MCN | Medical Consultants Network

The Power of a Second Look

Home / MCNTalk / Tag: Placebo Effect

Viewing items tagged:

Placebo Effect

Could you be Paying for Someone Else’s Prescription?

by Angela Sams

You get what you pay for, right? Not necessarily. Whether Americans realize it or not, they may in fact be paying $124 or more for the expensive prescriptions of a neighbor, a family member, or a complete stranger!

A recent op-ed article in the New York Times discusses a drug that “is a new class of cholesterol-lowering agents called PCSK9 inhibitors” as an example of a medicine that may result in higher insurance premiums for all of us. This new inhibitor, just approved by the FDA in July, is thought to reduce bad cholesterol (LDL) by up to 60 percent more than a placebo. And, though there is no solid proof that the drug (and others like it) can prevent heart attacks, strokes, and deaths caused by heart disease, researchers are still optimistic.

So what’s the problem with a drug that could potentially improve quality and length of life? The hefty price tag. The companies who create these drugs have disclosed that a prescription will cost more than $14,000 per year, per patient. Multiply this by the number of years that a patient must take that drug, and the number quickly becomes unfathomable. Those costs will then fall to insurers, and eventually trickle down to the rest of us. Policymakers and academics have a couple of proposals that could help save patients money, “such as separating out deductible limits for drugs from deductibles from other health benefits and limiting co-pays for these drugs to $100 to $250.” However, this won’t get rid of the fact that the drugs cost a certain price. That price must still be paid, even if it falls to the insurance company.

Here is where the idea of value comes into play. Are we really getting what we pay for? And how is one to determine the value of a particular medicine? Other items in our economy (think cars, phones, or TVs) are purchased by consumers, depending on whether or not that consumer thinks it’s a good “value.” In the case of medicine, value could potentially be determined by measuring the improved quality of life it gives to patients. Since we are all affected by the rising costs of these prescriptions, it is up to us as a society to determine the value of these medications, and how much they are worth, monetarily.

Can Your Sense of Smell Make Your Diet More Healthy?

by Angela Sams

As consumers, many of us have probably seen low-sodium chicken broth, or reduced salt frozen dinners. In effort to cater to those who desire a healthier diet, there are definitely many options out there when it comes to limiting sodium intake. However, a 2012 report published by a consumer-research firm found that “low-sodium” product sales had declined by 5 percent in the last year. It seems that consumers want less salt due to health concerns, but may not be willing to tolerate a replacement food that may not taste as good.

The recommended daily sodium intake is only 2,300 mg, but average Americans are consuming 1000 mg more than that each day. Over-consumption of sugar is also a growing problem. Both women and men are consuming much more than the recommended 100 calories per day of added sugar (for women) and the 150 calories per day of added sugar (for men).

So why do we need so much of the bad stuff in our food? There are a lot of reasons, it turns out. Salt and sugar are both well-known preservatives. Sugar can lower the temperature at which food freezes, and salt is also a factor in food’s texture (such as dough stickiness, for example). It seems that a good substitute may be very elusive.

But what if we could trick ourselves into thinking our food tastes good, even if it doesn’t? This is where our sense of smell comes in, and it’s a topic that Robert Sobel, Vice President of Research and Innovation at flavor company FONA International, has been investigating ever since he read about the concept of “phantom aroma” back in 2009. This term is used to describe a phenomenon where the brain perceives that it tastes certain ingredients, even when in reality they are not there at all.

Because our sense of smell and taste are so closely intertwined, we often associate certain smells with certain tastes. In one study, participants had a 15 percent increased perception of salt when they smelled beef in a broth that was low-sodium. Similarly, when people eat something that smells like vanilla, they perceive the food as sweet, even though it may not actually contain very much sugar. The trick is finding a balance so that the additional flavor isn’t overt enough to disappoint us, but still triggers our senses to perceive foods as being more sweet or salty than they are in reality.

Many phantom aromas are synthetically produced and therefore involve introducing more processed substances into one’s body, which has critics shaking their heads. However, if these aromas can help consumers eat less sugar and salt in the long run, it may come down to choosing the lesser of two evils.

To read more about this topic, please click here.

