Wired.com recently reported on something that may be considered atypical fare by most of its readers: pharmaceutical companies running into problems outperforming the placebo effect. But technology geeks or not, this is a very interesting story for all of us.
The story starts with Merck and the story of MK-869, an experimental antidepressant (the same class of drug as Prozac, Zoloft, Paxil, Effexor, and Xanax, among others). Everything is going fine with the clinical trials, and Merck even goes as far as to start bragging about its holy grail of happy pills at shareholder meetings. But then:
Behind the scenes, however, MK-869 was starting to unravel. True, many test subjects treated with the medication felt their hopelessness and anxiety lift. But so did nearly the same number who took a placebo, a look-alike pill made of milk sugar or another inert substance given to groups of volunteers in clinical trials to gauge how much more effective the real drug is by comparison. The fact that taking a faux drug can powerfully improve some people’s health–the so-called placebo effect–has long been considered an embarrassment to the serious practice of pharmacology.
Ultimately, Merck’s foray into the antidepressant market failed. In subsequent tests, MK-869 turned out to be no more effective than a placebo. In the jargon of the industry, the trials crossed the futility boundary.
The history of the placebo effect and how it came to change the way that pharmaceutical trials were conducted can be traced back to World War II and a nurse that very shrewdly told a wounded soldier he was getting morphine when in fact, the morphine supply had been exhausted and in fact the soldier was getting a shot of mere salt water.
There are several ways of looking at this and what it means for the future of medicine. To see where this came from, the regulations about pharmaceutical advertising were loosened about a decade ago; I’m a bit fuzzy on the year, and a cursory Web search hasn’t turned it up, so it may have been a bit longer than that. My point is there was an age during which a drug company simply could not air ads for prescription drugs like Prozac or Viagra; unless it was available over-the-counter, advertising was restricted to at most print media, if that.
These days one can’t leave the television on for longer than about three hours of normal commercially funded programming aimed at adults without seeing at least one prescription commercial. So we, as a society, have been trained more and more that “there’s a pill for everything.” I attribute at least some of the rise in the effectiveness of the placebo in drug trials to this.
Incidentally, the article ends with a twist describing a new protocol for testing drugs, called “open/hidden,” where some subjects get the drug at random intervals through an IV line controlled by a hidden computer. This will be something to keep an eye on in the months and years to come.