Is it all in the mind? And finally!

Couple of subjects today, the first was sent to me by a friend, and the second is blindingly obvious.

Placebos Are Getting More Effective. Drug makers Are Desperate to Know Why.

Bits below:

In interviews with the press, Edward Scolnick, Merck's research director, laid out his battle plan to restore the firm to preeminence. Key to his strategy was expanding the company's reach into the antidepressant market, where Merck had lagged while competitors like Pfizer and GlaxoSmithKline created some of the best-selling drugs in the world. "To remain dominant in the future," he told Forbes, "we need to dominate the central nervous system."

His plan hinged on the success of an experimental antidepressant codenamed MK-869. Still in clinical trials, it looked like every pharma executive's dream: a new kind of medication that exploited brain chemistry in innovative ways to promote feelings of well-being. The drug tested brilliantly early on, with minimal side effects, and Merck touted its game-changing potential at a meeting of 300 securities analysts.

Behind the scenes, however, MK-869 was starting to unravel. True, many test subjects treated with the medication felt their hopelessness and anxiety lift. But so did nearly the same number who took a placebo, a look-alike pill made of milk sugar or another inert substance given to groups of volunteers in clinical trials to gauge how much more effective the real drug is by comparison. The fact that taking a faux drug can powerfully improve some people's health—the so-called placebo effect—has long been considered an embarrassment to the serious practice of pharmacology.

Ultimately, Merck's foray into the antidepressant market failed. In subsequent tests, MK-869 turned out to be no more effective than a placebo. In the jargon of the industry, the trials crossed the futility boundary.

MK-869 wasn't the only highly anticipated medical breakthrough to be undone in recent years by the placebo effect. From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.

The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson's disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn's disease, an intestinal ailment, citing an "unusually high" response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.

It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.


Interesting.




And:

Bleedin obvious

One extra cleaner on hospital wards can reduce new cases of MRSA by a quarter while saving the NHS tens of thousands of pounds, Unison has claimed.

A research study sponsored by the union found that one extra cleaner on a hospital ward cut new cases of MRSA by one quarter and saved between £30,000 and £70,000.
The detailed study found that one extra cleaner targeting patient beds lockers, trays, buzzers and curtains with ordinary cleaning products. MRSA contamination on surfaces was reduced by one third.

The research was published in the journal BioMed Central Medicine and was carried out by microbiologist Dr Stephanie Dancer at the Southern General Hospital, Glasgow.

The cleaner worked on one ward for six months and then switched to another similar ward for six months. Cases of MRSA rose again after the cleaner changed wards.

Dave Prentis, General Secretary of Unison, said: “The number of cleaners employed by the NHS has been cut almost in two since the 80s and patients have paid the price.

"Armed with this evidence, Unison will be arguing that every cleaner plays an invaluable part in the control of infections and employing more in the NHS is a win, win situation – lives are saved as well as much needed NHS money.”

Dr Stephanie Dancer said: “It is very tempting to look for easy ways to clean a hospital ward. Look at all the wonderful ideas out there; bug buster dusters, clean air machines, kill-all disinfectants and gases, electrostatic wall tiles, copper lavatories, silver pyjamas and self-clean computers, for example.

"Whilst such things are innovative and interesting, we should not forget that basic hospital cleaning with detergent and water is the first line of defence against hospital infections.

"Cleaning is hard work, and complicated work, and the gadgets, gimmicks and gizmos cannot, and should not, replace a hospital cleaner."

Providing that you get the right cleaner of course.


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