28 May 2008

Contains No Chemical Drugs

Yesterday, the New York Times reported on a new product for children: a cherry-flavored, chewable sugar pill being marketed by a mom-and-pop operation called the Placebo Store under the name Obecalp.

Some doctors are outspoken against this. They point out that while the placebo effect is well documented, it's effective when patients believes that a pill's not just a sugar pill. Thus, parents giving Obecalp to their children must be deceptive at some level, stating or implying that it's a chemically active medicine. Pediatricians also dislike promoting the notion that there's a pill for every ill instead of, say, a hug and an oatmeal cookie.

The Times article stated that one 2007 study of 70 children with ADHD suggested that acknowledging a pill contained no actual medicine but calling it a "dose extender" could be effective in weaning kids off their medications. It strikes me that study could just as well have showed that:

  • ADHD drugs might be overprescribed to begin with.
  • Children who have trouble paying attention are also likely not to pay attention to technical information.
  • Physicians conducting studies can come up with nice-sounding jargon like "dose extender" just as well as marketing professionals.
To be sure, there's a debate within medicine about how to handle placebos, and how strict the rules should be. At the base of that debate is a paradox. If a deception helps to make itself true, does it remain a deception? In other words, if a placebo has a chance of working when the patient believes in it, is it wrong to tell the patient that it has a chance of working?

When I looked into this story, I found that two years ago, in March 2006, there was a little spurt of television news about a Gulf War veteran named Mike Woods who recalled having been prescribed Obecalp. Here are reports from North Carolina and Washington.

Woods had actually testified in November 2005, according to this transcript of the hearing. And he described his experienced with Obecalp as having occurred long before that, at some unspecified time for some unspecified symptoms:
Years ago, I left the VA health care system, after being prescribed a powerful medication by the VA, "Obecalp"--a medication to be used with extreme caution. However, it does not work very well. Spelled backward, it is simply "Placebo."
This was part of the ongoing medical debate about "Gulf War syndrome," and whether that's a form of post-traumatic stress disorder and/or has a chemically detectable cause. The current war may have made the PTSD diagnosis more acceptable; it's certainly made it more widespread.

Back then, the idea that the Veterans Affairs medical system had deceived one man was enough to produce TV stories and angry blog postings. (Interestingly, I didn't find reports of any other veteran with the same complaint, nor any who said that sugar pills had helped them.) Now the target audience for Obecalp--a term that's apparently not trademarked--is children. I don't think this is progress. It just seems like a quest for the even more desperate (parents) and more credulous (kids).

Obecalp also prompted a dim memory of reading about a product advertised in the middle of the twentieth century whose name was also something good spelled backwards. It took a little Googling before I confirmed it was Serutan, a natural laxative. For more about Serutan's marketing profile, visit the Original Old-Time Radio. (Evian and Tums are two other brand names that are also words spelled backwards, but their makers don't actually encourage customers to do that.)


Anonymous said...

I have to disagree with you that the use of a placebo is deception that shouldn't occur. Sometimes the placebo effect is very real and useful: studies have shown that under certain circumstances, the use of a placebo can be as effective as a prescription drug for things as serious as depression or as minor as a wart. Apparently the body has, in many cases, the capacity to heal itself if nudged--and if the mind is tricked into believing that the nudge (the false drug) is doing something to help the condition, the body does the rest.

A small anecdote: when my youngest was 4 years old, she developed a large wart on one of her toes. Our pediatrician explained to her that if she thought about the wart every day and told it to disappear, it would go away. The following day we were at a book fair were a mother was dressed up as Strega Nona, and my daughter who knew the story, went up to her and asked her to cure her wart. Keeping to her role, Strega Nona told her that she needed to think loving thoughts, and it would disappear if she thought hard enough about it. Within a week it was gone.

I telephoned our pediatrician to tell her about this "cure". She reported that there have been studies that, with young enough children, telling them that you can cure a wart with magic works--faster than any chemical, freezing or other known cure.

I realize we have a strong regard for the truth. But, in limited circumstances, a deception can both be helpful and become true. It is perhaps a dangerous proposition, especially in our current political world, but in medicine, it's worth exploring.

J. L. Bell said...

First of all, I didn't write that deceiving children or others about a placebo "shouldn't occur." I wrote that any such deception was problematic, yet also that placebos' effects depend on their being thought effective.

If parents do decide to fool children with pills, I think they might as well offer chewable vitamins than something which requires a special order and has little nutritive value.

Warts usually disappear spontaneously, as your pediatrician no doubt knew. Because they're so visible and bothersome, humans have long tried to get rid of them more quickly. But most of the easy cures have been about as effective as Huck Finn's plan to whirl a dead cat in a graveyard. The latest, unavailable until recent decades, is duct tape. Most of the hard cures probably aren't worth the trouble.

Because warts so often go away spontaneously, to be effective a placebo has to be not only consistently better than other treatments, but also consistently better than nothing. I don't know of a study showing that.

Of course, if what families want isn't just the departure of the wart but the belief that they're doing something about the problem, then a placebo might be effective. And it carries less risk of harm than anything else, including the dead cat in the graveyard.