From Robert Matthews
The interview with psychiatrist Patrick Lemoine highlighted some intriguing features of the placebo effect, notably the impact of the doctor-patient relationship (16 December 2006, p 42). It would be interesting to know more about the effect of this on drugs trials.
Complementary therapies well-regarded by the public notoriously fare badly in clinical trials. The usual explanation for this is that the public is deluding itself.
It is often overlooked, however, that in such trials “efficacy” is measured by the proportion of patients receiving the therapy who recover, relative to the proportion who did so after receiving a placebo: the bigger the ratio, the more effective the therapy is deemed to be. Thus a complementary therapy that cures just as high a proportion of patients as a conventional therapy can appear “useless” simply because the trial also produced a relatively high placebo response.
The corollary is also true: that a relatively useless conventional drug can be made to look very impressive simply by minimising the placebo response rate. Perhaps drugs companies should spend less time on quantum chemistry, and more on how to create thoroughly unsympathetic doctor-patient relationships.
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Oxford, UK
