Skip Ribbon Commands
Skip to main content
Translate
Translate this website into the following languages:



Close Tab
Donations
<a href="/"><img alt="UC San Diego Health"  oncontextmenu="return false;" style="position:relative;top:10px" src="data:image/png;base64,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" /></a>
menu iconMenu
search iconSearch

No Standard for the Placebo?

 

October 18, 2010  |  

Much of medicine is based on what is considered the strongest possible evidence: The placebo-controlled trial. A paper published in the October 19 issue of  Annals of Internal Medicine – entitled “What’s In Placebos: Who Knows?” calls into question this foundation upon which much of medicine rests, by showing that there is no standard behind the standard – no standard for the placebo.

The thinking behind relying on placebo-controlled trials is this: to be sure a treatment itself is effective, one needs to compare people whose only difference is whether or not they are taking the drug. Both groups should equally think they are on the drug – to protect against effects of factors like expectation. So study participants are allocated “randomly” to the drug or a “placebo” – a pill that might be mistaken for the active drug but is inert.

But, according to the paper’s author, Beatrice Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego School of Medicine, this standard has a fundamental problem, “there isn’t anything actually known to be physiologically inert. On top of that, there are no regulations about what goes into placebos, and what is in them is often determined by the makers of the drug being studied, who have a vested interest in the outcome. And there has been no expectation that placebos’ composition be disclosed. At least then readers of the study might make up their own mind about whether the ingredients in the placebo might affect the interpretation of the study.”

Golomb pointed out these limitations to the placebo in a pair of letters to the journal Nature 15 years ago.

“A positive or negative effect of the placebo can lead to the misleading appearance of a negative or positive effect of the drug,” she said. “And an effect in the same direction as the drug can lead a true effect of the drug to be lost. These concerns aren’t just theoretical. Where the composition has been disclosed, the ingredients of the placebo have in some instances had a likely impact on the result of the study – in either direction (obscuring a real effect, or creating a spurious one). In the cases we know about, this is not because of any willful manipulation, but because it can in fact be difficult to come up with a placebo that does not have some kind of problem.”

Since 15 years have elapsed, the situation might have improved. Therefore, Golomb and her colleagues analyzed just how often randomized trials published in the past two years in each of the top four general medical journals actually disclosed the makeup of placebos.

The answer is not reassuring, according to the researchers, who found that the placebo ingredients for pills were disclosed in fewer than 10 percent of cases. (The nature of the “control” was significantly more likely to be stated for other types of treatments – like injections, acupuncture, or surgery – where people are more likely to question what “placebo” actually means.)

“How often study results are affected by what’s in the placebo is hard to say – because, as this study showed, most of the time we have no idea what the placebo is,” Golomb concluded.

Additional contributors to the study included Laura C. Erickson, BS, Sabrina Koperski, BS, Deanna Sack, BS, and UCSD Department of Medicine; Murray Enkin, MD, Departments of Obstetrics and Gynaecology, McMaster University, Ontario, Canada; and Jeremy Howick, PhD, Centre for Evidence-Based Medicine, University of Oxford, England.

# # #

Media Contact: Debra Kain, ddkain@ucsd.edu, 619-543-6163




Media Contact

Share This Article


Related News

5/23/2016
In a paper published in the current Journal of Alzheimer’s Disease, researchers at University of California San Diego School of Medicine and Veterans Affairs San Diego Healthcare System say existing s ...
5/20/2016
All scientific achievement begins with an idea. Yesterday, three researchers at University of California San Diego School of Medicine were awarded funding by the Independent Citizens Oversight Committ ...
5/19/2016
Immunology – and the idea that many diseases can best be addressed by boosting the body’s own immune response – is one of the hottest areas in medical research and clinical treatment. University of Ca ...
5/19/2016
IBM's World Community Grid and scientists from Brazil, the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego, and Rutgers New Jersey Medical School have launc ...



Follow Us