Placeboism

Interestingly, in recent years several derivatives of thalidomide have received approval for treatment of certain cancers, both in the U.S. and in Europe.

Placeboism

By Dr. Klaus L.E. Kaiser

Everyone knows (or ought to): Everything is getting better all the time. That’s certainly true in spring or early summer, when nature re-awakens after a long and cold winter but, just perhaps, not all the time.

And that’s why cunning politicians like to make big promises and have elections at those times.  That’s just one example of the placebo effect, the proclamation that “your vote counts.”

But there are ever better reasons for placebos:

The Placebo Effect

The placebo effect is real. Many studies have confirmed its existence. For some people, just taking any “medicine” will make them feel better; Wiki confirms it Who could argue with that?

After all, just taking this novel XYZ-product is promising some benefit. So what harm could it be to give it a try?

For some, the mere mention of hope produces a beneficial effect, a more positive and life-embracing attitude. There’s nothing wrong with that thinking, as long is the expectations are within the framework of cautions, like ineffectiveness and/or potentially undesirable “side effects” of an experimental stage novel drug. Those patients are often part of a so-called ”double blind study.”

Double Blind Studies

When it comes to field testing new materials (for treatment against whatever affliction or disease), and after all other initial studies to ascertain a lack of detrimental effects have been done, a new drug candidate is being subjected to a “double blind” study of its efficacy – with real people – in real hospitals, etc.

That’s when the chaff is separated from the wheat.

In a Double Blind Study (DBS), neither the prescribing physician nor the novel-drug-candidate-consuming patient know “what, exactly” they are prescribing, respectively consuming. Therefore, it’s impossible to fake the “right” answer. As a result, the patient is left to his/her own true assessment as to whether they feel better or not. Such DBS are also termed “Randomized controlled trial”, though that term has been replaced with new terminologies that are better defined as to who knows what or not.

Many new drug candidates fail in such tests – they are not significantly different from true placebos. It certainly is disappointing for the patients that hoped for a cure, for the company that developed the product, and its shareholders. That’s why smaller pharmaceutical drug developers’ shares can sharply rise or fall with the outcomes of such DBS tests.

Also, that’s why developing novel drugs has become such an expensive enterprise and any effective medication naturally demands its corresponding price.  Of course, comparatively small size molecules can generally be synthesized with a good yield, in almost any laboratory. The cost is not in the substance itself but the extensive testing requirements that can (and often do) take years to complete. How critical such testing principles are can be demonstrated on one sad example: the thalidomide case.

The Thalidomide Case

Thalidomide was developed and marketed in the mid 1950’s as a sedative and to relieve relatively minor ailments, such as “anxiety, insomnia, gastritis, and tension.” It was also found to relieve morning sickness in expecting mothers and widely prescribed for that purpose. That use turned into a major disaster. Many women who took that drug during pregnancy gave birth to severely deformed offspring, most commonly with massive malformation of the limbs.

The cause-effect relationship between consumption of this drug and appearance of malformed infants took some time to be recognized.

Thalidomide is a really small molecule (molecular weight 258) and simple structure. However, it has one carbon atom that is “chiral”, meaning its four bonds extending in tetrahedral fashion from the central carbon atom center) can exist in a “right” (R) or “left” (S) configuration. Only one of these two enantiomers (mirror image-like) is actually teratogenic (causing or foster malformation of an embryo); the other one is benign.

The graphs below show that with 3D information (modified from Thalidomide):

Fig.: The two enantiomers of thalidomide; the red circles mark the chiral carbon atom, also indicated by the solid and dashed wedges emanating from it. Only the S-form (at bottom) is bioactive.

Except for this minor geometric difference between the R and S configurations, both molecules are identical. However, their biological properties are miles apart. Moreover, even pure samples of the non-teratogenic compound (upper part in the figure) are converted in a placenta into a mixture of both forms of the material. That conversion was not (or could not be – I’m unsure of that) recognized with the standard testing procedures of the time; remember, that was six decades ago. In any event, many countries instituted more stringent testing requirements following this unfortunate situation.

Interestingly, in recent years several derivatives of thalidomide have received approval for treatment of certain cancers, both in the U.S. and in Europe.

_________________________________________________

Dr Klaus L E KaiserDr. Klaus L.E. Kaiser is a professional scientist with a Ph.D. in chemistry from the Technical University, Munich, Germany. He has worked as a research scientist and project chief at Environment Canada‘s Canada Centre for Inland Waters for over 30 years and is currently Director of Research at TerraBase Inc. He is author of nearly 300 publications in scientific journals, government and agency reports, books, computer programs, trade magazines, and newspaper articles.

Dr. Kaiser has been president of the International Association for Great Lakes Research, a peer reviewer of numerous scientific papers for several journals, Editor-in-Chief of the Water Quality Research Journal of Canada for nearly a decade, and an adjunct professor. He has contributed to a variety of scientific projects and reports and has made many presentations at national and international conferences.

Dr. Kaiser is author of CONVENIENT MYTHS, the green revolution – perceptions, politics, and facts
convenientmyths.com

Dr. Kaiser can be reached at: mail@convenientmyths.com


10 thoughts on “Placeboism

  1. I’m not real sure about pharmaceutical costs being determined by the high cost of testing. Seems the cost of most drugs is radically different in different countries; appears the cost is whatever the market will bear.

