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Sugar Pills, now more effective!

Byoliveridley

Well, all sugar is not bad for you. Apparently, when given to you in pill form by someone wearing a white coat with a pleasant demeanour, it can cure all kinds of ills.

It’s not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.

Via Wired

An interesting article that takes the reader through a recent history of placebos, why they seem to work better now than they used to, and tangentially, why the competitive research paradigm of the pharmaceutical industry delayed recognition, and continues to delay possible fixes and therapies.

A few things about the placebo effect:

  1. There appears to be a physiological and neurological basis to the effect, something that can actually be turned off by deactivating the body’s natural production of opioids.
  2. This effect is triggered by various patient stimuli, including exposure to advertising, faith in the medicine, doctor bedside manner, etc. It appears that for minor ailments, these effects could be as strong as the medication prescribed.
  3. It is not short lived, the effects can linger well after consumption of sugar pills.
  4. Despite all this, the article states that we are no closer to finding the most appropriate way to administer placebos (Hmm, or are we? Read on!).

Pharmaceutical companies conduct hundreds of clinical trials every year. They are not required to publish them in most countries, so negative results, failures, etc. which reflect badly on the company’s stock price are routinely hushed up. This means that the mounds of data that show tested drugs as no better than placebo are not accessible for research. This is one of the greatest drawbacks of competitive research paradigms, the lack of cooperation, the inefficiency that comes from duplication of negative results, and the lack of statistical power that comes from inability to use all the data available. In a milieu where knowledge = stock price, this is the logical approach, but something to note next time an Ayn Rand acolyte comes bleating to you about the beauty and perfection of the market. You might ask “What are some options to the current patent exclusivity driven regime”? My favourite economist Dean Baker of the Center for Economics and Policy Research has written extensively about the drug development process and alternatives in his excellent (and free to download) book The Conservative Nanny State, I suggest reading at least the chapter on drug development and patents!

Anyway, back to placebos, what to do? How to administer sugar pills in a quasi-official setting for minor ailments. It’s almost like you need a parallel paradigm of medicine that dispenses sugar pills that did not have to go through double blind randomised clinical trials. it would help if this paradigm uses vaguely scientific terminology while doing very little harm. It would work in conjunction with the conventional approach, not in competition so there is little danger of people taking sugar pills for malaria!

I give you, Homeopathy!!! This blog(ger) is no stranger to this wonderful form of medicine, involving concepts such as the memory of water, similars, dilution, etc. When I wrote about homeopathy last year, it was more in relation to the psychological aspects of my experience with it. I (and I assume you did not click through to read!) wrote about my parents’ great and enduring relationship with their homeopath, and the benefits it brought them. Back in India this time around, it was suggested that I take some homeopathy for a cold I was developing, which I did (yum, sugar!). The cold went away in a few days 🙂 There was some swine flu medicine being passed around as well (I did not partake), which worked too, nobody at home got swine flu 🙂

So, how to make it work? It already works in India because belief in the efficacy of homeopathy is well established. As long as the homeopath is well qualified in basic diagnosis, and crucially, knows when to punt the patient into conventional therapy, the system works to a certain extent. But what about a society with no such foundation? Do you go to a clinic with both an allopath and a homeopath, and if your ailment is one where placebo works about as well, let the homeopath make some well diluted similars for you to consume? How to settle turf wars? Would it be better for the allopath to feign develop an expertise in homeopathy and make that work for her in treating the patient? Would they apply the most important lessons in homeopathic treatment, Listen, Empathise, Soothe?

I don’t know. It is not my nature to believe in sugar pills, faith, or advertising. So it is hard for me to say what would work. But given that sugar pills work well, it is vital for society to find a way.

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  • AARP – Selling to you AND advocating for you at the same time

    Byoliveridley

    Am I just slow on the uptake? How can you simultaneously be an advocate for someone, and also sell them something very expensive and important? If at some point in time, these two tasks conflict, will AARP drop out of the healthcare industry to ensure that its role as advocate does not get compromised? I think not, the conflict of interest simply boggles the mind. How can you write a whole article about this issue and not have CONFLICT OF INTEREST flashing in big bold letters!!

    For example, if it is proven that single payer, universal healthcare was the most effective way to ensure that people 50-64 (before they hit medicare, which used to work very much like single payer healthcare without drug coverage until a really complex and crazy drug insurance was written on top of it) were insured and healthy, how would this affect the AARP? They are now in the business of selling you the health insurance that would be rendered less necessary by said policy, what would the AARP do? Somehow, I don’t see them saying “Yeah, we’ll close our multimillion dollar profit making business because it is the right thing to do”.

    This is ridiculous!

