1526: Placebo Blocker
Title text: They work even better if you take them with our experimental placebo booster, which I keep in the same bottle.
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This comic is a joke about the difficulty of testing a drug that is supposed to block the placebo effect.
In a classic exparament there is a test group and a control. The control group is used to isolated a variable that the exparament can not be devised to avoid. For example, when people are treated for a illness they generally show improvement relative to an untreated patient, regardless of the efectivity of the treatment. This is called the placebo effect. Because scientists wish to determine the effectivity of the treatment, they wish to isolated it from the placebo effect. Therefore in many drug trials one group is given a placebo (an ineffective treatment) and one group is given the real treatment.
This comic specifically refers to a study published in May 2015, the same month in which the comic was released, about possible mechanisms for the placebo effect:
- Kathryn T. Hall, Joseph Loscalzo, and Ted J. Kaptchuk. (2015) Genetics and the placebo effect: the placebome. Trends in Mol Medicine. Volume 21, Issue 5, May 2015, Pages 285–294
The joke centers around the difficulty in designing an experiment which would be able to test whether such a drug actually worked. Cueball begins to tell how to test this new drug with a trial. Following the typical experimental design, patients experiencing the placebo effect would be split into two groups. The first group would then receive the Placebo Blocker drug, while the second would receive yet another placebo pill. However, Cueball then trails off after realizing the problems with such a trial. The treatment given to the control group is supposed to be designed so that it is not influenced by the variable trying to be isolated. As the placebo is the treatment that will have an effect, it can not be used as a control treatment against a placebo blocker.
Cueball and Hair Bun Girl think about this trial until they both develop headache from trying to think of how to design this trial. Cueball then kindly offers Hair Bun Girl a sugar pill. While this might have helped cure the headache via the placebo effect had he told her it was a headache treatment, by revealing the pill as merely a sugar pill, it may suppress or reduce the effect.
It is possible to test the placebo blocker by adding a control group that receives no treatment what so ever, as this is the variable that an actual placebo is designed to control for. Still it might be hard to determine if the pills are having a negative effect or blocking the placebo effect, so multiple trials with multiple diseases may have to be done.
In title text, Cueball mentions that his sugar pills against headache works even better together with the new experimental placebo boosters. Incidentally, he indicates that he keeps those in the same bottle with his sugar pills. Assuming he or anyone that knows the pills are sugar pills believes cebo boosters are in the jar this this would allow them to take the sugar pills in the jar and receive the placebo effect, and would therefore boost the placebo effect regardless of whether there are placebo boosters in the jar.
It is possible but unlikely that:
- Cueball's sugar pills are, in fact, the Placebo Blockers themselves and that, seeing Hair Bun Girl has a headache, Cueball is inspired to somehow use the opportunity as an experiment to test the Blockers
- The entire bottle is simply sugar pills which Cueball is passing off as other drugs (making them placebos themselves)
- Cueball is suggesting Hair Bun Girl take a "placebo booster" which is really a "placebo blocker", thus testing the blocker he mentioned earlier in the comic.
Questionable neuroscience research is also discussed in 1453: fMRI.
The placebo effect refers to the phenomenon in which patients given an inactive treatment such as a sugar pill can still show improvement relative to an untreated patient. The placebo effect is thus very important to consider when testing new drugs, since even ineffective drugs can have a positive effect on the patients due to the placebo effect. Modern drug experiments are hence conducted as double-blind trials, where the patients are randomly given either the treatment or a placebo without either they or the administering doctors knowing who receives the new drug and who received the placebo pill.
Generally the patients need to believe that they are receiving an active treatment, but one study showed that the effect can occur even if the patients are told that they are receiving a placebo pill. The key factor seems to be that the patients most believe that a positive effect will occur. For example, (1) patients experience a greater effect if they believe that the treatment is expensive and (2) patients who know that they have not been given an active treatment will experience the effect if they are told that placebos can have a positive effect through the power of the mind.
Several reasons for the placebo effect have been proposed, from study artifacts - such as under-reporting of negative outcomes by patients who think they are being treated, to neurological explanations for how mental state can translate into physical outcomes.
- [Hair Bun Girl is standing in front of Cueball who does all the talking. Below them is a footnote.]
- Cueball: Some researchers* are starting to figure out the mechanism behind the placebo effect.
- Cueball: We've used their work to create a new drug: A placebo effect blocker.
- Footnote: * Hall et al, DOI: 10.1016/J.MOLMED.2015.02.009
- [Zoom in on Cueball who now holds his arms out.]
- Cueball: Now we just need to run a trial! We'll get two groups, give them both placebos, then give one the real placebo blocker, and the other a...
- Cueball: ...wait.
- [Hair Bun Girl holds her chin, while Cueball just stand there for a beat panel.]
- [Hair Bun looks again at Cueball who begins to take the lid off of a medicine bottle.]
- Hair Bun Girl: ...My head hurts.
- Cueball: Mine too.
- Cueball: Here, want a sugar pill?
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