Sugar – Our #1 Food Villain

by Jen Jenkins, Market Analyst

Over the past several months we have often blogged on the topic of sugar and soda consumption and the possible detrimental effects both may have on human health. Sugar is quickly claiming the spotlight as the most villainous of foods that we consume, due to soaring rates of diabetes, obesity, and heart disease — all sugar-related disorders. Up until now, however, there has not been a study that truly proves sugar is a lone culprit in the rise of these chronic diseases. Dr. Robert Lustig is the reason we may now have, in his words, “hard and fast data that sugar is toxic irrespective of its calories and irrespective of weight.”

A new study developed by Dr. Lustig, out of the University of California, San Francisco, tested the effects of removing sugar from the diet of 43 children while keeping their weight and the amount of calories consumed exactly the same. Previous studies argued that it couldn’t be proven that removing sugar alone creates positive outcomes, since removing sugar also lowers calorie consumption and induces weight loss. To overcome this argument, Dr. Lustig made sure the children weighed themselves daily. If the children were losing weight, he had them eat more of the foods provided, to keep their weight the same. According to Dr. Lustig, after only 9 days “everything got better.”

Overall, their fasting blood sugar levels dropped by 53%, along with the amount of insulin their bodies produced since insulin is normally needed to break down carbohydrates and sugars. Their triglyceride and LDL levels also declined and, most importantly, they showed less fat in their liver. – Time

The main goal of this study was to look at sugar and how its negative effect on the body isn’t correlated with other diet concerns, calorie consumption, or weight loss. In fact, Dr. Lustig admitted that the diet the children were fed was far from ideal and still loaded with processed foods. Despite that, there were very noticeable improvements in the children’s health. Dr. Lustig is hoping these findings, along with new ones that continue to emerge, will encourage the U.S. Department of Agriculture to consider this new information on sugar when finalizing the updated Dietary Guidelines for 2016.

For more information on why not everyone is convinced by this new study and for other concerns expressed by experts, see this Time article.

Sugar Pills & Saline Solutions

by Jen Jenkins, Market Analyst

By definition, the Placebo Effect is a remarkable phenomenon in which a placebo – a fake treatment using an inactive substance such as sugar, etc. – can in some cases improve a patient’s condition simply because the person has the expectation that it will. Recent studies have investigated the power of placebos specifically in athletic performance, and this New York Times article asks, “Can a shot of salt water make you a faster runner?” The answer? Yes, why yes it can.

Previous studies have shown that lying to an athlete and telling them they are moving slower than they are will cause them to speed up past what they originally thought possible. Same with lying and telling them that the pill they just took contains caffeine or steroids when it does not. These studies, however, were never done in competitive situations. The difference between isolating a study done during training from one done during real-life competition is that most athletes are already exerting what (they believe) is their maximum physical capability during a competitive race. By testing the theory of the Placebo Effect during competition, researchers aimed to find out if this phenomenon would still apply, or if athletes were indeed at their maximum physiological ceiling.

In a study to test this, 15 male recreational runners were told they’d be given erythropoietin, or E.P.O., which increases the number of red blood cells in the human body. The runners were under the assumption that this drug would not only improve their athletic performance, but that it was also a formulation that was legal and that the amount administered would not be considered “doping.” In reality, the runners were given an injection of a saline solution. The study rotated the runners between receiving injections one week and not receiving them the next. After a few different phases, nearly unanimous results showed that the injections made training easier, recovery faster, and motivated runners to push harder. Most significantly, all the runners saw an improvement in their race by approximately 1.5 percent during a 3K race.

This is a very small study, but it does show that in this case the placebo did indeed enhance the performance of the runners, even in the most physiologically demanding circumstance such as a competition. For the everyday athlete or fitness guru, it is possible that even if you know you’re taking a placebo you may still achieve the desired effect of running faster or working out harder due to some “unconscious psychology going on.” To quote the popular Under Armour campaign: you will what you want.

The FDA and Supplement Regulation

by Jen Jenkins, Market Analyst

Although we see the topic wending its way in and out of the media spotlight, the Federal Drug Administration remains quietly under fire for its lack of effectively enforcing laws within the supplement industry. A rather surprising and intriguing reason for this lack of enforcement has been traced to a cross-contamination of the hierarchy of the FDA and industry officials in the supplement industry. However, this is disputed by a current chief executive of the Natural Products Association, Dr. Daniel Fabricant, who was formerly running the FDA’s division of dietary supplement programs up until last year. “I did more there in three and a half years than was done in the 16 years prior,” Dr. Fabricant has said.