    AARP Says It Will Become Major Medicare Insurer While Remaining a Consumer Lobby – New York Times

    AARP, the lobby for older Americans, announced Monday that it would become a major participant in the nation’s health insurance market, offering a health maintenance organization to Medicare recipients and several other products to people 50 to 64 years old.

    The products for people under 65 include a managed care plan, known as a preferred provider organization, and a high-deductible insurance policy that could be used with a health savings account.

    When the new coverage becomes available next year, AARP will be the largest provider of private insurance to Medicare recipients. In addition to the new H.M.O., AARP will continue providing prescription drug coverage and policies to supplement Medicare, known as Medigap coverage.

    William D. Novelli, the chief executive of AARP, said, “In launching these initiatives, we are driven by our mission to create a healthier America.”

    The group also said it would use its leverage to reshape the health insurance market. The organization has 38 million members, and Mr. Novelli said it hoped to have 50 million by 2011.

    The new Medicare product will be marketed with UnitedHealth Group. Policies for people under 65 will carry the AARP name and will be marketed with Aetna.

  • China Sentences Former Drug Regulator to Death

    Byoliveridley

    China Sentences Former Drug Regulator to Death – New York Times

    The former head of China’s top food and drug safety agency was sentenced to death today after pleading guilty to corruption and accepting bribes, according to the state-controlled news media.

    That’s barbaric, we may have our problems with the FDA, but kill someone for taking a bribe? That’s medieval justice.

  • China Food Quality Questioned

    Byoliveridley

    I mentioned briefly that I would not trust anything coming out of China at this point in time, the Post runs with it this morning.

    China Food Fears Go From Pets To People – washingtonpost.com

    The scandal, which unfolded three years ago after hundreds of babies fell ill in an eastern Chinese province, became the defining symbol of a broad problem in China’s economy. Quality control and product-safety regulation are so poor in this country that people cannot trust the goods on store shelves.

    China has been especially poor at meeting international standards. The United States subjects only a small fraction of its food imports to close inspection, but each month rejects about 200 shipments from China, mostly because of concerns about pesticides and antibiotics and about misleading labeling. In February, border inspectors for the U.S. Food and Drug Administration blocked peas tainted by pesticides, dried white plums containing banned additives, pepper contaminated with salmonella and frozen crawfish that were filthy.

    China’s development in many areas has been remarkably rapid, but one has to remember that basic infrastructure such as food safety standards, environmental controls, etc. follow along a little later. China being what it is, the U.S government really needs to be more careful and comprehensive with its food testing and safety programs. There’s no sense in blaming China for this, the Chinese government can’t possibly control all this activity. It takes both buyer beware, and seller beware to ensure safety. The U.S should take the European Union’s approach on this issue.

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    Circumspection on Circumcision – Lessons for India

    Byoliveridley

    Circumcision May Help Protect Against HIV – washingtonpost.com

    Getting circumcised may reduce men’s risk of acquiring HIV, according to a study conducted in Africa. “Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men,” lead study author Robert Bailey, professor of epidemiology at the University of Illinois at Chicago (UIC), said in a prepared statement.

    This study, published in The Lancet (registration and kidney donation required!) adds to the growing body of research suggesting that circumcision significantly reduces the incidence of HIV infection. The doubts on circumcision as a protective factor against HIV are falling away.

    But, is this a viable public health strategy? In context, the US health and human services reports an 85% reduction in HIV risk through condom usage. This is probably a conservative estimate. There’s no indication yet that the gains from circumcision and condom use together are multiplicative.

    Let’s look at India, for instance. Circumcision is not practiced among Hindus. There is no history of circumcision, and when I was growing up, it was clear that circumcision was for Muslims and Muslims only. It was often laughed about and there was a sense of superiority about not having to mutilate. It was a clear distinction setting difference between “us” and “them”. This article by Jaishanker and Haldar provides some perspective on Hindu-Muslim identities.

    Apart from that, the other important identity of Muslim males is circumcision. It is found in many riots that Muslims were victimized based on their religious identity. In the riots if the perpetrators or the police are not able to identify victims with their religion they forcefully remove the pants of the victims to check whether they are circumcised or not. Once they find that the victim is circumcised he is targeted without further analysing which community he belongs to.

    For example in Bombay riot (1992) there is a case of man who was frisked by the police for assessing whether he was a Muslim. However, out of fear he gave his name as Raju (a Hindu name) the officer made him take out his trousers and, noticed that he was a circumcised Muslim, and fired at him.

    No Hindu parent in their right mind would circumcise their male child. It’s that simple. It’s part of the ingrained Hindu psyche that having an uncut member sets us apart from our Muslim brethren.