    Also the pharmaceutical companies and the medical insurance companies are in league to prevent insurance coverage of effective treatments that don’t make pharmaceutical profits. An example is natural thyroid. No insurance company will cover its use, rather than the pharmaceutical substitute– although many studies have shown that natural thyroid is much more effective. The pharmaceutical substitute was grandfathered in and has never been tested for effectiveness.

    The very newest studies have established that the test by which thyroid dosage is determined is irrelevant.

    For anyone who takes thyroid medication I highly recommend Dr. Mark Starr’s “Hypothyroidism Type 2”

  2. Penelope,
    Excellent points. I have had insurance that will pay for the generic natural thyroid, but not often and now I find that Medicare will not pay for the natural. Their way of forcing people onto the least effective synthetic drugs is to not include reimbursement for the effective natural drugs. I will never use their synthetic crap.

    • You are lucky to have a doctor who will even consider natural thyroid instead of synthetic. Most will not.

      As to the placebo effect, if the “placebo” contained sugar or digestible starch, all bets are off. With low thyroid (probably the most commonly undiagnosed/misdiagnosed condition out there; it accounts for probably half of all chronic conditions and most of the “symptoms of aging”) as little as 1/4th teaspoon of sugar is enough to make you feel better and mitigate a broad range of symptoms, at least for a while. When the brain is starving, as it does with hypothyroidism, even the smallest influx of energy can have a noticeable effect.

  3. Even the DBS part are not straight forward. Different people metabolize chemicals differently and the (side-)effects may differ.

    As I remember, Swedish “Pharmasia” had a nasty case years ago when they failed to include Asians in their DBS.

    It also implies that a drug that fails a general study may be suitable for individuals. Also, a good doctor will add test that observes how the patient metabolizes the drugs. Commonly employed for blood thinning chemicals like warfarin.

  4. i suspect the rats they used first for thalidomide DID produce deformed offspring too…but its truly amazing howq tats n results get warped to suit the outcome
    then bigpharma pays!! the fda to pretty much read their own very very selective trials ie ONLY the ones that look good fails are dissed smartly
    so refusals to allow patent n production are rare indeed
    even proven harmful drugs take a lot of deaths and misery to even manage a blackbox warning
    think VIOXX and Bextra the statin…thousands made ill or died.
    GMO is the same
    bigagri choses whom to allow to do the sudies then places their “consultants” in the labs to “monitor and assist…. with the results n write up
    anyone else wanting to study the seeds etc isnt allowed to have material.
    a usa lab cornell uni? long time back now wanted to sudy the corn borers monsanto denied them seed cos they wanted to do it independently.
    statins n ssris are probably the best scams theyve ever managed

  5. Unless it’s side effects are really dramatic, like Thalidomide, a worthless drug is typically on the market for abut 30 years before (sometimes) being removed.

  6. Thanks Doctor. I like your articles. I still remember stereoisomers from Organic Chemistry 202 in the 80’s and it was/is fascinating stuff. These mirror-image molecules that behave in totally different ways in the human body.
    The only practical application of this knowledge in my life has been with vitamin E, which is generally found in multivitamins as d-alpha-tocopherol.
    The name made me curious, so I did some homework and learned that naturally-sourced Vitamin E contains 8 chemical forms: four tocopherols (alpha, beta, delta and gamma tocopherols) and four tocotrienols (alpha, beta, delta and gamma tocotrienols). The other 7 molecules also have their own unique health benefits.
    Moral of the story: If you want all the many health benefits Vitamin E has to offer, than get your Vitamin E from natural sources like almonds and dark greens, or buy the “full spectrum” Vitamin E, AKA “…with mixed tocopherols and tocotrienols”.
    Peace from BC

  7. So many drugs on the market today, for “Illness X”, were discovered as side effects for some other use.

    So, remember, while you use this drug for your condition, you are getting all the other side effects, which you don’t want, from your cure.

    The drug isn’t curing anything. You are just benefiting individually from the “side effect” that you like. They next guy will have a different reaction.

    The variability between different people, concerning drug actions/reactions are very, very large. Unfortunately, you will not know how you will react, and which of the tens of side-effects you will get and which you can live with.

    I know. I’ve been there and now do everything I can to avoid ALL pharmaceuticals.

    Oh, one more thing. These herbs and spices that you read and hear about? They too have multiple actions on you and they TOO have side effects. St. Johns Wort caused me to have to pee 9-12 times in a single night !!!! I thought I had some prostate cancer or some other hideous disease. When I ran out of it, and didn’t get to the stores to buy more, I noticed I was back to my one-pee-a-night.

    • Pick up a copy of the Physicians Desk Reference for Herbal Medicines. You need only read the Side Effects and Contraindications sections to realise that nearly all of these “herbal remedies” are at best deleterious, and often outright dangerous. They are drugs, make no mistake, and need to be regarded with the same caution.

  8. Whisky is the ‘water of life’ and some claim medicinal properties.
    I will fight shy of making such claims because I am not a medical man. But I believe only a wee dram is needed for a wee tonic LOL. Drinking to get drunk (like me) is foolish.
    And if the ice age set in and you got lost in the snow, brandy is not going to help. Your body will lose even more heat and you might die.
    I suggest keeping alcohol for recreation only and try investigating natural remedies if you can. Good luck.

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