Please give me a Placebo

This morning an article was published on the BBC News website:  “Anti-depressants: Major study finds they work.”  Apparently there has been some debate about this.  “Scientists say they have settled one of medicine’s biggest debates after a huge study found that anti-depressants work.  The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.”


The BBC article came with a meaningless picture of pills, so here is my meaningless picture of pills.  They are multivitamins in case you are interested.

Well that would seem like good news.  Until that is you read a little deeper.  Then we find that “the study found they ranged from being a third more effective than a placebo to more than twice as effective.”

Just a minute.  If a drug is one third more effective than a placebo I think that means that in a trial where the placebo cures 3 people the drug cured 4 people.  So this means that for every extra person cured by the drug three other people are cured, but would have also been cured if they took a sugar pill, and would have suffered none of the side effects.

Even the most effective drug on the list of 21 studied was only “more than twice as effective.”  Given that they didn’t say “nearly three times as effective,” let’s assume that it was at best 2.5 times as effective.   That means that if 10 people could be cured by a placebo 25 people are cured by the drug.  In other words, nearly half the people taking the drug would have been better off without it.  And this is for the best drug available.

Now let’s be clear: depression is a terrible thing, and it blights the lives of some people, or even leads them to take their own life, and sometimes the lives of others too.  However, most of the data in the study came from trials covering just eight weeks of treatment.  If all of those people had been treated with a placebo for eight weeks a bunch of them would have become better with no side effects at all.  And if those that didn’t improve were then given the drug that would result in about the same number again getting better, albeit some weeks later.  Wouldn’t that be a great result?

For some reason giving people placebos is seen as unethical but I can’t quite work out why.  Sure, it’s important to address the needs of someone with suicidal thoughts as fast as possible.  We should trust the doctors to have some idea who those people might be.  Let’s also bear in mind that some anti-depressants have also been linked to increased risk of suicide and we trust the doctors to prescribe them appropriately.

All I can say is that if a drug is only twice as effective as a placebo, then for my own case, in a non-critical situation, I would much rather be prescribed a placebo in the first instance.

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8 Responses to Please give me a Placebo

  1. Sue Katz says:

    I couldn’t quite follow the numbers, but I got the point. And appreciate it. And I would add one more factor. Drugs are now prescribed by so many different specialists that there are huge numbers of medical messes because of the interaction of drugs. So adding any medicine, including anti-depressants, to the mix adds another layer of possible complications.

    • Mike Evans says:

      As an engineer it seems obvious to me that tests of drugs done independently are not necessarily valid when several are combined. Yet the medical world operates as though there will never be any interaction. D and I are so fortunate that neither of us are on any medication.

  2. Fresca says:

    I followed your comment on Gwenyth’s blog about changing you name at marriage, and just wanted to say I enjoyed this post.
    This past fall I was getting a flu shot as part of a general check-up, and I commented to the doctor that I didn’t know if they worked, but since I believed it would, maybe that would give me SOME protection.
    And she laughed and said, yes, placebos have something like a 30% effectiveness rate, which is really pretty good, if you think about it!

    It’s complicated, and too many drugs are over-prescribed.
    However, given that the number of anti-vacciners is on the rise, I will also stick up for actual medicine that is medicine–don’t want to be a looney-tune who spreads measles…

    • Mike Evans says:

      Quite agree Fresca – measles rates are already heading upwards due to the whole aniti-vac movement. Like you, I wouldn’t want to spread that disproved message. I was born in an era when we all got the measles and chicken pox and thought it was normal. But I was a child and unaware of the serious risks, and there wasn’t a vaccine. Of course we were all vaccinated for smallpox as it had not been eradicated then. I understand children don’t get that one these days.

  3. Fresca says:

    P.S. Eek. Misspelling. I meant “Gwynneth” at ook?! of course.

    • Mike Evans says:

      Welsh names (actually Welsh in general) have fiendish spelling. It’s theoretically phonetic, more so than English, but only if you know the rules. I should know, Evans, whilst not difficult, is a Welsh name and my family on my father’s side have tricky names. Thanks for your comments.

  4. Peter says:

    I do rather hate having to take pills, but currently have a combination of 4 per day to keep me alive so am thankful for them… (and I think an attitude of Thankfulness helps!). The over prescription of drugs is an awful problem, and I often hear of people who get prescribed a bewildering collection of pills and potions that end up causing more problems than they are worth because of interactions. Being prescribed a placebo is quite a compelling argument, especially for many complaints that involve stress or aches and pains. Of course stress and pain is real, however, it is amazing how much more easily such things can be coped with if a doctor has listened, understood, and has given reassurance that the problem is able to be managed. A placebo could function a bit like the visible written part of a contract…. it is just words on paper, but it is also the seal of a much deeper transaction and agreement. Would a placebo still work if the doctor was “up front” about it being a placebo? I think that it could.

    • Mike Evans says:

      I’m all for pills that keep people alive. And actually I’m all for anti-depressants because in some cases they keep people alive too. I was just a bit horrified to learn that in the case of these drugs some of them are only fractionally more effective than a placebo. What the placebo seems to stand for is that a suitably knowledgeable person is prepared to take you seriously and to try to do something to help, and that in itself is a great comfort.

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