Big KNY3, while everybody is having pFun, GG, I think it is good to ponder today's timely article in the Wall Street Journal which I have
posted in Vivus thread :
Message 3832901
have pfun,
TA
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Zebra; in these times it is worth pondering again the very important issue of " the placebo effect ". You and I are familiar with it, but many non-medical people aren't. It is worth reading this timely editorial in the Wall Street Journal. In particular one ought to look at the experiments published in the past to prove the placebo effect, i.e. the " sham " chest surgery to cure angina in the 50s, the Scripps Clinic review of an old study showing a drug to be 70% effective that was subsequently found to be worthless and the " physician - bias effect " when he knows which drug is given rather than have a truly double blind study. I placed those 3 sections in an alone standing paragraph for each, so that people can go through it quickly if they so wish:
Wall Street Journal, Wed, March 25, 1998.
Business World
Is Advertising The New Wonder Drug?
By HOLMAN W. JENKINS JR.
Like the prosperous, well-built widower down the street, the drug industry has always been with us. Like the comely widow up the block, the advertising business has long been a familiar neighborhood fixture. Now that they are finally hooking up, one can only wonder what took them so long.
The amount of traffic between their two houses has been growing impressively. Last year they joined forces to spend $1 billion on advertising prescription drugs to the general public, up from an inconsequential $50 million six years earlier. The neighborhood bluenoses may be out of joint, but the meetings of these Harrys and Sallys herald something new and beneficial under the sun.
The romance first bloomed during the ulcer wars of the last decade. Drug makers threw millions of dollars at ads, giving birth to a $6 billion market for more or less identical acid blockers. First there was SmithKline's Tagamet, soon followed by Glaxo's Zantac, Lilly's Axid and Merck's Prilosec.
The bluenoses accused the industry of creating me-too drugs for a mass audience. They complained that acid blockers treated only the symptoms, turning sufferers into chronic customers. New research had shown that ulcers were caused by bacteria and could be cured with antibiotics.
Some even carped the drugs were getting a free ride from the placebo effect.
<<<<<The Scripps Clinic and Research Foundation went back and
checked patients who received a popular treatment in the
1960s that was subsequently shown to be worthless. The
success rate, at 70%, was not much different from the
new ulcer drugs. >>>>>>
Oh, but we learned so much more from the ulcer wars.
We learned that competitive advertising of similar products can produce huge benefits. Whatever the medical quibbles, 60 million people who suffer tummy pain from ulcers, or think they do, voted with their feet. So effective were marketing campaigns in coaxing them to seek help that doctors now consider ulcers to have been "cured."
It would not be the smallest irony if advertising turned out to be the real therapeutic miracle of our times.
Until it was forced to surrender last year, the FDA refused to let drug makers say on TV both the name of the drug and what it was meant to cure, unless accompanied by an endless scroll of side effects. That led to some weird ads, like Claritin's man windsurfing in a wheat field to hint enigmatically at hay fever relief.
Dr. Sidney Wolfe, chief medic of the Naderites, noticed that drug companies are "big business," so their advertising must be bad, bad, bad. Nor was every doctor pleased when patients started showing up and demanding drugs they saw on TV. Their tyranny of expertise was being challenged.
But adapt they must, for the lid has come off this child-proof bottle. Prescription medicine's ad spending is expected to hit $1.6 billion this year, another 60% increase.
We can already measure the benefits. James Charnetski, who oversees the annual survey of the drug market for Scott-Levin Associates, reported last year that "patient visits for osteoporosis have gone through the roof." Why? Because Merck smacked women over the head with ads for Fosamax.
The same with cholesterol fighters like Zocor, Lipitor, Mevacor and Pravachol: Companies spent millions to put these brand names under the noses of consumers, and consumers responded by rushing to see their doctors. Some 60% of heart disease has typically gone untreated until somebody keels over from an attack. Ads can save lives.
Ditto the marketing success of Prozac, which launched the $4.6 billion battle of the antidepressants. Sufferers no longer feel obliged to suffer in silence, and doctors have learned to keep a better eye peeled for the warning signs, not least because depression can lead to worse health problems later on.
So far, the bulk of the ad dollars has been consumed by ulcers, antidepressants and cholesterol, soon to be joined by impotence and herpes. To the Dr. Wolfes of the world, this can only mean one thing: A few profitable diseases are eating up all the resources. Such people are haunted by the old socialist bugaboo of "wasteful competition," in which consumers are the useful idiots of business. What the ad wars actually teach is altogether different. Our biggest medical gains still come from getting people to seek help for those diseases we know how to treat or prevent.
Second, the profits from mass-market drugs actually underwrite a vast amount of research into new cures for niche afflictions. So many ideas are coming out of the labs, companies need pots of money to finance them all.
Sure, a study by the respected Journal of General Internal Medicine found that only 10% of the new approvals really do anything new. But the number of new approvals has surged dramatically, 60 last year alone, an all-time record. Buried among them were several genuine advances, like Warner-Lambert's Rezulin for diabetes.
But there remains another benefit of advertising even the drug companies keep mum about. Still today, most new drugs are tested against placebos, and the placebos routinely prove effective in 30% to 35% of cases. During the ulcer wars, doctors found that patients felt better just knowing the pills were in their pockets, ready to be taken. Later studies confirmed it.
<<<<<<<Some believe the standard data actually understate
the psychological component of a cure. One famously
unethical study in the 1950s found that angina patients
whose chests were merely sliced open and then sewn up
fared about as well as patients who got an actual
operation.>>>>>>>>>
<<<<<<More recent work has further fuzzed up the boundary
between "effective" medicine and the placebo effect.
Kenneth Schulz of the Centers for Disease Control found
that clinicians are not always so rigorous about
observing the double-blind rules, since they "know" which
drugs are most promising and steer them to the
sickest subjects.>>>>
<<<< He showed that experimental treatments were 30% more
effective on average if their security codes could easily be
broken.>>>>>>
Not even the dogma of informed consent seems able to rid medicine of its mysterious element.
<<<<<<Other studies have found that sick subjects who know
they're getting a sugar pill feel better anyway.>>>>
Just the fact that medical science is taking notice of them seems to help.
So here is one more reason for the FDA to feel sheepish about trying to stop the drug companies from planting seeds of hope in their customers: Hope may be half the cure.
TA |
