May/June 2016
7
expectations. Broader exposure to medi-
cations as more patients receive medical
care is another factor.
24
In the study of psychiatric medications, it
was concluded that patients selected in
recent years were not as severely schizo-
phrenic as those in older studies. A lower
placebo effect makes sense in that patients
with a higher level of disease might have
less anticipation of benefit from treatment.
In addition, they might have less influence
from provider expectations because of
poor interpersonal relationships. When
psychiatric illness is more severe, the pure
pharmacologic benefit stands out better.
25
Since many individuals in the United States
are already on medications, trials of new
drugs are commonly held in Africa, India,
China, and the former Soviet Union, where
patients are less likely to have experience
with a similar product. But involvement in
a drug trial in one of these countries may
offer relatively extravagant health benefits,
raising expectations, and potentially altering
the placebo effect.
26
Some pharmaceutical companies are
moving to a different type of drug trial, using
more trials that show that a drug is as good
as the gold standard, a comparator trial,
rather than a trial of drug versus placebo.
Clinical trials must aim to minimize the
placebo effect, but providers want to take
advantage of it in practice. The real chal-
lenge for medicine is to learn how best to
harness the potential benefits. The context
of administering medication is rich with
meaning. The subsequent effects are real,
and activating them adds tremendously to
the provider’s armamentarium
.
About the Author
Dr. Barbara Gehrett
is a retired MD and
feature columnist for
The Bulletin
.
24.“Placebos are getting more effective.”
25.“Placebo Response in Antipsychotic Clinical Trials.”
26.“Placebos are getting more effective.”
FEATURE