    Nothing has changed about AIDS prevention strategies. But it’s boring to study the same variables all the time, let’s recap them one more time, shall we!

    Education and awareness: Look at this picture from India (from the NFHS Survey):
    Now tell me that increasing awareness among women and empowering them is not the most important thing you can do!

    Condom use = 85% risk reduction

    Nothing more to say. Continuing to improve access to condoms is important. Avert indicates that condom use is very state dependent, especially among sex workers, with Tamil Nadu having an 80-90% use rate and Mysore in neighboring Karnataka having a 9% use rate.

    Access to antiviral therapy

    India is in a lucky position here with a very well established pharmaceutical industry. So, drugs are likely to be available (patent issues notwithstanding). The issue however is with infrastructure, getting the drugs to the right people at the right time. This 2004 paper from the Indian Journal of Medical Ethics indicates that coverage is spotty at best. India’s National AIDs Control Organization (NACO) recognizes this, but in my opinion does not go far enough to provide free/affordable drugs to infected people, especially to prevent mother-child transmission.

    So, to cut a long story short, circumcision in India is not likely to be a factor in the pantheon of choices available. We have a long way to go with our other major AIDS prevention challenges, and I hope this circumcision issue does not become an increasing distraction.

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    Lasers shooting into irises

    Byoliveridley

    I did not think my first minor surgery would involve someone shooting lasers to make holes in my iris. It sounds like more fun than it actually was, but was mostly painless and here I am, looking at a computer screen 3 hours later. My eyes feel like they’ve had about 5 hours of sleep, which is good considering they’re now sporting two brand new drain holes.

    Laser iridotomy is also performed prophylactically(preventively) on asymptomatic individuals with narrow angles and those with pigment dispersion. Individuals with a narrow angle are at higher risk of an acute angle closure, especially upon dilation of the eye

    http://www.surgeryencyclopedia.com/La-Pa/Laser-Iridotomy.html

    I also just started reading Bad Science by Ben Goldacre, which is about the use and misuse of the banner of science by a large group of people including nutritionists, pharmaceutical companies and “alternative” treatment specialists. It has a great chapter on the “placebo” effect, how much of it is culturally mediated, and how much doctor demeanour and confidence in their skills and outcome affects results. The doctor shooting holes in my eye was extremely confident in their skills and their results, and normally, my brain would be sending off all kinds of hubris warnings. In this case, their confidence reassured me a bit, and Bad Science definitely helped. It was also interesting to see a large section on homeopathy in the book, since I’ve written about my contact with homeopathy and felt that the cultural practices of a good homeopath can be of some use to people as long as they don’t go too far. The book confirmed some of that.

  • | |

    Chemical Warfare

    Byoliveridley

    This story from a local Chicago TV station does an excellent job of documenting the chemical weapons dropped on Vietnam by the United States in the 1960s, the effects they still have on Vietnam, and the Americans who handled these so called “defoliants”.

    cbs2chicago.com – Agent Orange: A View From Vietnam

    During the eight years of the Vietnam War that the U.S. Military dusted the Vietnamese landscape with Agent Orange, it was only intended to kill vegetation. It was a combination of two herbicides 2,4D and 2,4,5T mixed together into the most potent plant killer ever made. It was spread over 3 1/2 million acres of forests and crops to kill the trees and vegetation so the United States troops could see the enemy. The Armed Forces were told it was harmless. But in March 1978, Bill Kurtis broke the story on CBS 2 that American veterans of Vietnam who had been exposed to Agent Orange were complaining of illnesses, birth defects among their children, skin rashes, cancer, nervous problems and respiratory problems.

    orange3_small.jpgPeople tend to blame dioxins for all the health effects. But 2,4-D and 2,4,5-T, constituents of Agent Orange, are no spring chickens. Exposure during spraying, especially of the grossly excessive amounts that rained down upon Vietnam, can cause various health effects as well, not to mention long-term devastation of entire ecosystems.

    Side note: New Zealand, in 2004, apologized to New Zealand’s “veterans” for their exposure to Agent Orange during the Vietnam war. Not a word to the Vietnamese, of course.

    Side note 2: A US Federal court, in 2005, dismissed the first claims brought by Vietnamese plaintiffs against Dow Chemicals and Monsanto, here was the government’s  reasoning:

    In a brief filed in January, it said opening the courts to cases brought by former enemies would be a dangerous threat to presidential powers to wage war.

    Translation: We reserve the right to drop chemical weapons on our “enemies”, and doing anything to abrogate this right is “dangerous”.

    Image courtesy of Reuters shows a Vietnamese child, one of many with birth defects associated with Agent Orange exposure.

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