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15 May 2008

Placebo effects and the probability of assignment to active treatment

I just finished reading an interesting paper on placebo effects in drug trials by Anup Malani. Malani noticed that participants in high probability trials know that they more likely to get active treatment (because of informed consent prior to the trial). They have higher expectations and hence should have higher placebo effects than patients in low probability trials. Malani compares outcomes across trials with different assignment probabilities and finds evidence for placebo effects. A related finding is that the control group in high probability trials reports more side effects.

The paper discusses some potential implications of placebo effects, e.g. that patients who are optimistic about the outcome might change their behavior and hence get better even without the active drug. It makes me wonder how this might translate into non-medical settings and whether there are studies of placebo effects in the social sciences. Also, if placebo drugs can improve health outcomes, maybe ineffective social programs would still work as long as participants don’t know whether the program works or doesn’t? Maybe this is the role of politics. But what about the side-effects?

Malani, A (2006) “Identifying Placebo Effects with Data from Clinical Trials” Journal of Political Economy, Vol. 114, pp. 236-256. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=901838

Abstract:
A medical treatment is said to have placebo effects if patients who are optimistic about the treatment respond better to the treatment. This paper proposes a simple test for placebo effects. Instead of comparing the treatment and control arms of a single trial, one should compare the treatment arms of two trials with different probabilities of assignment to treatment. If there are placebo effects, patients in the higher-probability trial will experience better outcomes simply because they believe that there is a greater chance of receiving treatment. This paper finds evidence of placebo effects in trials of antiulcer and cholesterol-lowering drugs.

Posted by Sebastian Bauhoff at 12:00 PM