At the beginning of April of this year, 14 state attorneys general insisted Congress provide the FDA with more power to regulate supplements. More attention has been paid in the last few years to supplements invading shelves that have dangerous hidden ingredients “with amphetamine-like chemicals” labeled only under obscure plant names. BMPEA is a chemical nearly identical to amphetamine that is currently causing the most concern. Canadian health authorities pulled all supplements containing the chemical from their shelves this past December. Meanwhile, the FDA has been aware of nine specific supplements containing the dangerous chemical for the past two years but chose to never make the names of those supplements public.

The biggest concern for consumers is that BMPEA is not listed as being an ingredient in many products that are still on store shelves. Many large retailers of supplements, such as the Vitamin Shoppe, are supportive of the FDA using the authority it has to regulate supplements the way it does other drugs in order to keep the industry safe. As suggested by the linked New York Times article, it remains in the best interest of the public to remain wary when incorporating new weight-loss and workout supplements into any diet: until we can fully trust that supplements are being properly regulated by the FDA, the safe bet is to stick to products that have familiar ingredients or to run it by a doctor.

See this New York Times article for a list of current supplements that are known to contain BMPEA.

Dr. Oz to Respond to Criticism

Dr. Mehmet Oz will question the credibility of critics who sought to have him removed from his position at Columbia in a segment on his show on Thursday, a spokesman for the show said.

Why is this important, and why does MCNTalk care? Dr. Oz has noted on his Facebook page, “I bring the public information that will help them on their path to be their best selves. We provide multiple points of view, including mine which is offered without conflict of interest. That doesn’t sit well with certain agendas which distort the facts.”

But in the multi-billion dollar world of celebrity and supplement endorsement, is there such a thing as “without conflict of interest?” And, as we noted in 2013, “In medicine there is a continuum between hard science, that which can be objectively observed and tested, so-called ‘art,’ and unsubstantiated beliefs masquerading as science.”

There is certainly no harm in being a good person and given the nature of many illnesses, conveying warmth while the body heals itself may be more than enough. But promoting amulets, strange foods, and other hocus pocus presented by charlatans does a disservice to society. Oz appears to personally promote unproven products and their promoters in his show – conveying an irresponsible and unearned aura of legitimacy. It appears he has embraced celebrity at the expense of credibility and his millions of fans are none the wiser.

Dr. Oz’s Presence on Columbia Faculty Deemed "Unacceptable"

Dr. Mehmet Oz, celebrity doctor and host of “The Dr. Oz Show” since 2009 is no stranger to controversy. In 2014 he appeared before Congress where he admitted that weight loss products he’s endorsed “Don’t pass scientific muster.”

This week ten prominent national physicians, led by Dr. Henry Miller of Stanford University, sent a letter to Columbia University’s Faculties of Health Sciences and Medicine noting that:

“Dr. Oz is guilty of either outrageous conflicts of interest or flawed judgements about what constitutes appropriate medical treatments, or both…members of the public are being misled and endangered, which makes Dr. Oz’s presence on the faculty of a prestigious medical institution unacceptable.” (Text of the letter can be found here.)

A graduate of Harvard University and both the University of Pennsylvania’s School of Medicine and their Wharton School, Dr. Oz has been on the faculty of Columbia University since 2001, where he serves as professor at the Department of Surgery; he also directs the Cardiovascular Institute and Complementary Medicine Program at New York-Presbyterian Hospital.

The nine other doctors from across the country included Dr. Joel Tepper, a cancer researcher from the University of North Carolina School of Medicine, and Dr. Gilbert Ross of the American Council on Science and Health in New York City.

In a recent The New Yorker article subtitled “Is the most trusted doctor in America doing more harm than good?” Dr. Oz is quoted as saying:

“Medicine is a very religious experience…I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean….You find the arguments that support your data and it’s my fact versus your fact.”

 

Eating Sawdust Will Not Make You Smarter

Eating sawdust will not make you smarter. Nor, likely, will eating powdered houseplants or a mixture of dried rice, mustard, wheat and radish, no matter how the product is labeled. And yet millions of Americans apparently are eating just that: As it turns out, testing announced by the state of New York this week found that the Ginkgo biloba sold by Walmart, for example, contained no Ginkgo biloba DNA — it was a mixture of rice, mustard, wheat and radish.

