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 //

If the physician can effect the trial by knowing to whom they're administering the placebo it seems that the trial lacks in its design. Someone else said that the person administering the drug/control could repeat a test because they felt the result was wrong - why is such a person involved in a drug trial? If they lie about that then it seems they can pervert the trial any number of ways.

How do the patients know how the other members of the study are being affected? If they don't get a dry mouth, but the drug company thinks they should, how does the patient know?

Surely you need the physicians and patients to record exactly what happened, no more and no less.

It seems that you're doomed to fail if you don't know that this is what's happening: suppose you use an active control that dries the mouth (for 95% of patients), if you don't have the side-effect with the drug on test then you know you're part of the active group with a high enough confidence level to alter the results in a qualitatively similar way to using a non-active control (placebo).

So what you need is a placebo that matches exactly the profile of the side-effects of the drug. I'd warrant that's impossible - you don't know the side-effects of the drug that are expected in a wide scale longitudinal study because that's what you're testing isn't it?

What is entirely nefarious is any use of "no significant side-effects beyond that experienced under placebo" when in fact they don't mean placebo but "active-control".

Placebo may be synonymous with active control in Pharma circles but it's not in common usage and so this is still a fraud.

Re: Are Placebos Really Sugar Pills?

#117

Post by bigfudge2 » Wed, Jan 30, 2013, 9:47 PM UTC

tptacek wrote: post #109

koide wrote: post #108

Earlier quoted context omitted.

I'm talking about the quote you used on your comment. That quote by itself does not sound particularly outrageous or ignorant. You should have chosen a different line to illustrate how shady the author thinks active placebos are.

Outlawing active placebos might be a reasonable course of action?

Outlawing active placebos would actually be very foolish. Up to 90% of patients and 100% of physicians have been found to have broken blinds in trials of tricyclics, almost certainly because of the side effects. The original article is extremely weak in failing to address this... in fact, drug companies really should be adding ingredients with side effects to their placebos, but won't because it increases the complexity and reduces the statistical power of the trials they run.

Re: Are Placebos Really Sugar Pills?

#118

Post by bigfudge2 » Wed, Jan 30, 2013, 9:52 PM UTC

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…

Agreed the article is bullshit. However getting the issue 100% backwards the author actually raises an important point. Active placebos do make for a different comparator than inert placebos --- arguably a much better one. Given that north of 90% of patients and doctors have been found to correctly guess allocation in blinded trials of tricyclic antidepressants and other antipsychotics, it might actually help to add something to the placebo which does generate side effects to make it harder for people to pick which group they are in.

It always made me laugh reading about 'double blinded' trials of cannabis extract for MS... In this and many other cases the blind is a complete fiction.

Re: Are Placebos Really Sugar Pills?

#119

Post by tptacek » Wed, Jan 30, 2013, 9:58 PM UTC

koide wrote: post #114

tptacek wrote: post #109

Earlier quoted context omitted.

Outlawing active placebos might be a reasonable course of action?

I take the sentence to mean "If there are no rigorous controls in place on active placebos, they should be outlawed" which doesn't sound unreasonable.

It's totally unreasonable; it would be saying "because we don't trust the FDA, we should unblind drug trials".

Re: Are Placebos Really Sugar Pills?

#120

Post by esrauch » Wed, Jan 30, 2013, 11:05 PM UTC

tptacek wrote: post #55

ahoyhere wrote: post #51

Earlier quoted context omitted.

> But the blog post says "Hey! Drug companies are trying to pull a fast on all of you!…" Actually what it says is that placebo ingredients should be documented in studies, and regulated by the FDA. Why is that such heresy? If placebos are sugar pills, they don't need regulation. If they are designed to cause side effects, they are drugs . And that will skew the results of the drug tests, too, and as he describes in t…

That's not all the blog post says. Your implicit summary is inaccurate. The blog overtly implies that drug companies use active placebos to minimize advertised side effects, and later suggests that active placebos be outlawed. In fact, active placebos are a requirement for drug trials, because without them, the trial can't be effectively blinded.

Everything else aside, it should be illegal to advertise that your drug "has similar side-effects to placebo" if the placebo has active ingredients deliberately intended to cause the side effects.

The claim as made by the ads indicates to the average rational person that taking the drug has no higher chance of side effects than simple sugar pills. The reasonable conclusion for anyone who would be willing to take sugar pills is that this medication is safe, when in fact it easily might not be.