27 October 2016

Placebo pills

Clinical Drugs General Practice Mental Health

 

There was an interesting review published in The Lancet about the placebo rate in use of antidepressants.

The review found that that the placebo response rate had remained steady over the last 20 years – at around 40%. What was even more interesting was the way this was spun.  Australian Doctor reported international experts hailing this review as “debunking the myth of rising placebo responses”.

Exactly how much higher do we need the placebo rate to be before we acknowledge there is a problem? The placebo effect occurs when people respond to taking a pill with no active ingredient. The power of the mind (or other unexplained mechanism) means that the same response is seen in those who take a medicine as well as those who do not.

A placebo rate of 50% would mean that the medic action is effectively useless. There would be no difference between the people taking a drug and those taking a “sugar” tablet, which has no medicinal activity. In other words it is useless as a medication but “works” because people believe it will. I may be missing something here but 40% is not that far from 50%.

In the 1990’s trials showed benefit from these medications at well over 95% based on published data. When unpublished data was added the effectiveness actually fell to 50%. It has been known over the last six years that in mild and moderate depression, SSRI medications are no better than placebo.

Yet doctors keep prescribing them and patients keep seeking them.

This is in part due to the medicalization of life. Day to day problems such as financial stress, relationship issues, or work pressures became reclassified as mental health problems. In turn a medical problem looks for a medical solution. Rather than see the underlying problem as the reason why we feel down or stressed or sad, we have been convinced that it is primarily a medical problem caused by biochemical imbalances in the brain.

It is critical to note that the biochemical imbalance theory has never been proven. The rate of mental health illness is further increased by well meaning advocates who put the idea into peoples heads that their normal responses to life must be due to illness. This is particularly the case in teenagers where normal teenage angst is now to be medicalized and “treated”.

As Dave Clements wrote on spiked.com “Campaigners are encouraging the young to out themselves as mentally or emotionally unwell. They are claiming mental health is a taboo subject, despite the fact that everyone from royalty down is talking about it endlessly. When they say there is a mental-health crisis, they are absolutely right. There is a crisis. And it is one of their own making”.

Meanwhile Robert W. Pies writing in the Psychiatric Times describes the “astonishing non – epidemic of mental health illness. He notes that rates of diagnosis of actual mental health disorders have changed little over the last two decades. What has increased, is psychological distress, also know as stress!

There is collateral damage in medical over diagnosis. Those with genuine problems get pushed back in the queue and may miss treatment they actually need. Suicide rates in Australia are at an all time high despite billions being poured into a raft of campaigns and “programs”.

Furthermore the real problem is not dealt with if we pretend that the cause is medical. A UK study as confirmed the obvious – children with an absent parent by age seven are more likely to smoke and drink before becoming teens. A US survey showed that children in foster care had poorer mental health. There is no tablet to fix this. These findings are not politically correct so don’t expect to hear about them.

And medications are not without side effects even if they have no actual effect. I have resisted for some years mentioning the growing link between use of SSRI antidepressants and childhood problems. These include autism, speech and language disorders. Maybe it is coincidence. I am less convinced every time the finding is replicated.

Health authorities who scream at women who dare have a glass of wine during pregnancy are certainly unperturbed.

Mental health is important. Some have serious psychiatric illness and need treatment. There is a much larger group who have genuine problems which affect their lives and which may impact their mental health – but which are life problems. In turn the solution lies in addressing the life problem, not in a pill. Especially not in a placebo.

Dr Joe Kosterich M.B.B.S is an author, speaker, media presenter and health industry consultant, who wants you to be healthy and get the most out of life. Dr Joe also gives practical, motivational health talks for the general public and organisations where he is known as “An independent doctor who talks about health”.

His latest book “60 minutes to Better Health” is available on Amazon.

This blog was originally published on Dr Joe Today.