Thursday, April 9, 2015

Uncertain Health in an Insecure World – 33

“Lollipops of Optimism”

Matthieu Ricard has dubbed placebos the “lollipops of optimism”. Holistic therapists tout the placebo effect of colorful fruit lollipops in children with pain. Heroin addicts can get a high from injecting water into a vein!

It is belief that makes the therapeutic or psychogenic placebo effect happen.

But first, let’s discuss hard science and real drugs.

Hypercholesterolemia is a recognized cardiovascular risk factor. Full disclosure… I have done clinical research on many patients with this medical condition. The available published evidence and expert guidelines have recommended aggressively treating ‘bad’ LDL cholesterol numbers. Drug companies are very interested in treating sub-segments of highly prevalent diseases populations. Pharma was a key driver of many high-impact high cholesterol journal publications.

With changing heart attack risks over the last two decades, the medical benefits of treating high cholesterol to prevent heart attacks have decreased. New evidence from years of retrospectively analyzed data indicates that there is a risk of widespread drug overtreatment of adults without a proportional health benefit.

A 2015 publication in JAMA Pediatrics reported that based on data from 6,300 17-21 year olds studied between 1999-2012, fully 2.5% would qualify for LDL cholesterol lowering statin drug therapy by the numbers. That’s nearly 500,000 young Americans! The authors deftly split the therapeutic baby by advising that doctors & patients “engage in shared decision making around the potential benefits, harms and patient preferences for treatment”. Experts commenting on the research disagreed about the medical wisdom of starting statin drug therapy in this age group, as compared to healthy lifestyle changes like diet and exercise.

In 2012 the New York Times reported on U.S. Institute of Medicine findings that overtreatment, often potentiated by redundant testing called medical waste, costs the U.S. healthcare system US$210 billion per year. Over-prescribing is compounded when the side effects of one or more drugs cause other unintended medical conditions. For example, anti-depression therapy in a stroke victim can produce drug-induced dementia, confusing doctors and patients alike.

There was a time when such over-testing and over-prescribing was conveniently blamed on defensive medicine in highly litigious health care environments. But after we “kill all the lawyers”, there’s still plenty of blame to go around. 

Question: What is a patient or parent to do?

Answer: Consult a magician!

Eric Mead’s 2009 TEDMED talk explored the magical belief system underpinning the medication placebo effect – about one third of patients treated with a sugar pill get a therapeutic benefit. He points out that performing magic is about selling a lie... convincingly.

His placebo story goes on.

Eric recounts that a plain white aspirin-like placebo is less effective than a colored pill, which less effective than a multicolored capsule, which is less effective than an oddly shaped pill with a number and logo pressed into its surface.  The ultimate placebo is a needle with a clear inert liquid… injected not ingested.
Unbelievably believable!! But true…

Honestly, the truth is that some of science is like the placebo effect. We want to believe it, because published research is based on a reality… the data… BIG or small. Medicine is about the facts of the matter, translated into human physiology and pharmacology. Negative clinical trials are not commonly published, and retractions of discredited research are rare.

Why would science that has worked before not work again?

Watching the national news for advertising medical wisdom risks a lifetime of expensive treatment. Drug makers’ digital media commercial warnings and disclaimers abound – “Consult your doctor” if something bad happens to you. That new lump growing in your neck might be worthwhile reporting. And “Oh Yes”, please be aware of the higher risk of suicide when trying to stop smoking with our 35% effective drug.

As I watch the nightly news or the Sunday morning news magazines, heavily populated with direct-to-public Pharma advertising, I wonder what I’m really watching. Is this scientifically infused magic, or worse – a confusing mass media narcosis?

We in the Square are optimistic about good science improving human health. It really exists.

But we must also remain alert to the powerful brain candy placebo effect!

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