“Supplements” are not considered by the Food and Drug Administration to be drugs or food and therefore are not subjected to rigorous testing and related laws regarding product labeling. The results of multiple tests have shown that many supplements don’t contain much, if any, of what they’re labeled as being (though to be clear, nothing has been found so far that does contain sawdust). Ginkbo biloba may or may not be good for your health, but you might never find out – because the product you’ve bought might not actually contain any.

One in four dollars in the supplement market passes though Utah, the home stage of Senator Orrin Hatch, whose son is a longtime lobbyist for the supplement industry and who was the chief author of a federal law enacted 17 years ago that allows companies to make general health claims about their products, but exempts them from federal reviews of their safety or effectiveness before they go to market.

“There’s a lot of wrong information out there,” warns the American Cancer Society, in its tutorial on these products. “Even for those who are usually well informed, it can be hard to find reliable information about the safe use and potential risks of dietary supplements.”

Read more…

Smooth Operator

by Laura McFarland, Communications Director

According to a 2008 survey, operating room staff play music during about two thirds of surgeries, as reported in this year’s British Medical Journal’s Christmas issue, which reviews the history of music in the operating room.

Aside from a more general effect on health, numerous data specifically support music for patients having surgery under local or general anaesthesia. BMJ notes that in a randomised trial of 372 patients having elective surgery, relaxing melodies (60-80 bpm, mimicking the resting heart rate) proved to be superior to midazolam as a pre-anaesthetic anxiolytic. Combined data suggest that this calming effect is maintained before, during (when awake), and after surgery, with music faring better than noise blocking devices alone. For patients requiring further respiratory support postoperatively, music’s ability to reduce anxiety, heart rate, and respiratory rate extends even to ventilated patients in intensive care.

My son, delivered by C-section, was born to the sounds of Loverboy, “Working for the Weekend.” Personally I would have preferred something a little more classical, which is apparently the preferred genre. Its popularity may be in part due to the lack of lyrics, which alas rules out holiday carols. The Journal offers a number of suggestions and some understandable don’ts (REM’s “Everybody Hurts,” for instance) if readers find themselves needing to make a selection.

MCN wishes a joyful holiday season to all of our readers. We will be closed on Thursday, December 25th and Thursday, January 1st. To meet the needs of our clients, MCN is open during regular business hours throughout the rest of the season. Our 26 offices nationwide, including operational centers in Tampa, FL, Long Island, NY, Chicago, IL, and Seattle, WA, are seamlessly connected through one fully integrated database. Whatever the weather, MCN staff are available to answer client questions, receive referrals, and review and deliver reports from 8 am – 8 pm EST.

Do Patients Feel Better in Redesigned Hospitals/Rooms?

Often ignored by front-rank architects, left to corporate specialists who churn out too many heartless buildings, hospitals are a critical frontier for design, for exterior design as shown in the photos included here, individual room layout, and overall hospital layout.

As an example of the impact of interior changes, after months of testing a new room layout at the University Medical Center of Princeton, patients in the model room rated food and nursing care higher than patients in the old rooms did, although the meals and care were the same.

Some innovations are logical and even seem obvious, and some do have their downside: patients in single rooms are likely to share more information with the medical staff more quickly than those in double rooms, so the Princeton plan opts solely for single rooms, though this increased the building’s overall size, thus forcing a larger separation between certain departments and thereby requiring new methods of internal communications. The new rooms include a sink positioned in plain sight, so nurses and doctors will be sure to wash their hands, and patients can watch them do so. A second sink is in the bathroom, which is next to the bed, a handrail linking bed and bathroom, so patients don’t have to travel far between them and will fall less often.

But the real eye-opener was this: Patients also asked for 30 percent less pain medication. Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections.

Health care is a trillion-dollar industry just discovering the medical and economic benefits of better design. “It’s a significant part of our G.D.P.,” noted Christopher Korsh, the principal architect on the Princeton project. “Patients now say they won’t come to a facility because they don’t like it, and if there’s a building that can save 2 percent on the cost of delivering health care, that’s huge. Plus good design really can make you better faster.” Read more…