Diana Zuckerman, PhD, president of the National Center for Health Research
Q: How is watching shooting stars like taking “pink Viagra”?
A: They’re both subject to a very strong placebo effect, and in both cases that can make people very happy. But one is more dangerous than the other.
Let me explain. Like millions of other optimistic Americans, I was sitting outside last Saturday night, hoping to see the fantastic meteor shower that NASA scientists had predicted. It was a beautiful, clear night, and I could see many stars, but they didn’t seem to be doing anything. But wait—was that one moving? The sky seemed to be vibrating a little. Did I just see a shooting star out of the corner of my eye? Or maybe two?
In fact, the predicted meteor extravaganza did not happen. My tired eyes were playing tricks on me. And I wasn’t the only one. The placebo effect enabled NASA to put the best possible spin on its predictions the next morning—instead of admitting the shower was a total dud, they wrote: “It sounds like some people saw some good meteors, but many people didn’t see a lot of meteors… While there’s always the hope that we’ll end up with ‘a great show,’ Nature gives us what we get. ”
I know a placebo effect when I see one—even at 3:30 in the morning. On any given night, there are “shooting stars.” Whether you’re seeing part of a hyped-and-hoped-for shooting star extravaganza or just the usual occasional shooting star—or nothing at all—is often in the eye of the beholder.
In the same way, a person with almost any medical condition has good days and bad days. If your good day coincides with taking a new, expensive, hyped-and-hoped-for miraculous drug, you are going to feel better and assume the drug is the reason, even if it is a placebo (a sugar pill with no real medical value).
The placebo effect contributed greatly to the controversy when the Food and Drug Administration (FDA) recently rejected a “pink Viagra” pill called flibanserin. The agency appropriately rejected the drug because its benefits were almost identical to placebo and it wasn’t studied long enough to determine the risks. Some complained about the FDA’s decision because the women taking it reported having a few more “satisfying sexual encounters” per month after taking the pills for a while, but so did the women taking placebo. Most of the benefit wasn’t from the drug; it was from the hope that the drug gave them.
Unfortunately, doctors often prescribe drugs with benefits that are almost identical to placebo.
Here are a few examples:
- An antidepressant called Effexor is often used to reduce hot flashes, with a new study showing that after taking the drug for two months, women reported an average of 4 hot flashes a day instead of 8. The placebo was almost as effective, reducing hot flashes from 8 per day to 5.5. And the cost of those 1.5 fewer hot flashes per day? Effexor is known to increase the risk of suicidal thoughts and behaviors, as well as chest pain, serious vision problems, sexual problems, and severe confusion.
- The FDA has approved Brisdelle for hot flashes. Brisdelle is also an antidepressant—it’s Paxil with another name and a different color. Studies showed that Brisdelle has a similar benefit to placebo—only 1 less hot flash per day—and that it increases the risk of suicide and other risks. But the FDA approved it anyway.
- Have you noticed the recent TV ads for Osphena, a pill to reduce pain during sexual intercourse? The women in the ads all look very sexually satisfied, and are apparently unworried that “common side effects can include hot flashes, vaginal discharge, muscle spasms, and increased sweating… Serious but less common side effects can include stroke, blood clots, and cancer of the lining of the uterus.”
Since there are already much safer vaginal creams and lubricants on the market that have the same benefits as Osphena, why would women chance a stroke? Are they just assuming that this product must be much better because the women in the ads look so very happy? If they take Osphena, will the placebo effect convince them to keep taking it every day despite the much safer alternatives that are used only when needed? And if Osphena causes them to have hot flashes, will they then take Effexor or Brisdelle for those, which would then increase their risk of suicide?
The placebo effect is especially powerful for subjective reactions like sexual arousal and for stress-related symptoms such as hot flashes, which means it can contribute to the apparent effectiveness of antidepressants, sleeping pills, anti-anxiety drugs, painkillers, and many other meds. The more you believe that your drug is helping you, the more it helps. But that same belief won’t protect you from the drug’s harms, which are very real and in most cases far outweigh the barely-better-than placebo benefit.
So, go outside and enjoy the night sky. Even if there’s no meteor shower, you can wish upon a star—wish for prescription drugs that are safe, affordable, and really work. Or let us know if you’d like to join us in letting the FDA know those are the kinds of medical products that patients and consumers want them to approve.
Diana Zuckerman is the president of the National Center for Health Research (formerly National Research Center for Women & Families.) After serving on the faculty of Vassar and Yale and as a researcher at Harvard, she spent a dozen years as a health policy expert in the U.S. Congress and a senior policy adviser in the Clinton White House. She is the author of five books, several book chapters, and dozens of articles in medical and academic journals as well as in newspapers across the country.