This story summarizes a study that tested responses to two placebos — one cheap and one expensive — in patients with Parkinson’s disease. The expensive placebo seemed to work better, but the effect was small. The study itself was also tiny — just 12 patients — which is something we think the story should have called more attention to.
This study suggests that, as with hair shampoo, people believe that pricier drugs are better. This is a challenge to attempts to deliver more effective treatments for less money. Better means to communicate drug efficacy may be needed to help offset this effect. We could also potentially harness this effect to develop more effective placebos, which would reduce the need for expensive drug treatments.
The cost of sugar pills is not in question. But the story does explore the cost implications of developing more effective placebos. It says, “To the extent that doctors can use placebos to improve patients’ symptoms, they can use the real drugs less, which may be expensive or toxic.”
The story quantifies results appropriately. It notes that in one test, “67% of the patients were judged ‘very good’ or having ‘marked improvement’ after they took the expensive placebo, compared with 58% of patients after they took the purportedly cheap placebo.” Readers can tell from the story’s numbers that we’re talking about a relatively modest amount of improvement.
The story did not discuss potential harms. From a bioethics standpoint, there is concern that the use of a placebo without the patient’s knowledge may undermine trust between the physician and patient, thereby leading to medical harm. (More background on these concerns in this Science-Based Medicine post.) In addition, patients receiving placebo treatments in clinical studies commonly complain of adverse drug reactions. The story also could have discussed the potential for harm resulting from the participants’ interruption of active drug therapy for the study.
While the mechanics of the study are nicely described, a sample size of only 12 patients is far too small to draw definitive conclusions. The story never cautions readers about this very important limitation.
The story does not exaggerate the burden of Parkinson’s or other diseases.
The story ends with a quote from an accompanying editorial by experts not affiliated with the study. Although the quote in question doesn’t really add to our understanding of the results — it merely reinforces the study authors’s conclusions — we’ll rate this as satisfactory. We would ideally have liked for the story to have interviewed an expert, or at least called attention to comments from the editorial that provide some critical analysis of the results.
The study itself was a comparison of two different placebos — one cheap, the other expensive. The story makes this clear.
The availability of sugar pills is not in question. However, many physicians would not consider it ethical to prescribe a placebo. The story does not convey this nuance.
The story establishes that the placebo effect has been around for quite some time and that many studies have explored this effect in Parkinson’s disease. The new study looked at how the perceived cost of the placebo treatment would affect its efficacy. The story explains this.
The story quotes from an accompanying editorial, so we can be sure that it went beyond this news release issued by the University of Cincinnati.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (1)
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Alberto Espay, MD
February 4, 2015 at 3:06 pmI appreciate this review of the news story, which I think it is a fair assessment. As the study’s author, I would make these points:
(1) Given the ethical challenges of this research, more patients were not allowed by the IRB. It is remarkable, however, that with such small numbers the differences were statistically significant. With greater numbers, the magnitude of statistical significance would have increased, not decreased, so technically, more patients would not have changed the story or provided greater validity to the findings.
(2) The implications to the trust to patients are discussed in the original study. All patients were from my own clinic (per request of the IRB) and all have remained my patients after the study. Debriefing them about the nature of the study did not end our patient-physician relationship. They understood that the scientific question being probed required the calibrated use of deception.
(3) The study does not advocate for the use of placebo. It advocates for the interpretation of these findings as indicating that there is an untapped opportunity to magnify the magnitude of benefits of standard interventions by enhancing their perception of efficacy.
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